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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda
AIDS, Volume 20, No. 1, Year 2006
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Description
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. © 2006 Lippincott Williams & Wilkins.
Authors & Co-Authors
Bunnell, Rebecca E.
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Uganda, Entebbe
Uganda Virus Research Institute
Ekwaru, John Paul
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Solberg, Peter
United States, San Francisco
University of California, San Francisco
Wamai, Nafuna
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Bikaako-Kajura, Winnie
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Were, Willy A.
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Coutinho, Alex G.
Uganda, Kampala
Aids Support Organization Uganda
Liechty, Cheryl A.
United States, San Francisco
University of California, San Francisco
Madraa, Elizabeth
Uganda, Kampala
Uganda Ministry of Health
Rutherford, George Williams
United States, San Francisco
University of California, San Francisco
Mermin, Jonathan H.
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Statistics
Citations: 535
Authors: 11
Affiliations: 5
Identifiers
Doi:
10.1097/01.aids.0000196566.40702.28
Research Areas
Infectious Diseases
Sexual And Reproductive Health
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
Uganda