Does antiretroviral therapy change partnership dynamics and HIV risk behaviours among HIV-infected adults

OBJECTIVE: We explore the impact of antiretroviral therapy (ART) on partnership acquisition and dissolution rates and changes in sexual behaviours among HIV-infected adults. DESIGN: Using detailed longitudinal data from a prospective cohort of HIV-infected adults with CD4(+) cell count below 200 cells/μl (ART-eligible) or CD4(+) cell count above 500 cells/μl (pre-ART) conducted in rural KwaZulu-Natal, South Africa, from 2009 to 2012. METHODS: Partnership acquisition and dissolution are explored through survival analysis methods, whereas generalized linear models were fitted for the sexual behaviour outcomes with interaction terms to allow the association with ART to vary over time. Throughout, the primary comparison of interest for each outcome is differences between the two ART groups. RESULTS: ART is not associated with partner acquisition or relationship dissolution. During follow-up, the two ART groups do not differ in the odds of being sexually active nor the number of sex acts, whereas the odds of unprotected sex are significantly lower for partnerships of ART-eligible participants (adjusted odds ratio 0.26, 95% confidence interval 0.15, 0.43). Relationship-level characteristics including cohabitation status and wanting more children with that partner are associated with higher odds and increased frequency of sexual activity, and increased odds of unprotected sex, whereas living with partner, higher relationship quality and longer relationship duration are associated with lower risk of partnership dissolution. CONCLUSION: Being on ART was not associated with increased sexual risk behaviours, a reassuring finding given the WHO recommends ART initiation upon HIV diagnosis. The importance of relationship-level characteristics provides evidence that HIV care services should offer routine support for HIV disclosure and sexual risk reduction, and promotion of couples-testing and positive couple relationships.