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Change in Sexual Activity 12 Months After ART Initiation Among HIV-Positive Mozambicans

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Abstract

We assessed sexual behaviors before and 12-months after ART initiation among 277 Mozambicans attending an HIV clinic. Measured behaviors included the number of sexual partners, condom use, concurrent relationships, disclosure of HIV status, alcohol use, and partners’ serostatus. Compared to before ART initiation, increases were seen 12 months after ART in the proportion of participants who were sexually active (48% vs. 64% respondents, P < 0.001) and the proportion of participants with HIV-negative or unknown serostatus partners (45% vs. 80%, P < 0.001). Almost all (96%) concurrent partnerships reported at 12 months formed after ART initiation. Although reported correct and consist condom use increased, the number of unprotected sexual relationships remained the same (n = 45). Non-disclosure of HIV-serostatus to sexual partners was the only significant predictor of practicing unprotected sex with partners of HIV-negative or unknown serostatus. Sexual activity among HIV-positive persons on ART increased 12 months after ART initiation. Ongoing secondary transmission prevention programs addressing sexual activity with multiple partners, disclosure to partners and consistent condom use with serodisconcordant partners must be incorporated throughout HIV care programs.

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References

  1. Palella FJ, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med. 1998;338:853–60.

    Article  PubMed  Google Scholar 

  2. Colebunders R, Verdonck K, Nachega J, Kothari P. Impact of new developments in antiretroviral treatments on AIDS patient care in resource-poor countries. AIDS Patient Care STDs. 2000;14:251–7.

    Article  PubMed  CAS  Google Scholar 

  3. De Gruttola V, Wulfsohn M, Fischl MA, Tsiatis A. Modeling the relationship between survival and CD4 lymphocytes in patients with AIDS and AIDS-related complex. J Acquir Immune Defic Syndr. 1993;6:359–65.

    PubMed  Google Scholar 

  4. Bangsberg DR, Hecht FM, Clague H, Charlebois ED, Ciccarone D, Chesney M, et al. Provider assessment of adherence to HIV antiretroviral therapy. J Acquir Immune Defic Syndr. 2001;26:435–42.

    Article  PubMed  CAS  Google Scholar 

  5. Hogg RS, Heath KV, Yip B, Craib KJP, O’Shaughnessy MV, Schechter MT, et al. Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA. 1998;279:450–4.

    Article  PubMed  CAS  Google Scholar 

  6. Barroso PF, Schechter M, Gupta P, Bressan C, Bomfim A, Harrison LH. Adherence to antiretroviral therapy and persistence of HIV RNA in semen. J Acquir Immune Defic Syndr. 2003;32:435–40.

    Article  PubMed  CAS  Google Scholar 

  7. Cu-Uvin S, Snyder B, Harwell JI, et al. Association between paired plasma and cervicovaginal lavage fluid HIV-1 RNA levels during 36 months. J Acquir Immune Defic Syndr. 2006;42:584–7.

    Article  PubMed  CAS  Google Scholar 

  8. UNAIDS, WHO. 07 AIDS epidemic update. Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS), World Health Organization (WHO); 2007.

  9. Vanable P, Ostrow D, McKirnan D, Taywaditep K, Hope B. Impact of combination therapies on HIV risk perceptions and sexual risk among HIV-positive and HIV-negative gay and bisexual men. Health Psychol. 2000;19:134–45.

    Article  PubMed  CAS  Google Scholar 

  10. Elford J. HIV treatment optimism and high-risk sexual behaviour among gay men: the attributable population risk. AIDS. 2004;18:2216–7.

    Article  PubMed  Google Scholar 

  11. Valdiserri RO. Mapping the roots of HIV/AIDS complacency: implications for program and policy development. AIDS Educ Prev. 2004;16:426–39.

    Article  PubMed  Google Scholar 

  12. Bunnell R, Ekwaru JP, Solberg P, Wamai N, Bikaako-Kajura W, Were W, et al. Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda. AIDS. 2006;20:85–92.

    Article  PubMed  Google Scholar 

  13. Wood E, Braitstein P, Montanerr JS, et al. Extent to which low-level use of antiretroviral treatment could curb the AIDS epidemic in sub-Saharan Africa. Lancet. 2000;355:2095–100.

    Article  PubMed  CAS  Google Scholar 

  14. Das-Douglas M, Chu S, Santos G-M, Scheer S, McFarland W, Vittinghoff E, Colfax G. Decreases in community viral load are associated with a reduction in new HIV diagnoses in San Francisco. Paper # 33. In: 17th conference on retroviruses and opportunistic infections, San Francisco; 16–19 Feb 2010.

  15. Montaner J, Wood E, Kerr T, Yip B, Lima V, Shannon K, et al. Association of expanded HAART coverage with a decrease in new HIV diagnoses, particularly among Injection drug users in British Columbia, Canada. Paper 88LB. In: 17th conference on retroviruses and opportunistic infections, San Francisco; 2010.

  16. Granich R, Crowley S, Vitoria M, Lo YR, Souteyrand Y, Dye C, et al. Highly active antiretroviral treatment for the prevention of HIV transmission. J Int AIDS Soc. 2010;13:1.

    Article  PubMed  Google Scholar 

  17. Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet. 2009;373:48–57. Epub 2008 Nov 2027.

    Article  PubMed  Google Scholar 

  18. Blower S, Bodine E, Kahn J, et al. The antiretroviral rollout and drug-resistant HIV in Africa: insights from empirical data and theoretical models. AIDS. 2005;19:1–14.

    Article  PubMed  Google Scholar 

  19. CDC. HIV/AIDS surveillance report, 2006, vol 18. Atlanta: U.S. Department of Health and Human Services, CDC; 2008. p. 1–55.

  20. Stolte IG, Dukers NH, Geskus RB, Coutinho RA, de Wit JB. Homosexual men change to risky sex when perceiving less threat of HIV/AIDS since availability of highly active antiretroviral therapy: a longitudinal study. AIDS. 2004;18:303–9.

    Article  PubMed  Google Scholar 

  21. Rietmeijer CA, Patnaik JL, Judson FN, Douglas JM Jr. Increases in gonorrhea and sexual risk behaviors among men who have sex with men: a 12-year trend analysis at the Denver Metro Health Clinic. Sex Transm Dis. 2003;30:562–7.

    Article  PubMed  Google Scholar 

  22. Stolte IG, Dukers NH, De Wit JB, Fennema JS, Coutinho RA. Increase in sexually transmitted infections among homosexual men in Amsterdam in relation to HAART. Sex Transm Dis. 2001;77:184–6.

    CAS  Google Scholar 

  23. Klausner JD, Kent CK, Wong W, McCright J, Katz MH. The public health response to epidemic syphilis, San Francisco, 1999–2004. Sex Transm Dis. 2005;32:S11–8.

    Article  PubMed  Google Scholar 

  24. Pearson CR, Kurth AE, Cassels S, Martin DP, Simoni JM, Hoff P, et al. Modeling HIV transmission risk among Mozambicans prior to their initiating highly active antiretroviral therapy. AIDS Care. 2007;19:594–604.

    Article  PubMed  CAS  Google Scholar 

  25. Diabate S, Alary M, Koffi CK. Short-term increase in unsafe sexual behaviour after initiation of HAART in Cote d’Ivoire. AIDS. 2008;22:154–6.

    Article  PubMed  Google Scholar 

  26. Eisele TP, Mathews C, Chopra M, Brown L, Silvestre E, Daries V, et al. High levels of risk behavior among people living with HIV Initiating and waiting to start antiretroviral therapy in Cape Town South Africa. AIDS Behav. 2008;12:570–7.

    Article  PubMed  Google Scholar 

  27. McClelland RS, Graham SM, Richardson BA, Peshu N, Masese LN, Wanje GH, et al. Treatment with antiretroviral therapy is not associated with increased sexual risk behavior in Kenyan female sex workers. AIDS. 2010;24:891–7.

    Article  PubMed  Google Scholar 

  28. Moatti JP, Prudhomme J, Traore DC, Juillet-Amari A, Akribi HA, Msellati P. Access to antiretroviral treatment and sexual behaviours of HIV-infected patients aware of their serostatus in Cote d’Ivoire. AIDS. 2003;17:S69–77.

    Article  PubMed  Google Scholar 

  29. Bateganya M, Colfax G, Shafer LA, Kityo C, Mugyenyi P, Serwadda D, et al. Antiretroviral therapy and sexual behavior: a comparative study between antiretroviral-naive and -experienced patients at an urban HIV/AIDS care and research center in Kampala, Uganda. AIDS Patient Care STDS. 2005;19:760–8.

    Article  PubMed  Google Scholar 

  30. Eisele TP, Mathews C, Chopra M, Lurie MN, Brown L, Dewing S, et al. Changes in risk behavior among HIV-positive patients during their first year of antiretroviral therapy in Cape Town South Africa. AIDS Behav. 2009;13:1097–105. Epub 2008 Oct 1010.

    Article  PubMed  Google Scholar 

  31. Peltzer K, Ramlagan S. Safer sexual behaviours after 1 year of antiretroviral treatment in KwaZulu-Natal, South Africa: a prospective cohort study. Sex Health. 2010;7:135–41.

    Article  PubMed  Google Scholar 

  32. Kaida A, Gray G, Bastos FI, Andia I, Maier M, McIntyre J, et al. The relationship between HAART use and sexual activity among HIV-positive women of reproductive age in Brazil, South Africa, and Uganda. AIDS Care. 2008;20:21–5.

    Article  PubMed  CAS  Google Scholar 

  33. Pearson CR, Micek M, Simoni JM, Matediana E, Martin DP, Gloyd S. Modified directly observed therapy to facilitate highly active antiretroviral therapy adherence in Beira, Mozambique. Development and implementation. J Acquir Immune Defic Syndr. 2006;43:S134–41.

    Article  PubMed  Google Scholar 

  34. Pearson CR, Micek MA, Simoni JM, Hoff PD, Matediana E, Martin DP, et al. Randomized control trial of peer-delivered, modified directly observed therapy for HAART in Mozambique. J Acquir Immune Defic Syndr. 2007,9:238–44.

    Google Scholar 

  35. Kelly JA, Kalichman SC. Reinforcement value of unsafe sex as a predictor of condom use and continued HIV/AIDS risk behavior among gay and bisexual men. Health Psychol. 1998;17:328–35.

    Article  PubMed  CAS  Google Scholar 

  36. Kennedy C, O’Reilly K, Medley A, Sweat M. The impact of HIV treatment on risk behaviour in developing countries: a systematic review. AIDS Care. 2007;19:707–20.

    Article  PubMed  CAS  Google Scholar 

  37. Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Res Nurs Health. 2001;24:518–29.

    Article  PubMed  CAS  Google Scholar 

  38. Holzemer WL, Makoae M, Greeff PS, Dlamini PS, Kohi ML, Chirwa ML, et al. Measuring HIV stigma for PLHAs and nurses over time in five African countries. SAHARA J. 2009;6:76–82.

    PubMed  Google Scholar 

  39. Genberg BL, Hlavka Z, Konda KA, Maman S, Chariyalertsak S, Chingono A, et al. A comparison of HIV/AIDS-related stigma in four countries: negative attitudes and perceived acts of discrimination towards people living with HIV/AIDS. Soc Sci Med. 2009;68:2279–87.

    Article  PubMed  Google Scholar 

  40. Brown RL, Leonard T, Rounds LA, Papasouliotis O. A two-item screening test for abuse of alcohol and other drug problems. J Fam Pract. 1997;44:151–60.

    PubMed  CAS  Google Scholar 

  41. Sullivan P, et al. Reduction of HIV transmission risk and high risk sex while prescribed ART: results from discordant couples in Rwanda and Zambia. In: 16th conference on retroviruses and opportunistic infections, Montreal; 2009.

  42. Reynolds S, et al. ART reduced the rate of sexual transmission of HIV among HIV-discordant couples in rural Rakai, Uganda. In: 16th conference on retroviruses and opportunistic infections, Montreal; 2009.

  43. Porco TC, Martin JN, Page-Shafer KA, et al. Decline in infectivity following the introduction of highly active antiretroviral therapy. AIDS. 2004;18:81–8.

    Article  PubMed  Google Scholar 

  44. Attia S, Egger M, Muller M, Zwahlen M, Low N. Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis. AIDS. 2009;23:1397–404.

    Article  PubMed  Google Scholar 

  45. Donnell D, Baeten JM, Kiarie J, Thomas KK, Stevens W, Cohen CR, et al. Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis. Lancet. 2010;375:2092–8. Epub 2010 May 2026.

    Article  PubMed  Google Scholar 

  46. Lurie M, Rosenthal S, Williams B. Concurrency driving the African HIV epidemics: where is the evidence? Lancet. 2009;374:1420. author reply 1420–1421.

    Article  PubMed  Google Scholar 

  47. Lurie MN, Rosenthal S. Concurrent partnerships as a driver of the HIV epidemic in sub-Saharan Africa? The evidence is limited. AIDS Behav. 2010;14:17–24; discussion 25–18.

    Google Scholar 

  48. Rothenberg R. HIV transmission networks. Curr Opin HIV AIDS. 2009;4:260–5.

    Article  PubMed  Google Scholar 

  49. Helleringer S, Kohler HP, Kalilani-Phiri L. The association of HIV serodiscordance and partnership concurrency in Likoma Island (Malawi). AIDS. 2009;23:1285–7.

