Sexual risk behaviors among HIV-infected South Indian couples in the HAART era: implications for reproductive health and HIV care delivery

Abstract

The current study examines sexual behaviors among HIV-infected Indians in primary care, where access to highly active antiretroviral therapy (HAART) has recently increased. Between January to April 2008, we assessed the sexual behaviors of 247 HIV-infected South Indians in care. Multivariable logistic regression models were used to determine predictors of being in a HIVseroconcordant primary relationship, being sexually active, and reporting unprotected sex. Over three-fourths (80%) of participants were HAART-experienced. Among the 58% of participants who were currently in a seroconcordant relationship, one-third were serodiscordant when first tested for HIV. Approximately two-thirds (63.2%) of participants were sexually active; 9.0% reported unprotected sex. In the multivariable analyses, participants who were in a seroconcordant primary relationship were more likely to have children, use alcohol, report unprotected sex, and have been enrolled in care for >12 months. Sexually active participants were more likely to be on HAART, have a prior tuberculosis diagnosis, test Herpes simplex type 2 antibody seropositive, and have low general health perceptions. Participants who reported unprotected sex were more likely to be in a seroconcordant relationship, be childless, want to have a child, and use alcohol. We did not document an association between HAART and unprotected sex. Among HIV-infected Indians in primary care, predictors of unprotected sex included alcohol use and desire for children. Prevention interventions for Indian couples should integrate reproductive health and alcohol use counseling at entry into care.

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

“…In contrast, serostatus knowledge may play less of a role in subSaharan Africa where studies conducted among ARTexperienced individuals demonstrate that unprotected sex occurs mainly within primary partnerships [42,43], and it is estimated that nearly half of cohabiting HIV-infected individuals may be in a serodiscordant relationship [71,72]. need for more robust partner HIV testing [42,46,48].…”

“…Some of these early studies were later summarized in a systematic review on the impact of ART on sexual risk behavior [59]. A study conducted among HIV-infected Indians in care documented an association between ART and sexual abstinence, as well as an association between desire for having children and unprotected sex [46,60]. A national survey in the Cameroon found that not being on ARTwas associated with an over two-fold higher rate of inconsistent condom use [47], which also held for those who reported a partner who was HIV-uninfected or of unknown status [48].…”

“…Data on the impact of ARTon sexual risk behaviors are gradually emerging from developing world settings. Although most of the early studies were cross-sectional in design, increasingly observational cohorts have assessed changing patterns of sexual risk behaviors before and after ART initiation (Table 1) [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56].…”

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

“…Studies conducted in Tanzania and Kenya found low rates of consistent condom use among HIV-infected persons on ART [12] [13]. While findings from India, Ethiopia, and Uganda revealed that although a high proportion of HIV-infected persons on ART used condoms consistently, up to one third continue to practice unprotected sex [2] [8] [14].…”

Effects of a Community-Based HIV Risk Reduction Intervention Among HIV-Positive Individuals: Results of a Quasi-Experimental Study in Nepal

“…The World Health Organization (WHO) reports that the most common mode of HIV transmission in south Asia is unsafe sex (WHO, 2007). Since it is evident that many HIV-positive individuals in the region continue to engage in unsafe sexual practices even after knowing their HIV-positive status (Poudel, Nakahara, Poudel-Tandukar, Yasuoka, & Jimba, 2009;Venkatesh et al, 2011), there is an urgent need to develop and test culturally appropriate theory-guided behavioral interventions to improve safer sex practices among HIV-positive individuals.…”