title: HIV transmission risk behavior among HIV-positive patients receiving antiretroviral therapy in KwaZulu-Natal, South Africa.
abstract: The aim of this investigation was to identify factors associated with HIV transmission risk behavior among HIV-positive women and men receiving antiretroviral therapy (ART) in KwaZulu-Natal, South Africa. Across 16 clinics, 1,890 HIV+ patients on ART completed a risk-focused audio computer-assisted self-interview upon enrolling in a prevention-with-positives intervention trial. Results demonstrated that 62 % of HIV-positive patients' recent unprotected sexual acts involved HIV-negative or HIV status unknown partners. For HIV-positive women, multivariable correlates of unprotected sex with HIV-negative or HIV status unknown partners were indicative of poor HIV prevention-related information and of sexual partnership-associated behavioral skills barriers. For HIV-positive men, multivariable correlates represented motivational barriers, characterized by negative condom attitudes and the experience of depressive symptomatology, as well as possible underlying information deficits. Findings suggest that interventions addressing gender-specific and culturally-relevant information, motivation, and behavioral skills barriers could help reduce HIV transmission risk behavior among HIV-positive South Africans.
authors.affiliation: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, M5S 2S1, Canada, paul.shuper@camh.ca.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Shuper
authors.forename: Susan M
authors.initials: SM
authors.lastname: Kiene
authors.forename: Gethwana
authors.initials: G
authors.lastname: Mahlase
authors.forename: Susan
authors.initials: S
authors.lastname: MacDonald
authors.forename: Sarah
authors.initials: S
authors.lastname: Christie
authors.forename: Deborah H
authors.initials: DH
authors.lastname: Cornman
authors.forename: William A
authors.initials: WA
authors.lastname: Fisher
authors.forename: Ross
authors.initials: R
authors.lastname: Greener
authors.forename: Umesh G
authors.initials: UG
authors.lastname: Lalloo
authors.forename: Sandy
authors.initials: S
authors.lastname: Pillay
authors.forename: Francois
authors.initials: F
authors.lastname: van Loggerenberg
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Fisher
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D037001:Directive Counseling; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000523:psychology / Q000635:transmission; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033181:Information Dissemination; D008297:Male; D009042:Motivation; D010817:Physician-Patient Relations; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology*; D057545:Social Stigma; D012944:Social Support; D013019:South Africa / Q000453:epidemiology