Unprotected Sex Among Youth Living with HIV Before and After the Advent Of Highly Active Antiretroviral Therapy

Center for Community Health, University of California, Los Angeles, CA, USA.
Perspectives on Sexual and Reproductive Health (Impact Factor: 2). 10/2006; 38(3):162-7. DOI: 10.1363/psrh.38.162.06
Source: PubMed


Since the advent of highly active antiretroviral therapy (HAART) in 1996, the incidence of HIV-especially among young men who have sex with men-and the prevalence of unprotected sex among HIV-positive persons have increased. The characteristics associated with unprotected sex among youth living with HIV since the advent of HAART have not been explored.
Samples of HIV-positive youth aged 13-24 were taken from two intervention studies that targeted the sexual behaviors of HIV-positive youth-one from 1994 to 1996 (pre-HAART) and the other from 1999 to 2000 (post-HAART). Generalized estimating equations were used to identify characteristics associated with unprotected sex in each sample.
The prevalence of unprotected sex in the post-HAART sample was more than twice that in the pre-HAART sample (62% vs. 25%). Among the pre-HAART sample, being a man who has sex with men and having sex with a casual partner were negatively associated with the odds of unprotected intercourse (odds ratios, 0.5 and 0.2, respectively). Among the post-HAART sample, unprotected sex was negatively associated with knowing that a partner was HIV-negative (0.2) and positively associated with poorer mental health (1.02). In analyses among the post-HAART sample, poorer mental health was associated with increased odds of unprotected sex among youth living with HIV who were not receiving the treatment (1.02).
Interventions for HIV-positive youth must be designed to address the complex needs of those youth who simultaneously suffer from HIV and poor mental health.

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    • "Although studies have been conducted on the sexual behaviour of people on ART, most have focused on sexual partnerships, sexual acts and the consequences of risky sexual behaviour [6,7,9,11]. There is a dearth of studies employing a longitudinal qualitative design to understand the evolving experiences and sexual desires of people on ART as they progress on medication. "
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    ABSTRACT: As immune compromised HIV sero-positive people regain health after initiating antiretroviral treatment (ART), they may seek a return to an active 'normal' life, including sexual activity. The aim of the paper is to explore the changing sexual desires and behaviour of people on ART in Uganda over a 30 month period. This study employed longitudinal qualitative interviews with forty people starting ART. The participants received their ART, adherence education and counselling support from The AIDS Support Organisation (TASO). The participants were selected sequentially as they started ART, stratified by sex, ART delivery mode (clinic or home-based) and HIV progression stage (early or advanced) and interviewed at enrolment, 3, 6, 18 and 30 months of their ART use. Sexual desire changed over time with many reporting diminished desire at 3 and 6 months on ART compared to 18 and 30 months of use. The reasons for remaining abstinent included fear of superinfection or infecting others, fear that engaging in sex would awaken the virus and weaken them and a desire to adhere to the counsellors' health advice to remain abstinent. The motivations for resumption of sexual activity were: for companionship, to obtain material support, social norms around marriage, desire to bear children as well as to satisfy sexual desires. The challenges for most of the participants were using condoms consistently and finding a suitable sexual partner (preferably someone with a similar HIV serostatus) who could agree to have a sexual relationship with them and provide for their material needs. These findings point to the importance of tailoring counselling messages to the changing realities of the ART users' cultural expectations around child bearing, marriage and sexual desire. People taking ART require support so they feel comfortable to disclose their HIV status to sexual partners.
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    • "Thus, it is important for HIV prevention to address fundamental mental health and psychosocial issues (Wolitski et al.). Researchers who also advocate for a holistic approach to HIV prevention include Blank, Gallagher, Washburn, and Rogers (2005), Rice et al. (2006), Rosario, Schrimshaw, and Hunter (2006), and Stall et al. (2003). A holistic approach encompasses addressing mental health problems and their association with psychosocial stressors such as discrimination and prejudice, physical assault and victimization, and substance abuse. "
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