Skip to main content

Advertisement

SpringerLink
Log in

Sexual Risk Behaviors Among HIV-Infected South African Men and Women with Their Partners in a Primary Care Program: Implications for Couples-Based Prevention

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

We studied 1163 sexually-active HIV-infected South African men and women in an urban primary care program to understand patterns of sexual behaviors and whether these behaviors differed by partner HIV status. Overall, 40% reported a HIV-positive partner and 60% a HIV-negative or status unknown partner; and 17.5% reported >2 sex acts in the last 2 weeks, 16.4% unprotected sex in the last 6 months, and 3.7% >1 sex partner in the last 6 months. Antiretroviral therapy (ART) was consistently associated with decreased sexual risk behaviors, as well as with reporting a HIV-negative or status unknown partner. The odds of sexual risk behaviors differed by sex; and were generally higher among participants reporting a HIV-positive partner, but continued among those with a HIV-negative or status unknown partner. These data support ART as a means of HIV prevention. Engaging in sexual risk behaviors primarily with HIV-positive partners was not widely practiced in this setting, emphasizing the need for couples-based prevention.

Resumen

Nosotros estudiamos 1163 hombres y mujeres Sudafricanos, sexualmente activos e infectados con el VIH, en un programa urbano de atencia primaria para entender los patrones de comportamiento sexual y si estos compartimientos variaron dependiendo del estatus de VIH de la pareja. En general, 40% reportaron tener una pareja VIH positiva y 60% una pareja VIH negativo de estatus desconocido; y 17.5% reportaron más 2 actos sexuales en las últimas 2 semanas, y 16.4% reportaron sexo sin protección en los últimos 6 meses, y 3.7% reportaron tener más de una pareja sexual en los últimos 6 meses. La terapia antirretroviral (ART) se vio consistentemente asociada con reducción en los comportamientos sexuales de riesgo, así como con el reporte de tener una pareja VIH negativa o de estatus desconocido. Las probabilidades de reportar comportamientos sexuales de riesgo variaron acorde al género; y fueron generalmente más altas entre participantes que reportaron tener una pareja VIH positiva, pero continuar ocurriendo entre aquellos con una pareja VIH negativa o de estatus desconocido. Esta información apoya el uso do ART como un medio de prevención del VIH. La práctica de comportamientos sexuales de riesgo con parejas VIH positivas no fue común en este ambiente, recalcando la necesidad de programas de prevención del VIH para parejas.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Dukers N, Goudsmit J, de Wit JB, Prins M, Weverling GJ, Coutinho RA. Sexual risk behaviour relates to the virological and immunological improvements during highly active antiretroviral therapy in HIV-1 infection. AIDS. 2001;15(3):369–78.

    Article  PubMed  CAS  Google Scholar 

  2. Kelly J, Otto-Salaj LL, Sikkema KJ, Pinkerton SD, Bloom FR. Implications of HIV treatment advances for behavioral research on AIDS: protease inhibitors and new challenges in HIV secondary prevention. Health Psychol. 1998;17(4):310–9.

    Article  PubMed  CAS  Google Scholar 

  3. Stolte I, Dukers NH, Geskus RB, Coutinho RA, de Wit JB. Homosexual men change to risky sex when perceiving less threat of HIV/AIDS since availability of highly active antiretroviral therapy: a longitudinal study. AIDS. 2004;18(2):303–9.

    Article  PubMed  Google Scholar 

  4. Ostrow D, Fox KJ, Chmiel JS, Silvestre A, Visscher BR, Vanable PA, Jacobson LP, et al. Attitudes towards highly active antiretroviral therapy are associated with sexual risk taking among HIV-infected and uninfected homosexual men. AIDS. 2002;16(5):775–80.

    Article  PubMed  Google Scholar 

  5. Granich R, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet. 2009;373(9657):48–57.

    Article  PubMed  Google Scholar 

  6. Dodd P, Garnett GP, Hallett TB. Examining the promise of HIV elimination by ‘test and treat’ in hyperendemic settings. AIDS. 2010;24(5):729–35.

