title: Changes in sexual behaviour among HIV-infected women in west and east Africa in the first 24 months after delivery.
abstract: OBJECTIVE
  Describe changes in sexual behaviour and determinants of unsafe sex among HIV-infected women in the 24 months after delivery.
  
  
  METHODS
  Cohort analysis nested within a prevention of mother-to-child transmission trial in Burkina Faso (n = 339) and Kenya (n = 432).
  
  
  METHODS
  Women were followed during pregnancy and until 12-24 months after delivery. At each visit, structured questionnaires were administered about sexual activity and condom use, and risk-reduction counselling and condoms were provided.
  
  
  RESULTS
  At study entry, a median 2 months after HIV testing (interquartile range =1-4), 411/770 (53.4%) of women reported partner disclosure, increasing to 284/392 (71.9%) at the final visit. Although most partners were supportive following disclosure, between 5 and 10% of disclosed women experienced hostile or unsupportive partner responses during follow-up visits. At each visit, about a third of sexually active women reported unsafe sex (unprotected sex with HIV-uninfected or unknown status partner). In multivariable logistic regression, unsafe sex was 1.70-fold more likely in Kenyan than in Burkinabe women [95% confidence interval (95% CI) = 1.14-2.54], and in those with less advanced HIV disease or aged 16-24 years. Compared with women who disclosed their status to partners and others, unsafe sex was over six-fold higher in nondisclosers (95% CI = 3.31-12.11), the effect size reducing with increasing disclosure.
  
  
  CONCLUSIONS
  HIV-infected women who recently delivered have a high potential for further HIV transmission, especially as HIV discordance is common in Africa. Longitudinal care for women, including positive-prevention interventions, is needed within new services providing antiretroviral prophylaxis during breastfeeding - this repeated interface with services could focus on reducing unsafe sex. Much remains unknown about how to facilitate beneficial disclosure.
authors.affiliation: International Centre for Reproductive Health, Mombasa, Kenya.
authors.forename: Eunice
authors.initials: E
authors.lastname: Irungu
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Chersich
authors.forename: Clarisse
authors.initials: C
authors.lastname: Sanon
authors.forename: Rosemary
authors.initials: R
authors.lastname: Chege
authors.forename: Philippe
authors.initials: P
authors.lastname: Gaillard
authors.forename: Marleen
authors.initials: M
authors.lastname: Temmerman
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Read
authors.forename: Stanley
authors.initials: S
authors.lastname: Luchters
mesh_terms: D000293:Adolescent; D000328:Adult; D002050:Burkina Faso; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007630:Kenya; D008137:Longitudinal Studies; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D012307:Risk Factors; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012747:Sexual Partners; D011795:Surveys and Questionnaires; D014342:Truth Disclosure; D047568:Unsafe Sex / Q000706:statistics & numerical data; D055815:Young Adult