What Works for Women and Girls

EVIDENCE1. Providing antiretroviral treatment to people living with HIV can increase HIV preventionbehaviors, including condom use.A prospective cohort study between May 2003 and December 2004 a total of 926HIV-positive adults in rural Uganda found that within six months of initiating ART, riskysexual behavior reduced by 70%. Risky sex was defined as inconsistent or no condomuse with partners of HIV-negative or unknown serostatus in the previous 3 months.Study participants were followed in a home-based ART program that included preventioncounseling, voluntary counseling and testing (VCT) for cohabitating partners andcondom provision. At baseline and follow-up, participants’ HIV plasma viral load andpartner-specific sexual behaviors were assessed. Estimated risk of HIV transmissionfrom cohort members declined by 98%, from 45.7 to 0.9 per 1000 person years. Morethan 85% of risky sexual acts occurred within married couples (Bunnell et al., 2006a).(Gray III) (treatment, risk behavior, HIV testing, counseling, Uganda)A prospective cohort in Uganda of HIV-negative household members of HIV-positivepatients on ART receiving home-based care found that risky sex decreased amongHIV-negative adult household members. The study of 182 men and 273 women foundthat inconsistent condom use decreased from 29% at baseline to 15% at 24 months(Bechange et al., 2008). (Gray III) (treatment, condom use, Uganda)A comparative study of people living with HIV or AIDS on HAART and those receivingpreventative therapy (PT) in Kenya found participants receiving HAART were morelikely to report condom use at last sex and consistent condom use with regular partnersthan those receiving PT. The study also found fewer multiple and casual partnersamong PLWHA receiving HAART compared with those receiving PT. However, morethan 40 percent of all participants in the study did not know the HIV status of theirregular partners (Sarna et al., 2008). (Gray III) (treatment, condom use, sex behavior,Kenya)A 2007 review of evidence for the impact of ART on sexual behavior in developing countriesfound three relevant studies conducted in Africa—one in Côte d’Ivoire and two inUganda. In each study, condom use at last sexual intercourse was significantly higheramong ART patients compared to non-ART patients. In the Côte d’Ivoire study of 711patients, condom use at last sex was 80 percent for ART patients versus 59 percentfor non-patients, regardless of partnership type (Moatti et al., 2003). Bateganya et al.(2005) on reported that of 926 participants in Uganda, of whom 164 received ART.Condom use was higher among ART patients: 71 percent used condom use at last sexwith a spouse for ART patients, versus 47 percent for non-ART patients. Among studyparticipants receiving weekly home-based ART delivery and individual counseling inUganda, Bunnell et al. (2006) found that of 723 patients, with 354 ART-naïve patientsand 369 ART-experienced patients, condom use at last sex increased from 59 to 82178 CHAPTER 7 TREATMENT