By Jeannie Wraight
A meta-analysis of sexual
behavior studies performed between 1990 and 2012 in low-income countries found
that the initiation of antiretroviral treatment (ART) did not contribute to an
increase in risky sexual behavior. Researchers from The Evidence Project, a program sponsored by the National
Institute of Mental Health, presented their findings at AIDS 2014 in Melbourne,
authors of this meta- analysis stated the need for an assessment of risky
sexual behavior in low-income countries due to the possibility of increased
risk caused by treatment optimism, physical health improvements and an
assumption of non-infectiousness with low/undetectable viral load that can
accompany viral suppression due to ART use. However, they also state that ART
may be associated with less risky behavior due to reduced depression, increased
hope and regular medical contact. As such, a meta-analysis was performed to
determine actual risk.
risk’ was measured in numerous ways throughout the studies reviewed. It was
defined as condom use, number of partners, casual sex, abstinence, time of
sexual debut, and incidence of sexually transmitted infections (STIs). Researchers
decided to narrow the definition of sexual risk for this analysis to include condom
use only. This decreased the number of studies to 15 that were reviewed by
researchers at John Hopkins University and South Carolina University for this
Researchers found an increased
use of condoms (a decrease in sexual risk) was consistently associated with
initiation of ART. This held true for both male and female participants, for
those with partners known and not known to be HIV negative and for sexual acts
in committed relationships as well as casual sex.
Overall, the studies reviewed found that
people taking ART used condoms 80% more often than people not on ART. Condom
use doubled for women on ART compared with women not on ART, and was 50% higher
in men on ART.
When researchers reviewed the four
studies that measured condom use in people of opposite or unknown HIV status,
they found that condom use in people on ART rose by 160%. It also rose by 160%
with spouses or regular partners.
Although the findings were highly
consistent among the studies reviewed, most of the participants were
heterosexual males from sub-Saharan Africa. This limits the reliability of the
study in a global aspect.
It was also reported at AIDS
2014 that the reduced risky sexual behaviors in HIV patients on ART is partially
responsible for the decrease in new HIV infections in countries with a high HIV
C et al. Is use of
antiretroviral treatment (ART) associated with decreased condom use? A
meta-analysis of studies from low- and middle-income countries (LMICs). 20th International AIDS Conference, Melbourne,
abstract WEAC0104, 2014.