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Safer sexual behaviours after 1 year of antiretroviral treatment in KwaZulu-Natal, South Africa: a prospective cohort study

Karl Peltzer A B C and Shandir Ramlagan A
+ Author Affiliations
- Author Affiliations

A Social Aspect of HIV/AIDS and Health, Human Sciences Research Council, Pretoria, South Africa.

B Department of Psychology, University of the Free State, Bloemfontein, South Africa.

C Corresponding author. Email:

Sexual Health 7(2) 135-141
Submitted: 10 October 2009  Accepted: 5 February 2010   Published: 14 May 2010


Background: As antiretroviral treatment (ART) becomes more widely available in low and middle income countries, the relationship between treatment and sexual risk behaviour in these countries has also become more important. Methods: This is a prospective study of all treatment-na?ve patients (n = 735) recruited from all three public hospitals in Uthukela health district in KwaZulu-Natal and followed up at 6 and 12 months of being on ART. Results: No evidence of increased risky sexual behaviours over time was found, from before commencing on ART, to 6 and 12 months on ART. Specifically, a significant reduction in risk taking was reported regarding sex without a condom in the past 3 months (P = 0.001) and unprotected sex with HIV-negative or unknown HIV status persons (P = 0.003). The number of sexual partners did, however, not significantly reduce over time. Some socio-demographic factors were associated with unprotected sex (being a man: odds ratio 1.7 (1.1–2.7), lower education: 0.4 (0.2–0.8)), one health factor (higher CD4 cell counts: 2.6 (1.1–6.1)) and social-behavioural factors (higher stigma: 1.2 (1.1–1.3), alcohol use at last sex: 6.9 (1.8–26.1)) and lower ART adherence: 0.5 (0.2–0.08)), while HIV knowledge (ART optimism, duration since known HIV-positive, HIV disease and treatment related knowledge), HIV symptoms and depression were not associated with unprotected sex. Conclusions: This prospective study with a large sample of persons on ART showed evidence of inhibition of risky sexual behaviours over time. Although unsafe sexual behaviours had decreased, some proportion did not practice safe sex.

Additional keywords: condom, HIV, risk, safe sex.


We thank the TIBOTEC REACH initiative for funding this study.


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