Safer Sexual Behaviors after 12 Months of Antiretroviral Treatment in Mombasa, Kenya: A Prospective Cohort

Abstract

Roll-out of antiretroviral treatment (ART) raises concerns about the potential for unprotected sex if sexual activity increases with well-being, resulting in continued HIV spread. Beliefs about reduced risk for HIV transmission with ART may also influence behavior. From September 2003 to November 2004, 234 adults enrolled in a trial assessing the efficacy of modified directly observed therapy in improving adherence to ART. Unsafe sexual behavior (unprotected sex with an HIV-negative or unknown status partner) before starting ART and 12 months thereafter was compared. Participants were a mean 37.2 years (standard deviation [SD] = 7.9 years) and 64% (149/234) were female. Nearly half (107/225) were sexually active in the 12 months prior to ART, the majority (96/107) reporting one sexual partner. Unsafe sex was reported by half of those sexually active in the 12 months before ART (54/107), while after 12 months ART, this reduced to 28% (30/107). Unsafe sex was associated with nondisclosure of HIV status to partner; recent HIV diagnosis; not being married or cohabiting; stigma; depression and body mass index <18.5 kg/m(2). ART beliefs, adherence, and viral suppression were not associated with unsafe sex. After adjusting for gender and stigma, unsafe sex was 0.59 times less likely after 12 months ART than before initiation (95% confidence interval [CI] = 0.37-0.94; p = 0.026). In conclusion, although risky sexual behaviors had decreased, a considerable portion do not practice safe sex. Beliefs about ART's effect on transmission, viral load, and adherence appear not to influence sexual behavior but require long-term surveillance. Positive prevention interventions for those receiving ART must reinforce safer sex practices and partner disclosure.

Disclosure, Multiple Sex Partners, and Consistent Condom Use among HIV Positive Adults on Antiretroviral Therapy in Johannesburg, South Africa

“…Therefore, strengthening the provision of secondary prevention messages and risk-reduction interventions in ART programs creates an enabling environment for reduction of risky sexual behaviours [13] [22]. Moreover, HIV-infected persons with longer duration on ART might use condoms consistently to protect their sex partners from infection [4] [6]. Our data further point out that the association between longer duration on ART and awareness of partner's HIV status is crucial in the reduction of risky sexual behaviour among HIV-infected persons on ART.…”

“…Several studies have shown that access to ART has not led to significant reductions in risky sexual behavior among HIV-infected persons [2] [3] [6]. Moreover, there are concerns that providing ART may lead to an increase in sexual risk behaviours because of the improved quality of life associated with ART [1] [7].…”

The impact of highly active antiretroviral therapy on high-risk behaviour of HIV-infected patients in sub-Saharan Africa

“…Of these, 50 were excluded from the systematic review (for reasons such as unclear study designs, outcomes or unclear relationship between HAART and sexual behavior variables), but used in the literature review, while 28 were entirely excluded. Finally, 14 articles [6][7][8][19][20][21][22][23][24][25][26][27][28][29] met the criteria for inclusion in this review as primary articles.…”

“…Most studies had low rigor, as only three [21,22,24] scored at least 5 on methodological rigor. Limitations found in the reviewed studies were reliance on self-report of sexual behaviors, convenience, consecutive or other non-random sampling, assessment of health facility-based populations, and failure to adjust for major confounding variables or failure to assess any interaction effects in the predictor variables.…”

“…The studies were scored according to the following criteria where each scored one mark: (1) longitudinal study design such as prospective or retrospective cohort; (2) presence of a referent or comparison group; (3) quasiexperimental design where data of pre/post intervention is available; (4) random assignment of the intervention; (5) comparability of participants on baseline characteristics; (6) comparability of participants at baseline regarding the outcome measures; (7) comparison of high-risk behavior outcomes; (8) efforts to minimize loss to follow-up. Only three studies [21,22,24] scored at least 5 on the methodological rigor, indicating that 11 studies had low rigor.…”