    Article  PubMed  Google Scholar 

  50. Mah TL, Halperin DT. Concurrent sexual partnerships and the HIV epidemics in africa: evidence to move forward. AIDS Behav. 2008, Epub ahead of print.

  51. Morris M, Goodreau SM, Moody J. Sexual networks, concurrency, and STD/HIV. In: Holmes KK, editor. Sexually transmitted diseases. New York: McGraw-Hill; 2007.

  52. Morris M, Kurth AE, Hamilton DT, Moody J, Wakefield S. Concurrent partnerships and HIV prevalence disparities by race: linking science and public health practice. Am J Public Health. 2009;99:1023–31.

    Article  PubMed  Google Scholar 

  53. Morris M, Kretzschmar M. Concurrent partnerships and the spread of HIV. AIDS. 1997;11:641–83.

    Article  PubMed  CAS  Google Scholar 

  54. King R, Lifshay J, Nakayiwa S, Katuntu D, Lindkvist P, Bunnell R. The virus stops with me: HIV-infected Ugandans’ motivations in preventing HIV transmission. Soc Sci Med. 2009;68:749–57.

    Article  PubMed  Google Scholar 

  55. Kielmann K, Cataldo F. Tracking the rise of the “expert patient” in evolving paradigms of HIV care. AIDS Care. 2010;22:21–8.

    Article  PubMed  Google Scholar 

  56. Atuyambe L, Neema S, Otolok-Tanga E, Wamuyu-Maina G, Kasasa S, Wabwire-Mangen F. The effects of enhanced access to antiretroviral therapy: a qualitative study of community perceptions in Kampala City, Uganda. Afr Health Sci. 2008;8:13–9.

    PubMed  Google Scholar 

  57. McClelland L, Wanje G, Kashonga F, McClelland RS, Kiarie J, Mandaliya K, et al. Understanding the risk context of HIV and sexual behaviour following antiretroviral therapy rollout in a population of high-risk women in Kenya. AIDS Educ Behav. In review.

  58. Kurth AE, Martin DP, Golden MG, Weiss N, Heagerty P, Handsfield HH, et al. A comparison of sexually transmitted infection risk reporting in audio computer-assisted self- interviews and clinician interviews. Sex Transm Dis. 2004;31:719–26.

    Article  PubMed  Google Scholar 

  59. Gilbert L, Walker L. ‘My biggest fear was that people would reject me once they knew my status’: stigma as experienced by patients in an HIV/AIDS clinic in Johannesburg, South Africa. Health Soc Care Community. 2010;18:139–46.

    Article  PubMed  Google Scholar 

  60. Gebrekristos HT, Lurie MN, Mthethwa N, Karim QA. Disclosure of HIV status: experiences of patients enrolled in an integrated TB and HAART pilot programme in South Africa. Afr J AIDS Res. 2009;8:1–6.

    Article  PubMed  Google Scholar 

  61. Myers JJ, Shade SB, Rose CD, Koester K, Maiorana A, Malitz FE, et al. Interventions delivered in clinical settings are effective in reducing risk of HIV transmission among people living with HIV: results from the Health Resources and Services Administration (HRSA)’s Special Projects of National Significance initiative. AIDS Behav. 2010;14:483–92.

    Article  PubMed  Google Scholar 

  62. Crepaz N, Hart TA, Marks G. Highly active antiretroviral therapy and sexual risk behavior: a meta-analytic review. JAMA. 2004;292:224–36.

    Article  PubMed  CAS  Google Scholar 

  63. Dawson Rose C, Gutin SA, Reyes M. Adapting positive prevention interventions for international settings: applying U.S. evidence to epidemics in developing countries. J Assoc Nurses AIDS Care. 2010;9:9.

    Google Scholar 

  64. Bunnell R, Mermin J, De Cock KM. HIV prevention for a threatened continent: implementing positive prevention in Africa. JAMA. 2006;296:855–8.

    Article  PubMed  CAS  Google Scholar 

  65. Eaton LA, Kalichman SC. Changes in transmission risk behaviors across stages of HIV disease among people living with HIV. J Assoc Nurses AIDS Care. 2009;20:39–49.

    Article  PubMed  Google Scholar 

  66. Richardson JL, Milam JAM, Stoyanoff S, Bolan R, Weiss J, et al. Effect of brief safer-sex counseling by medical providers to HIV-1 seropositive patients: a multi-clinic assessment. AIDS. 2004;18:1179–86.

