Changes in sexual activity and risk behaviors among PLWHA initiating ART in rural district hospitals in Cameroon – Data from the STRATALL ANRS 12110/ESTHER trial

Abstract

The continued scaling-up of antiretroviral therapy (ART) in Sub-Saharan Africa provides an opportunity to further study its impact on sexual behaviors among people living with HIV/AIDS (PLWHA). We explored time trend and correlates of sexual activity among PLWHA initiating ART in Cameroon and compared sexual risk behaviors between patients sexually active before and after initiating ART and those resuming sexual activity after ART initiation. Analyses were based on longitudinal data collected within the randomized trial (n=459) conducted in nine rural district hospitals in Cameroon. Sexual activity was defined as reporting at least one sexual partner during the previous 3 months. Inconsistent condom use (ICU) was defined as reporting to have "never," "sometimes," or "nearly always" used condoms at least once with a partner(s) either HIV-negative or of unknown HIV status during the same period. Mc Nemar tests were used to assess time trend, while mixed-effect logistic regressions were conducted to analyze the effect of time since ART initiation on sexual activity. The proportion of sexually active patients significantly increased over time: from 31.8% at baseline to 40.2 and 47.1% after 6 and 12 months of ART, respectively (p=0.001), to 55.9% after 24 months (p=0.02). After adjustment for behavioral and psychosocial factors, time since ART initiation was independently associated with reporting sexual activity (AOR [95% CI]=1.30 [1.17-1.46] per 6-month increase, p=0.001). ICU was more frequent among patients sexually active both before and after ART initiation than among those who resumed sexual activity after ART initiation (82 vs. 59%, p<B0.001). To conclude, while ART initiation fosters resumption of sexual activity in patients who are inactive before starting treatment; unsafe sexual behaviors remain less frequent in this population than in patients who are already sexually active before starting ART. Risk reduction programs should be reinforced among PLWHA in the context of ART scaling-up.

The Value of Support Group Participation in Influencing Adherence to Antiretroviral Treatment among People Living with Human Immunodeficiency Virus (HIV)

“…In a study in Atlanta, USA, results show that nonadherent Men who have Sex with Men (MSM) were more likely to have a greater number of sex partners and engage in unprotected sex than those who were adherent [7]. Also, there is evidence that ART reinvigorates sexual desires and sexual activity of PLHIV; and that few PLHIV practice safe sex [8]- [10].…”

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“…It has been shown nevertheless by several studies that initiating ART may have dual impact on risky behaviors: Higher unsafe sex among PLWHA on ART and several studies from Africa have found an increase in high risk sexual behavior among persons initiating ART [23][24][25]. On the other hand, ART initiation has lowered the risk behaviors among PLWHA [12,16,19,22,[26][27][28][29][30].…”

Geographical Distribution of HIV-patients with Respect to HIV-treatment Units in Cameroon: A Cross-sectional Study

“…WHO reported that more than 14.9 million of people living with HIV were under antiretroviral therapy worldwide, including 13.5 million (more than 90%) in low-and middle-income countries and this was only 40% of people living with HIV [7]. In the other hand, the availability of therapeutic protocols in Africa remains the lowest meanwhile this part of the world shelters more than 90% of the ART (Antiretroviral treatment) needs [8,9]. Like many countries, Cameroon adopted this system as one of the strategic axes of its national policy to control HIV through the creation and extension of care units since access to ART was made free in 2007 [10,11].…”

“…In Cameroon, as in many sub-Saharan countries, the prevalence of HIV is still high (4.3% in 2011) as the number of new infections keep increasing (6 new infections per hour) [15,16]. Sexual activity remains as important as the fertility index among PLHIV.…”

“…Sexual activity remains as important as the fertility index among PLHIV. multisexual partnership and the desire of having a child which is a warning signal for rapid and precise intervention are also important [15]. In the other hand all regions of the country are affected by the pandemic with prevalence that varies from region to region; but more, the country had an inequitable distribution of care units from one region to another as well as care offer varies with the health pyramid, which can highly cause patients to migrate and face resultant difficulties.…”