AIDS and Behavior

, Volume 14, Issue 4, pp 816–823

Two-Year Follow-Up of Sexual Behavior Among HIV-Uninfected Household Members of Adults Taking Antiretroviral Therapy in Uganda: No Evidence of Disinhibition

  • Stevens Bechange
  • Rebecca Bunnell
  • Anna Awor
  • David Moore
  • Rachel King
  • Jonathan Mermin
  • Jordan Tappero
  • Kenneth Khana
  • Bradford Bartholow
Original Paper

Abstract

This paper examines HIV risk behavior 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 behavior, 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 behavior over time and to identify behavioral 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/AIDS as curable and lower AIDS-related anxiety were independently associated with risky sex. No evidence of behavioral disinhibition was observed. Concerns regarding behavioral disinhibition should not slow down efforts to increase ART access in Africa.

Keywords

Africa Sexual behavior Antiretroviral therapy Disinhibition HIV-uninfected Uganda 

References

  1. Abbas, U. L., Anderson, R. M., & Mellors, J. W. (2006). Potential impact of antiretroviral therapy on HIV-1 transmission and AIDS mortality in resource-limited settings. Journal of Acquired Immune Deficiency Syndromes, 41, 632–641. doi:10.1097/01.qai.0000194234.31078.bf.CrossRefPubMedGoogle Scholar
  2. Baggaley, R. F., Garnett, G. P., & Ferguson, N. M. (2006). Modelling the impact of antiretroviral use in resource-poor settings. PLoS Medicine, 3, e124. doi:10.1371/journal.pmed.0030124.CrossRefPubMedGoogle Scholar
  3. Bunnell, R., Ekwaru, J. P., King, R., Bechange, S., Moore, D., Khana, K., et al. (2008). 3-Year follow-up of sexual behavior and HIV transmission risk of persons taking ART in Rural Uganda. Paper presented at the 15th Conference on Retroviruses and Opportunistic Infections, Boston, MA, February.Google Scholar
  4. Bunnell, R., Ekwaru, J. P., Solberg, P., Wamai, N., Bikaako-Kajura, W., Were, W., et al. (2006). Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda. AIDS (London, England), 20, 85–92. doi:10.1097/01.aids.0000196566.40702.28.Google Scholar
  5. Cassell, M. M., Halperin, D. T., Shelton, J. D., & Stanton, D. (2006). Risk compensation: The Achilles’ heel of innovations in HIV prevention? BMJ (Clinical Research Edition), 332, 605–607. doi:10.1136/bmj.332.7541.605.CrossRefGoogle Scholar
  6. Crepaz, N., Hart, T. A., & Marks, G. (2004). Highly active antiretroviral therapy and sexual risk behavior: A meta-analytic review. Journal of the American Medical Association, 292, 224–236. doi:10.1001/jama.292.2.224.CrossRefPubMedGoogle Scholar
  7. Dukers, N. H., Goudsmit, J., de Wit, J. B., Prins, M., Weverling, G. J., & Coutinho, R. A. (2001). Sexual risk behaviour relates to the virological and immunological improvements during highly active antiretroviral therapy in HIV-1 infection. AIDS (London, England), 15, 369–378. doi:10.1097/00002030-200102160-00010.Google Scholar
  8. Elford, J., Bolding, G., & Sherr, L. (2002). High-risk sexual behaviour increases among London gay men between 1998 and 2001: What is the role of HIV optimism? AIDS (London, England), 16, 1537–1544. doi:10.1097/00002030-200207260-00011.Google Scholar
  9. Fitzmaurice, G. M., & Laird, N. M. (2000). Generalized linear mixture models for handling nonignorable dropouts in longitudinal studies. Biostatistics (Oxford, England), 1, 141–156. doi:10.1093/biostatistics/1.2.141.Google Scholar
