Antiretroviral therapy and sexual behavior in Uganda: a cohort study.
OBJECTIVE
To assess evidence for sexual behavior change in response to antiretroviral therapy (ART) among members of a Ugandan clinical cohort. Secondarily, to examine factors associated with both sexual behavior and ART independently, that may help to assess the impact that ART is likely to have on the HIV epidemic.


METHODS
Retrospective analysis of data from an open cohort.


METHODS
ART roll-out began in the cohort in 2004. Using 3-monthly data from 2002 to 2009, we conducted regression and descriptive analyses to examine associations between timing of ART initiation and sexual behavior among HIV-infected, and timing of ART availability and sexual behavior among HIV-uninfected. We also examined partner turnover rates, and the proportion of HIV-infected on ART - two important factors for modeling the potential impact of ART on the HIV epidemic.


RESULTS
Risky sexual behavior among HIV-infected people rose on several indicators after ART initiation, but not to levels higher than two or more years before initiation. Some evidence suggests that the availability of ART may impact risky behavior among HIV-uninfected people, although this was inconsistent across different reported behavior variables.


CONCLUSIONS
The HIV-uninfected is larger than the HIV-infected population. If risky behavior among this population increases due to the feeling of safety that ART provides, this will affect the impact of ART on the HIV epidemic. Policy makers are urged to intensify messages associating sexual behavior and HIV and to target both HIV-infected and uninfected people.
Medical Research Council Unit on AIDS/Uganda Virus Research Institute, Uganda. shafer@umanitoba.ca
Leigh Anne
LA
Shafer
Rebecca N
RN
Nsubuga
Richard
R
White
Billy N
BN
Mayanja
Ruth
R
Chapman
Katie
K
O'brien
Lieve
L
Van der Paal
Heiner
H
Grosskurth
Dermot
D
Maher
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology* / Q000635:transmission; D006801:Humans; D008297:Male; D008875:Middle Aged; D011050:Policy Making; D012189:Retrospective Studies; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology*; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
D044966:Anti-Retroviral Agents