title: The impact of highly active antiretroviral therapy on high-risk behaviour of HIV-infected patients in sub-Saharan Africa.
abstract: BACKGROUND
  High-risk sexual behaviors such as multiple sexual partners, inconsistent condom use, acquisition of sexually transmitted infection (STIs), and non-use of contraceptives persist in HIV patients undergoing care. We conducted a systematic review of studies conducted in the era of increased access to HAART (2000-2010) to assess whether wide-scale use of HAART was associated with high-risk behavior among HAART-using patients.
  
  
  METHODS
  We conducted a comprehensive search of databases (AIDSLINE, National Library of Medicine, MEDLINE, PubMed, CINHAL and EMBASE) from January 2002 to January 2010, reviewed conference proceedings and journals, and contacted the researchers involved. We analyzed the association of high-risk behaviors (non-disclosure of sero-status to sexual partners, inconsistent condom use, unprotected sexual intercourse, multiple sexual partners, non-use of contraceptives and acquisition of STIs) with using HAART. Information from eligible studies was abstracted using a standardized checklist. Fourteen English-language studies met the selection criteria of having high-risk behavior as an outcome in patients using HAART in sub-Saharan Africa.
  
  
  RESULTS
  Of the 92 eligible articles screened, 14 met the criteria for inclusion as primary articles, 10 showed that HAART is not associated with increased high-risk behavior, two showed increase in acquisition of STIs among HAART-using patients, (which was inconsistent with other measures of high-risk behavior), and two studies showed short-term increase in high-risk behavior.
  
  
  CONCLUSIONS
  Persistence of high-risk behavior in HAART-using patients suggests that more effort needs to be incorporated in HIV care to reduce such behavior to reduce HIV transmission to uninfected populations.
authors.affiliation: School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda. dankkaye@yahoo.com
authors.forename: Dan Kabonge
authors.initials: DK
authors.lastname: Kaye
authors.forename: Othman
authors.initials: O
authors.lastname: Kakaire
authors.forename: Michael Odongo
authors.initials: MO
authors.lastname: Osinde
authors.forename: John Chrysestom
authors.initials: JC
authors.lastname: Lule
authors.forename: Nelson
authors.initials: N
authors.lastname: Kakande
mesh_terms: D017954:Africa South of the Sahara; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D003140:Communicable Disease Control / Q000379:methods; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D012309:Risk-Taking; D012725:Sexual Behavior / Q000706:statistics & numerical data*
chemical_list: D044966:Anti-Retroviral Agents