Abstract
BackgroundThe World Health Organisation (WHO) advocates early initiation of HIV treatment as a prevention strategy among people living with HIV. There is strong evidence for the effectiveness of antiretroviral therapy (ART) as a preventive tool for HIV transmission. We aimed to determine the sexual behaviour of HIV outpatients and assess if it reflects the current preventive strategy for HIV transmission.MethodsWe conducted a cross-sectional study among adult (aged at least 18 years) patients with confirmed HIV diagnosis, and aware of their diagnosis, attending HIV outpatient care in Kenya. Data were gathered through self-report (using validated questionnaires) and file extraction. Multivariate logistic regression assessed the association between sexual risk taking behaviour controlling for gender, HIV clinical stage, HIV treatment status, Tuberculosis (TB) treatment status, and CD4 count.ResultsWe recruited n = 400 participants (n = 280[70%] female gender). The mean age was 39.4 (SD = 9.9) years. The mean CD4 count was 393.7 (SD = 238.2) and ranged from 2 to 1470 cells/mm3. N = 61 (15.64%) were on TB treatment. The majority (n = 366, 91.5%) were on ART. Just over half (n = 202, 50.5%) reported having a sexual partner. Of these n = 33 (16.1%) reported having unprotected sexual intercourse with a person of unknown HIV status in the previous 3 months.Multivariate analysis showed that participants not on ART (HIV treatment) were more likely to report unprotected sexual intercourse compared to those who were on ART (odds ratio .25, 95% CI .09 to .69; P = 0.007).Participants at early stage of HIV infection (stages 1/2) were more likely to report unprotected sexual intercourse compared to participants at advanced HIV infection (stages 3/4) (odds ratio .34, 95% CI .13 to .92; P = 0.035). Males participants were more likely to be involved in sexual risk taking behaviours compared to female participants (odds ratio .36, 95% CI .16 to .82; P = 0.015). TB treatment status, and CD4 count were not significantly associated with sexual risk taking.ConclusionParticipants not on ART have more unprotected sexual intercourse than those who are on ART. This calls for the need to scale up coverage and early ART initiation in order to reduce transmission of HIV.
Highlights
The World Health Organisation (WHO) advocates early initiation of Human immune deficiency virus (HIV) treatment as a prevention strategy among people living with HIV
Participants who were not on antiretroviral therapy (ART) (HIV treatment) were likely to report sexual risk-taking behaviour compared to participants who were on ART
Participants who were not on ART were more likely to report unprotected sexual intercourse with someone of unknown HIV status in the previous 3 months compared to participants who were on ART
Summary
The World Health Organisation (WHO) advocates early initiation of HIV treatment as a prevention strategy among people living with HIV. At the end of 2017, there were 1.5 million people living with HIV in Kenya with 4.8% adult prevalence [1, 2]. There have been inconsistent reports about sexual behaviour of people living with HIV (PLWH). Initiation of ART has been reported to reduce HIV transmission among discordant couples. A trial among predominantly heterosexual discordant couples reported 96% reduction of risk of HIV transmission [15]. Systematic reviews of randomised controlled trials (RCT) and observational studies report that ART reduces HIV transmission among discordant couples due to undetectable viral loads [17, 18]
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