Changes in Risk Behavior Among HIV-Positive Patients During Their First Year of Antiretroviral Therapy in Cape Town South Africa

Abstract

We explore changes in sexual risk behaviour over the first year of antiretroviral therapy (ART) among a cohort of patients in Cape Town South Africa initiating treatment in five public facilities in 2006 and again 1 year later (Time 1 and Time 2). Contemporaneous measures of unprotected sex were also obtained from 2 cross-sectional samples of HIV-positive patients waiting to start ART attending the same facilities. Unprotected sex at last sex among patients on ART decreased significantly from a baseline of 44.7-23.2% one year later, regardless of partner status. After controlling for confounding factors, the observed decrease in unprotected sex among the ART cohort was highly significant in relation to the 2 cross-sectional samples of patients at Time 1 and Time 2 waiting to initiate ART. Findings suggest it is critical to start positive prevention to decrease risky sexual behavior prior to the start of ART within this setting.

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.…”

“…Likewise, married or cohabiting respondents were 8.3 times more likely to report sexual activity compared to single/divorced/widowed respondents (95% CI: 4.96-14.14; p = 0.001). In longitudinal studies [8,24], the percentage of patients who were sexually active as well as the number of sexual partners either did not increase or decreased significantly at follow-up when HAART users and non-HAART users were compared.…”

“…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.…”

The Feasibility of Implementing a Sexual Risk Reduction Intervention in Routine Clinical Practice at an ARV Clinic in Cape Town: A Case Study

“…A recent study revealed that, of HIV positive people initiating ARV treatment in public health clinics in Cape Town, 44.7% had had unprotected sex at last sex [3]. Given that ARVs do not eliminate the possibility of HIV transmission, there is concern that unprotected sex within this population has implications not only for the spread of HIV, but for the spread of drug resistant strains as well [4].…”