    Article  PubMed  Google Scholar 

  7. Mayer K, Venkatesh KK. Antiretroviral therapy for HIV prevention: current status and future prospects. Am J Public Health. 2010;100(10):1867–76.

    Article  PubMed  Google Scholar 

  8. United Nations. 2008 update on the global AIDS epidemic. http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/2008_Global_report.asp (2008).

  9. Rehle T, Hallett TB, Shisana O, Pillay-van Wyk V, Zuma K, Carrara H, et al. A decline in new HIV infections in South Africa: estimating HIV incidence from three national HIV surveys in 2002, 2005 and 2008. PLos ONE. 2010;5(6):e11094.

    Google Scholar 

  10. Pettifor A, Kleinschmidt I, Levin J, Rees HV, MacPhail C, Madikizela-Hlongwa L, et al. A community-based study to examine the effect of a youth HIV prevention intervention on young people aged 15–24 in South Africa: results of the baseline survey. Trop Med Int Health. 2005;10(10):971–80.

    Article  PubMed  Google Scholar 

  11. Eaton L, Flisher AJ, Aarø LE. Unsafe sexual behaviour in South African youth. Soc Sci Med. 2003;56(1):149–65.

    Article  PubMed  Google Scholar 

  12. Hargreaves J, Bonell CP, Morison LA, Kim JC, Phetla G, Porter JD, et al. Explaining continued high HIV prevalence in South Africa: socioeconomic factors, HIV incidence and sexual behaviour change among a rural cohort, 2001–2004. AIDS. 2007;21(Supplement 7):S39–48.

    Article  PubMed  Google Scholar 

  13. Lurie M, Williams BG, Zuma K, Mkaya-Mwamburi D, Garnett GP, Sweat MD, et al. Who infects whom? HIV-1 concordance and discordance among migrant and non-migrant couples in South Africa. AIDS. 2003;17(15):2245–52.

    Article  PubMed  Google Scholar 

  14. Grabbe K, Bunnell R. Reframing HIV prevention in sub-Saharan Africa using couple-centered approaches. J Am Med Assoc. 2010;304(3):346–7.

    Article  CAS  Google Scholar 

  15. Dunkle K, Stephenson R, Karita E, Chomba E, Kayitenkore K, Vwalika C, et al. New heterosexually transmitted HIV infections in married or cohabiting couples in urban Zambia and Rwanda: an analysis of survey and clinical data. Lancet. 2008;371(9631):2183–91.

    Article  PubMed  Google Scholar 

  16. Hugonnet S, Mosha F, Todd J, Mugeye K, Klokke A, Ndeki L, et al. Incidence of HIV infection in stable sexual partnerships: a retrospective cohort study of 1802 couples in Mwanza Region, Tanzania. J Acquir Immune Defic Syndr. 2002;30(1):73–80.

    PubMed  Google Scholar 

  17. Eyawo O, de Walque D, Ford N, Gakii G, Lester RT, Mills EJ. HIV status in discordant couples in sub-Saharan Africa: a systematic review and meta-analysis. Lancet Infect Dis. 2010;10(11):770–7.

    Article  PubMed  Google Scholar 

  18. Foss A, Hossain M, Vickerman PT, Watts CH. A systematic review of published evidence on intervention impact on condom use in sub-Saharan Africa and Asia. Sex Transm Infect. 2007;83(7):510–6.

    Article  PubMed  CAS  Google Scholar 

  19. Guthrie B, de Bruyn G, Farquhar C. HIV-1-discordant couples in sub-Saharan Africa: explanations and implications for high rates of discordancy. Curr HIV Res. 2007;5(4):416–29.

    Article  PubMed  CAS  Google Scholar 

  20. Sarna A, Luchters SM, Geibel S, Kaai S, Munyao P, Shikely KS, et al. Sexual risk behaviour and HAART: a comparative study of HIV-infected persons on HAART and on preventive therapy in Kenya. Int J STD AIDS. 2008;19(2):85–9.

