title: Intimacy versus isolation: a qualitative study of sexual practices among sexually active HIV-infected patients in HIV care in Brazil, Thailand, and Zambia.
abstract: The success of global treatment as prevention (TasP) efforts for individuals living with HIV/AIDS (PLWHA) is dependent on successful implementation, and therefore the appropriate contribution of social and behavioral science to these efforts. Understanding the psychosocial context of condomless sex among PLWHA could shed light on effective points of intervention. HPTN 063 was an observational mixed-methods study of sexually active, in-care PLWHA in Thailand, Zambia, and Brazil as a foundation for integrating secondary HIV prevention into HIV treatment. From 2010-2012, 80 qualitative interviews were conducted with PLWHA receiving HIV care and reported recent sexual risk. Thirty men who have sex with women (MSW) and 30 women who have sex with men (WSM) participated in equal numbers across the sites. Thailand and Brazil also enrolled 20 biologically-born men who have sex with men (MSM). Part of the interview focused on the impact of HIV on sexual practices and relationships. Interviews were recorded, transcribed, translated into English and examined using qualitative descriptive analysis. The mean age was 25 (SD = 3.2). There were numerous similarities in experiences and attitudes between MSM, MSW and WSM across the three settings. Participants had a high degree of HIV transmission risk awareness and practiced some protective sexual behaviors such as reduced sexual activity, increased use of condoms, and external ejaculation. Themes related to risk behavior can be categorized according to struggles for intimacy and fears of isolation, including: fear of infecting a sex partner, guilt about sex, sexual communication difficulty, HIV-stigma, and worry about sexual partnerships. Emphasizing sexual health, intimacy and protective practices as components of nonjudgmental sex-positive secondary HIV prevention interventions is recommended. For in-care PLWHA, this approach has the potential to support TasP. The overlap of themes across groups and countries indicates that similar intervention content may be effective for a range of settings.
authors: The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America.
authors: Elizabeth F
authors: EF
authors: Closson
authors: The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America; Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts, United States of America; Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors: Matthew J
authors: MJ
authors: Mimiaga
authors: Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America.
authors: Susan G
authors: SG
authors: Sherman
authors: Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.
authors: Arunrat
authors: A
authors: Tangmunkongvorakul
authors: Instituto de Pesquisa Clinica Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.
authors: Ruth K
authors: RK
authors: Friedman
authors: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors: Mohammed
authors: M
authors: Limbada
authors: FHI360, Durham, North Carolina, United States of America.
authors: Ayana T
authors: AT
authors: Moore
authors: Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand; Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors: Kriengkrai
authors: K
authors: Srithanaviboonchai
authors: Instituto de Pesquisa Clinica Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.
authors: Carla A
authors: CA
authors: Alves
authors: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors: Sarah
authors: S
authors: Roberts
authors: The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America; Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors: Catherine E
authors: CE
authors: Oldenburg
authors: National Institute of Allergy and Infectious Disease, Bethesda, Maryland, United States of America.
authors: Vanessa
authors: V
authors: Elharrar
authors: The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America; Harvard School of Public Health, Boston, Massachusetts, United States of America; Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.
authors: Kenneth H
authors: KH
authors: Mayer
authors: The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America; Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts, United States of America.
authors: Steven A
authors: SA
authors: Safren
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D017280:Condoms; D003695:Delivery of Health Care; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission*; D006801:Humans; D008297:Male; D062486:Public Health Surveillance; D036301:Qualitative Research; D012307:Risk Factors; D012725:Sexual Behavior; D012747:Sexual Partners; D011795:Surveys and Questionnaires; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology