title: Changes in sexual activity and risk behaviors among PLWHA initiating ART in rural district hospitals in Cameroon -- data from the STRATALL ANRS 12110/ESTHER trial.
abstract: The continued scaling-up of antiretroviral therapy (ART) in Sub-Saharan Africa provides an opportunity to further study its impact on sexual behaviors among people living with HIV/AIDS (PLWHA). We explored time trend and correlates of sexual activity among PLWHA initiating ART in Cameroon and compared sexual risk behaviors between patients sexually active before and after initiating ART and those resuming sexual activity after ART initiation. Analyses were based on longitudinal data collected within the randomized trial (n=459) conducted in nine rural district hospitals in Cameroon. Sexual activity was defined as reporting at least one sexual partner during the previous 3 months. Inconsistent condom use (ICU) was defined as reporting to have "never," "sometimes," or "nearly always" used condoms at least once with a partner(s) either HIV-negative or of unknown HIV status during the same period. Mc Nemar tests were used to assess time trend, while mixed-effect logistic regressions were conducted to analyze the effect of time since ART initiation on sexual activity. The proportion of sexually active patients significantly increased over time: from 31.8% at baseline to 40.2 and 47.1% after 6 and 12 months of ART, respectively (p=0.001), to 55.9% after 24 months (p=0.02). After adjustment for behavioral and psychosocial factors, time since ART initiation was independently associated with reporting sexual activity (AOR [95% CI]=1.30 [1.17-1.46] per 6-month increase, p=0.001). ICU was more frequent among patients sexually active both before and after ART initiation than among those who resumed sexual activity after ART initiation (82 vs. 59%, p<B0.001). To conclude, while ART initiation fosters resumption of sexual activity in patients who are inactive before starting treatment; unsafe sexual behaviors remain less frequent in this population than in patients who are already sexually active before starting ART. Risk reduction programs should be reinforced among PLWHA in the context of ART scaling-up.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Ndziessi
authors.forename: Julien
authors.initials: J
authors.lastname: Cohen
authors.forename: Charles
authors.initials: C
authors.lastname: Kouanfack
authors.forename: Sylvie
authors.initials: S
authors.lastname: Boyer
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Moatti
authors.forename: Fabienne
authors.initials: F
authors.lastname: Marcellin
authors.forename: Christian
authors.initials: C
authors.lastname: Laurent
authors.forename: Bruno
authors.initials: B
authors.lastname: Spire
authors.forename: Eric
authors.initials: E
authors.lastname: Delaporte
authors.forename: Maria Patrizia
authors.initials: MP
authors.lastname: Carrieri
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D063425:Binge Drinking; D002163:Cameroon; D017280:Condoms / Q000706:statistics & numerical data / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D020276:HIV Long-Term Survivors; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D012068:Religion and Medicine; D012725:Sexual Behavior / Q000523:psychology*; D012747:Sexual Partners; D047568:Unsafe Sex / Q000523:psychology
chemical_list: D019380:Anti-HIV Agents