    Article  PubMed  Google Scholar 

  67. Luchters S, Sarna A, Geibel S, Chersich MF, Munyao P, Kaai S, et al. Safer sexual behaviors after 12 months of antiretroviral treatment in Mombasa, Kenya: a prospective cohort. AIDS Patient Care STDS. 2008;22:587–94.

    Article  PubMed  Google Scholar 

  68. Deribe K, Woldemichael K, Wondafrash M, Haile A, Amberbir A. Disclosure experience and associated factors among HIV positive men and women clinical service users in Southwest Ethiopia. BMC Public Health. 2008;8:81.

    Article  PubMed  Google Scholar 

  69. Simbayi LC, Kalichman SC, Strebel A, Cloete A, Henda N, Mqeketo A. Disclosure of HIV status to sex partners and sexual risk behaviours among HIV-positive men and women, Cape Town, South Africa. Sex Transm Infect. 2007;83:29–34.

    Article  PubMed  CAS  Google Scholar 

  70. Harding R, Lampe FC, Norwood S, Date HL, Clucas C, Fisher M, et al. Symptoms are highly prevalent among HIV outpatients and associated with poor adherence and unprotected sexual intercourse. Sex Transm Infect. 2010;15:15.

    Google Scholar 

  71. Wong LH, Rooyen HV, Modiba P, Richter L, Gray G, McIntyre JA, et al. Test and tell: correlates and consequences of testing and disclosure of HIV status in South Africa (HPTN 043 Project Accept). J Acquir Immune Defic Syndr. 2009;50:215–22.

    Article  PubMed  Google Scholar 

  72. Loubiere S, Peretti-Watel P, Boyer S, Blanche J, Abega SC, Spire B. HIV disclosure and unsafe sex among HIV-infected women in Cameroon: results from the ANRS-EVAL study. Soc Sci Med. 2009;69:885–91.

    Article  PubMed  Google Scholar 

  73. King R, Katuntu D, Lifshay J, al. e. Processes and outcomes of HIV serostatus disclosure to sexual partners among people living with HIV in Uganda. AIDS Behav 2008;12:232–243.

    Google Scholar 

  74. Sarna A, Chersich MF, Okal J, Luchters SMF, Mandaliya KN, Rutenberg N, et al. Changes in sexual risk taking with antiretroviral treatment: influence of context and gender norms in Mombasa, Kenya. Cult Health Sex. 2009;11:783–97.

    Article  PubMed  Google Scholar 

  75. Stoneburner RL, Low-Beer D. Population-level HIV declines and behavioral risk avoidance in Uganda. Science. 2004;304:714–8.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This work was supported in part by the Stroum Endowed Minority Dissertation Fellowship and the Indigenous Wellness Research Institute funding to Pearson, 5 K01 PS000066 funding to Kurth, the Sociobehavioral and Prevention Research Core at the Center for AIDS Research, University of Washington (NIH/NIAID P30 AI27757) and K99 HD057533 to Cassels, PEPFAR and TAP funding Grant No. 1440/TAP:HIV-AIDS/MS-DPC/GACOPI/04 to Gloyd, Micek, and Montoya. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the University of Washington, the Mozambique Ministry of Health, or the NIH.

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Authors and Affiliations

  1. School of Social Work, Indigenous Wellness and Research Institute, University of Washington, Seattle, WA, 98195-1525, USA

    Cynthia R. Pearson

  2. Center for AIDS Research, University of Washington, Seattle, WA, USA

    Susan Cassels & Ann E. Kurth

  3. School of Nursing, University of Washington, Seattle, WA, USA

    Ann E. Kurth

  4. Department of Global Health, University of Washington, Seattle, WA, USA

    Ann E. Kurth, Pablo Montoya, Mark A. Micek & Stephen S. Gloyd

  5. Health Alliance International, Seattle, WA, USA

    Pablo Montoya, Mark A. Micek & Stephen S. Gloyd

  6. Health Alliance International, Beira, Mozambique

    Pablo Montoya, Mark A. Micek & Stephen S. Gloyd

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  1. Cynthia R. Pearson
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  2. Susan Cassels
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  4. Pablo Montoya
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  6. Stephen S. Gloyd
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Correspondence to Cynthia R. Pearson.

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Pearson, C.R., Cassels, S., Kurth, A.E. et al. Change in Sexual Activity 12 Months After ART Initiation Among HIV-Positive Mozambicans. AIDS Behav 15, 778–787 (2011). https://doi.org/10.1007/s10461-010-9852-3

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