Barcelona 2013
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| Abstract #509 - E-Posters English | ||||
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Session: 50.124: E-Posters English (Poster) on Sunday in Chaired by Authors: Presenting Author: Dr. Paul Shuper - Centre for Addiction and Mental Health; University of Toronto, Canada |
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| Additional Authors: Dr. Jordi Casabona, Sra Cristina Sanclemente, Dra. Anna Esteve, Dra. Victoria Gonzalez, Grupo HIVITS TS, | ||||
| Aim: South Africa is experiencing one of the world's most severe HIV epidemics. In 2011, nearly 400,000 South Africans became infected with HIV, and an estimated 5.6 million were living with the virus. Although concerted South African public health efforts have focused on testing and treating HIV, a proportion of South Africans who test HIV-positive and successfully present in care may not be immediately eligible for antiretroviral therapy (ART) due to CD4 cell counts that exceed treatment guideline cut-offs. These individuals and their partners are unable to benefit from treatment's rapid viral suppression, and the extent to which on-going risk behaviors occur in untreated populations may carry considerable consequences for the ongoing epidemic. The present investigation therefore examined a sample of HIV-positive South Africans linked to clinical care but not yet eligible for ART to identify rates and correlates of 1) recent unprotected sexual activity; and 2) recent unprotected sexual activity involving partners who were HIV-negative (HIV-) or of unknown HIV status (HIV?). | ||||
| Method / Issue: At four clinics in KwaZulu-Natal, South Africa, HIV-positive patients who were not yet eligible for ART completed a comprehensive audio computer-assisted self-interview (ACASI) in isiZulu or English that assessed sexual risk behaviour during the past 4 weeks and potential correlates of risk. Medical chart extraction was also performed to identify CD4 cell counts and relevant clinical factors. Univariable logistic regression was employed to identify correlates of 1) recent unprotected sex, and 2) recent unprotected sex involving HIV-/HIV? partners. Factors demonstrating significant univariable associations at the p<.10 level for each outcome were included in corresponding multivariable logistic regression models. | ||||
| Results / Comments: A total of 407 predominantly Black-Zulu HIV-positive patients (290 women, 117 men) completed the ACASI. Mean age was 31 (SD=9), 65% were unemployed, and 62% lived in a rural area. All participants had CD4 cell counts >200, and the majority (77%) had CD4 cell counts >=350. 38% of study participants reported engaging in condomless sex during the past 4 weeks, and one in four study participants (25%) reported engaging in condomless sex with an HIV-/HIV? partner. Multivariable correlates of unprotected sex included problematic drinking (i.e., AUDIT>=8) (AOR=2.03, 95%CI=1.03-3.99), lower perceived power to use/negotiate condoms (AOR=0.64, 95%CI=0.44-0.93), current efforts to conceive a child (AOR=1.89, 95%CI=1.15-3.11), and age<30 (AOR=1.87, 95%CI=1.16-3.03). For unprotected sex involving HIV-/HIV? partners, multivariable correlates included lower perceived power to use/negotiate condoms (AOR=0.48, 95%CI=0.31-0.74) and poorer supportive social norms for condom use (AOR=0.63, 95%CI=0.41-0.97). | ||||
| Discussion: Recent HIV transmission risk behaviour was reported by a quarter of HIV-positive individuals who were not yet eligible for ART. Findings identified a set of primarily behavioural factors which can be addressed through behavioral intervention efforts that build knowledge, motivation, and skills for safer sex negotiations with partners. Safer sex interventions among those not yet eligible for ART, or who otherwise are not virally suppressed, will play a critical role in multicomponent approaches to eliminating onward transmission of HIV. | ||||
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