    Article  PubMed  CAS  Google Scholar 

  21. Kennedy C, O’Reilly K, Medley A, Sweat M. The impact of HIV treatment on risk behaviour in developing countries: a systematic review. AIDS Care. 2007;19(6):707–20.

    Article  PubMed  CAS  Google Scholar 

  22. Moatti J, Prudhomme J, Traore DC, Juillet-Amari A, Akribi HA, Msellati P, Côte d’Ivoire HIV Drug Access Initiative Socio-Behavioural Evaluation Group. Access to antiretroviral treatment and sexual behaviours of HIV-infected patients aware of their serostatus in Côte d’Ivoire. AIDS. 2003;17(Supplement 3):S69–77.

    Article  PubMed  Google Scholar 

  23. Bateganya M, Colfax G, Shafer LA, Kityo C, Mugyenyi P, Serwadda D, et al. Antiretroviral therapy and sexual behavior: a comparative study between antiretroviral- naive and -experienced patients at an urban HIV/AIDS care and research center in Kampala, Uganda. AIDS Patient Care STDs. 2005;19(11):760–8.

    Article  PubMed  Google Scholar 

  24. Bunnell R, Ekwaru JP, Solberg P, Wamai N, Bikaako-Kajura W, Were W, et al. Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda. AIDS. 2006;20(1):85–92.

    Article  PubMed  Google Scholar 

  25. McClelland R, Graham SM, Richardson BA, Peshu N, Masese LN, Wanje GH, et al. Treatment with antiretroviral therapy is not associated with increased sexual risk behavior in Kenyan female sex workers. AIDS. 2010;24:891–7.

    Article  PubMed  Google Scholar 

  26. Marcellin F, Bonono CR, Blache J, Carrieri MP, Spire B, Koulla-Shiro S. EVAL Study Group Higher risk of unsafe sex and impaired quality of life among patients not receiving antiretroviral therapy in Cameroon: results from the EVAL survey (ANRS 12-116). AIDS. 2010;24(Supplement 1):S17–25.

    Article  PubMed  Google Scholar 

  27. Dia A, Marcellin F, Bonono R-C, Boyer S, Bouhnik A-D, Protopopescu C, et al. Prevalence of unsafe sex with one’s steady partner either HIV-negative or of unknown HIV status and associated determinants in Cameroon (EVAL ANRS12-16 survey). Sex Transm Infect. 2010;86:148–54.

    Article  PubMed  Google Scholar 

  28. Eaton L, Kalichman SC, O’Connell DA, Karchner WD. A strategy for selecting sexual partners believed to pose little/no risks for HIV: serosorting and its implications for HIV transmission. AIDS Care. 2009;21(10):1279–88.

    Article  PubMed  Google Scholar 

  29. Suarez T, Kelly JA, Pinkerton SD, Stevenson YL, Hayat M, Smith MD, et al. Influence of a partner’s HIV serostatus, use of highly active antireretroviral therapy, and viral load on perceptions of sexual risk behavior in a community sample of men who have sex with men. J Acquir Immune Defic Syndr. 2001;28(5):471–7.

    PubMed  CAS  Google Scholar 

  30. Human Sciences Research Council. South African national HIV prevalence, incidence, behavior, and communication survey, 2008: a turning tide among teenagers? Cape Town: HSRC Press; 2008.

  31. Lurie M, Pronyk P, de Moor E, Heyer A, de Bruyn G, Struthers H, et al. Sexual behavior and reproductive health among HIV-infected patients in urban and rural South Africa. J Acquir Immune Defic Syndr. 2008;47(4):484–93.

    Article  PubMed  Google Scholar 

  32. Venkatesh K, de Bruyn G, Lurie MN, Mohapi L, Pronyk P, Moshabela M. Decreased sexual risk behavior in the era of HAART among HIV-infected urban and rural South Africans attending primary care clinics. AIDS. 2010;24(17):2687–96.

