Sexual behaviour after antiretroviral therapy initiation in female sex workers and HIV-positive patients from the general population, Cotonou, Benin

Abstract

From September 2008 to December 2011, we enrolled and followed-up 247 HIV-negative, 88 untreated and 32 treated HIV-positive female sex workers (FSWs), as well as 238 untreated and 115 treated HIV-positive patients from the general population (GP) of Cotonou, Benin. We wanted to assess the effect of antiretroviral therapy (ART) on sexual risk-taking in FSWs and patients from the GP. We used multivariate log binomial regression models for repeated measures to compare risky behaviours reported during pre-ART and post-ART visits and we performed linear time-trend analyses to assess changes in condom use in all five groups. At 58.8% of pre-ART and 45.3% of post-ART visits (adjusted p-value=0.293), treated FSWs have reported ≥16 clients during the last week of work. Inconsistent condom use with clients over the same period decreased by more than 50% (from 20.7 to 10.0%, adjusted p-value=0.082). In treated patients from the GP, inconsistent condom use with regular partners during the last four months was reported at 52.8% of pre-ART and 53.5% of post-ART visits (p=0.778). Reported casual sex was stable (36.8% versus 38.7%, adjusted p-value=0.924). In linear time-trend analyses, there was a significant downward trend in inconsistent condom use at the early stage of the study and stability thereafter in all HIV-negative and HIV-positive FSWs. There was no negative alteration in sexual behaviour following ART initiation either inpatients from the GP or in FSWs. The results underscore the key role of concomitant sexual risk-reduction strategies.

Review of Sexuality Studies in Africa: Setting a New Post-2015 Research Agenda

“…Also, there are speculations that initiation of antiretroviral treatment promotes risky sexual behaviour in HIV positive persons 26 . The evidence is not consistent given the different findings from diverse contexts 27,28 .…”

HIV care and treatment experiences among female sex workers living with HIV in sub-Saharan Africa: A systematic review

“…Overall, our search showed that six articles examined ART initiation (Braunstein et al, 2011; Diabaté et al, 2011; Konate et al, 2011; Cowan et al, 2013; Diabaté et al, 2013; Mtetwa, Busza, Chidiya, Mungofa, & Cowan, 2013). Five of the articles used quantitative methods to assess determinants of ART initiation, while one article used qualitative methods to provide a more in-depth understanding of care experiences related to ART initiation among FSW in Zimbabwe (Mtetwa et al, 2013).…”

Potential Impact of Existing Interventions and of Antiretroviral Use in Female Sex Workers on Transmission of HIV in Burkina Faso

“…74 However, studies of African FSWs have shown that sexual risk taking in women on ART can be minimized if behavioral change programs are maintained. [75][76][77] Even when assuming a more conservative efficacy of ART in reducing HIV infectivity, targeting ART towards FSW still prevents more infections than the current policy. Although targeting OSW reduces efficiency due to their lower PAF, it is likely that their inclusion would be easier to implement.…”