Evidence from a cross-sectional study performed in an HIV-endemic region and published in Current HIV research (Bentham Science Publishers) suggests that duration of antiretroviral therapy (ART), HIV stage, and alcohol use predict risky sexual behavior.
The study builds on recent data from Joint United Nations Programme on HIV/AIDS which disclosed persistently elevated new HIV infections in southern and eastern Africa by evaluating the determinants of risky sexual behavior among ART users in the growing population of Dodoma, Tanzania. Dodoma is situated at the center of an important highway crossing between western areas of Tanzania and neighboring countries (Rwanda, Burundi, Uganda, and Zaire). In addition to its draw as a political and education center, Dodoma’s proximity to this busy road network has stimulated rapid development of business centers and parking areas. The approximate prevalence of HIV in Tanzania is 4.8% and in Dodoma specifically is 5%.
Although access to and availability of ART in this region is undeniably high, the quality of life and general wellbeing enabled by ART use may facilitate continued risky sexual practices, leading to increased HIV transmission. Transmission of drug-resistant HIV is also possible, which may lead to failure of the first-line ART regimen and increasingly complex treatment of resistant strains. This treatment approach involving multiple lines of regimens for people living with HIV (PLHIV) may be challenging to accommodate in HIV-endemic and resource-limited environments.
In response to this public health challenge, Moses New-Aaron, a researcher and Ph.D. candidate at the University of Nebraska Medical Center (UNMC), collaborated with Stephen M. Kibusi, Ph.D, Dean of Public Health and School of Nursing at University of Dodoma and other scientists to assess risky sexual behavior among PLHIV. New-Aaron was mentored by Jane L. Meza, Ph.D. and Martha H. Goedert, CNM, FNP, PhD, FACNM, throughout the project.
The study revealed that inconsistent or no condom use during intercourse was practiced by nearly half (44%) of the HIV participants. Moreover, 21% admitted to having multiple sexual partners, and 13% had casual sexual encounters. While prostitution is not legal in Tanzania, 4% admitted to participating in transactional sex. Overall, 60% of the participants were categorized as having high risk sexual behavior. Symptoms of sexually transmitted diseases (STDs) were reported by 15% of the participants.
A sexual risk score was generated by combining all the sexual risk indices to measure sexual behavior. Further analysis using the sexual risk score showed that HIV patients who recently commenced ART were approximately two times more likely to engage in risky sexual behavior. Those with a current HIV stage 4 were even riskier in terms of sexual practices. This study also found higher risk scores among alcohol drinkers.
The existence of risky sexual behavior among PLHIV and receiving care at Dodoma’s largest government-owned HIV clinic is evident and characterized by recent commencement of ART, late HIV stage, and alcohol use. These findings will ultimately help inform appropriate intervention to mitigate risky sexual behaviors among adult ART users in HIV-endemic and resource-limited environments. Intervention strategies at this and other similar HIV clinics should prioritize HIV patients with the identified characteristics.