Sexual behavior of HIV-positive adults not accessing HIV treatment in Mombasa, Kenya: Defining their prevention needs

AIDS Research and Therapy

Avina Sarna⁵  Stanley Luchters³  Melissa Pickett¹  Matthew Chersich⁶  Jerry Okal⁴  Scott Geibel⁴  Nzioki Kingola²  Marleen Temmerman³ 

[1] UCLA Center for Health Policy Research, Los Angeles, USA

[2] International Centre of Reproductive Health, Mombasa, Kenya

[3] International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium

[4] Population Council, Nairobi, Kenya

[5] Population Council, 142 Golf Links, New Delhi 110048, India

[6] Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

关键词: Africa;    Unsafe sex;    Sexual behavior;    Prevention of sexual transmission of HIV;    PLHIV;   

Others  :  789671
DOI  :  10.1186/1742-6405-9-9

 received in 2011-09-08, accepted in 2012-03-19,  发布年份 2012

【 摘 要 】

Background

HIV spread continues at high rates from infected persons to their sexual partners. In 2009, an estimated 2.6 million new infections occurred globally. People living with HIV (PLHIV) receiving treatment are in contact with health workers and therefore exposed to prevention messages. By contrast, PLHIV not receiving ART often fall outside the ambit of prevention programs. There is little information on their sexual risk behaviors. This study in Mombasa Kenya therefore explored sexual behaviors of PLHIV not receiving any HIV treatment.

Results

Using modified targeted snowball sampling, 698 PLHIV were recruited through community health workers and HIV-positive peer counsellors. Of the 59.2% sexually-active PLHIV, 24.5% reported multiple sexual partners. Of all sexual partners, 10.2% were HIV negative, while 74.5% were of unknown HIV status. Overall, unprotected sex occurred in 52% of sexual partnerships; notably with 32% of HIV-negative partners and 54% of partners of unknown HIV status in the last 6 months. Multivariate analysis, controlling for intra-client clustering, showed non-disclosure of HIV status (AOR: 2.38, 95%CI: 1.47-3.84, p < 0.001); experiencing moderate levels of perceived stigma (AOR: 2.94, 95%CI: 1.50-5.75, p = 0.002); and believing condoms reduce sexual pleasure (AOR: 2.81, 95%CI: 1.60-4.91, p < 0.001) were independently associated with unsafe sex. Unsafe sex was also higher in those using contraceptive methods other than condoms (AOR: 5.47, 95%CI: 2.57-11.65, p < 0.001); or no method (AOR: 3.99, 95%CI: 2.06-7.75, p < 0.001), compared to condom users.

Conclusions

High-risk sexual behaviors are common among PLHIV not accessing treatment services, raising the risk of HIV transmission to discordant partners. This population can be identified and reached in the community. Prevention programs need to urgently bring this population into the ambit of prevention and care services. Moreover, beginning HIV treatment earlier might assist in bringing this group into contact with providers and HIV prevention services, and in reducing risk behaviors.

