Prevalence and Contexts of Inconsistent Condom Use Among Heterosexual Men and Women Living with HIV in India: Implications for Prevention

Abstract

This investigation examined sexual behaviors among heterosexual persons living with HIV (PLHIV) in India. Study participants (mostly married) were interviewed during August to November 2006 in five Indian states using a quantitative survey (n ¼ 100 men and 100 women), eight focus groups (n ¼ 58 participants), and in-depth interviews (n ¼ 31). One third of men and one fourth of women reported inconsistent condom use with regular sexual partners. Facilitators of condom use with regular partners included a feeling of personal responsibility to protect the health of the partner, desire to prevent acquisition and=or transmission of sexually transmitted infections, and the belief that condoms are needed for antiretroviral therapy to be effective. Barriers to consistent condom use with regular partners included the belief that condoms are unnecessary in HIV-positive seroconcordant relationships; lack of sexual satisfaction with condoms; the desire to have a child; husband's alcohol use, depression, and anxiety; fear that disclosure of HIV status will bring marital discord and family shame; and inadequate counseling by health care providers. Positive prevention programs should include counseling about benefits of safer sex in HIV-positive seroconcordant relationships, counseling about integrating condom use with sexual satisfaction and intimacy, condom use self-efficacy and negotiation skills-building, family planning counseling, mental health and alcohol dependence treatment, and counseling and skills-building about disclosure. Health care providers must be trained to provide these services. Furthermore, efforts are needed to promote tolerance for family planning choices made by couples and to counter the stigma associated with HIV=AIDS and condoms in the broader society.

Disclosure, Multiple Sex Partners, and Consistent Condom Use among HIV Positive Adults on Antiretroviral Therapy in Johannesburg, South Africa

“…The association between consistent condom use and duration of time on ART has been reported in other studies [13] [22] [26]. We also found that longer ART use was significantly associated with consistent condom use.…”

“…The on-going counselling and HIV prevention messages provided at ART initiation and follow up has contributed to reductions in sexual risk behaviours. Furthermore, it had been shown that when persons receiving ART accept their illness and adjust to being HIV positive, they are likely to modify sexual behaviours [1] [26]. Therefore, strengthening the provision of secondary prevention messages and risk-reduction interventions in ART programs creates an enabling environment for reduction of risky sexual behaviours [13] [22].…”

Disclosure, Knowledge of Partner Status, and Condom Use Among HIV-Positive Patients Attending Clinical Care in Tanzania, Kenya, and Namibia

“…25,26 While rates of consistent condom use among couples who are aware of their status are higher, unprotected sex among these couples is still common 27,28 and has been shown to be associated with desire for pregnancy 29 and alcohol use. 30 PLHIV who inconsistently use condoms and who simultaneously have higher viral loads due to non-adherence to antiretroviral treatment (ART) or because they are not yet eligible for ART are at high risk for transmitting HIV to negative sex partners. [31][32][33] These individuals are also at higher risk for acquiring other sexually transmitted infections which could compromise their own health.…”

Behavioral interventions to promote condom use among women living with HIV: a systematic review update

“…Furthermore, behavioral interventions especially tailored for condom use promotion among women living with HIV are still scarce, which could explain why subgroup analyses could not find differences in intervention effects, based on whether they were exclusively tailored for women. Despite repeated research findings indicating the challenges faced by women living with HIV, more studies are needed to understand how gender-linked factors (e.g., skill-building to negotiate condom use, gender violence, and gender power imbalances regarding economic resources and employment) influence the effectiveness of behavioral interventions to promote condom use 16,54,55 . A recent systematic review of behavioral interventions to improve contraceptive use for family planning among women living with HIV also found limited evidence to compare the interventions' results 56 .…”

“…We recommend that behavioral interventions focusing on condom use promotion among women living with HIV could have greater public health impact if they were part of broad positive prevention programs delivered with a gender perspective (including women-initiated prevention options) and developing actions that involve male partners, family planning counseling, community empowerment, mental health and drug abuse treatment, and safe serostatus disclosure settings 11,55 . As seen in the qualitative syntheses, few studies included issues beyond sexual risk behavior and none approached family planning or included women's partners.…”