Six month partnership change and sexual activity by ART-eligibility in an ART programme in rural KwaZulu-Natal, South Africa

McGrath, N., Richter, L. and Newell, M.L. (2011) Six month partnership change and sexual activity by ART-eligibility in an ART programme in rural KwaZulu-Natal, South Africa. 18th Conference on Retroviruses and Opportunistic Infections (CROI), Boston, United States. 27 Feb - 02 Mar 2011.

Abstract

Background: Studies have raised concerns that ART initiation may result in increases in sexual risk behavior and partnership instability. In Africa, an important, increasing group are HIV-infected people in contact with ART programs but not yet eligible to start ART (monitoring group). Individuals with CD4 >500 may be earlier in their HIV disease, expected to be partnered, and more sexually active. They also provide a comparison group to investigate the impact of ART on sexual risk behavior.

Methods: A prospective cohort study of ART-eligible and monitored (CD4 >500) participants at 3 rural HIV treatment and care program clinics. Enrollment started 1 January 2009. Data are collected about partnerships and sexual activity every 6 months.

Results: By 10 October 2010, 484 individuals had been interviewed at baseline and 6 months; 72% female; median age 34 years, IQR (28 to 42); 318 (66%) ART-eligible and 166 (34%) monitored. At baseline, 238 (74%) ART-eligible and 137 (83%) monitored individuals had at least 1 partner. By 6 months, the rate of new partner acquisition among ART-eligible was 13.0/100 patient-years vs 14.7/100 patient-years among monitored individuals (p = 0.7). In these new partnerships, 49% had disclosed to their partner, 63% of partners had not tested, 29% were HIV concordant, 89% had sex in the last month (median number of acts = 4, IQR [2 to 6]); with no significant difference between groups. By 6 months, the rate of partnership dissolution was 24.3/100 patient-years in ART-eligible vs 27.4/100 patient-years in monitored group (p = 0.6). Among those with the same partner at 6 months, the proportion sexually active in the previous 6 months was 88% and 94% at baseline, 83% and 90% at 6 months, and at 6 months the median number of sexual acts in the last month was 2, IQR (1 to 4) vs 3, IQR (1 to 6.5), p = 0.03, in ART-eligible and monitored groups, respectively. At baseline, 11 (3%) ART-eligible people had concurrent partners vs 0 in the monitored group (?2p = 0.02). By 6 months, 2 ART-eligible and 3 monitored individuals had acquired a concurrent partner, and 3 ART-eligible individuals were no longer in concurrent relationships.

Conclusions: The majority of individuals accessing the ART program are in partnerships. ART initiation is not associated with different rates of partner acquisition or partnership dissolution in the first 6 months. Individuals not yet on ART and in stable partnerships appear to have sex more frequently. These findings highlight the need for ongoing safe sex messages and promotion of couples testing before and after ART initiation.

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Contributors

Author: N. McGrath

Author: M.L. Newell

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