Factors Associated with Condom Use Among HIV Clients in Stable Relationships with Partners at Varying Risk for HIV in Uganda

RAND Corporation, Santa Monica, CA 90407, USA.
AIDS and Behavior (Impact Factor: 3.49). 02/2010; 14(5):1055-65. DOI: 10.1007/s10461-010-9673-4
Source: PubMed


In Africa, HIV infections occur mostly in stable relationships, yet little is known about the determinants of condom use in this context. We examined condom use among 272 coupled HIV clients in Uganda who had just screened for ART eligibility; 128 had an HIV-positive partner, 47 HIV-negative, and 97 a partner with unknown HIV status. Sixty-six percent reported unprotected sex with their partner over the past 6 months (57-70% across the three subgroups). Multiple variables among socioeconomic characteristics, physical health, social support, and psychosocial adjustment were correlated with condom use in bivariate analysis, but in multivariate analysis, condom use self-efficacy was the only predictor of condom use in the total sample and subgroups; church attendance and physical functioning were also predictors among unknown status couples. This analysis reveals high rates of unprotected sex among coupled HIV clients, regardless of partner's HIV status, and suggests multiple targets for prevention.

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    • "Although the focus of the studies that were conducted was on the impact of ART on consistent condom use, other variables associated with consistent condom use are also under researched and vary across studies. An understanding of the dynamics that contribute to high sexual risk behavior among HIV-infected persons will inform the development of effective interventions for safe sexual practices [15]. This study examined the association between socio-demographic variables and knowing partners' HIV status, multiple sex partners, and consistent condom use among HIV positive adults on ART in a clinic in Johannesburg, South Africa. "
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    ABSTRACT: Inconsistent condom use among persons on antiretroviral treatment (ART) is a major public health concern because of the risk of HIV transmission. This study examined the association between socio-demographic variables and knowing partners’ HIV status, multiple sex partners, and consistent condom use among 400 HIV-infected adults who had received ART for at least six months in Johannesburg, South Africa. The study used a cross-sectional survey and a structured interviewer administered questionnaire. Over half (n = 225, 56.3%) of participants were on ART for more than two years. Two thirds (n = 234, 63.2%) were aware of partner’s HIV status. Over a third (n = 136, 34.0%) reported having more than one sex partners. Three quarters (n = 279, 75.8%) reported consistent condom use with regular partner. Discussing HIV testing (aOR = 2.28, CI: 1.31 - 3.95), awareness of partner’s HIV status (aOR = 2.59, CI: 1.50 - 4.46), level of education (aOR = 0.64, CI: 0.42 - 0.98), and duration on ART (aOR = 0.71, CI: 1.31 - 3.95) were predictors for consistent condom use. Awareness of partner’s HIV status was associated with multiple partnership (aOR = 0.38, CI: 0.21 - 0.66), living with partner (aOR = 4.75, CI: 2.86 - 7.91), discussing HIV testing (aOR = 2.43, CI: 1.48 - 3.99), and duration on ART (aOR = 2.04, CI: 1.43 - 2.92). While gender (aOR = 5.68, CI: 3.46 - 9.34), marital status (aOR = 0.44, CI: 0.25 - 0.77), and awareness of partner’s HIV status (aOR = 0.52, CI: 0.30 - 0.89) were associated with multiple partnerships. Risky sexual behaviours occurred in all types of partners and knowing partner’s HIV status was a predictor for consistent condom use with all types of partners. It is essential that HIV prevention strategies create an enabling environment for disclosure and reductions of risky sexual behaviours by HIV-infected persons on ART.
    World Journal of AIDS 03/2014; 4(01):62-73. DOI:10.4236/wja.2014.41008
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    • "Although sex of the respondent was not associated with unsafe sex in univariate analysis, it was forced into the model as socio-demographic characteristics varied markedly between women and men (Table 1). Also, a priori, disclosure of HIV status and type of partner were included in initial models, based on previous evidence of association with unprotected sex [7,34-37]. As a participant's sexual behavior with one partner may not be independent from her or his behavior with other partners, we controlled for multiple observations on sexual partners reported by the same study participant (intra-client clustering). "
