Eunice Irungu 1, Matthew F Chersich, Clarisse Sanon, Rosemary Chege, Philippe Gaillard, Marleen Temmerman, Jennifer S Read, Stanley Luchters; Kesho Bora Study Group
Collaborators
- Kesho Bora Study Group:
Bobo Dioulasso, Burkina Faso, Nicolas Meda, Paulin Fao, Odette Ky-Zerbo, Clarisse Gouem, Paulin Somda, Hervé Hien, Patrice Elysée Ouedraogo, Dramane Kania, Armande Sanou, Ida Ayassou Kossiwavi, Bintou Sanogo, Moussa Ouedraogo, Issa Siribie, Diane Valéa, Sayouba Ouedraogo, Roseline Somé, François Rouet, Stanley Luchters, Marcel Reyners, Eunice Irungu, Christine Katingima, Mary Mwaura, Gina Ouattara, Kishor Mandaliya, Sammy Wambua, Mary Thiongo, Ruth Nduati, Judith Kose, Ephantus Njagi, Peter Mwaura, Brigitte Bazin, Claire Rekacewicz, Allan Taylor, Nicole Flowers, Michael Thigpen, Mary Glenn Fowler, Denise Jamieson, Jennifer S Read, Kirsten Bork, Cécile Cames, Amandine Cournil, Patricia Claeys, Marleen Temmerman, Stanley Luchters, Philippe Van de Perre, Pierre Becquart, Vincent Foulongne, Michel Segondy
Affiliation
- 1International Centre for Reproductive Health, Mombasa, Kenya.
PMID: 22343965
DOI: 10.1097/QAD.0b013e3283524ca1
Abstract
Objective: Describe changes in sexual behavior and determinants of unsafe sex among HIV-infected women in the 24 months after delivery.
Design: Cohort analysis nested within a prevention of mother-to-child transmission trial in Burkina Faso (n = 339) and Kenya (n = 432).
Methods: Women were followed during pregnancy and until 12-24 months after delivery. At each visit, structured questionnaires were administered about sexual activity and condom use, and risk-reduction counselling and condoms were provided.
Results: At study entry, a median 2 months after HIV testing (interquartile range =1-4), 411/770 (53.4%) of women reported partner disclosure, increasing to 284/392 (71.9%) at the final visit. Although most partners were supportive following disclosure, between 5 and 10% of disclosed women experienced hostile or unsupportive partner responses during follow-up visits. At each visit, about a third of sexually active women reported unsafe sex (unprotected sex with HIV-uninfected or unknown status partner). In multivariable logistic regression, unsafe sex was 1.70-fold more likely in Kenyan than in Burkinabe women [95% confidence interval (95% CI) = 1.14-2.54], and in those with less advanced HIV disease or aged 16-24 years. Compared with women who disclosed their status to partners and others, unsafe sex was over six-fold higher in nondisclosures (95% CI = 3.31-12.11), the effect size reducing with increasing disclosure.
Conclusion: HIV-infected women who recently delivered have a high potential for further HIV transmission, especially as HIV discordance is common in Africa. Longitudinal care for women, including positive-prevention interventions, is needed within new services providing antiretroviral prophylaxis during breastfeeding – this repeated interface with services could focus on reducing unsafe sex. Much remains unknown about how to facilitate beneficial disclosure.
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