HIV and the Church

Posted by Jeannie Wraight

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, Australia. 

The 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.

‘Sexual 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 study.

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 prevalence.


Kennedy 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.

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