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Antiretroviral therapy and sexual behavior in Uganda: a cohort study

Shafer, Leigh Annea,c; Nsubuga, Rebecca Na; White, Richardb; Mayanja, Billy Na; Chapman, Ruthb; O'Brien, Katieb; Van der Paal, Lievea,d; Grosskurth, Heinera,b; Maher, Dermota

doi: 10.1097/QAD.0b013e328341fb18
Epidemiology and Social

Objective: To assess evidence for sexual behavior change in response to antiretroviral therapy (ART) among members of a Ugandan clinical cohort. Secondarily, to examine factors associated with both sexual behavior and ART independently, that may help to assess the impact that ART is likely to have on the HIV epidemic.

Design: Retrospective analysis of data from an open cohort.

Methods: ART roll-out began in the cohort in 2004. Using 3-monthly data from 2002 to 2009, we conducted regression and descriptive analyses to examine associations between timing of ART initiation and sexual behavior among HIV-infected, and timing of ART availability and sexual behavior among HIV-uninfected. We also examined partner turnover rates, and the proportion of HIV-infected on ART – two important factors for modeling the potential impact of ART on the HIV epidemic.

Results: Risky sexual behavior among HIV-infected people rose on several indicators after ART initiation, but not to levels higher than two or more years before initiation. Some evidence suggests that the availability of ART may impact risky behavior among HIV-uninfected people, although this was inconsistent across different reported behavior variables.

Conclusion: The HIV-uninfected is larger than the HIV-infected population. If risky behavior among this population increases due to the feeling of safety that ART provides, this will affect the impact of ART on the HIV epidemic. Policy makers are urged to intensify messages associating sexual behavior and HIV and to target both HIV-infected and uninfected people.

aMedical Research Council Unit on AIDS/Uganda Virus Research Institute, Uganda

bLondon School of Hygiene and Tropical Medicine, London, UK

cUniversity of Manitoba, School of Medicine, Winnipeg, Canada

dInternational Rescue Committee, Dar es Salaam, Tanzania.

Received 7 May, 2010

Revised 21 October, 2010

Accepted 27 October, 2010

Correspondence to Leigh Anne Shafer, PhD, University of Manitoba, School of Medicine, 727 McDermot Avenue, Winnipeg, MB R3E 3P5, Canada. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.