|Year : 2020 | Volume
| Issue : 2 | Page : 84-89
Sexual behavior of persons living with HIV/AIDS on antiretroviral therapy
Helen C Okoye1, Chilota C Efobi2, Hannah Omunnakwe3, Nkemsinachi M Onodingene4
1 Department of Haematology and Immunology, College of Medicine, University of Nigeria Ituku/Ozalla Campus, Enugu, Enugu State, Enugu
2 Department of Hematology and Blood Transfusion, College of Health Sciences, Nnamdi Azikiwe University Nnewi Campus, Nnewi, Anambra State, Nigeria
3 Department of Haematology, Rivers State University, Port Harcourt, Rivers State, Nigeria
4 Department of Hematology and Immunology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
|Date of Submission||09-Feb-2020|
|Date of Decision||11-Mar-2020|
|Date of Acceptance||30-Apr-2020|
|Date of Web Publication||29-Jul-2020|
Chilota C Efobi
Department of Hematology and Blood Transfusion, College of Health Sciences, Nnamdi Azikiwe University Nnewi Campus, Nnewi, Anambra State.
Source of Support: None, Conflict of Interest: None
Background: High-risk sexual practices are an important driver for the spread of HIV; little is known about the sexual practices of persons living with HIV/AIDS (PLWH) in Nigeria. Aim: The aim of this study was to evaluate the sexual behaviors of PLWH and determinants of the practice of multiple sexual partners. Materials and Methods: This was a cross-sectional descriptive study. Information on sexual practices before and after diagnosis of HIV/AIDS was sought from PLWH on antiretroviral therapy. Data were analyzed using the Statistical Package for the Statistical Package for the Social Sciences (SPSS) software, version 22 (IBM Chicago Illinois, USA). Results: A total of 250 PLWH participated in the study with the interquartile age range of 31–42 years. 72% were females and 43.6% had multiple sexual partners before diagnosis, whereas only 6.0% had multiple sexual partners after diagnosis (P < 0.001). Gender was associated with multiple sexual partners before diagnosis (P = 0.001) but age group, marital status, level of education, knowledge of sex, and condom use were not (P > 0.05). Conclusion: This study identifies gender as a determinant of high-risk sexual practices; males were more likely to have multiple sexual partners than their female counterparts before diagnosis. However, diagnosis or knowledge of HIV status is associated with a decline in risky sexual behaviors.
Keywords: Antiretroviral therapy (ART), persons living with HIV/AIDS (PLWHA), sexual behavior
|How to cite this article:|
Okoye HC, Efobi CC, Omunnakwe H, Onodingene NM. Sexual behavior of persons living with HIV/AIDS on antiretroviral therapy. Int J Med Health Dev 2020;25:84-9
|How to cite this URL:|
Okoye HC, Efobi CC, Omunnakwe H, Onodingene NM. Sexual behavior of persons living with HIV/AIDS on antiretroviral therapy. Int J Med Health Dev [serial online] 2020 [cited 2020 Oct 20];25:84-9. Available from: https://www.ijmhdev.com/text.asp?2020/25/2/84/291053
| Introduction|| |
Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a pandemic condition whose spread over time and attendant medical, social, and religious consequences have led to the great burden worldwide with a significant decline in the gross domestic product, especially in Africa.,,
The control of HIV/AIDS is of national and global concern as HIV/AIDS contributes significantly to mortality. According to the joint United Nations program on HIV/AIDS (UNAIDS) report in 2016 from Nigeria, Nigeria recorded the second greatest burden of HIV/AIDS globally with 3.2 million persons living with HIV/AIDS (PLWH). There were about 6.88% new infections in 2016 and it is estimated that up to 75% of PLWH were infected through sexual intercourse. This and more importantly because of the transmission of resistant strains, high-risk sexual behavior has become a public health issue among PLWH on highly active antiretroviral therapy (HAART)., Infection by HIV is thought to affect one’s sexual function likewise the use of ART among PLWH. Researchers have documented a reduction in risky sexual behaviors among PLWH on ART when compared with their ART naïve counterparts.,
Several researchers have studied the sexual behaviors of PLWH as an important driver to HIV spread with focus on condom use and sexual activities. This study focuses on evaluating the sexual behaviors of PLWH and determinants of the practice of multiple sexual partners.
| Materials and Methods|| |
The study was carried out at the University of Port Harcourt Teaching Hospital (UPTH), a tertiary care and research center founded approximately 38 years ago with an annual patient load of over 200,000. About 200,000 patients are seen annually in both outpatient and inpatient settings. The hospital is situated in Port Harcourt, the most densely populated city in the Niger Delta and specifically in Alakahia on the East-West road which connects to other cities in the Niger Delta. It served patients from Rivers state and the neighboring states. Through the Institute of Human Virology, Nigeria, UPTH offers care and treatment to PLWH. Rivers state has one of the highest prevalence rates of HIV (15.2%) in Nigeria.
