Sexual behavior among persons living with HIV in Uganda: implications for policy and practice.
BACKGROUND
HIV epidemics are sustained and propagated by new cases of infection which result from transmission from infected persons to uninfected susceptible individuals. People living with HIV (PLHIV) play a critical role in prevention if they adopt safer sexual behaviors. This study estimated the prevalence of and factors associated with safer sexual behaviors among PLHIV seeking care from civil society organizations (CSOs).


METHODS
In a cross sectional study PLHIV were interviewed about their sexual practices, use of alcohol, HIV status of their regular sexual partners, desire for more children and about their socio-demographic characteristics. We calculated the proportion of PLHIV who abstained and consistently used condoms in the previous twelve months. Independent associations between safer sex and other variables were estimated using adjusted prevalence ratios (aPR) and their 95% confidence intervals (CI).


RESULTS
Of the 939 PLHIV, 54% (508) were either abstaining or using condoms consistently and 291 (31%) desired more children. The prevalence of consistent condom use among the sexually active was 41.3% (300/731). Consistent condom use was higher among PLHIV who: didn't use alcohol (aPR 1.30, CI 1.03-1.63); were educated about re-infection with a new strain of HIV (aPR 1.84, CI 1.08-3.12) and had regular sexual partner who was HIV negative (aPR 1.29, CI 1.05-1.57). Prevalence of abstinence was 22.2% (208/939). Abstinence increased with age from 9.4% among PLHIV <25 years to 40.5% among those >50 years. Abstinence was extremely low (2.5%) among PLHIV who were married.


CONCLUSIONS
Effective interventions that reduce alcohol consumption among PLHIV are needed to avert HIV transmission, prevent acquisition of new HIV strains and STIs. In addition, strategies are needed to address needs of PLHIV who desire more children.
Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
Geofrey
G
Musinguzi
Civil Society Fund, Kampala, Uganda.
Denis
D
Bwayo
Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
Noah
N
Kiwanuka
Civil Society Fund, Kampala, Uganda.
Sheila
S
Coutinho
Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
Aggrey
A
Mukose
Civil Society Fund, Kampala, Uganda.
Joseph
J
Kabanda
Civil Society Fund, Kampala, Uganda.
Lilian
L
Sekabembe
Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
Fred
F
Nuwaha
D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006291:Health Policy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015980:Public Health Practice; D012309:Risk-Taking; D021841:Safe Sex; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult