title: Inconsistent condom use among HIV-positive women in the "Treatment as Prevention Era": data from the Italian DIDI study.
abstract: BACKGROUND
  Translation of the evidence regarding the protective role of highly active antiretroviral therapy (HAART) on HIV sexual transmission rates into sexual behaviour patterns of HIV-infected subjects remains largely unexplored. This study aims to describe frequency of self-reported condom use among women living with HIV in Italy and to investigate the variables associated with inconsistent condom use (ICU).
  
  
  METHODS
  DIDI (Donne con Infezione Da HIV) is an Italian multicentre study based on a questionnaire survey performed during November 2010 and February 2011. Women-reported frequency of condom use was dichotomized in "always" versus "at times"/"never" (ICU).
  
  
  RESULTS
  Among 343 women, prevalence of ICU was 44.3%. Women declared a stable partnership with an HIV-negative (38%) and with an HIV-positive person (43%), or an occasional sexual partner (19%). Among the 194 women engaged in a stable HIV-negative or an occasional partnership, 51% reported fear of infecting the partner. Nonetheless, 43% did not disclose HIV-positive status. Less than 5% of women used contraceptive methods other than condoms. At multivariable analysis, variables associated with ICU in the subgroup of women with a stable HIV-negative or an occasional HIV-unknown partner were: having an occasional partner (AOR 3.51, 95% confidence interval [CI] 1.44-8.54, p=0.005), and reporting fear of infecting the sexual partner (AOR 3.20, 95% CI 1.43-7.16, p=0.004). Current use of HAART together with virological control in plasma level did not predict ICU after adjusting for demographic, behavioural and HIV-related factors. With regard to socio-demographic factors, lower education was the only variable significantly associated with ICU in the multivariate analysis (AOR 2.27, 95% CI 1.07-4.82, p=0.03). No association was found between high adherence to HAART and ICU after adjusting for potential confounders (AOR 0.89, 95% CI 0.39-2.01, p=0.78).
  
  
  CONCLUSIONS
  Currently in Italy, the use of HAART with undetectable HIV RNA in plasma as well as antiretroviral adherence is not associated with a specific condom use pattern in women living with HIV and engaged with a sero-discordant or an HIV-unknown partner. This might suggest that the awareness of the protective role of antiretroviral treatment on HIV sexual transmission is still limited among HIV-infected persons, at least in this country.
authors.affiliation: Department of Health Sciences, Institute of Infectious and Tropical Diseases, San Paolo University Hospital, Milan, Italy; cicconi.paola@gmail.com.
authors.forename: Paola
authors.initials: P
authors.lastname: Cicconi
authors.forename: Antonella d'Arminio
authors.initials: Ad
authors.lastname: Monforte
authors.forename: Antonella
authors.initials: A
authors.lastname: Castagna
authors.forename: Tiziana
authors.initials: T
authors.lastname: Quirino
authors.forename: Anna
authors.initials: A
authors.lastname: Alessandrini
authors.forename: Miriam
authors.initials: M
authors.lastname: Gargiulo
authors.forename: Daniela
authors.initials: D
authors.lastname: Francisci
authors.forename: Enza
authors.initials: E
authors.lastname: Anzalone
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Liuzzi
authors.forename: Paola
authors.initials: P
authors.lastname: Pierro
authors.forename: Adriana
authors.initials: A
authors.lastname: Ammassari
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D007558:Italy; D012725:Sexual Behavior; D011795:Surveys and Questionnaires
keywords: HIV; adherence; antiviral therapy; condom use; women