The study design was cross-sectional descriptive using a pretested structured questionnaire administered to a sample of PLWH receiving care at the facility. All HIV-positive clients seen at UPTH were eligible to participate. A systematic random sampling method was used to select the 250 consenting PLWH on ART after adequate counseling by members of the research team.
The questionnaire was of two parts: the first was on the sociodemographic data, whereas the second part sought information on the primary outcome measure which was on sexual practices. Information retrieved was transferred to and analyzed using the Statistical Package for the Social Sciences (SPSS) software program, version 22.0 (SPSS, Chicago, Illinois). Statistics was both descriptive and inferential. Differences concerning sociodemographic were tested, depending on the distribution of the data. Statistics tools used include chi-square and Spearman rank correlation tests. The correlation coefficient (r) was used to measure the association between variables and number of sexual partners before and after diagnosis with r = 1 indicating a perfect positive correlation and r = –1 indicating a perfectly negative correlation and r = 0 no correlation at all. A value of P < 0.05 was considered statistically significant.
| Results|| |
A total of 250 patients on ART consented to participate in the study, 28.0% were males and 72.0% females, with a median age of 35 years and mean duration on ART of 2 (1–5) months. As can be seen from [Table 1], majority of them were less than 40 years (69.6%) and married (66.4%). Most (78.8%) of the respondents were diagnosed between 2006 and 2013, whereas only 20.0% were diagnosed earlier. Fifty-six percent were diagnosed following illness, 20.4% during voluntary counseling and testing, 14.0% during routine antenatal visits, and 4.0% were tested because their partners were positive. Approximately 2.4% of the participants did not respond, whereas the others 6.0% were tested as part of the presurgical, premarital, preemployment, and postpartum screening. The majority (56.8%) of respondents do not know how they acquired the infection, 31.6% got it via casual sex, 6.0% from their partners, 2.8% via blood transfusion, and 1.2% from needle stick injury.
[Table 2] shows that 43.6% had two or more sexual partners before diagnosis. However, following diagnosis, the proportion of respondents with multiple sexual partners declined to 6.0%. The difference in proportion was statistically significant (P < 0.001).
[Table 3] shows that males are more likely to have multiple sexual partners when compared to females before diagnosis, whereas there was no significant difference in the number of sexual partner for gender after diagnosis as depicted in [Table 4]. The number of sexual partners did not show any significant difference with age, marital status, educational status, knowledge about safe sex, and condom use both before and after diagnosis.
|Table 3: Association between demographic parameters, condom use, disclosure status, knowledge of partner’s status, and knowledge of safe sex with the number of sexual partners before diagnosis|
Click here to view
|Table 4: Association between demographic parameters, condom use, disclosure status, knowledge of partner’s status, and knowledge of safe sex with the number of sexual partners after diagnosis|
Click here to view
[Table 5] shows a correlation of sexual behavior before diagnosis with demographic and other variables. There was a weak positive correlation between age group and number of sexual partners (r = 0.145; P = 0.024) and a positive correlation between male gender and number of sexual partners (r = 0.307; P = 0.001); a weak but significant correlation was found between the number of sexual partners before and after diagnosis of HIV (r = 0.260; P = 0.001) and a weak positive correlation was also found between those infected by casual sex and number of sexual partners before diagnosis (r = 0.175; P = 0.006).
|Table 5: Correlation between demographics and other variables with the number of sexual partner of respondents before diagnosis|
Click here to view
| Discussion|| |
As the prevalence of HIV/AIDS remains high in Nigeria, it is pertinent to identify possible drivers of the spread and measures put in place to reduce or halt the spread. Poor health care, indulgence in risky sexual behaviors, and coexistence of epidemics of other sexually transmitted infections are identified drivers to HIV transmission in Africa. The three core components of risky sexual behaviors include multiple sexual partners, sexual intercourse without condom use, and sexual activities involving the passage of body fluids. These make sexual partners key determinant of an individual’s sexual risk. Multiple sexual partners describe having two or more sexual partners within a given time period; it may be serial monogamy or concurrent sexual partnerships.