    Article  PubMed  Google Scholar 

  33. Omar TSS, Tshabangu N, Golub J, Hanrahan C, Gray G, Struthers H, et al. Progression and regression of pre-malignant cervical lesions in HIV-infected women from Soweto: a prospective cohort 17th conference on retroviruses and opportunistic infections; 2010. San Francisco; 2010.

  34. South African Clinicians Society Guidelines. Antiretroviral therapy in adults. South Afr J HIV Med. 2008;29:18–31.

    Google Scholar 

  35. Jonesm CY, Hogan JW, Snyder B, Klein RS, Rompalo A, Schuman P, Carpenter CC, HIV Epidemiology Research Study Group. Overweight and human immunodeficiency virus (HIV) progression in women: associations HIV disease progression and changes in body mass index in women in the HIV epidemiology research study cohort. Clin Infect Dis. 2003;37(Supplement 2):S69–80.

    Article  Google Scholar 

  36. Malvy E, Thiébaut R, Marimoutou C, Dabis F, Groupe d’Epidemiologie Clinique du Sida en Aquitaine. Weight loss and body mass index as predictors of HIV disease progression to AIDS in adults. Aquitaine cohort, France, 1985–1997. J Am Coll Nutr. 2001;20(6):609–15.

    PubMed  CAS  Google Scholar 

  37. World Health Organization. Physical status: the use and interpretation of anthropometry. Report of WHO Expert Committee. 1995.

  38. Kakinami L, de Bruyn G, Pronyk P, Mohapi L, Tshabangu N, Moshabela M, et al. The impact of highly active antiretroviral therapy on activities of daily living in HIV-infected adults in South Africa. AIDS Behav. 2010. doi:10.1007/s10461-010-9776-y.

  39. Szklo M, Nieto FJ. Epidemiology beyond the basics. 2nd ed. Sudbury: Jones and Bartlett Publishers; 2006.

    Google Scholar 

  40. Rothman K, Greenland S, Lash TL. Modern epidmiology. 3rd ed. Philadelphia: Walters Kluwer; 2008.

    Google Scholar 

  41. Mizuno Y, Purcell DW, Latka MH, Metsch LR, Ding H, Gomez CA, et al. Is sexual serosorting occurring among HIV-positive injection drug users? Comparison between those with HIV-positive partners only, HIV-negative partners only, and those with any partners of unknown status. AIDS Behav. 2010;14(1):92–102.

    Article  PubMed  Google Scholar 

  42. Hernando V, del Romero J, García S, Rodríguez C, del Amo J, Castilla J. Reducing sexual risk behavior among steady heterosexual serodiscordant couples in a testing and counseling program. Sex Transm Dis. 2009;36(10):621–8.

    Article  PubMed  Google Scholar 

  43. Allen S, Meinzen-Derr J, Kautzman M, Zulu I, Trask S, Fideli U, et al. Sexual behavior of HIV discordant couples after HIV counseling and testing. AIDS. 2003;17(5):733–40.

    Article  PubMed  Google Scholar 

  44. Burton J, Darbes LA, Operario D. Couples-focused behavioral interventions for prevention of HIV: systematic review of the state of evidence. AIDS Behav. 2010;14(1):1–10.

    Article  PubMed  Google Scholar 

  45. Roth D, Stewart KE, Clay OJ, van Der Straten A, Karita E, Allen S. Sexual practices of HIV discordant and concordant couples in Rwanda: effects of a testing and counselling programme for men. Int J STD AIDS. 2001;12(3):181–8.

    Article  PubMed  CAS  Google Scholar 

  46. Bunnell R, Nassozi J, Marum E, Mubangizi J, Malamba S, Dillon B, et al. Living with discordance: knowledge, challenges, and prevention strategies of HIV-discordant couples in Uganda. AIDS Care. 2005;17(8):999–1012.

    Article  PubMed  CAS  Google Scholar 

  47. Desgrées-du-Loû A, Orne-Gliemann J. Couple-centred testing and counselling for HIV serodiscordant heterosexual couples in sub-Saharan Africa. Reprod Health Matters. 2008;32:151–61.