  10. Gray, R. H., Li, X., Wawer, M. J., Gange, S. J., Serwadda, D., Sewankambo, N. K., et al. (2003). Stochastic simulation of the impact of antiretroviral therapy and HIV vaccines on HIV transmission; Rakai, Uganda. AIDS (London, England), 17, 1941–1951. doi:10.1097/00002030-200309050-00013.Google Scholar
  11. Huebner, D. M., Rebchook, G. M., & Kegeles, S. M. (2004). A longitudinal study of the association between treatment optimism and sexual risk behavior in young adult gay and bisexual men. Journal of Acquired Immune Deficiency Syndromes, 37, 1514–1519. doi:10.1097/01.qai.0000127027.55052.22.CrossRefPubMedGoogle Scholar
  12. International Collaboration on HIV Optimism. (2003). HIV treatments optimism among gay men: an international perspective. Journal of Acquired Immune Deficiency Syndromes, 32, 545–550. doi:10.1097/00126334-200304150-00013.CrossRefGoogle Scholar
  13. Kalichman, S. C., Nachimson, D., Cherry, C., & Williams, E. (1998). AIDS treatment advances and behavioral prevention setbacks: Preliminary assessment of reduced perceived threat of HIV-AIDS. Health Psychology, 17, 546–550. doi:10.1037/0278-6133.17.6.546.CrossRefPubMedGoogle Scholar
  14. Kelly, J. A., Otto-Salaj, L. L., Sikkema, K. J., Pinkerton, S. D., & Bloom, F. R. (1998). Implications of HIV treatment advances for behavioral research on AIDS: Protease inhibitors and new challenges in HIV secondary prevention. Health Psychology, 17, 310–319. doi:10.1037/0278-6133.17.4.310.CrossRefPubMedGoogle Scholar
  15. Kennedy, C., O’Reilly, K., Medley, A., & Sweat, M. (2007). The impact of HIV treatment on risk behaviour in developing countries: A systematic review. AIDS Care, 19, 707–720. doi:10.1080/09540120701203261.CrossRefPubMedGoogle Scholar
  16. Liden J., Low-Beer D., Archer J., Benn C., Schwartlander B., Rogerson A., and Schrade C. (2005). The Global Fund at three years. [Retrieved from: http://www.theglobalfund.org/en/files/about/replenishment/progress_report_en.pdf].
  17. Lin, P., Simoni, J. M., & Zemon, V. (2005). The health belief model, sexual behaviors, and HIV risk among Taiwanese immigrants. AIDS Education and Prevention, 17, 469–483. doi:10.1521/aeap.2005.17.5.469.CrossRefPubMedGoogle Scholar
  18. Little, R. J. A. (1995). Modelling the drop-out mechanism in repeated measures studies. Journal of the American Statistical Association, 88, 125–134. doi:10.2307/2290705.CrossRefGoogle Scholar
  19. Mbulaiteye, S. M., Mahe, C., Whitworth, J. A. G., Nakiyingi, J. S., Ojwiya, A., & Kamali, A. (2002). Declining HIV-1 incidence and associated prevalence over 10-years period in a rural population in South-West Uganda: A cohort study. Lancet, 360, 41–46. doi:10.1016/S0140-6736(02)09331-5.CrossRefPubMedGoogle Scholar
  20. Moatti, J. P., Prudhomme, J., Traore, D. C., Juillet-Amari, A., Akribi, H. A., & Msellati, P. (2003). Access to antiretroviral treatment and sexual behaviours of HIV-infected patients aware of their serostatus in Cote d’Ivoire. AIDS (London, England), 17(Suppl. 3), S69–S77. doi:10.1097/00002030-200317003-00010.Google Scholar
  21. Osmond, D. H., Pollack, L. M., Paul, J. P., & Catania, J. A. (2007). Changes in prevalence of HIV infection and sexual risk behavior in men who have sex with men in San Francisco: 1997 2002. American Journal of Public Health, 97, 1677–1683. doi:10.2105/AJPH.2005.062851.CrossRefPubMedGoogle Scholar