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    ABSTRACT: HIV spread continues at high rates from infected persons to their sexual partners. In 2009, an estimated 2.6 million new infections occurred globally. People living with HIV (PLHIV) receiving treatment are in contact with health workers and therefore exposed to prevention messages. By contrast, PLHIV not receiving ART often fall outside the ambit of prevention programs. There is little information on their sexual risk behaviors. This study in Mombasa Kenya therefore explored sexual behaviors of PLHIV not receiving any HIV treatment. Using modified targeted snowball sampling, 698 PLHIV were recruited through community health workers and HIV-positive peer counsellors. Of the 59.2% sexually-active PLHIV, 24.5% reported multiple sexual partners. Of all sexual partners, 10.2% were HIV negative, while 74.5% were of unknown HIV status. Overall, unprotected sex occurred in 52% of sexual partnerships; notably with 32% of HIV-negative partners and 54% of partners of unknown HIV status in the last 6 months. Multivariate analysis, controlling for intra-client clustering, showed non-disclosure of HIV status (AOR: 2.38, 95%CI: 1.47-3.84, p < 0.001); experiencing moderate levels of perceived stigma (AOR: 2.94, 95%CI: 1.50-5.75, p = 0.002); and believing condoms reduce sexual pleasure (AOR: 2.81, 95%CI: 1.60-4.91, p < 0.001) were independently associated with unsafe sex. Unsafe sex was also higher in those using contraceptive methods other than condoms (AOR: 5.47, 95%CI: 2.57-11.65, p < 0.001); or no method (AOR: 3.99, 95%CI: 2.06-7.75, p < 0.001), compared to condom users. High-risk sexual behaviors are common among PLHIV not accessing treatment services, raising the risk of HIV transmission to discordant partners. This population can be identified and reached in the community. Prevention programs need to urgently bring this population into the ambit of prevention and care services. Moreover, beginning HIV treatment earlier might assist in bringing this group into contact with providers and HIV prevention services, and in reducing risk behaviors.
    AIDS Research and Therapy 03/2012; 9:9. DOI:10.1186/1742-6405-9-9 · 1.46 Impact Factor
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    • "In our study all participants had to disclose their status to their partners, which has been shown to have a positive effect on condom use and care-seeking behaviours (King et al. 2008; Rwemisisi et al. 2008). These psychosocial components of condom negotiation and self-efficacy have been shown to be the strongest predictors of condom-use among Ugandan couples (Wagner et al. 2010). The high rates of condom use in this sample could mask group differences and explain why there was no differentiation between couples on reported condom use at last sex. "
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    ABSTRACT: Stable serodiscordant relationships and sexual concurrency are pathways that contribute to the HIV epidemic in sub-Saharan Africa. However whether polygyny imparts the same risks as informal concurrent relationships remains an open research question. Using data collected at enrollment from a cohort study of sero-discordant couples, this analysis investigates how polygynous relationships differ from those involving only a single female spouse and whether men involved in polygynous partnerships are more likely to report HIV-risk behaviour than those in single spouse partnerships. Of 444 enrolled couples, 111 (25%) were polygynous and 333 (75%) were single-spouse partnerships. We found that polygynous men were more likely to report controlling sexual decision-making and to report any unprotected sex with unknown sero-status partner. After controlling for potential confounders, polygynous men were still more likely to report unprotected sex with an unknown sero-status partner. In this sample of sero-discordant couples we found indication of excess HIV-risk behaviour among men involved in polygynous relationships.
    Culture Health & Sexuality 09/2011; 13(8):933-44. DOI:10.1080/13691058.2011.590901 · 1.55 Impact Factor
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