【 授权许可】

   
2012 Sarna et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]UNAIDS, Global report: [http://www.unaids.org/globalreport/Global_report.htm] webciteUNAIDS report on the global AIDS epidemic 2010. 2010.
• [2]Luchters S, et al.: Safer sexual behaviors after 12 months of antiretroviral treatment in Mombasa, Kenya: a prospective cohort. AIDS Patient Care STDS 2008, 22(7):587-594.
• [3]Peltzer K, Ramlagan S: Safer sexual behaviors after 1 year of antiretroviral treatment in KwaZulu Natal, South Africa: a prospective cohort study. Sex Heal 2010, 7(2):135-141.
• [4]Bunnell R, et al.: Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda. AIDS 2006, 20(1):85-92.
• [5]Crepaz N, Hart TA, Marks G: Highly Active Antiretroviral Therapy and Sexual Risk Behavior A Meta-analytic Review. JAMA 2004, 292(2):224-236.
• [6]Wandera B, et al.: Sexual behaviors over a 3-year period among individuals with advanced HIV/AIDS receiving antiretroviral therapy in an urban HIV clinic in Kampala, Uganda. J Acquir Immune Defic Syndr 2011, in press.
• [7]Sarna A, et al.: Sexual risk behavior and HAART: a comparative study of HIV-infected persons on HAART and on preventive therapy in Kenya. Int J STD AIDS 2008, 19:85-89.
• [8]Moatti J-P, et al.: Access to antiretroviral treatment and sexual behaviors of HIV-infected patients aware of their serostatus in Côte d'Ivoire. AIDS 2003, 17(supplementary 3):S69-S77.
• [9]Eisele TP, 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(4):570-577.
• [10]Bateganya M, 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 and STDs 2005, 19(11):760-768.
• [11]Roura M, et al.: Scaling up stigma? The effects of antiretroviral roll-out on stigma and HIV testing. Early evidence from rural Tanzania. Sex Transm Infect 2009, 85(4):308-312.
• [12]Mshana G, et al.: Barriers to accessing antiretroviral therapy in Kisesa, Tanzania: a qualitative study of early rural referrals to the national program. AIDS Patient Care STDS 2006, 20(9):649-657.
• [13]Crepaz N, Marks G: Towards an understanding of sexual risk behavior in people living with HIV: a review of social, psychological, and medical findings. AIDS 2002, 16:135-149.
• [14]Shiltz M, Sandfort TGM: HIV-positive people, risk and sexual behavior. Social Sci Med 2000, 50(11):1571-1588.
• [15]Courtney-Quirk C, et al.: Factors associated with sexual risk behavior among persons living with HIV: Gender and sexual identity group differences. AIDS Behav 2008, 12(5):685-694.
• [16]Kiene SM, et al.: High rates of unprotected sex occurring among HIV-positive individuals in a daily diary study in South Africa: The role of alcohol use. J Acquir Immune Defic Syndr 2008, 49(2):219-226.
• [17]Kalichman SC: HIV transmission risk behaviors of men and women living with HIV-AIDS: Prevalence, predictors and emerging clinical interventions. Clin Psychological Sci Pract 2000, 7:32-47.
• [18]Kerrigan D, et al.: The search for social validation and the sexual behavior of people living with HIV in Rio de Janeiro, Brazil: understanding the role of treatment optimism in context. Social Sci Med 2006, 62(10):2386-2396.
• [19]Sarna A, et al.: Changes in sexual risk taking with antiretroviral treatment: influence of context and gender norms in Mombasa, Kenya. Cult Heal Sex 2009, 11(8):783-797.
• [20]King R, et al.: The virus stops with me: HIV-infected Ugandans' motivations in preventing HIV transmission. Soc Sci Med 2009, 68(4):749-757.
• [21]King R, et al.: Processes and outcomes of HIV serostatus disclosure to sexual partners among people living with HIV in Uganda. AIDS Behav 2008, 12(2):232-243.
• [22]Moore AR, Oppong J: Sexual risk behavior among people living with HIV/AIDS in Togo. Social Sci Med 2007, 64(5):1057-1066.
• [23]Kanniappan S, Jeyapaul MJ, Kalyanwala S: Desire for motherhood: exploring HIV-positive women's desires, intentions and decision-making in attaining motherhood. AIDS Care 2008, 20(6):625-630.
• [24]NACC, UNGASS on HIV and AIDS Country Report: Kenya. National AIDS Control Council: Nairobi; 2010.
• [25]Watters J, Biernacki P: Targeted sampling: Options for the study of hidden populations. Soc Probl 1989, 36(4):416-430.
• [26]Rothenberg R: Commentary: Sampling in Social Networks. Connections 1995, 18(1):104-110.
