HIV This Week

Bechange S, Bunnell R, Awor A, Moore D, King R, Mermin J, Tappero J, Khana K, Bartholow B. Two-Year Follow-Up of Sexual Behavior Among HIV-Uninfected Household Members of Adults Taking Antiretroviral Therapy in Uganda: No Evidence of Disinhibition. AIDS Behav. 2008 Oct 24. [Epub ahead of print]

This paper examines HIV risk behaviour among HIV-uninfected adults living with people taking antiretroviral therapy (ART) in Uganda. A prospective cohort of 455 HIV-uninfected non-spousal household members of ART patients receiving home-based AIDS care was enrolled. Sexual behaviour, HIV risk perceptions, AIDS-related anxiety, and the perception that AIDS is curable were assessed at baseline, 6, 12 and 24 months. Generalized linear mixture models were used to model risk behaviour over time and to identify behavioural correlates. Overall, risky sex decreased from 29% at baseline to 15% at 24-months. Among women, risky sex decreased from 31% at baseline to 10% at 6 months and 15% at 24 months. Among men, risky sex decreased from 30% at baseline to 8% at 6 months and 13% at 24 months. Perceiving HIV as curable and lower AIDS-related anxiety were independently associated with risky sex. No evidence of increased risk compensation was observed. Concerns regarding increased risk compensation should not slow down efforts to increase ART access in Africa.

Editors’ note: Directly observing the positive impact that antiretroviral treatment has on one’s sexual partner may result in risk compensation (increases in risky behaviour) related to treatment optimism. This study of uninfected adult household members of people starting on antiretroviral treatment in rural Uganda showed the opposite. Decreases in sexual risk behaviours occur when treatment and prevention programmes are integrated and delivered at household level.