| dc.description.abstract | Background: The effect of antiretroviral therapy (ART) scale-up in Africa on sexual risk
behaviors and the prevention of new HIV infections remain unknown. Studies from the
developed world suggest that prevalence of unprotected sex and incidence of sexually
transmitted infections have increased since the introduction of antiretroviral therapy.
Models demonstrating that ART can reduce HIV incidence also show that small increases
in risky sexual behaviors can mask and reverse gains achieved by therapy.
Objective: To examine the influence of HAART on high risk sexual behavior among
people living with HIV/AIDS (PLHA) n Busia.
Design and methods: A cross-sectional survey was carried out in the months of April
and May 2007 on a total of 314 clients living with HIVIAIDS and attending the
Academic Model for the Prevention and Treatment of HIVIAIDS (AMP ATH) medical
establishment in Busia district. The participants were recruited as they came in for routine
follow-up services at the facility. High risk sexual behavior was defined as inconsistent or
no condom use the previous 6 months, no knowledge of sexual partner HIV status, and nondisclosure
of own HlV status to partners, Pre-tested interviewer administered questionnaire
completed by 322 respondents was used to collect quantitative data. SPSSIPC
Programme was used to enter data. The results were summarized into frequency tables
and figures. For qualitative data descriptive statistics were determined and data from the
qualitative survey were transcribed, coded summarized and analyzed manually according
to the study objectives.
Results: The study showed a lower risk sexual behavior among PLHA receiving HAART
compared to PLHA on Non-HAART therapy. Less than half (45%) of the respondents
had been sexually active over the past six months. Patients on HAART were four times
less likeJy to report sex with a casual partner and multiple partners compared to those on
Non HAART. 64% of the respondents failed to disclose their serostatus to sexual partners
and did not know their partners' serostatus i
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Among factors influencing high risk sexual behaviors, stigma, cultural factors, trust and
beliefs on unsafe sex were found to have a direct impact on the behavior of both clients
on HAART and non-HAART clients. The results also indicated that the HAART group
was more knowledgeable on the potential risk of high risk sexual behavior as compared
to the non-HAART group as well as exhibiting more informed beliefs and attitudes on
HIV transmission while on therapy
In summary, this study established that high risk sexual behavior does not actually
increase with initiation of HAART in this context. Although self-reported risk behavior
was lower among PLHA receiving HAART, a considerable risk of HIV transmission still
exists in both groups. Lack of knowledge of partner's serostatus and low levels of
disclosure of one's own HIV status, coupled with inconsistent condom use, sets the stage
for HIV transmission to serodiscordant partners, especially within regular partner
relationships. Transmission of resistant viral strains and reinfection with new strains are
serious public health risks.
This study further reveals that even though the clients on HAART display more informed
knowledge, beliefs and attitudes towards high risk sexual behavior, they are greatly
influenced by the norms and the culture -of the society where they reside. Given these
circumstances, early and continuous information, education and motivation will
constitute the best weapons in the sensitization of all PLWHA on therapy. There is need
to augment the type of knowledge PLWHA have on the implications and potential risks
of high risk sexual behavior. More aggressive educational approach is needed to re-teach
PLWHA foreseen ~misperceptions about HIV/AIDS during treatment. | en |