• [27]Magnani R, et al.: Review of sampling hard-to-reach and hidden population for HIV surveillance. AIDS 2005, 19(Supplement 2):S67-S72.
• [28]Kaai S, et al.: Perceived stigma among patients receiving antiretroviral treatment: a prospective randomised trial comparing an m-DOT strategy with standard-of-care in Kenya. SAHARA J 2010, 7(2):62-70.
• [29]Sarna A, et al.: Short- and long-term efficacy of modified directly observed antiretroviral treatment in Mombasa, Kenya: a randomized trial. J Acquir Immune Defic Syndr 2008, 48(5):611-619.
• [30]Berger BE, Ferrans CE, Lashley FR: Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Res Nurs Health 2001, 24(6):518-529.
• [31]Kline A, Van Landingham M: HIV-infected women and sexual risk reduction: the relevance of existing models of behavior change. AIDS Educ Prev 1994, 6(5):390-402.
• [32]VandeVen P, et al.: A scale of optimism-scepticism in the context of HIV treatments. AIDS Care 2000, 12(2):171-176.
• [33]Greenland S, Rothman KJ: Precision and Statistics in Epidemiologic Studies [Chapter 10:]. In Modern Epidemiology. 3rd edition. Lipincott Williams and Wilkins. 758; 2008.
• [34]Pettifor A, et al.: Continued High Risk Sexual Behavior Following Diagnosis with Acute HIV Infection in South Africa and Malawi: Implications for Prevention. AIDS Behav 2010, in press.
• [35]Loubiere s, et al.: HIV disclosure and unsafe sex among HIV-infected women in Cameroon: results from the ANRS-EVAL study. Socical Sci Med 2009, 69(6):885-891.
• [36]Eaton L, et al.: HIV transmission risk among HIV seroconcordant and serodiscordant couples: dyadic processes of partner selection. AIDS Behav 2009, 13(2):185-195.
• [37]Wagner G, et al.: Factors associated with condom use among HIV clients in stable relationships with partners at varying risk for HIV in Uganda. AIDS Behav 2010, 14(5):1055-1065.
• [38]Bursac Z, et al.: A Purposeful Selection of Macro Variables for Logistic Regression. SAS Global Forum 2007.
• [39]Marcellin F, et al.: Higher risk of unsafe sex and impaired quality of life among patients not receiving antiretroviral therapy in Cameroon: results from the EVAL survey (ANRS 12-116). AIDS 2010, 24(suppl 1):S17-S25.
• [40]Randolph ME, et al.: Sexual pleasure and condom use. Arch Sex Behav 2007, 36(6):844-848.
• [41]Conley T, Collins B: Difference between condom users and condom nonusers in their multidimensional condom attitudes. J Appl Soc Psychol 2005, 35:603-620.
• [42]Rutenberg N, Baek C: Field experiences integrating family planning into programs to prevent mother-to-child transmission of HIV. Stud Fam Plann 2005, 36(3):235-245.
• [43]Church K, Mayhew SH: Integration of STI and HIV prevention, care, and treatment into family planning services: a review of the literature. Stud Fam Plan 2009, 40(3):171-186.
• [44]Kalichman S, Simbayi L: Sexual exposure to blood and increased risks for heterosexual HIV transmission in Cape Town, South Africa. Afr J Reprod Health 2004, 8(2):55-58.
• [45]Tanfer K, Aral S: Sexual intercourse during menstruation and self-reported sexually transmitted disease history among women. Sex Transm Dis 1996, 23(5):395-401.
• [46]Geibel S, et al.: Factors associated with self-reported unprotected anal sex among male sex workers in Mombasa, Kenya. Sex Transm Dis 2008, 35(8):746-752.
• [47]Geibel S, et al.: Are you on the market?: a capture-recapture enumeration of men who sell sex to men in and around Mombasa, Kenya. AIDS 2007, 21(10):1361-1362.
• [48]Kalichman S, et al.: Heterosexual anal intercourse among community and clinical settings in Cape Town, South Africa. Sex Transm Infect 2009, 85(6):411-415.
• [49]Kalichman S, Simbayi L, Cain D: HIV transmission risk behaviors among HIV seropositive sexually transmitted infection clinic patients in Cape Town, South Africa. Eur J Public Health 2010, 20(2):202-206.
• [50]Obermeyer C: Reframing research on sexual behavior and HIV. Stud Fam Plann 2005, 36(1):1-12.
• [51]Ellish NJ, et al.: Reliability of partner reports of sexual history in a hetersexual population at a sexually transmitted diseases clinic. Sex Transm Dis 1996, 23(6):446-452.
• [52]Minnis A, et al.: Biomarker validation of reports of recent sexual activity: results of a randomized controlled study in Zimbabwe. Am J Epidemiol 2009, 170(7):918-924.