In this survey, most of our respondents were females. Our subjects were randomly selected irrespective of the gender. As a result, more females were recruited as they were more females presenting to the hospital. However, this may also be because females lack the potential to negotiate for safe sex due to economic and sociocultural disparities as well as differences in responses to risk factor, making them disproportionally more affected by HIV/AIDS than men. Majority of the study participants are between the ages of 31 and 42 years which correlates with the period of highest sexual activity, likewise, over two-thirds are married. Different researchers have recognized marriage as a risk factor for HIV infection., Although this holds true for both sexes, men involved in polygamous marriage are even more at risk. The Centre for Disease Control (CDC) in 2006 recommended that HIV testing should be available as routine screening. This has not been optimally practiced in our community as most individuals do not present voluntarily for testing due to fear and stigmatization and are only tested during illness. Evidently, the majority of our respondents were tested following ill health. This pattern has equally been observed in other parts of Africa.,
Diagnosis of HIV is associated with changes in sexual habits and HIV spread. Previous studies have reported that persons who tested positive for HIV had fewer sexual partners and are more likely to use a condom during sexual activities. It goes without saying that such actions lead to a decline in the spread of the virus., We documented that almost half of the study participants had multiple sexual partners before diagnosis and following diagnosis, there was a decline of over 80%. This confirms a previous report that knowing one’s HIV status leads to a behavioral change in HIV-positive individuals in a bid to reduce the HIV infection risk of others. Counseling is an integral part of HIV testing/diagnosis. It involves both pretest counseling and posttest counseling. Pretest counseling is centered around natural history, spread, and prevention on HIV, whereas posttest counseling is more concerned with management and prevention of onward spread for those who tested positive and preventive measures including safe sexual practices in those who tested negative. Our study suggests that those who were diagnosed with HIV/AIDS were properly counseled leading to a reduction in the number of sexual partners after diagnosis.
We studied different factors including age group, gender, marital status, level of education, knowledge of sex, and condom use to determine their association with the number of sexual partners before diagnosis. Of all these factors, only gender was observed to be associated with the number of sexual partners prior to diagnosis. Our study had more female participants which could have affected the result. We however observed that males were more likely to have multiple sexual partners than their female counterparts. In addition to sociocultural concepts where men are perceived as initiators of sexual activities and capable of disposing a higher level of sexual intimacy within or outside a relationship, numerous studies have shown that men are more likely to be involved in extradyadic relationships., This may have supported the findings that males are more likely to indulge in risky sexual practices in this study. We recorded a different finding for gender and number of sexual partners after diagnosis as men were found not to be more likely to have multiple sexual partners. This interesting finding may have resulted from the likelihood of safer sexual practices following good pre and posttesting counseling. HIV is transmitted in body fluids through sexual activities, needle stick injury or intravenous drug abuse, transplacental from mother to child, and blood transfusion., Sexual activities contribute the greatest to HIV transmission, accounting for up to 70% of HIV infections worldwide. This explains why the majority of our respondents (excluding those who could not recall) said they acquired the infection via casual sex.
In conclusion, this study identifies gender as a determinant of high-risk sexual practices; males are more likely to have multiple sexual partners than their female counterparts. However, diagnosis or knowledge of HIV status is associated with a decline in risky sexual behaviors.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Douaihy A, Singh N Factors affecting quality of life in patients with HIV infection. AIDS Read 2001;11:450-4, 460-1, 475.
Trevino KM, Pargament KI, Cotton S, Leonard AC, Hahn J, Caprini-Faigin CA, et al
. Religious coping and physiological, psychological, social, and spiritual outcomes in patients with HIV/AIDS: Cross-sectional and longitudinal findings. AIDS Behav 2010;14:379-89.
Institute of Medicine. Preparing for the Future of HIV/AIDS in Africa: A Shared Responsibility. Washington, DC: The National Academies Press; 2011. Available at: https://doi.org/10.17226/12991. [Accessed on 2018 Apr 27].
UNAIDS report on HIV/AIDS in Nigeria. Available from: http://www.unaids.org/en/regionscountries/countries/nigeria. [Accessed on 2018 Apr 23].
Martha A, Mead OA Confronting AIDS: Public priorities in a global epidemic (English). A World Bank policy research report. Washington, DC: The World Bank; 1997. Available from: http://documents.worldbank.org/curated/en/211211468779168446/Confronting-AIDS-public-priorities-in-a-global-epidemic. [Last accessed date 2018 Apr 27].
UNAIDS report on the global AIDS epidemic. 2013. Available from: http://www.unaids.org/sites/default/files/media_asset/20121120_UNAIDS_Global_Report_2012_with_annexes_en_1.pdf. [Accessed on 2018 Apr 23].
