Access to antiretroviral treatment and sexual behaviours of HIV-infected patients aware of their serostatus in Cote d'Ivoire

Objective: To compare sexual behaviours of HIV-infected patients in Cote d'Ivoire whether or not they had access to antiretroviral treatment (ARV). Design and methods: Cross-sectional survey using face-to-face interviews among all patients, informed of their HIV serostatus, attending the eight health centers in charge of HIV care in Abidjan and Bouake. Univariate comparisons of declared sexual behaviours during the prior 6 months between the 164 ARV-treated and the 547 non-ARV-treated respondents. Multiple logistic regressions to identify factors related to sexual abstinence in the total sample and to unprotected sexual intercourse in the subsample of sexually active respondents during the same period were performed. Results: More than half of the 711 respondents (53.0%) declared an absence of sexual activity during the previous 6 months, with this proportion being significantly higher among women (60.6%), and among both men (85.7%) and women (92.4%) who were not living in a stable relationship. Among the 334 sexually active patients, 49.7% declared a low frequency of sexual intercourse ('once a month or less'), and 43.7% declared at least one episode of unprotected sexual intercourse. In multivariate analysis, recent diagnosis of HIV infection (< 9 months), having only one sexual partner and not knowing her/his serostatus, high alcohol consumption, absence of episodes of acute morbidity, not participating in household's expenditures and not being ARV-treated were significantly related to a higher likelihood of HIV-related risky sexual behaviours. Conclusion: Sexual abstinence is the preventive strategy of choice for a majority of HIV-infected patients aware of their serostatus and consulting for care in Cote d'Ivoire. In these patients, access to ARV is not associated with an increase in HIV-related risky sexual behaviours. (C) 2003 Lippincott Williams Wilkins.