title: Association of attitudes and beliefs towards antiretroviral therapy with HIV-seroprevalence in the general population of Kisumu, Kenya.
abstract: BACKGROUND
  Since antiretroviral therapy (ART) became available in the developed world, the prevalence of unprotected sex and the incidence of sexually transmitted infections (STIs) and HIV have increased. We hypothesized that a similar phenomenon may be occurring in sub-Saharan Africa concomitant with the scale-up of HIV treatment.
  
  
  METHODS
  We conducted a general population-based survey in Kisumu, Kenya. Participants completed an interview that included demographics as well as ART-related attitudes and beliefs (AB) and then underwent HIV serological testing. Exploratory and confirmatory factor analyses of AB about ART indicated two factors: 1) ART-related risk compensation (increased sexual risk taking now that ART is available); and 2) a perception that HIV is more controllable now that ART is available. Logistic regression was used to determine associations of these factors with HIV-seroprevalence after controlling for age.
  
  
  RESULTS
  1,655 (90%) of 1,844 people aged 15-49 contacted, including 749 men and 906 women, consented to participate in the study. Most participants (n = 1164; 71%) had heard of ART. Of those who had heard of ART, 23% believed ART was a cure for HIV. ART-related risk compensation (Adjusted (A)OR = 1.45, 95% CI 1.16-1.81), and a belief that ART cures HIV (AOR = 2.14, 95% CI 1.22-3.76) were associated with an increased HIV seroprevalence in men but not women after controlling for age. In particular, ART-related risk compensation was associated with an increased HIV-seroprevalence in young (aged 15-24 years) men (OR = 1.56; 95% CI 1.12-2.19).
  
  
  CONCLUSIONS
  ART-related risk compensation and a belief that ART cures HIV were associated with an increased HIV seroprevalence among men but not women. HIV prevention programs in sub-Saharan Africa that target the general population should include educational messages about ART and address the changing beliefs about HIV in the era of greater ART availability.
authors.affiliation: Departments of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
authors.forename: Michele
authors.initials: M
authors.lastname: Montandon
authors.forename: Adam W
authors.initials: AW
authors.lastname: Carrico
authors.forename: Stephen
authors.initials: S
authors.lastname: Shiboski
authors.forename: Alan
authors.initials: A
authors.lastname: Bostrom
authors.forename: Alfredo
authors.initials: A
authors.lastname: Obure
authors.forename: Zachary
authors.initials: Z
authors.lastname: Kwena
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bailey
authors.forename: Rosemary
authors.initials: R
authors.lastname: Nguti
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D015528:HIV Seroprevalence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors
chemical_list: D019380:Anti-HIV Agents