    Article  Google Scholar 

  48. Cohen M, Gay C, Kashuba AD, Blower S, Paxton L. Narrative review: antiretroviral therapy to prevent the sexual transmission of HIV-1. Ann Intern Med. 2007;146(8):591–601.

    PubMed  Google Scholar 

  49. Donnell D, Kiarie J, Thomas K, Baeten J, Lingappa J, Cohen C, et al. ART and risk of heterosexual HIV-1 transmission in HIV-1 serodiscordant African couples: a multinational prospective study. In: 17th Conference on retroviruses and opportunistic infections, 2010. San Francisco; 2010.

  50. Nattabi B, Li J, Thompson SC, Orach CG, Earnest J. A systematic review of factors influencing fertility desires and intentions among people living with HIV/AIDS: implications for policy and service delivery. AIDS Behav. 2009;13(5):949–68.

    Article  PubMed  Google Scholar 

  51. Jewkes R, Dunkle K, Nduna M, Shai N. Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. Lancet. 2010;376(9734):41–8.

    Article  PubMed  Google Scholar 

  52. Jewkes R, Levin JB, Penn-Kekana LA. Gender inequalities, intimate partner violence and HIV preventive practices: findings of a South African cross-sectional study. Soc Sci Med. 2003;56(1):125–34.

    Article  PubMed  Google Scholar 

  53. Zablotska I, Imrie J, Prestage G, Crawford J, Rawstorne P, Grulich A, et al. Gay men’s current practice of HIV seroconcordant unprotected anal intercourse: serosorting or seroguessing? AIDS Care. 2009;21(4):501–10.

    Article  PubMed  Google Scholar 

  54. Schroder K, Carey MP, Vanable PA. Methodological challenges in research on sexual risk behavior: II. Accuracy of self-reports. Annals of. Behav Med. 2003;26(2):104–23.

    Article  Google Scholar 

  55. Langhaug L, Sherr L, Cowan FM. How to improve the validity of sexual behaviour reporting: systematic review of questionnaire delivery modes in developing countries. Trop Med Int Health. 2010;15(3):362–81.

    Article  PubMed  Google Scholar 

  56. Langhaug L, Cheung YB, Pascoe SJ, Chirawu P, Woelk G, Hayes RJ, et al. How you ask really matters: randomised comparison of four sexual behaviour questionnaire delivery modes in Zimbabwean youth. Sex Transm Infect. 2011;87(2):165–73.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Patient care is funded by a PEPFAR grant through USAID South Africa (674-A-00-08-00009-00). NIH grants HL090312 and AI048526 supported the analysis. The opinions herein do not necessarily reflect those of USAID or the US Government. KKV received support from an NIH training grant (F30 MH079738-01A2). TM received TB research training through the Fogarty International Center (U2RTW007370/3). We would also like to thank Naira Arellano, MPH for her assistance with Spanish translation.

Conflicts of interest

The authors have no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Community Health, Alpert Medical School, Brown University, Providence, RI, USA

    Kartik K. Venkatesh, Mark N. Lurie & Elizabeth W. Triche

  2. Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Soweto, South Africa

    Guy de Bruyn, Tebogo Modisenyane, Glenda E. Gray & Neil A. Martinson

  3. South African Centre for Epidemiological Modeling and Analysis, University of Stellenbosch, Stellenbosch, South Africa

    Alex Welte

  4. Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Neil A. Martinson

Authors
  1. Kartik K. Venkatesh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Guy de Bruyn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark N. Lurie
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tebogo Modisenyane
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elizabeth W. Triche
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Glenda E. Gray
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alex Welte
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Neil A. Martinson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kartik K. Venkatesh.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Venkatesh, K.K., de Bruyn, G., Lurie, M.N. et al. Sexual Risk Behaviors Among HIV-Infected South African Men and Women with Their Partners in a Primary Care Program: Implications for Couples-Based Prevention. AIDS Behav 16, 139–150 (2012). https://doi.org/10.1007/s10461-011-9941-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-011-9941-y

Keywords

Search

Navigation