Two-Year Follow-Up of Sexual Behavior Among HIV-Uninfected Household Members of Adults Taking Antiretroviral Therapy in Uganda: No Evidence of Disinhibition

Abstract

This paper examines HIV risk behavior among HIV-uninfected adults living with people taking antiretroviral therapy (ART) in Uganda. A prospective cohort of 455 HIV-uninfected non-spousal household members of ART patients receiving home-based AIDS care was enrolled. Sexual behavior, HIV risk perceptions, AIDS-related anxiety, and the perception that AIDS is curable were assessed at baseline, 6, 12 and 24 months. Generalized linear mixture models were used to model risk behavior over time and to identify behavioral correlates. Overall, risky sex decreased from 29% at baseline to 15% at 24-months. Among women, risky sex decreased from 31% at baseline to 10% at 6 months and 15% at 24 months. Among men, risky sex decreased from 30% at baseline to 8% at 6 months and 13% at 24 months. Perceiving HIV/AIDS as curable and lower AIDS-related anxiety were independently associated with risky sex. No evidence of behavioral disinhibition was observed. Concerns regarding behavioral disinhibition should not slow down efforts to increase ART access in Africa.

Sexual behavior and HIV transmission risk of Ugandan adults taking antiretroviral therapy: 3 year follow-up

“…This may have limited the strength of our conclusions; however, our laboratory-confirmed findings of only one sero-conversion in 3 years among 62 sero-discordant couples were consistent with the estimated risks. Lastly, this analysis did not include assessment of potential risk compensation in other household or community members, and thus could underestimate disinhibition effects, although an earlier analysis of the household member' sexual behavior showed no indications of disinhibition [26].…”

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

“…A population-based survey in Kenya suggested that individuals who reported higher risk compensation (that is increased sexual risk taking now that ARTwas available) and a belief that ART cures HIV were more likely to be infected with HIV [63], perhaps suggesting therapeutic optimism. 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].…”

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

“…25 28–30 The recruitment setting was community-based (n=5),19 22 24 28 30 clinic-based (n=3),20 21 27 a combination of community-based and clinic-based (n=5)23 25 26 29 31 and workplace-based in one study 32. The majority of studies were prospective cohorts (n=9),20 21 23 24 26–28 31 32 while the remainder were randomised controlled trials (n=5) 1922 25 29 30…”

“…23–25 27 31 32 Participants in all 14 studies underwent either individual19 20 22 24 26–32 or couples21 counselling, or a combination of both 2325 Of studies specifying whether counselling was pre-testing or post-testing, two used post-test counselling only,20 32 while two used both 25…”

“…Six studies recruited sexually active adults from the general population19 22 28–31 (one recruited half the sample from bar and hotel workers, regarded as higher risk individuals28), four evaluated HIV-negative partners in serodiscordant relationships,21 23 25 26 one focused on STI clinic attendees,27 one on general outpatients,20 one on employees32 and one on non-spousal household members of those initiating ART 24. No study specifically enrolled key populations, aside from seronegative partners in serodiscordant partnerships, or reported data by risk factors such as formal sex work.…”