Peretti-Watel P, Spire B, Schiltz MA, Bouhnik AD, Heard I, Lert F, et al
; VESPA Group. Vulnerability, unsafe sex and non-adherence to HAART: Evidence from a large sample of French HIV/AIDS outpatients. Soc Sci Med 2006;62:2420-33.
Schiltz MA, Sandfort TG HIV-positive people, risk and sexual behaviour. Soc Sci Med 2000;50:1571-88.
Luchters S, Sarna A, Geibel S, Chersich MF, Munyao P, Kaai S, et al
. Safer sexual behaviors after 12 months of antiretroviral treatment in Mombasa, Kenya: A prospective cohort. AIDS Patient Care STDS 2008;22:587-94.
Sarna A, Luchters S, Pickett M, Chersich M, Okal J, Geibel S, et al
. Sexual behavior of HIV-positive adults not accessing HIV treatment in Mombasa, Kenya: Defining their prevention needs. AIDS Res Ther 2012;9:9.
Shukla M, Agarwal M, Singh JV, Tripathi AK, Srivastava AK, Singh VK High-risk sexual behavior among people living with HIV/AIDS attending tertiary care hospitals in the district of Northern India. Indian J Sex Transm Dis 2016;3:46-51.
Federal Ministry of Health [Nigeria] (2013). National HIV & AIDS and Reproductive Health Survey, 2012 (NARHS Plus). Federal Ministry of Health Abuja, Nigeria.
Kalichman SC, Ntseane D, Nthomang K, Segwabe M, Phorano O, Simbayi LC Recent multiple sexual partners and HIV transmission risks among people living with HIV/AIDS in Botswana. Sex Transm Infect 2007;83:371-5.
Tsala DZ, Kuate DB Fostering accurate HIV/AIDS knowledge among unmarried youths in Cameroon: do family environment and peers matter? BMC Public Health 2011;11:348.
Mojola SA Fishing in dangerous waters: Ecology, gender and economy in HIV risk. Soc Sci Med 2011;72:149-56.
Gillespie S Poverty, food insecurity, HIV vulnerability, and the impacts of AIDS in Sub-Saharan Africa. IDS Bulletin 2008;39:10-18.
Beegle K, Ozler B Young women, rich(er) men, and the spread of HIV. Washington, DC: World Bank; 2007.
Bruce J, Shelley C The implications of early marriage for HIV/AIDS policy, brief based on background paper prepared for the WHO/UNFPA/Population Council Technical Consultation on Married Adolescents. New York:Population Council.2004.
Shisana O, Zungu-Dirwayi N, Toefy Y, Simbayi LC, Malik S, Zuma K Marital status and risk of HIV infection in South Africa. S Afr Med J 2004;94:537-43.
Sambisa W, Curtis S, Mishra V AIDS stigma as an obstacle to uptake of HIV testing: Evidence from a Zimbabwean national population-based survey. AIDS Care 2010;22: 170-86.
Bogart LM, Wagner G, Galvan FH, Banks D Endorsement of genocidal HIV conspiracy as a barrier to HIV testing in South Africa. JAIDS 2008;49:115-6.
Thomton RL The demand for, and impact of, learning HIV status. Am Econ Rev 2008;98:1829-63.
Sherr L, Lopman B, Kakowa M, Dube S, Chawira G, Nyamukapa C, et al
. Voluntary counselling and testing: Uptake, impact on sexual behaviour, and HIV incidence in a rural Zimbabwean cohort. AIDS 2007;21: 851-60.
Delavande A, Kohler HP The impact of HIV testing on subjective expectations and risky behavior in Malawi. Demography 2012;49:1011-36.
Department of Health Republic of South Africa. National HIV counselling and testing policy guidelines. 2015. Available from: https://aidsfree.usaid.gov/sites/default/files/hts_south_africa_2015.pdf. [Last accessed on 2018 May 4].
Wiederman MW Extramarital sex: Prevalence and correlates in a national survey. J Sex Res 1997;34:167-74.
Thorburn S, Harvey SM, Ryan EA HIV prevention heuristics and condom use among African-Americans at risk for HIV. AIDS Care 2005;17:335-44.
Global Report. UNAIDS report on the global AIDS epidemic. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS (UNAIDS); 2010. Available from: http://www.unaids.org/globalreport/documents/20101123_GlobalReport_full_en.pdf. [Last accessed on 2018 May 5].
Shaw GM, Hunter E HIV transmission. Cold Spring Harb Perspect Med 2012;2:1-65..
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]