Rates and Predictors of Consistent Condom-Use by People Living with HIV/aids on Antiretroviral Treatment in Uganda

Article excerpt

INTRODUCTION

HIV/AIDS continues to be a major global health problem. In 2009, 33.3 million people were living with HIV globally. There were 2.6 million new infections and 1.8 million deaths. Sub-Saharan Africa, with 22.5 million cases, including 1.8 million new infections and 1.3 million deaths, is the most affected region in the world (1). Sub-Saharan Africa also witnessed the highest increase in the number of PHAs on ART from a few thousands in 2003 to more than 3 million by the end of 2008. The increase was substantially higher in countries of Eastern and Southern Africa with high prevalence of HIV/AIDS (2).

The importance of ART in preventing HIV transmission cannot be understated. It has significantly reduced the risk of heterosexual transmissions and transmission from mothers to children (3,4), improved the quality of health of PHAs, reduced their AIDS-related mortality, and improved sexual functions (5). As a result, PHAs live longer and lead healthier, productive and sexually-active lives. These good effects of ART can augment the perception that ART cures AIDS and/or reduces the infectivity of people on ART (6). PHAs may also face difficulty in adhering to a lifetime safe sex because of their desire to bear children (7,8) and consider AIDS as a manageable chronic disease (9). These developments could inadvertently lead to treatment optimism, risk compensation or behavioural disinhibition (10,11), which has created the need for addressing HIV prevention by and among people who are infected.

Studies in developed and developing countries found that the effect of ART on sexual behaviour is mixed. Some studies in developed countries found that ART could trigger unprotected sex in the general population and people of unknown serostatus (12). However, most meta-analytic studies and systematic reviews found that ART does not increase unprotected sex or risky sexual behaviour by PHAs on ART (13-18). Although a few studies in sub-Saharan Africa discovered that some PHAs on ART engaged in unprotected sex due to the perceived non-infectivity or recovery from AIDS by ART (1921), a number of intervention studies did not find any increase in risk behaviour by PHAs on ART (10,22,23).

Uganda has reduced the HIV/AIDS prevalence to about 6% where it stagnated since 2002 (24) and has made significant progress in expanding access to ART (25). However, more recently, fears that ART could impede consistent use of condom among general population and PHAs have been reported (26). Although some studies in Uganda did not find evidence to suggest that ART could impede condomuse, these studies are few in number and took into account the condom-use at the last sex only (27,28). The objectives of this paper are to assess the rates and predictors of consistent use of condom after initiating ART by sexually-active PHAs in Uganda.

MATERIALS AND METHODS

Data and sample

The paper used data from a cross-sectional study conducted in 2005 on PHAs on ART receiving nutrition support provided by World Food Programme (WFP). Although the main objective of collecting the original data was to assess the impact of nutrition support on ART adherence, the survey collected retrospective data on sexual behaviour of PHAs before and after initiating ART. The data used in this paper focused on condom-use behaviour of PHAs after initiating ART.

Data were collected from HIV/AIDS clinics at Nsambya, Hoima, and Soroti hospitals. Nsambya Hospital in Central Uganda is one of the first health facilities to provide ART and social support (including nutrition support) for PHAs in Uganda. Soroti Hospital in Eastern Uganda and Hoima Hospital in Western Uganda collaborate with the Joint Clinical Research Centre, a pioneer AIDS treatment research institution in Uganda to provide routine HIV testing and ART for PHAs. These health facilities were selected because they provided ART and a WFP-supported nutrition programme for PHAs. …