Exploring HIV risk perception and behaviour in the context of antiretroviral treatment: results from a township household survey

Abstract

The objective of this cross-sectional household survey was to assess factors influencing HIV risk perception, behaviour and intervention uptake in a community characterised by high HIV prevalence and availability of antiretroviral therapy (ART). The survey was conducted in Khayelitsha, South Africa and involved two-stage sampling with self-weighting clusters and random selection of households within clusters. One man and woman between 14 and 49 years old was interviewed in each household; 696 men and 879 women were interviewed for a response rate of 84% and 92% respectively. Ninety-three percent and 94% were sexually active with median age of sexual debut 15.3 and 16.5 years. Eighty-three percent and 82% reported a partner at the time of interview and 29% and 8% had additional partner(s). Forty-one percent and 33% reported condom use during the last sexual encounter. Thirty-seven percent of men not using condoms did not as they believed their partner to be faithful, whilst 27% of women did not as their partner refused. Twenty-eight percent and 53% had been tested for HIV. Having undergone HIV testing was not associated with condom usage, whilst current relationship status was the strongest association with condom usage for both men and women. In spite of a relatively high uptake of condoms and testing as well as ART availability, the HIV epidemic has continued unabated in Khayelitsha. Even greater coverage of preventive interventions is required, together with a national social and political environment that builds on the availability of both preventive and treatment services.

A network-level explanation for the differences in HIV prevalence in South Africa's racial groups

“…A study of 15-26-year-olds in the Eastern Cape Province found that 55% of young men had engaged in one or more concurrent relationships in the past (Jewkes, Dunkle, Mduna, Levin, Jama, Khuzwayo et al, 2006). A household survey in Khayelitsha, Cape Town, found that 29% of men and 8% of women in sexual relationships reported that they had been sexually involved from outside their regular relationship in the last 12 months (Boulle et al, 2008). Based on this type of evidence, a joint inquiry in 2006 by the Southern African Development Community (SADC) and UNAIDS concluded that "high levels of multiple and concurrent sexual partnerships by men and women, with insufficient, correct condom use, combined with low levels of male circumcision are the key drivers of the epidemic in the [southern African] region" (SADC, 2006 , 2005b).…”

“…Coloureds and blacks had higher rates of pregnancy than did whites. Although CAPS did not collect information concerning circumcision, Boulle, Hilderbrand & Menten (2008) reported that the prevalence of circumcision was considerably higher among blacks (74.9%) than it was among the other racial groups in the Cape Town area.…”

Is expanded HIV treatment preventing new infections? Impact of antiretroviral therapy on sexual risk behaviors in the developing world

“…A study conducted among HIV-uninfected nonspousal household members of adults taking ART in Uganda found that perceiving HIV as curable and lower AIDS-related anxiety were independently associated with risky sex [64]. Despite expanding access to ART and HIV prevention services in hyperendemic settings, uptake of HIV testing remains relatively low and a substantial proportion of at-risk individuals continue to engage in unprotected sex [65,66]. The community impact of wider access to ART on sexual behavior remains an area for further studies and it is likely behavioral responses to treatment will vary in different socio-cultural settings.…”

HIV Prevention in High-Risk Women in South Africa: Condom Use and the Need for Change

“…Reported rates of condom use among sexually active populations in South Africa range from 32.8% to 78.4% [1], [16], [17], [18], [19], [20], [21]. In high-risk women, such as commercial sex workers, the rate of condom use is low [13], [14], [15].…”