  22. Ostrow, D. E., Fox, K. J., Chmiel, J. S., Silvestre, A., Visscher, B. R., Vanable, P. A., et al. (2002). Attitudes towards highly active antiretroviral therapy are associated with sexual risk taking among HIV-infected and uninfected homosexual men. AIDS (London, England), 16, 775–780. doi:10.1097/00002030-200203290-00013.Google Scholar
  23. Schroder, K. E., Carey, M. P., & Vanable, P. A. (2003). Methodological challenges in research on sexual risk behavior: I. Item content, scaling, and data analytical options. Annals of Behavioral Medicine, 26, 76–103. doi:10.1207/S15324796ABM2602_02.CrossRefPubMedGoogle Scholar
  24. Smith, D. J. (2003). Imagining HIV/AIDS: morality and perceptions of personal risk in Nigeria. Medical Anthropology, 22, 343–372. doi:10.1080/714966301.CrossRefPubMedGoogle Scholar
  25. Stolte, I. G., Dukers, N. H., Geskus, R. B., Coutinho, R. A., & de Wit, J. B. (2004). Homosexual men change to risky sex when perceiving less threat of HIV/AIDS since availability of highly active antiretroviral therapy: A longitudinal study. AIDS (London, England), 18, 303–309. doi:10.1097/00002030-200401230-00021.Google Scholar
  26. Stoneburner, R. L., & Low-Beer, D. (2004). Population-level HIV declines and behavioral risk avoidance in Uganda. Science, 304, 714–718. doi:10.1126/science.1093166.CrossRefPubMedGoogle Scholar
  27. UNAIDS and WORLD HEALTH ORGANIZATION. (2005). Progress on global access to HIV antiretroviral therapy: An update on 3” by 5” (June).Google Scholar
  28. Van de Ven, P., Kippax, S., Knox, S., Prestage, G., & Crawford, J. (1999). HIV treatments optimism and sexual behaviour among gay men in Sydney and Melbourne. AIDS, 13, 2289–2294.CrossRefPubMedGoogle Scholar
  29. Vanable, P. A., Ostrow, D. G., McKirnan, D. J., Taywaditep, K. J., & Hope, B. A. (2000). Impact of combination therapies on HIV risk perceptions and sexual risk among HIV-positive and HIV-negative gay and bisexual men. Health Psychology, 19, 134–145.CrossRefPubMedGoogle Scholar
  30. Weidle, P. J., Wamai, N., Solberg, P., Liechty, C., Sendagala, S., Were, W., et al. (2006). Adherence to antiretroviral therapy in a home-based AIDS care programme in rural Uganda. Lancet, 368, 1587–1594.CrossRefPubMedGoogle Scholar
  31. Were, W. A., Mermin, J. H., Wamai, N., Awor, A. C., Bechange, S., Moss, S., et al. (2006). Undiagnosed HIV infection and couple HIV discordance among household members of HIV-infected people receiving antiretroviral therapy in Uganda. Journal of Acquired Immune Deficiency Syndromes, 43, 1–5.CrossRefGoogle Scholar
  32. Zeger, S. L., Liang, K. Y., & Albert, P. S. (1988). Models for longitudinal data: a generalized estimating equation approach. Biometrics, 44, 1049–1060.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Stevens Bechange
    • 1
    • 2
  • Rebecca Bunnell
    • 1
    • 3
  • Anna Awor
    • 1
  • David Moore
    • 1
    • 4
  • Rachel King
    • 1
  • Jonathan Mermin
    • 1
    • 3
  • Jordan Tappero
    • 1
  • Kenneth Khana
    • 1
  • Bradford Bartholow
    • 1
  1. 1.CDC-Uganda, Global AIDS Program, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Uganda Virus Research InstituteCenters for Disease Control and Prevention (CDC)EntebbeUganda
  2. 2.School of Development StudiesUniversity of East AngliaNorwichUK
  3. 3.CDC-KenyaNairobiKenya
  4. 4.British Columbia Centre for Excellence in HIV/AIDSUniversity of British ColumbiaVancouverCanada

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