HIV Transmission Risk Behavior Among HIV-Positive Patients Receiving Antiretroviral Therapy in KwaZulu-Natal,South Africa

The aim of this investigation was to identify factors associated with HIV transmission risk behavior among HIV-positive women and men receiving antiretroviral therapy (ART) in KwaZulu-Natal, South Africa. Across 16 clinics, 1,890 HIV+ patients on ART completed a risk-focused audio computer-assisted self-interview upon enrolling in a prevention-with-positives intervention trial. Results demonstrated that 62 % of HIV-positive patients’ recent unprotected sexual acts involved HIV-negative or HIV status unknown partners. For HIV-positive women, multivariable correlates of unprotected sex with HIV-negative or HIV status unknown partners were indicative of poor HIV prevention-related information and of sexual partnership-associated behavioral skills barriers. For HIV-positive men, multivariable correlates represented motivational barriers, characterized by negative condom attitudes and the experience of depressive symptomatology, as well as possible underlying information deficits. Findings suggest that interventions addressing gender-specific and culturally-relevant information, motivation, and behavioral skills barriers could help reduce HIV transmission risk behavior among HIV-positive South Africans.     

Resumption of Sexual Intercourse Among Postnatal Women Enrolled on Lifelong Antiretroviral Therapy in Uganda

AIDS and Behavior - The postnatal period is critical to the delivery of interventions aimed at improving maternal health outcomes. This study examined the timing to resumption of sexual intercourse...     

Risk Perception and Sexual Risk Behaviors Among HIV-Positive Men on Antiretroviral Therapy

There are reports of increased sexual risk behavior among people on highly active antiretroviral therapy (HAART) due to beliefs about risk of HIV transmission when on HAART. In a cross-sectional study (Seropositive Urban Mens Study), we examined the relationship between risk perception and sexual risk behavior among sexually active, culturally diverse HIV positive men who have sex with men (N = 456). Less than twenty-five percent engaged in unprotected anal sex (either with an HIV negative, or unknown-status partner, or an HIV positive partner) within the past 3 months. Most men believed there was significant health risk (to partner or self) associated with unprotected sex when on HAART. There was no increased risk behavior associated with being on HAART, although the perception of negative health consequences, including HIV transmission, when on HAART was significantly lower for the relatively small subset of men who reported unprotected sex. Prevention strategies need to be tailored to address risk perception associated with HAART.     

Antiretroviral Treatment and Sexual Risk Behavior in South Africa

The sexual behavior of individuals living with HIV determines the onward transmission of HIV. With the understanding that antiretroviral therapy (ART) prevents transmission of HIV, the sexual behaviors of the individuals not on ART with unsuppressed viral loads becomes of the greatest importance in elucidating transmission. We assessed the association between being on ART and sexual risk behavior among those living with HIV in a nationally representative population-based cross-sectional survey of households in South Africa that was conducted in 2012. Of 2237 adults (aged 15–49) who tested HIV-seropositive, 667 (29.8 %) had detectable antiretroviral drugs in their blood specimens. Among males, 77.7 % of those on ART reported having had sex in the past year contrasted with 88.4 % of those not on ART (p = 0.001); among females, 72.2 % of those on ART reported having had sex in the past year while 80.3 % of those not on ART did (p < 0.001). For males and females, the odds of reporting consistent condom use and condom use at last sex were statistically significantly higher for individuals on ART compared to those not on ART (males: consistent condom use aOR 2.8, 95 % CI 1.6–4.9, condom use at last sex aOR 2.6, 95 % CI 1.5–4.6; females: consistent condom use aOR 2.3, 95 % CI 1.7–3.1, condom use at last sex aOR 2.3, 95 % CI 1.7–3.1), while there were no statistically significant differences in odds of reporting multiple sexual partners in the past year. In this nationally representative population-based survey of South African adults, we found evidence of less risky sexual risk behavior among people living with HIV on ART compared to those not on ART.     

Sexual Risk Behavior Among Injection Drug Users Before Widespread Availability of Highly Active Antiretroviral Therapy

HIV testing and counseling has been associated with reductions in risk behaviors in some populations. This study examined whether involvement in a long-term study, including exposure to repeated HIV testing and counseling, was associated with increased condom use among injection drug users (IDUs) through a retrospective analysis of an IDU cohort from Baltimore, MD, during 1994–1998. Eligibility included being aged 18 years or older, injecting within 10 years and not having initiated antiretroviral therapy. A logistic model of high versus low risk, based on condom use, was used. Of 322 eligible IDUs, most were male (66%) and African-American (94%). No significant change in the odds of inconsistent condom use was observed with continued study exposure. Condom use remained low, indicating a need for interventions to reduce sexual risks and HIV transmission in this population.     

Sexual Behavior and Depression Among HIV-Positive Gay Men

As a result of medical advances seropositive men may expect to have a longer and healthier life span than in the past. It is therefore increasingly important to determine which factors are related to the mental health of seropositive gay men, as well as those associated with a satisfying, yet safe sexual lifestyle. This study examined sexual behavior, indicators of mental health, and determinants of AIDS-preventive behavior among a group of seropositive gay men and a control group of seronegative gay men in the Netherlands. Most seropositive men consistently practiced AIDS-preventive behavior. Nevertheless, if the definition of potentially unsafe sexual behavior is broadened to include oral sex to ejaculation, a sizable proportion of seropositive men had to be categorized as having had unsafe sex. Depression scores were higher among seropositive men than among the general population, but not significantly higher than among seronegative controls. Depression was not related to unprotected anal sex. The attitudes and the intention toward condom use were positive. Seropositive men used recreational (noninjection) drugs relatively often, but this was generally not associated with unprotected anal sex. Seropositive men attached more value to anal sex than seronegative controls, but again, this preference was not related to practicing unprotected anal sex. In the relatively few cases that unprotected anal sex among seropositive men did occur, it appeared to be related to lower behavioral control and to a weaker safe-sex intention. Perceived barriers to condom use and low perceived risk were also associated with unprotected anal sex among seropositive men. Although depression was not directly related to unprotected anal sex, seropositive men with higher depression levels were less motivated to use condoms and perceived more barriers to condom use.     

Social Cognitive Predictors of Sexual Risk Behavior Change Among STD Clinic Patients

We tested the impact of four social cognitive constructs (multifaceted condom use self-efficacy and hedonic, social, and self-evaluative outcome expectations) on sexual risk behavior change. Each construct was hypothesized to have an independent effect on four indicators of behavior change: consistency of reported condom use, condom use at last intercourse, frequency of unprotected intercourse acts, and stage of condom use behavior change. STD clinic patients (n = 472) were recruited, given baseline interviews, and placed in small-group health education sessions. Three-month follow-up interviews were conducted. Hypotheses were tested with logistic regressions and general linear models. Results showed that baseline self-efficacy and hedonistic expectations regarding condom use predicted sexual behavior and stage of change. In addition, follow-up levels of each of two additional outcome expectation domains, expected partner reaction and self-approval for condom use, were associated with sexual behavior at follow-up, controlling baseline levels of each dependent variable. These latter outcome expectations accounted for the greatest proportion of the variance among the SCT factors. These results support a social cognitive model of condom use behavior change and provide important clues for refining condom promotion interventions.     

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

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.     

HIV, Sexually Transmitted Infections, and Sexual Risk Behavior Among Transgenders in Indonesia

Behavioral surveillance was undertaken among 1,150 male-to-female transgenders (waria) in Java, Indonesia, 2007; samples were collected for HIV and STI testing (n?=?748). Almost all waria had ever sold sex (median duration 10?years). Prevalence of HIV was 24.4%, syphilis 26.8% and rectal gonorrhea and/or chlamydia 47.0%. Syphilis and rectal STIs were associated with HIV infection. Consistent condom use during receptive anal sex with clients was reported by 35.9% waria and was higher among those who visited an STI clinic and who knew their HIV status. Efforts should continue to strengthen behavior change and STI care in future HIV prevention programs.     

Repeat Voluntary HIV Counseling and Testing (VCT), Sexual Risk Behavior and HIV Incidence in Rakai,Uganda

We examined the effects of repeat Voluntary HIV counseling and testing (VCT) on sexual risk behaviors and HIV incidence in 6,377 initially HIV-negative subjects enrolled in a prospective STD control for HIV prevention trial in rural Rakai district, southwestern Uganda. Sixty-four percent accepted VCT, and of these, 62.2% were first time acceptors while 37.8% were repeat acceptors. Consistent condom use was 5.8% in repeat acceptors, 6.1% in first time acceptors and 5.1% in non-acceptors. A higher proportion of repeat acceptors (15.9%) reported inconsistent condom use compared to first-time acceptors (12%) and non-acceptors (11.7%). Also, a higher proportion of repeat acceptors (18.1%) reported 2+ sexual partners compared to first-time acceptors (14.1%) and non-acceptors (15%). HIV incidence rates were 1.4/100 py (person-years) in repeat acceptors, 1.6/100 py in first time acceptors and 1.6/100 py in non-acceptors. These data suggest a need for intensive risk-reduction counseling interventions targeting HIV-negative repeat VCT acceptors as a special risk group.     

Bipolar Disorder is Associated with HIV Transmission Risk Behavior Among Patients in Treatment for HIV

This study examined HIV transmission risk behavior among 63 patients with bipolar disorder (BD), major depressive disorder, and no mood disorder; half had substance use disorders (SUDs). Patients with BD were more likely than others to report unprotected intercourse with HIV-negative partners and?<95?% adherence to antiretroviral medications. In multivariate models, BD and SUD were independent predictors of both risk behaviors. Participants with poorer medication adherence were more likely to have detectable HIV viral loads and unprotected intercourse with HIV-negative partners. Patients with BD deserve careful evaluation and HIV prevention services to reduce HIV transmission risk behaviors.     

HIV Prevalence,Sexual Partners,Sexual Behavior and HIV Acquisition Risk Among Trans Men,San Francisco, 2014

We surveyed 122 trans men using a hybrid sampling method that included randomly selected physical and online venues and peer referral to measure HIV prevalence and risk behaviors. HIV prevalence was 0% (one-sided 97.5% confidence interval 0–3.3%). Of 366 partnerships described, 44.8% were with cisgender women, 23.8% with cisgender men, 20.8% with trans men, and 10.7% with trans women. Condomless receptive anal and front hole/vaginal sex averaged one to three episodes per six months. HIV prevalence in trans men is likely closer to heterosexual cisgender men and women in San Francisco than trans women or MSM. Prevention prioritizing trans women and MSM, coupled with individualized and relevant sexual health education for trans men with partners from these populations, may best address the HIV prevention needs of trans men. Systematic collection of transgender status in Census and health data is needed to understand other health disparities among trans men.     

Sexual Behavior and Risk Factors for HIV Infection Among Homosexual and Bisexual Men in Thailand

HIV prevalence and associated risk behaviors were examined among Thai bisexually active men (MSMW, n = 450) and men who have sex with men only (MSM-only, n = 1,125). Cross sectional venue-day-time sampling was used to collect data. Chi-square and logistic regression were used to identify HIV risk factors. HIV prevalence was 8.2% among MSMW and 21.2% among MSM-only. Consistent condom use with male partners was higher among MSMW (77.6%) than MSM-only (62.9%), and lower with female partners (44.4%). Lack of family confidant, migration, concern about acquiring HIV infection, and self-reported STD were associated with HIV prevalence among MSMW. Older age, lower educational level, residing in Bangkok or Chiang Mai, living away from family, recruitment from a sauna, increased frequency of visiting the surveyed venue, practicing receptive or both receptive and insertive anal intercourse, inconsistent condom use with male paying partners, and a history of drug use were associated with HIV prevalence in MSM-only.     

Factors Associated with Sexual Risk Behavior Among Persons Living with HIV: Gender and Sexual Identity Group Differences

Factors associated with HIV transmission risk may differ between subgroups of persons living with HIV/AIDS (PLWHA). This study examined such factors in a sample of PLWHA recruited in 3 US metropolitan areas. Sexually active participants were categorized as gay or bisexual men (GBM) (n = 545), heterosexual men (HSM, n = 223), or women (n = 214). Of 982 participants, 27.1% reported serodiscordant unprotected anal or vaginal sex (SDUAV). SDUAV was associated with multiple (2 or more) partners, using poppers, and lower safer sex self-efficacy among GBM. SDUAV was associated with multiple partners among HSM. Among women, factors examined were not associated with SDUAV. These findings are consistent with prior research and facilitate our ability to target those who may be most at risk for transmitting HIV among HIV-positive GBM. More research must be conducted to identify factors associated with risk behavior among HSM and women.     

