HIV-1 acquisition and disease progression are associated with decreased high-risk sexual behaviour among Kenyan female sex workers.
BACKGROUND
Changes in sexual risk behaviour may occur following HIV-1 infection.


OBJECTIVE
To test the hypothesis that HIV-1 seroconversion and disease progression are associated with changes in risk behaviours, using data from a cohort of Kenyan female sex workers (FSWs).


METHODS
HIV-1-seronegative FSWs were enrolled in a prospective cohort study of risk factors for HIV-1 acquisition. At monthly visits, standardized interviews were conducted to assess sexual risk behaviour and HIV-1 serologic testing was performed. Seroconverters were invited to continue with follow-up. Between 1993 and 2004 (when antiretroviral therapy was introduced in the cohort), 265 women seroconverted for HIV-1 (incidence 7.7/100 person-years) and were included in this analysis.


RESULTS
Unprotected intercourse was reported at 546/2037 (27%) pre-seroconversion visits versus 557/3732 (15%) post-seroconversion visits (P < 0.001). These findings remained significant after adjustment for potential confounding factors [adjusted odds ratio (AOR) 0.69; 95% confidence interval (CI), 0.55-0.86]. Compared with HIV-1-seronegative women, there was a progressive stepwise decrease in unprotected intercourse among HIV-1-seropositive women with CD4 cell counts > or = 500 (AOR, 0.93; 95% CI, 0.62-1.39), 200-499 (AOR, 0.58; 95% CI, 0.41-0.82) and < 200 cells/microl (AOR, 0.45; 95% CI, 0.25-0.82). Decreases in unprotected intercourse reflected increases in both abstinence and 100% condom use. Women also reported fewer partners and fewer episodes of intercourse after HIV-1 seroconversion.


CONCLUSIONS
HIV-1 seroconversion and disease progression were associated with decreases in sexual risk behaviour among Kenyan FSWs.
McClelland
R Scott
RS
Departments of Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA. mcclell@u.washington.edu
Hassan
Wisal M
WM
Lavreys
Ludo
L
Richardson
Barbra A
BA
Mandaliya
Kishorchandra
K
Ndinya-Achola
Jeckoniah
J
Jaoko
Walter
W
Kurth
Ann E
AE
Baeten
Jared M
JM
D015492:AIDS Serodiagnosis; D000328:Adult; D015986:Confounding Factors, Epidemiologic; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D006801:Humans; D007630:Kenya; D016017:Odds Ratio; D011446:Prospective Studies; D012306:Risk; D012309:Risk-Taking; D011477:Sex Work; D012725:Sexual Behavior