Significant rates of risky sexual behaviours among HIV-infected patients failing first-line ART: A sub-study of the Europe–Africa Research Network for the Evaluation of Second-line Therapy trial
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Date
2018
Journal Title
Journal ISSN
Volume Title
Publisher
International journal of STD & AIDS
Abstract
There are limited data on the prevalence of risky sexual behaviours in individuals failing first-line antiretroviral therapy
(ART) and changes in sexual behaviour after switch to second-line ART. We undertook a sexual behaviour sub-study of
Ugandan adults enrolled in the Europe–Africa Research Network for the Evaluation of Second-line Therapy trial. A
standardized questionnaire was used to collect sexual behaviour data and, in particular, risky sexual behaviours (defined
as additional sexual partners to main sexual partner, inconsistent use of condoms, non-disclosure to sexual partners, and
exchange of money for sex). Of the 79 participants enrolled in the sub-study, 62% were female, median age (IQR) was 37
(32–42) years, median CD4 cell count (IQR) was 79 (50–153) cells/ml, and median HIV viral load log was 4.9 copies/ml
(IQR: 4.5–5.3) at enrolment. The majority were in long-term stable relationships; 69.6% had a main sexual partner and
87.3% of these had been sexually active in the preceding six months. At enrolment, around 20% reported other sexual
partners, but this was higher among men than women (36% versus 6.7 %, p<0.001). In 50% there was inconsistent
condom use with their main sexual partner and a similar proportion with other sexual partners, both at baseline and
follow-up. Forty-three per cent of participants had not disclosed their HIV status to their main sexual partner (73% with
other sexual partners) at enrolment, which was similar in men and women. Overall, there was no significant change in
these sexual behaviours over the 96 weeks following switch to second-line ART, but rate of non-disclosure of HIV status
declined significantly (43.6% versus 19.6%, p<0.05). Among persons failing first-line ART, risky sexual behaviours were
prevalent, which has implications for potential onward transmission of drug-resistant virus. There is need to intensify
sexual risk reduction counselling and promotion of partner testing and disclosure, especially at diagnosis of treatment
failure and following switch to second- or third-line ART.
Description
Keywords
Africa, antiretroviral therapy, high-risk behaviour, HIV, sexual behaviour
Citation
Wanyama, J. N., Nabaggala, M. S., Wandera, B., Kiragga, A. N., Castelnuovo, B., Mambule, I. K., ... & Easterbrook, P. (2018). Significant rates of risky sexual behaviours among HIV-infected patients failing first-line ART: A sub-study of the Europe–Africa Research Network for the Evaluation of Second-line Therapy trial. International journal of STD & AIDS, 29(3), 287-297.10.1177/0956462417724707