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Changes in Sexual Risk Behavior Before and After HIV Seroconversion in Southern African Women Enrolled in a HIV Prevention Trial

Venkatesh, Kartik K PhD*; de Bruyn, Guy MBCHB, MPH; Mayer, Kenneth H MD*; Cheng, Helen MSc; Blanchard, Kelly MPH; Ramjee, Gita PhD§; Chipato, Tsungai MBCHB; Triche, Elizabeth W PhD*; Padian, Nancy S PhD; van der Straten, Ariane PhD¶#

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 15th, 2011 - Volume 57 - Issue 5 - p 435-441
doi: 10.1097/QAI.0b013e318220379b
Epidemiology and Prevention

Background: We examine changes in sexual risk behaviors before and after HIV seroconversion in southern African women enrolled in the Methods for Improving Reproductive Health in Africa trial.

Methods: HIV testing and counseling, and assessment of sexual behaviors by audio computer-assisted self-interviewing were performed approximately every 3 months. We compared the following sexual behaviors: being sexually active, coital frequency, consistent male condom use, use of any female condoms, anal sex, and >1 sex partner, at study visits before and after HIV seroconversion.

Results: During the trial, 327 women seroconverted to HIV, contributing 718 pre-HIV and 1110 post-HIV study visits. Women were significantly more likely to report consistent condom use at visits after HIV seroconversion compared with visits before HIV infection [adjusted odds ratio, (AOR): 1.36 (95% confidence interval (CI): 1.11 to 1.67)] and were less likely to have >1 male sex partner after serconversion [AOR: 0.66 (95% CI: 0.48 to 0.91)]. Women reported less frequently being sexually active [AOR: 0.63 (95% CI: 0.39 to 1.02)], fewer episodes of sex [>4 sex acts over the past week AOR: 0.74 (95% CI: 0.60 to 0.91)], and a reduction in anal sex [AOR: 0.58 (95% CI: 0.36 to 0.95)] at visits after HIV seroconversion. The observed reductions in sexual risk behaviors persisted over time.

Conclusions: Women significantly decreased their sexual risk behaviors after HIV seroconversion, but these changes were relatively modest, suggesting the need for further secondary prevention. Timely notification of HIV status coupled with prevention messages can contribute to reductions in sexual risk behaviors.

From the *Department of Community Health, Division of Infectious Diseases, Department of Medicine, Alpert Medical School, Brown University, Providence, RI; †Perinatal HIV Research Unit, University of the Witwatersrand, Soweto, South Africa; ‡Ibis Reproductive Health, Cambridge, MA; §HIV Prevention Research Unit, Medical Research Council, Durban, South Africa; ‖University of Zimbabwe, Harare, Zimbabwe; ¶Women's Global Health Imperative, RTI International, San Francisco, CA; and #Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA.

Received for publication January 23, 2011; accepted March 30, 2011.

The Methods for Improving Reproductive Health in Africa trial was funded through a grant from the Bill and Melinda Gates Foundation (#21082).

K.K.V. and A.V.D. wrote the article. K.K.V., H.C., and E.W.T. conducted statistical analyses. K.K.V., A.V.D., G.D.B. designed the study. G.R., T.C., and G.D.B. provided patient care and oversaw data collection. N.S.P., K.B., and K.H.M. provided oversight on analysis and article writing.

The authors have no conflicts of interest to disclose.

Correspondence to: Kartik Kailas Venkatesh, PhD, Department of Medicine, Alpert Medical School, Brown University, Providence, RI, Box Gc8488, 02912. (e-mail: Kartik_Venkatesh@Brown.Edu).

© 2011 Lippincott Williams & Wilkins, Inc.