Sexual risk behaviors among HIV-infected South Indian couples in the HAART era: implications for reproductive health and HIV care delivery

Abstract

The current study examines sexual behaviors among HIV-infected Indians in primary care, where access to highly active antiretroviral therapy (HAART) has recently increased. Between January and April 2008, we assessed the sexual behaviors of 247 HIV-infected South Indians in care. Multivariable logistic regression models were used to determine predictors of being in a HIV-seroconcordant primary relationship, being sexually active, and reporting unprotected sex. Over three-fourths (80%) of participants were HAART-experienced. Among the 58% of participants who were currently in a seroconcordant relationship, one-third were serodiscordant when enrolling into care. Approximately two-thirds (63.2%) of participants were sexually active; 9.0% reported unprotected sex. In the multivariable analyses, participants who were in a seroconcordant primary relationship were more likely to have children, use alcohol, report unprotected sex, and have been enrolled in care for >12 months. Sexually active participants were more likely to be on HAART, have a prior tuberculosis diagnosis, test Herpes simplex type 2 antibody seropositive, and have low general health perceptions. Participants who reported unprotected sex were more likely to be in a seroconcordant relationship, be childless, want to have a child, and use alcohol. We did not document an association between HAART and unprotected sex. Among HIV-infected Indians in primary care, predictors of unprotected sex included alcohol use and desire for children. Prevention interventions for Indian couples should integrate reproductive health and alcohol use counseling at entry into care.

Keywords:

• HIV
• AIDS
• sexual behavior
• HAART
• India

Acknowledgements

The authors are grateful to Timothy P. Flanigan, MD and Charles C.J. Carpenter, MD, Division of Infectious Diseases, Department of Medicine, and Stephen T. McGarvey, Ph.D., MPH, Department of Community Health, at Alpert Medical School, Brown University, Providence, RI for their useful comments. We would also like to thank Sudha Raminani, MA, at Fenway Community Health (Boston, MA) for her assistance in assembling the survey instruments. Additionally, the authors would like to thank the clinical and research staff involved in this study at YRG Centre for AIDS Research and Education, VHS, Chennai, India, for their facilitation of the study.

Brown/Tufts/Lifespan Center for AIDS Research (CFAR) (grant no. P30AI042853), and Brown University's AIDS International Research and Training Program of the Fogarty International Center at the National Institutes of Health (NIH) (grant no. D43TW00237) supported this study. K.K. Venkatesh was also supported by a F-30 M.D./Ph.D. Ruth Kirschtein National Research Service Award (NRSA) (grant no.F30 MH079738-01A2).