Key Risk Factors in Stopping Spread of HIV

In 2015, 960,000 people were newly-infected with HIV in Eastern and Southern Africa. The disease continues to spread despite increased availability of antiretroviral therapy (ART) and increased awareness of how HIV is transmitted.

Researchers from the University of Southampton in South Africa questioned the effect of changes in sexual behavior on HIV's incidence and whether ART influenced the types of relationships formed in sub-Saharan African. Their results were published in the journal AIDS.

The researchers conducted a prospective cohort study using data from KwaZulu-Natal, South Africa between 2009 and 2012 (note that during that time, clinicians prescribed ART based on CD4 counts). They enrolled 632 patients with HIV and split them into 2 groups: ART eligible or pre-ART, based on their CD4 counts. The team administered questionnaires at enrollment and every 6 months for at least 36 months. The questionnaire addressed sexual partner acquisition, partnership dissolution, condom use, sexual activity, partner disclosure, and fertility intentions.

The researchers noted that ART and pre-ART groups were similar in terms of partnership and sexual activity. However, couples who desired to have children together were at increased risk of unprotected sex and were more sexually active, regardless of ART status. This places uninfected partners at increased risk for HIV.

They also discovered that odds of unprotected sex were higher among couples with histories of relationship violence, alcohol consumption, or non-disclosure of illness between the partners.

Other studies have also identified these risk factors for HIV infection in developed nations including the United States.

The researchers urged HIV clinical staff to ask questions about each patient’s relationships and sexual activity regularly and redundantly.

Every clinic visit and interaction with an HIV patient is an opportunity to deliver education that could create healthier, disease-free lives. The nature of the relationships formed among patients with HIV is an important clue to prevention, according to the study reesearchers.

Reference

McGrath N, Grapsa E. Does antiretroviral therapy change partnership dynamics and HIV risk behaviors among HIV-infected adults? AIDS. 2017;31(10):1451-1460.