title: Disinhibition in risky sexual behavior in men, but not women, during four years of antiretroviral therapy in rural, southwestern Uganda.
abstract: BACKGROUND
  In resource-rich areas, risky sexual behavior (RSB) largely diminishes after initiation of anti-retroviral therapy, with notable exceptions among some populations who perceive a protected benefit from anti-retroviral therapy (ART). Yet, there is limited data about long-term trends in risky sexual behavior among HIV-infected people in sub-Saharan Africa after initiation of anti-retroviral therapy.
  
  
  METHODS
  We administered questionnaires every three months to collect sexual behavior data among patients taking ART in southwestern Uganda over four years of follow-up time. We defined RSB as having unprotected sex with an HIV-negative or unknown status partner, or unprotected sex with a casual partner. We fit logistic regression models to estimate changes in RSB by time on ART, with and without adjustment for calendar year and CD4 count.
  
  
  RESULTS
  506 participants were enrolled between 2005 and 2011 and contributed a median of 13 visits and 3.5 years of observation time. The majority were female (70%) and median age was 34 years (interquartile range 29-39). There was a decrease in the proportion of men reporting RSB from the pre-ART visit to the first post-ART visit (16.2 to 4.3%, p<0.01) but not women (14.1 to 13.3%, p = 0.80). With each year of ART, women reported decreasing RSB (OR 0.85 per year, 95%CI 0.74-0.98, p = 0.03). In contrast, men had increasing odds of reporting RSB with each year of ART to near pre-treatment rates (OR 1.41, 95%CI 1.14-1.74, p = 0.001), which was partially confounded by changes in calendar time and CD4 count (AOR = 1.24, 95%CI 0.92-1.67, p = 0.16).
  
  
  CONCLUSIONS
  Men in southwestern Uganda reported increasing RSB over four years on ART, to levels approaching pre-treatment rates. Strategies to promote long-term safe sex practices targeted to HIV-infected men on ART might have a significant impact on preventing HIV transmission in this setting.
authors.affiliation: Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda. akembabazi2005@yahoo.com
authors.forename: Annet
authors.initials: A
authors.lastname: Kembabazi
authors.forename: Francis
authors.initials: F
authors.lastname: Bajunirwe
authors.forename: Peter W
authors.initials: PW
authors.lastname: Hunt
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Martin
authors.forename: Conrad
authors.initials: C
authors.lastname: Muzoora
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Haberer
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Siedner
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003617:Dangerous Behavior; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D012424:Rural Population; D012725:Sexual Behavior; D016896:Treatment Outcome; D014454:Uganda; D047568:Unsafe Sex
chemical_list: D019380:Anti-HIV Agents
references.citation: AIDS. 2006 Jan 2;20(1):85-92
references.pmid: 16327323
references.citation: Health Psychol. 1997 Jul;16(4):369-73
references.pmid: 9237089
references.citation: AIDS. 2011 Oct 23;25(16):1939-49
references.pmid: 21811137
references.citation: Int J STD AIDS. 2008 Feb;19(2):85-9
references.pmid: 18334059
references.citation: J Acquir Immune Defic Syndr. 2005 Aug 1;39(4):446-53
references.pmid: 16010168
references.citation: Am J Prev Med. 2001 Aug;21(2):84-92
references.pmid: 11457627
references.citation: J Acquir Immune Defic Syndr. 2008 Aug 15;48(5):553-60
references.pmid: 18645518
references.citation: AIDS. 2003 Jul;17 Suppl 3:S69-77
references.pmid: 14565612
references.citation: AIDS Patient Care STDS. 2008 Jul;22(7):587-94
references.pmid: 18601582
references.citation: AIDS. 2011 Mar 13;25(5):671-8
references.pmid: 21252634
references.citation: N Engl J Med. 2011 Aug 11;365(6):493-505
references.pmid: 21767103
references.citation: J Acquir Immune Defic Syndr. 2005 Jun 1;39(2):228-41
references.pmid: 15905741
references.citation: AIDS Patient Care STDS. 2005 Nov;19(11):760-8
references.pmid: 16283836
references.citation: AIDS. 2002 Mar 29;16(5):775-80
references.pmid: 11964534
references.citation: AIDS. 2002 Jul 26;16(11):1529-35
references.pmid: 12131191
references.citation: Ann Behav Med. 2003 Oct;26(2):76-103
references.pmid: 14534027
references.citation: AIDS Res Ther. 2012 May 14;9(1):14
references.pmid: 22583930
references.citation: AIDS. 2004 Jan 23;18(2):303-9
references.pmid: 15075549
references.citation: AIDS. 2012 Aug 24;26(13):1585-98
references.pmid: 22507927
references.citation: Clin Infect Dis. 2004 Apr 15;38(8):1167-74
references.pmid: 15095224
references.citation: Lancet. 2001 Feb 10;357(9254):432-5
references.pmid: 11273063
references.citation: Int J STD AIDS. 2002 Mar;13(3):181-3
references.pmid: 11860696
references.citation: JAMA. 2004 Jul 14;292(2):224-36
references.pmid: 15249572
references.citation: J Acquir Immune Defic Syndr. 2003 Aug 1;33(4):494-9
references.pmid: 12869838
references.citation: AIDS Behav. 2010 Aug;14(4):816-23
references.pmid: 18949550
references.citation: AIDS. 2012 Feb 20;26(4):489-95
references.pmid: 22156971
references.citation: AIDS. 2001 Feb 16;15(3):369-78
references.pmid: 11273217
references.citation: AIDS Care. 2008 Jan;20(1):21-5
references.pmid: 18278611
references.citation: N Engl J Med. 2012 Aug 2;367(5):399-410
references.pmid: 22784037
references.citation: Sex Health. 2010 Jun;7(2):135-41
references.pmid: 20465976