Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda

Bibliographic Data

ID23346349
AuthorsRebecca Bunnell (0000-0002-4146-4982, Centers for Disease Control and Prevention, corresponding author), John Paul Ekwaru (0000-0001-7385-4769), Peter Solberg (University of California, San Francisco), Nafuna Wamai, Winnie Bikaako-Kajura, Willy Were, Alex Coutinho (The AIDS Support Organization), Cheryl A Liechty (University of California, San Francisco), Cheryl Liechty, Elizabeth Madraa, Geddes W Rutherford (0000-0002-0707-8287), George W Rutherford (0000-0002-1789-734X, University of California, San Francisco), George Rutherford, Jonathan Mermin (0000-0001-9022-4961)
Year2006
Volume20
Issue1
Pages85-92
Publication date2006-01-02
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueAIDS (JOURNAL)
Journal identifiersISSN: 0269-9370 • E-ISSN: 1473-5571
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/01.aids.0000196566.40702.28
PMID16327323
OpenAlexW2115053153
LanguageEN
Citations received84
References cited34

BACKGROUND: The impact of antiretroviral therapy (ART) on sexual risk behavior and HIV transmission among HIV-infected persons in Africa is unknown. OBJECTIVE: To assess changes in risky sexual behavior and estimated HIV transmission from HIV-infected adults after 6 months of ART. DESIGN AND METHODS: A prospective cohort study was performed in rural Uganda. Between May 2003 and December 2004 a total of 926 HIV-infected adults were enrolled and followed in a home-based ART program that included prevention counselling, voluntary counseling and testing (VCT) for cohabitating partners and condom provision. At baseline and follow-up, participants' HIV plasma viral load and partner-specific sexual behaviors were assessed. Risky sex was defined as inconsistent or no condom use with partners of HIV-negative or unknown serostatus in the previous 3 months. The rates of risky sex were compared using a Poisson regression model and transmission risk per partner was estimated, based on established viral load-specific transmission rates. RESULTS: Six months after initiating ART, risky sexual behavior reduced by 70% [adjusted risk ratio, 0.3; 95% confidence interval (CI), 0.2-0.7; P = 0.0017]. Over 85% of risky sexual acts occurred within married couples. At baseline, median viral load among those reporting risky sex was 122 500 copies/ml, and at follow-up, < 50 copies/ml. Estimated risk of HIV transmission from cohort members declined by 98%, from 45.7 to 0.9 per 1000 person years. CONCLUSIONS: Providing ART, prevention counseling, and partner VCT was associated with reduced sexual risk behavior and estimated risk of HIV transmission among HIV-infected Ugandan adults during the first 6 months of therapy. Integrated ART and prevention programs may reduce HIV transmission in Africa.

Antiretroviral therapy · Environmental health · Human immunodeficiency virus (HIV) · Psychiatry · Psychological intervention · Sexual behavior · Sexual transmission · Transmission (telecommunications) · Treatment as prevention · Viral load · Adolescent Sexual and Reproductive Health · Clinical Psychology · HIV/AIDS Research and Interventions · Immunology · Medicine · Sex work and related issues · Virology