Sexual risk behaviors among HIV-patients receiving antiretroviral therapy in Southern Thailand: roles of antiretroviral adherence and serostatus disclosure

ABSTRACT

The objective of this study was to examine the extent of unprotected sex among patients already established in HIV-medical care and their associated factors. Sexually active patients who were receiving antiretroviral therapy (ART) from five public hospitals in Trang province, Southern Thailand, were interviewed. Of 279 studied patients, 37.3% had unprotected sex in the prior 3 months and 27.2% did not disclose their serostatus to sexual partners. The median duration interquartile range (IQR) of using ART was 47 (27–60) months and 26.7% were non-adherent to ART (i.e., taking less than 95% of the prescribed doses). More than one-third had the perception that ART use would protect against HIV transmission even with unprotected sex. About 36.6% reported that they were unaware of their current CD4 counts and nearly one-third did not receive any safe sex counseling at each medical follow-up. After adjustment for potential confounders, non-adherence to ART and HIV-nondisclosure were strongly associated with an increase in the risk of unprotected sex with the adjusted odds ratio (aOR) of 5.03 (95% CI 2.68–9.44) and 3.89 (95% CI 1.57–9.61), respectively. In contrast, the risk for engaging in unprotected sex was less likely among patients having a negative-serostatus partner (aOR = 0.30; 95% CI 0.12–0.75), a longer duration of the use of ART (aOR = 0.98; 95%CI 0.97–0.99) and an unawareness of their current CD4 levels (aOR = 0.54; 95% CI 0.30–0.99). To maximize the benefits from ART, there should be a bigger emphasis on the “positive prevention” program and more efforts are needed to target the population at risk for unprotected sex. Strategies to encourage adherence to ART and for disclosure of serostatus are also required.

KEYWORDS:

• Sexual risk behavior
• HIV
• antiretroviral therapy
• adherence
• serostatus disclosure

Acknowledgements

The authors would like to thank all the respondents who gave their valuable time to answer very personal questions. We gratefully acknowledge Dr Brian Hodgson who provided assistance with the English and valuable comments on drafts of this paper and the hospital staff that enabled us to complete this study.

Disclosure statement

No potential conflict of interest was reported by the authors.