title: Sexual behavior and HIV transmission risk of Ugandan adults taking antiretroviral therapy: 3 year follow-up.
abstract: BACKGROUND
  Long-term impact of antiretroviral therapy (ART) on sexual HIV-transmission risk in Africa is unknown. We assessed sexual behavior changes and estimated HIV transmission from HIV-infected adults on ART in Uganda.
  
  
  METHODS
  Between 2003 and 2007, we enrolled and followed ART-naive HIV-infected adults in a home-based AIDS program with annual counseling and testing for cohabitating partners, participant transmission risk-reduction plans, condom distribution and prevention support for cohabitating discordant couples. We assessed participants' HIV plasma viral load and partner-specific sexual behaviors. We defined risky sex as intercourse with inconsistent/no condom use with HIV-negative or unknown serostatus partners in previous 3 months. We compared rates using Poisson regression models, estimated transmission risk using established viral load-specific transmission estimates, and documented sero-conversion rates among HIV-discordant couples.
  
  
  RESULTS
  Of 928 participants, 755 (81%) had 36 months data: 94 (10%) died and 79 (9%) missing data. Sexual activity increased from 28% (baseline) to 41% [36 months (P < 0.001)]. Of sexually active participants, 22% reported risky sex at baseline, 8% at 6 months (P < 0.001), and 14% at 36 months (P = 0.018). Median viral load among those reporting risky sex was 122,500 [interquartile range (IQR) 45 100-353 000] copies/ml pre-ART at baseline and undetectable at follow-up. One sero-conversion occurred among 62 cohabitating sero-discordant partners (0.5 sero-conversions/100 person-years). At 36 months, consistent condom use was 74% with discordant partners, 55% with unknown and 46% with concordant partners. Estimated HIV transmission risk reduced 91%, from 47.3 to 4.2/1000 person-years.
  
  
  CONCLUSIONS
  Despite increased sexual activity among HIV-infected Ugandans over 3 years on ART, risky sex and estimated risk of HIV transmission remained lower than baseline levels. Integrated prevention programs could reduce HIV transmission in Africa.
authors.affiliation: CDC-Uganda, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Entebbe, Uganda. hmm9@ug.cdc.gov
authors.forename: Rose
authors.initials: R
authors.lastname: Apondi
authors.forename: Rebecca
authors.initials: R
authors.lastname: Bunnell
authors.forename: John Paul
authors.initials: JP
authors.lastname: Ekwaru
authors.forename: David
authors.initials: D
authors.lastname: Moore
authors.forename: Stevens
authors.initials: S
authors.lastname: Bechange
authors.forename: Kenneth
authors.initials: K
authors.lastname: Khana
authors.forename: Rachel
authors.initials: R
authors.lastname: King
authors.forename: James
authors.initials: J
authors.lastname: Campbell
authors.forename: Jordan
authors.initials: J
authors.lastname: Tappero
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mermin
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology* / Q000635:transmission; D006801:Humans; D008297:Male; D012307:Risk Factors; D012725:Sexual Behavior / Q000523:psychology*; D012747:Sexual Partners; D014454:Uganda / Q000453:epidemiology; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents