title: Decreased sexual risk behavior in the era of HAART among HIV-infected urban and rural South Africans attending primary care clinics.
abstract: OBJECTIVE
  In light of increasing access to HAART in sub-Saharan Africa, we conducted a longitudinal study to assess the impact of HAART on sexual risk behaviors among HIV-infected South Africans in urban and rural primary care clinics.
  
  
  METHODS
  Prospective observational cohort.
  
  
  METHODS
  We conducted a cohort study at rural and urban primary care HIV clinics in South Africa consisting of 1544 men and 4719 women enrolled from 2003 to 2010, representing 19703 clinic visits. The primary outcomes were being sexually active, unprotected sex, and more than one sex partner and were evaluated at 6 monthly intervals. Generalized estimated equations assessed the impact of HAART on sexual risk behaviors.
  
  
  RESULTS
  Among 6263 HIV-infected men and women, over a third (37.2%) initiated HAART during study follow-up. In comparison to pre-HAART follow-up, visits while receiving HAART were associated with a decrease in those reporting being sexually active [adjusted odds ratio: 0.86 (95% confidence interval: 0.78-0.95)]. Unprotected sex and having more than one sex partner were reduced at visits following HAART initiation compared to pre-HAART visits [adjusted odds ratio: 0.40 (95% confidence interval: 0.34-0.46) and adjusted odds ratio: 0.20 (95% confidence interval: 0.14-0.29), respectively].
  
  
  CONCLUSIONS
  Sexual risk behavior significantly decreased following HAART initiation among HIV-infected South African men and women in primary care programs. The further expansion of antiretroviral treatment programs could enhance HIV prevention efforts in Africa.
authors.affiliation: Department of Community Health, Brown University, Providence, Rhode Island, USA.
authors.forename: Kartik K
authors.initials: KK
authors.lastname: Venkatesh
authors.forename: Guy
authors.initials: G
authors.lastname: de Bruyn
authors.forename: Mark N
authors.initials: MN
authors.lastname: Lurie
authors.forename: Lerato
authors.initials: L
authors.lastname: Mohapi
authors.forename: Paul
authors.initials: P
authors.lastname: Pronyk
authors.forename: Mosa
authors.initials: M
authors.lastname: Moshabela
authors.forename: Edmore
authors.initials: E
authors.lastname: Marinda
authors.forename: Glenda E
authors.initials: GE
authors.lastname: Gray
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Triche
authors.forename: Neil A
authors.initials: NA
authors.lastname: Martinson
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology*; D013019:South Africa / Q000453:epidemiology; D019562:Viral Load
references.citation: AIDS. 2006 Jan 2;20(1):85-92
references.pmid: 16327323
references.citation: AIDS. 2003 Mar 28;17(5):733-40
references.pmid: 12646797
references.citation: AIDS. 2008 Jan 2;22(1):154-6
references.pmid: 18090406
references.citation: AIDS. 2010 Mar 13;24(5):729-35
references.pmid: 20154580
references.citation: South Afr J HIV Med. 2020 Sep 16;21(1):1115
references.pmid: 33101723
references.citation: PLoS Med. 2005 Jan;2(1):e16
references.pmid: 15647780
references.citation: Sex Transm Infect. 2010 Apr;86(2):148-54
references.pmid: 19837727
references.citation: Lancet. 2009 Jan 3;373(9657):48-57
references.pmid: 19038438
references.citation: AIDS Patient Care STDS. 2008 Jul;22(7):587-94
references.pmid: 18601582
references.citation: Soc Sci Med. 2003 Jan;56(1):149-65
references.pmid: 12435558
references.citation: J Acquir Immune Defic Syndr. 2008 Apr 1;47(4):484-93
references.pmid: 18209685
references.citation: AIDS Care. 2007 Jul;19(6):707-20
references.pmid: 17573590
references.citation: Curr Opin HIV AIDS. 2009 Jul;4(4):279-87
references.pmid: 19532065
references.citation: AIDS Behav. 2009 Dec;13(6):1097-105
references.pmid: 18846418
references.citation: Int J STD AIDS. 2008 Feb;19(2):85-9
references.pmid: 18334059
references.citation: AIDS. 2009 Mar 13;23(5):631-6
references.pmid: 19525621
references.citation: N Engl J Med. 1998 Mar 26;338(13):853-60
references.pmid: 9516219
references.citation: AIDS. 2004 Jan 23;18(2):303-9
references.pmid: 15075549
references.citation: AIDS. 2010 Jan;24 Suppl 1:S17-25
references.pmid: 20023436
references.citation: Clin Infect Dis. 2005 Nov 15;41(10):1525-8
references.pmid: 16231268
references.citation: AIDS. 2003 Jul;17 Suppl 3:S69-77
references.pmid: 14565612
references.citation: Trop Med Int Health. 2005 Oct;10(10):971-80
references.pmid: 16185231
references.citation: AIDS. 2010 Mar 27;24(6):891-7
references.pmid: 20179576
references.citation: Health Psychol. 1998 Jul;17(4):310-9
references.pmid: 9697940
references.citation: AIDS. 2001 Feb 16;15(3):369-78
references.pmid: 11273217
references.citation: AIDS Care. 2008 Jan;20(1):21-5
references.pmid: 18278611
references.citation: J Antimicrob Chemother. 2009 Sep;64(3):599-606
references.pmid: 19602563
references.citation: AIDS. 1999 Jun 18;13(9):1083-9
references.pmid: 10397539
references.citation: AIDS Patient Care STDS. 2005 Nov;19(11):760-8
references.pmid: 16283836
references.citation: AIDS. 2005 Sep 23;19(14):1525-34
references.pmid: 16135907
references.citation: Clin Infect Dis. 2010 Sep 15;51(6):725-31
references.pmid: 20707698
references.citation: AIDS. 2002 Mar 29;16(5):775-80
references.pmid: 11964534
references.citation: AIDS Behav. 2008 Jul;12(4):570-7
references.pmid: 17636372
references.citation: Am J Public Health. 2001 Jul;91(7):1019-24
references.pmid: 11441723
references.citation: Am J Public Health. 2010 Oct;100(10):1867-76
references.pmid: 20724682
references.citation: AIDS. 2003 Oct 17;17(15):2245-52
references.pmid: 14523282
references.citation: AIDS. 2007 Nov;21 Suppl 7:S39-48
references.pmid: 18040163