title: HIV-1 acquisition and disease progression are associated with decreased high-risk sexual behaviour among Kenyan female sex workers.
abstract: 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.
authors.affiliation: Departments of Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA. mcclell@u.washington.edu
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClelland
authors.forename: Wisal M
authors.initials: WM
authors.lastname: Hassan
authors.forename: Ludo
authors.initials: L
authors.lastname: Lavreys
authors.forename: Barbra A
authors.initials: BA
authors.lastname: Richardson
authors.forename: Kishorchandra
authors.initials: K
authors.lastname: Mandaliya
authors.forename: Jeckoniah
authors.initials: J
authors.lastname: Ndinya-Achola
authors.forename: Walter
authors.initials: W
authors.lastname: Jaoko
authors.forename: Ann E
authors.initials: AE
authors.lastname: Kurth
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
mesh_terms: 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