Changes in sexual risk behavior before and after HIV seroconversion in Southern African women enrolled in a HIV prevention trial

Abstract

BACKGROUND:: We examine changes in sexual risk behaviors before and after HIV seroconversion in southern African women enrolled in the Methods for Improving Reproductive Health in Africa (MIRA) trial. METHODS:: HIV testing and counseling, and assessment of sexual behaviors by ACASI were performed approximately every 3 months. We compared the following sexual behaviors: being sexually active, coital frequency, consistent male condom use, use of any female condoms, anal sex, and >1 sex partner, at study visits before and after HIV seroconversion. RESULTS:: During the trial, 327 women seroconverted to HIV, contributing 718 pre-HIV and 1110 post-HIV study visits. Women were significantly more likely to report consistent condom use at visits following HIV seroconversion compared to visits prior to HIV infection (adjusted odds ratio, AOR: 1.36 [95%CI: 1.11-1.67]), and were less likely to have >1 male sex partner following serconversion (AOR: 0.66 [95%CI: 0.48-0.91]). Women reported less frequently being sexually active (AOR: 0.63 [95%CI: 0.39-1.02]), fewer episodes of sex (>4 sex acts over the past week AOR: 0.74 [95%CI: 0.60-0.91]), and a reduction in anal sex (AOR: 0.58 [95%CI: 0.36-0.95) at visits after HIV seroconversion. The observed reductions in sexual risk behaviors persisted over time. CONCLUSIONS:: Women significantly decreased their sexual risk behaviors following HIV seroconversion, but these changes were relatively modest, suggesting the need for further secondary prevention. Timely notification of HIV status coupled with prevention messages can contribute to reductions in sexual risk behaviors