Does sexual behaviour of people with HIV reflect antiretroviral therapy as a preventive strategy? A cross-sectional study among outpatients in Kenya

Abstract

Background The World Health Organisation (WHO) advocates early initiation of HIV treatment as a prevention strategy among people living with HIV. There is strong evidence for the effectiveness of antiretroviral therapy (ART) as a preventive tool for HIV transmission. We aimed to determine the sexual behaviour of HIV outpatients and assess if it reflects the current preventive strategy for HIV transmission. Methods We conducted a cross-sectional study among adult (aged at least 18 years) patients with confirmed HIV diagnosis, and aware of their diagnosis, attending HIV outpatient care in Kenya. Data were gathered through self-report (using validated questionnaires) and file extraction. Multivariate logistic regression assessed the association between sexual risk taking behaviour controlling for gender, HIV clinical stage, HIV treatment status, Tuberculosis (TB) treatment status, and CD4 count. Results We recruited n = 400 participants (n = 280[70%] female gender). The mean age was 39.4 (SD = 9.9) years. The mean CD4 count was 393.7 (SD = 238.2) and ranged from 2 to 1470 cells/mm3. N = 61 (15.64%) were on TB treatment. The majority (n = 366, 91.5%) were on ART. Just over half (n = 202, 50.5%) reported having a sexual partner. Of these n = 33 (16.1%) reported having unprotected sexual intercourse with a person of unknown HIV status in the previous 3 months. Multivariate analysis showed that participants not on ART (HIV treatment) were more likely to report unprotected sexual intercourse compared to those who were on ART (odds ratio .25, 95% CI .09 to .69; P = 0.007). Participants at early stage of HIV infection (stages 1/2) were more likely to report unprotected sexual intercourse compared to participants at advanced HIV infection (stages 3/4) (odds ratio .34, 95% CI .13 to .92; P = 0.035). Males participants were more likely to be involved in sexual risk taking behaviours compared to female participants (odds ratio .36, 95% CI .16 to .82; P = 0.015). TB treatment status, and CD4 count were not significantly associated with sexual risk taking. Conclusion Participants not on ART have more unprotected sexual intercourse than those who are on ART. This calls for the need to scale up coverage and early ART initiation in order to reduce transmission of HIV.

Risky sexual behaviors and associated factors among adult patients on antiretroviral treatment at Mankweng Hospital in Limpopo Province, South Africa

“…Reports on the sexual behaviors of individuals on HIV treatment in Africa have indicated that individuals on treatment (ART) are more likely to have unprotected sex compared to those who are not on treatment (7,8). Although ART is increasing globally, the impact of ART on sexual risk behavior and transmission of HIV in Africa is still unknown (9).…”

“…Although ART may minimize the risk of HIV transmission by persistent viral suppression, therapy may also serve as an excuse for unsafe sexual activities (10). There are several factors, which were reported as contributing factors to the spread of HIV among adults, such as domestic violence, having multiple partners, the practice of unprotected sex, homosexuality, and commercial sex (8,11,12).…”

Is There Risk Compensation among HIV Infected Youth and Adults 15 Years and Older on Antiretroviral Treatment in South Africa? Findings from the 2017 National HIV Prevalence, Incidence, Behaviour and Communication Survey

“…In contrast, others found no difference in sexual risk behaviour, comparing PLHIV on ART and those not on ART [19]. Some studies showed that participants who are not on ART, have more unprotected sexual intercourse than those who are on ART, due to these participants believing that HIV treatment was a sufficient prevention strategy because the risk of transmission is reduced when one is on HIV treatment and viral load has been suppressed [23][24][25]. However, empirical studies have dismissed the increased risk behaviours regarding the perception of reduced HIV transmission risk after ART initiation have largely been dispelled in [9,20,26].…”