Sexual behavior of HIV-positive adults not accessing HIV treatment in Mombasa, Kenya: Defining their prevention needs

Abstract

BackgroundHIV spread continues at high rates from infected persons to their sexual partners. In 2009, an estimated 2.6 million new infections occurred globally. People living with HIV (PLHIV) receiving treatment are in contact with health workers and therefore exposed to prevention messages. By contrast, PLHIV not receiving ART often fall outside the ambit of prevention programs. There is little information on their sexual risk behaviors. This study in Mombasa Kenya therefore explored sexual behaviors of PLHIV not receiving any HIV treatment.ResultsUsing modified targeted snowball sampling, 698 PLHIV were recruited through community health workers and HIV-positive peer counsellors. Of the 59.2% sexually-active PLHIV, 24.5% reported multiple sexual partners. Of all sexual partners, 10.2% were HIV negative, while 74.5% were of unknown HIV status. Overall, unprotected sex occurred in 52% of sexual partnerships; notably with 32% of HIV-negative partners and 54% of partners of unknown HIV status in the last 6 months. Multivariate analysis, controlling for intra-client clustering, showed non-disclosure of HIV status (AOR: 2.38, 95%CI: 1.47-3.84, p < 0.001); experiencing moderate levels of perceived stigma (AOR: 2.94, 95%CI: 1.50-5.75, p = 0.002); and believing condoms reduce sexual pleasure (AOR: 2.81, 95%CI: 1.60-4.91, p < 0.001) were independently associated with unsafe sex. Unsafe sex was also higher in those using contraceptive methods other than condoms (AOR: 5.47, 95%CI: 2.57-11.65, p < 0.001); or no method (AOR: 3.99, 95%CI: 2.06-7.75, p < 0.001), compared to condom users.ConclusionsHigh-risk sexual behaviors are common among PLHIV not accessing treatment services, raising the risk of HIV transmission to discordant partners. This population can be identified and reached in the community. Prevention programs need to urgently bring this population into the ambit of prevention and care services. Moreover, beginning HIV treatment earlier might assist in bringing this group into contact with providers and HIV prevention services, and in reducing risk behaviors.

Sexual Behavior among Persons Living with HIV in Uganda: Implications for Policy and Practice

“…More than 77% of the people living with HIV were sexually active in the past 12 months preceding the study. This is a high proportion compared to previous studies conducted in Uganda [12], [23] and elsewhere within the East African region [15], [16]. The increase in sexual activity among PLHIV could be attributed to improved quality of life because of antiretroviral therapy, opportunistic infection prophylaxis and other health care packages.…”

Sexual risk behavior among HIV-positive persons in Jamaica

“…For instance, studies show that condom use fatigue, HIV transmission myths, lack of HIV knowledge, and a desire to have children may lead to PLWHA ignoring the risks of unprotected sex. 1,14,15 Conversely, self-efficacy regarding safe sex, and motivation to protect partners as well as themselves against re-infection with new HIV strain or other STIs may lead to safe sex practices among HIV-positive individuals. 15 Expanded access to anti-retroviral drugs (ARV) has enabled people with HIV to live longer and healthier lives.…”

“…1,14,15 Conversely, self-efficacy regarding safe sex, and motivation to protect partners as well as themselves against re-infection with new HIV strain or other STIs may lead to safe sex practices among HIV-positive individuals. 15 Expanded access to anti-retroviral drugs (ARV) has enabled people with HIV to live longer and healthier lives. Consequently, the increasing number of sexual transmissions of HIV may result from those who know their HIV-seropositive status but engage in sexual risk behavior.…”

Case Management: Steadfast Resource for Addressing Linkage to Care and Prevention With Hospitalized HIV-Infected Crack Users

“…Previous studies have either examined case management in conjunction with other services, such as counseling and prevention interventions, or has examined the effects of case management only on HIV risk behaviors among specific populations, such as prisoners and PLWH outside of the United States (Gasiorowicz, 2005;Johnson, 2008;Johnson, 2010;Joseph, 2010;Ko, 2011;Luchters, 2008;Robles, 2004;Sarna, 2012;Schumann, 2007). These previous studies report conflicting results; some show reduced risk behaviors and others found no change in risk behaviors.…”