Sexual risk behaviours of HIV positive persons not receiving HIV treatment in Mombasa: are prevention programs missing healthy positives in the community?

Abstract

Background: HIV prevention programs for persons living with HIV (PLHA) often target those who are receiving care and treatment. There is little information on sexual behaviours of 'healthy' PLHA who are not receiving ART. Methods: Researchers undertook a cross-sectional survey in Mombasa to examine sexual behaviours of PLHA not, receiving ART. A total of 698 PLHA (164 males; 534 females) were recruited from the community through community health workers and post-test clubs. Results: The mean age was 34 years, 34% were currently married and 77% had no contact with HIV programs. Fifty-nine percent of participants were sexually active. Males reported a higher median number of sexual partners than females (15 vs. 4; p< 0.001) over the past 6 months. Females reported sex with regular partners more frequently than males (80% vs. 62%; p< 0.001), while males reported sex with casual partners (11% vs. 8%) and sex workers (7% vs. 2%) more frequently than females (p< 0.001). Three-quarter of sexual partners were of unknown HIV-status. Unprotected sex (UPS) in the last 6-months was reported in 48% of sexual relationships. Females reported UPS more commonly than male respondents (55% vs. 44%; p=0.01). On multivariate analysis, non-disclosure of HIV-status to partners (AOR 2.47, 95% CI:1.53-3.99), moderate levels of perceived stigma (AOR 3.00; CI:1.55-5.80), believing condoms reduce sexual pleasure (AOR 2.99, CI:1.71-5.23) or being ambivalent about condoms reducing pleasure (AOR 9.19, CI: 2.70-31.19), not using any family planning (FP) method (AOR 4.17, CI:2.13 8.17) and using a non-condom FP method (AOR 5.48, CI:2.56-11.73) were independently associated with UPS. Females reported significantly more UPS than males (OR 1.96, CI: 1.07-3.57). Conclusions: HIV prevention programs need to target 'healthy positives' in the community, to facilitate disclosure of HIV-status, encourage partner testing and emphasize condom use with all partners, and address internalized stigma. FP services should be integrated into prevention programs.