How do HIV-negative individuals in sub-Saharan Africa change their sexual risk behaviour upon learning their serostatus? A systematic review

Abstract

ObjectiveTo determine whether, and how, sexual behaviour of HIV-negative individuals in sub-Saharan Africa (SSA) changes upon learning their serostatus.MethodsWe systematically reviewed the published literature using EMBASE and Medline to search for publications between 2004 and 2014. We included studies that quantified behaviour change (condom use, number of sexual partners or sex acts) following an HIV test in HIV-negative adults in SSA, and extracted relevant data including study characteristics and measurement type.ResultsFrom 2185 unique citations, n=14 studies representing 22 390 participants met our inclusion criteria. We did not pool data due to marked heterogeneity in study outcome measures. The proportion of participants reporting consistent condom use (n=6) post-testing ranged from 7.6% greater, to 10.6% fewer, while ‘no condom use’ (n=5) ranged from 40.0% less, to 0.7% more. Condom use in serodiscordant couples increased (n=3). Five studies measured the proportion reporting abstinence, finding an increase of 10.9% to a decrease of 5.3% post-testing. The post-testing change in the mean number of sex acts (n=3) ranged from a relative decrease of 15.7% to a relative increase of 9.4%. Two studies reported relative decreases in the mean number of sexual partners of 35.2% and 14.0%. Three studies examining serodiscordant primary relationships specifically all showed increases in extrarelational sex.ConclusionsWith the exception of serodiscordant couples, there is variable evidence that awareness of one's serostatus leads to substantial changes in risk behaviour among HIV-negative individuals. Further research is needed to estimate the behavioural impact of learning one's serostatus in SSA.

No Evidence of Sexual Risk Compensation Following PrEP Initiation Among Heterosexual HIV Serodiscordant Couples in Kenya and Uganda

“…The majority of participants in this study learned their study partner was living with HIV a month or less than a month before they initiated PrEP, which may have also contributed to the observed decrease in HIV risk-related sexual behaviors within heterosexual HIV serodiscordant couples in the month following PrEP initiation. HIV serodiscordant couples face a fragile period in their relationship when they learn their discordant diagnosis and often change their sexual behaviors in response to this knowledge [32,33]. In this study, it was difficult for us to disentangle the association between knowledge among participants of their study partner's HIV-positive status on HIV risk-related sexual behaviors from that of PrEP initiation on HIV risk-related sexual behaviors because often these two events happened very close to one another.…”

Primary HIV prevention in pregnant and lactating Ugandan women: A randomized trial

“…[32] However, a systematic review on the behavioral impact of finding out one’s own HIV-negative serostatus in sub-Saharan Africa concluded that, with the exception of serodiscordant couples, there is variable evidence that awareness of one's HIV-negative serostatus leads to substantial changes in risk behavior. [33] Data on the potential behavioral effect of repeat testing and counseling in postpartum women are lacking. We hypothesized that: 1) extended repeat HIV testing and enhanced counseling during late pregnancy and throughout breastfeeding can increase and sustain risk reduction behaviors and prevent incident sexually transmitted infections (STI) and HIV infections among HIV-uninfected pregnant and lactating women, and 2) that enhanced couple counseling can further enhance this effect through improved couple communication and emotional and economic support from male partners.…”

Impact of HIV testing and treatment services on risky sexual behaviour in the uMgungundlovu District, KwaZulu-Natal, South Africa: a cross-sectional study

“…Studies have found only a moderate positive influence on risky sexual behaviour following access to HTS [12], with others indicating no impact on risky sexual behaviour following utilisation of HTS [11]. There is evidence that clinician-delivered counselling is effective in reducing unprotected sex among people testing positive for HIV [13], whilst further studies have revealed no impact for individuals testing HIV negative [18]. A further study has revealed that exposure to HTS (compared to non-exposure) was associated with a 41% reduction in the hazard of HIV acquisition among youth in KwaZulu-Natal over 4.5 years [19].…”