Sexual behaviours of HIV sero-discordant couples in the context of art: a systematic review of studies from Sub-Saharan Africa

Abstract

The impact of the use of antiretroviral therapy (ART) on the sexual behaviours of serodiscordant couples (SDC) is not well documented. This systematic review attempts to examine the strength of evidence from primary studies on the impact of ART on the sexual behaviours of serodiscordant couples in SSA. In this study, 16 studies that fit the inclusion criteria were identified. Nine were cohort studies, six cross-sectional and one randomised controlled trial. Risky sexual behaviours generally declined on several indicators used to assess them. Five within individual studies reported a decrease in unprotected sex from baseline to follow-up, while of the four that said consistent condom use, they observed a significant increase in condom use from baseline to follow-up. For the between-individual studies, one study posited that ART is significantly associated with inconsistent condom use, whereas reporting multiple and concurrent partners and self-reported symptoms of sexually transmitted infections (STIs) were associated with not being on ART. Overall, there was evidence of lower-risk sexual behaviours with ART among SDC in sub-Saharan Africa. However, this relationship was not established to be causal. Further research is required to fully explore and validate the impact of ART on the sexual practices of these couples. Behavioural programmes should be strengthened and targeted towards couple-based counselling and testing with disclosure of status and continue encouraging consistent condom use among steady couples.