title: Sexual behaviors over a 3-year period among individuals with advanced HIV/AIDS receiving antiretroviral therapy in an urban HIV clinic in Kampala, Uganda.
abstract: BACKGROUND
  Few studies have prospectively examined sexual behaviors of HIV-infected person on antiretroviral therapy (ART) in sub-Saharan Africa.
  
  
  METHODS
  Between 2004 and 2005, 559 HIV-infected, ART-naïve individuals initiating ART at an HIV clinic in Kampala, Uganda, were enrolled into a prospective study and followed to 2008. Clinical and sexual behavior information was assessed at enrollment and semiannually for 3 years after ART initiation. Using log-binomial regression models, we estimated prevalence ratios (PRs) to determine factors associated with being sexually active and having unprotected sex over 3 years after initiating ART.
  
  
  RESULTS
  Five hundred fifty-nine adults contributed 2594 person-visits of follow-up. At the time of ART initiation, 323 (57.9%) were sexually active of which 176 (54.5%) had unprotected sex at last sexual intercourse. The majority (63.4%) of married individuals were unaware of their partner's HIV status. Female gender (PR, 2.97; 95% confidence interval, 1.85-4.79), being married (PR, 1.48; 95% confidence interval, 1.06-2.06), and reporting unprotected sex before ART (PR, 1.68; 95% confidence interval, 1.16-2.42) were among the factors independently associated with unprotected sex while on ART. Overall, 7.3% of visit intervals of unprotected sex, 1.0% of intervals of sexual activity, occurred when plasma viral load greater than 1500 copies/mL, representing periods of greater HIV transmission risk.
  
  
  CONCLUSIONS
  Although unprotected sex reduced over time, women reported unprotected sex more often than men. Disclosure of HIV status was low. Integration of comprehensive prevention programs into HIV care is needed, particularly ones specific for women.
authors.affiliation: Infectious Diseases Institute, Kampala, Uganda. bonniewandera@yahoo.com
authors.forename: Bonnie
authors.initials: B
authors.lastname: Wandera
authors.forename: Moses R
authors.initials: MR
authors.lastname: Kamya
authors.forename: Barbara
authors.initials: B
authors.lastname: Castelnuovo
authors.forename: Agnes
authors.initials: A
authors.lastname: Kiragga
authors.forename: Andrew
authors.initials: A
authors.lastname: Kambugu
authors.forename: Jane N
authors.initials: JN
authors.lastname: Wanyama
authors.forename: Philippa
authors.initials: P
authors.lastname: Easterbrook
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Sethi
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology* / Q000635:transmission / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012044:Regression Analysis; D012725:Sexual Behavior / Q000523:psychology*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014454:Uganda; D014505:Urban Population
chemical_list: D019380:Anti-HIV Agents