HIV This Week

Eisele TP, Mathews C, Chopra M, Lurie MN, Brown L, Dewing S, Kendall C. Changes in Risk Behavior Among HIV-Positive Patients During Their First Year of Antiretroviral Therapy in Cape Town South Africa. AIDS Behav. 2008 Oct 10. [Epub ahead of print]

Eisele and colleagues explored explore changes in sexual risk behaviour over the first year of antiretroviral therapy among a cohort of patients in Cape Town South Africa initiating treatment in five public facilities in 2006 and again 1 year later (Time 1 and Time 2). Contemporaneous measures of unprotected sex were also obtained from 2 cross-sectional samples of HIV-positive patients waiting to start antiretroviral therapy attending the same facilities. Unprotected sex at last sex among patients on antiretroviral therapy decreased significantly from a baseline of 44.7-23.2% one year later, regardless of partner status. After controlling for confounding factors, the observed decrease in unprotected sex among the ART cohort was highly significant in relation to the 2 cross-sectional samples of patients at Time 1 and Time 2 waiting to initiate antiretroviral therapy. Findings suggest it is critical to start positive prevention to decrease risky sexual behaviour prior to the start of antiretroviral therapy within this setting.

Editors’ note: This is the first study to assess prospectively a causal relationship between antiretroviral treatment and sexual risk compensation, using community controls to compare findings with prevailing or secular changes in sexual behaviour. The striking decrease in unprotected sex reported by patients on antiretroviral treatment in this study is consistent with the results of previous cross-sectional studies in sub-Saharan Africa. Although experiencing significant increases in libido, nearly three-quarters (72.7%) of patients reported disclosing their HIV status which likely facilitated intimate discussions with sex partners, including condom negotiation.