Food Insecurity and Sexual Risk in an HIV Endemic Community in Uganda

Food insecurity has been linked to high-risk sexual behavior in sub-Saharan Africa, but there are limited data on these links among people living with HIV/AIDS, and on the mechanisms for how food insecurity predisposes individuals to risky sexual practices. We undertook a series of in-depth open-ended interviews with 41 individuals living with HIV/AIDS to understand the impact of food insecurity on sexual-risk behaviors. Participants were recruited from the Immune Suppression Clinic at the Mbarara University of Science and Technology in Mbarara, Uganda. Interviews were recorded, transcribed verbatim, translated, and coded following the strategy of grounded theory. Four major themes emerged from the interview data: the relationship between food insecurity and transactional sex for women; the impact of a husband’s death from HIV on worsening food insecurity among women and children; the impact of food insecurity on control over condom use, and the relationship between food insecurity and staying in violent/abusive relationships. Food insecurity led to increased sexual vulnerability among women. Women were often compelled to engage in transactional sex or remain in violent or abusive relationships due to their reliance on men in their communities to provide food for themselves and their children. There is an urgent need to prioritize food security programs for women living with HIV/AIDS and address broader gender-based inequities that are propelling women to engage in risky sexual behaviors based on hunger. Such interventions will play an important role in improving the health and well-being of people living with HIV/AIDS, and preventing HIV transmission.     

HIV Knowledge and Sexual Risk Behavior Among Pregnant Couples in South Africa: The PartnerPlus Project

In sub-Saharan Africa, 60 % of people living with HIV are women and most are of childbearing age. Alarmingly, seroconversion rates during pregnancy are high and increase as pregnancy progresses, highlighting the importance of increasing HIV-knowledge among pregnant women and their partners. This study compared sexual risk behavior, HIV knowledge and condom use pre- to post-partum among South African couples (n = 239 couples) randomly assigned to an intervention or an enhanced standard of care with the PMTCT protocol at rural community health antenatal clinics. Consistent condom use and HIV-related knowledge increased baseline to post-intervention and was maintained at long term follow up post-partum among participants in the intervention condition. HIV knowledge mediated the relationship between the intervention and consistent condom use. Results from this pilot study provide support for the integration of HIV risk reduction interventions for both women and men into existing PMTCT services during and following pregnancy.     

Depression and CD4 Cell Count Among Persons with HIV Infection in Uganda

This paper presents data from a brief, anonymous, open-ended survey of 50 behavioral research experts in HIV prevention. Responses were received from 31 participants who provided input regarding the primary reasons they believe the rate of the HIV epidemic in the United States has persisted in recent years, and how they believe we can most efficiently decrease the current rate of new HIV infections in the United States. Four clusters of reasons suggested for the persistent rate of new infections: Intervention level reasons, Society level reasons, Person level reasons, and Multiple Risk Factor reasons. Three clusters of strategies suggested for decreasing the current rate: Improved Targeting of HIV Prevention efforts, Larg-Scale Changes to HIV prevention, and Integrating HIV Prevention into more aspects of society. Results are reviewed with the objective of providing a fresh perspective on the potential means for addressing the current HIV epidemic. Electronic supplementary material Electronic supplementary material is available for this article at and accessible for authorised users.     

Transitions in Latent Classes of Sexual Risk Behavior Among Young Injection Drug Users Following HIV Prevention Intervention

We analyzed data from a large randomized HIV/HCV prevention intervention trial with young injection drug users (IDUs). Using categorical latent variable analysis, we identified distinct classes of sexual behavior for men and women. We conducted a latent transition analysis to test the effect of the intervention on transitions from higher to lower risk classes. Men who were in a high-risk class at baseline who received the intervention were 86 % more likely to be in a low-risk class at follow-up compared to those in the control group (p = 0.025). High-risk intervention participants were significantly more likely to transition to the class characterized by unprotected sex with a main partner only, while low-risk intervention participants were significantly less likely to transition to that class. No intervention effect was detected on the sexual risk behavior of women, or of men who at baseline were having unprotected sex with a main partner only.