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Abstract
A prospective cohort study of the effect of antiretroviral therapy on sexual risk behavior in a high-risk cohort of Kenyan women
L.N. Masese1, S.M. Graham2, B.A. Richardson2, N. Peshu3, G.H. Wanje1, K.N. Mandaliya4, A.E. Kurth2, W. Jaoko1, J.O. Ndinya-Achola1, R.S. McClelland1,2
Background: The effect of the rollout of antiretroviral therapy (ART) on global HIV epidemiology will depend, to a great extent, on the long-term effects of treatment on sexual risk behavior. Few studies have examined the effect of ART on sexual risk behavior in sub-Saharan Africa.
Methods: We conducted a prospective cohort analysis to test the hypothesis that ART use would be associated with increased sexual risk behavior among female sex workers in Mombasa, Kenya. Women in the cohort were invited to return for monthly follow-up including a standardized interview about sexual risk behavior. They received basic HIV care, sexual risk reduction counseling, and free condoms. Data from 1993-2008 were included in this analysis. Since 2004, ART has been offered to women in the cohort who qualify for treatment according to the Kenyan National Guidelines. We compared sexual risk behavior during ART-naïve versus ART-exposed follow-up using generalized estimating equations.
Results: Of the 899 HIV-seropositive women included in this analysis, 147 (16.4%) initiated ART. The women accrued 2,380 person-years of follow-up. The median number of visits was 10 (IQR 3-27) and the median interval between visits was 33 days (IQR 29-49). In analyses adjusted for calendar year, there was no increase in reported unprotected sex (aOR 0.74, 95%CI 0.53-1.02). Women on ART were significantly more likely to report 100% condom use (aOR 1.69, 95%CI 1.17-2.44) and less likely to report multiple partners (aOR 0.77, 95%CI 0.60-0.98). Sex frequency was similar during ART-naïve and ART-treated periods of follow-up.
Conclusions: In the setting of ongoing sexual risk reduction counseling and provision of free condoms, the introduction of ART did not increase sexual risk behaviour. On the contrary, while the overall level of sexual activity remained stable, condom use increased and there was a reduction in the number of sexual partners.
5th IAS Conference on HIV Pathogenesis and Treatment
Abstract no.
WEPDC106
Suggested Citation
"L.N.Masese, et al.
A prospective cohort study of the effect of antiretroviral therapy on sexual risk behavior in a high-risk cohort of Kenyan women .
:
5th IAS Conference on HIV Pathogenesis and Treatment:
Abstract no.
WEPDC106 "
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