Safer sexual behaviours after 1 year of antiretroviral treatment in KwaZulu-Natal, South Africa: a prospective cohort study

Abstract. Background: As antiretroviral treatment (ART) becomes more widely available in low and middle income countries, the relationship between treatment and sexual risk behaviour in these countries has also become more important. Methods: This is a prospective study of all treatment-naive patients (n = 735) recruited from all three public hospitals in Uthukela health district in KwaZulu-Natal and followed up at 6 and 12 months of being on ART. Results: No evidence of increased risky sexual behaviours over time was found, from before commencing on ART, to 6 and 12 months on ART. Specifically, a significant reduction in risk taking was reported regarding sex without a condom in the past 3 months (P = 0.001) and unprotected sex with HIV-negative or unknown HIV status persons (P = 0.003). The number of sexual partners did, however, not significantly reduce over time. Some socio-demographic factors were associated with unprotected sex (being a man: odds ratio 1.7 (1.1-2.7), lower education: 0.4 (0.2-0.8)), one health factor (higher CD4 cell counts: 2.6 (1.1-6.1)) and social-behavioural factors (higher stigma: 1.2 (1.1-1.3), alcohol use at last sex: 6.9 (1.8-26.1)) and lower ART adherence: 0.5 (0.2-0.08)), while HIV knowledge (ART optimism, duration since known HIV-positive, HIV disease and treatment related knowledge), HIV symptoms and depression were not associated with unprotected sex. Conclusions: This prospective study with a large sample of persons on ART showed evidence of inhibition of risky sexual behaviours over time. Although unsafe sexual behaviours had decreased, some proportion did not practice safe sex.