title: Factors associated with change in sexual transmission risk behavior over 3 years among HIV-infected patients in Tanzania.
abstract: BACKGROUND
  The reduction of HIV transmission risk behaviors among those infected with HIV remains a major global health priority. Psychosocial characteristics have proven to be important correlates of sexual transmission risk behaviors in high-income countries, but little attention has focused on the influence of psychosocial and psychological factors on sexual transmission risk behaviors in African cohorts.
  
  
  RESULTS
  The CHAT Study enrolled a representative sample of 499 HIV-infected patients in established HIV care and 267 newly diagnosed HIV-infected individuals from the Kilimanjaro Region of Tanzania. Participants completed in-person interviews every 6 months for 3 years. Using logistic random effects models to account for repeated observations, we assessed sociodemographic, physical health, and psychosocial predictors of self-reported unprotected sexual intercourse. Among established patients, the proportion reporting any recent unprotected sex was stable, ranging between 6-13% over 3 years. Among newly diagnosed patients, the proportion reporting any unprotected sex dropped from 43% at baseline to 11-21% at 6-36 months. In multivariable models, higher odds of reported unprotected sex was associated with female gender, younger age, being married, better physical health, and greater post-traumatic stress symptoms. In addition, within-individual changes in post-traumatic stress over time coincided with increases in unprotected sex.
  
  
  CONCLUSIONS
  Changes in post-traumatic stress symptomatology were associated with changes in sexual transmission risk behaviors in this sample of HIV-infected adults in Tanzania, suggesting the importance of investing in appropriate mental health screening and intervention services for HIV-infected patients, both to improve mental health and to support secondary prevention efforts.
authors.affiliation: Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Pence
authors.affiliation: Center for Health Policy & Inequalities Research, Duke Global Health Institute, Sanford School of Public Policy, Duke University, Durham, North Carolina, United States of America.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Whetten
authors.affiliation: Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America ; Center for Health Policy & Inequalities Research, Duke Global Health Institute, Sanford School of Public Policy, Duke University, Durham, North Carolina, United States of America.
authors.forename: Kristen G
authors.initials: KG
authors.lastname: Shirey
authors.affiliation: Center for Health Policy & Inequalities Research, Duke Global Health Institute, Sanford School of Public Policy, Duke University, Durham, North Carolina, United States of America.
authors.forename: Jia
authors.initials: J
authors.lastname: Yao
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Thielman
authors.affiliation: Center for Health Policy & Inequalities Research, Duke Global Health Institute, Sanford School of Public Policy, Duke University, Durham, North Carolina, United States of America.
authors.forename: Rachel
authors.initials: R
authors.lastname: Whetten
authors.affiliation: Tanzania Women Research Foundation, Moshi, Tanzania.
authors.forename: Dafrosa
authors.initials: D
authors.lastname: Itemba
authors.affiliation: Kilimanjaro Christian Medical Center, Moshi, Tanzania.
authors.forename: Venance
authors.initials: V
authors.lastname: Maro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D008297:Male; D008875:Middle Aged; D012309:Risk-Taking; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D013636:Tanzania; D055815:Young Adult