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Title: | Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda |
Authors: | Rebecca, Bunnell John, Paul Ekwaru Peter, Solberg Nafuna, Wamai Winnie, Bikaako-Kajura Willy, Were Alex, Coutinho Cheryl, Liechty Elizabeth George, Rutherford Jonathan, Mermin |
Keywords: | Africa, antiretroviral therapy prevention of sexual transmission sexual behaviour viral load epidemiology Uganda |
Issue Date: | 7-Jul-2005 |
Publisher: | Lippincott Williams & Wilkins |
Series/Report no.: | ISSN 0269-9370; Volume 20 NO 1; |
Abstract: | 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 loadspecific 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 ¼ 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 HIVinfected Ugandan adults during the first 6 months of therapy. Integrated ART and prevention programs may reduce HIV transmission in Africa |
URI: | http://ir.mu.ac.ke:8080/xmlui/handle/123456789/328 |
Appears in Collections: | School of Medicine |
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