title: Changes in sexual risk behavior before and after HIV seroconversion in Southern African women enrolled in a HIV prevention trial.
abstract: BACKGROUND
  We examine changes in sexual risk behaviors before and after HIV seroconversion in southern African women enrolled in the Methods for Improving Reproductive Health in Africa trial.
  
  
  METHODS
  HIV testing and counseling, and assessment of sexual behaviors by audio computer-assisted self-interviewing were performed approximately every 3 months. We compared the following sexual behaviors: being sexually active, coital frequency, consistent male condom use, use of any female condoms, anal sex, and >1 sex partner, at study visits before and after HIV seroconversion.
  
  
  RESULTS
  During the trial, 327 women seroconverted to HIV, contributing 718 pre-HIV and 1110 post-HIV study visits. Women were significantly more likely to report consistent condom use at visits after HIV seroconversion compared with visits before HIV infection [adjusted odds ratio, (AOR): 1.36 (95% confidence interval (CI): 1.11 to 1.67)] and were less likely to have >1 male sex partner after serconversion [AOR: 0.66 (95% CI: 0.48 to 0.91)]. Women reported less frequently being sexually active [AOR: 0.63 (95% CI: 0.39 to 1.02)], fewer episodes of sex [>4 sex acts over the past week AOR: 0.74 (95% CI: 0.60 to 0.91)], and a reduction in anal sex [AOR: 0.58 (95% CI: 0.36 to 0.95)] at visits after HIV seroconversion. The observed reductions in sexual risk behaviors persisted over time.
  
  
  CONCLUSIONS
  Women significantly decreased their sexual risk behaviors after HIV seroconversion, but these changes were relatively modest, suggesting the need for further secondary prevention. Timely notification of HIV status coupled with prevention messages can contribute to reductions in sexual risk behaviors.
authors.affiliation: Department of Community Health, Division of Infectious Diseases, Department of Medicine, Alpert Medical School, Brown University, Providence, RI 02912, USA. Kartik_Venkatesh@Brown.Edu
authors.forename: Kartik K
authors.initials: KK
authors.lastname: Venkatesh
authors.forename: Guy
authors.initials: G
authors.lastname: de Bruyn
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.forename: Helen
authors.initials: H
authors.lastname: Cheng
authors.forename: Kelly
authors.initials: K
authors.lastname: Blanchard
authors.forename: Gita
authors.initials: G
authors.lastname: Ramjee
authors.forename: Tsungai
authors.initials: T
authors.lastname: Chipato
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Triche
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Padian
authors.forename: Ariane
authors.initials: A
authors.lastname: van der Straten
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control*; D006679:HIV Seropositivity / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012309:Risk-Taking; D021841:Safe Sex; D012747:Sexual Partners; D013019:South Africa / Q000453:epidemiology; D014505:Urban Population; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology