International Centre for Reproductive Health, Mombasa, Kenya.
AIDS. 2012 May 15;26(8):997-1007. doi: 10.1097/QAD.0b013e3283524ca1.
Describe changes in sexual behaviour and determinants of unsafe sex among HIV-infected women in the 24 months after delivery.
Cohort analysis nested within a prevention of mother-to-child transmission trial in Burkina Faso (n = 339) and Kenya (n = 432).
Women were followed during pregnancy and until 12-24 months after delivery. At each visit, structured questionnaires were administered about sexual activity and condom use, and risk-reduction counselling and condoms were provided.
At study entry, a median 2 months after HIV testing (interquartile range =1-4), 411/770 (53.4%) of women reported partner disclosure, increasing to 284/392 (71.9%) at the final visit. Although most partners were supportive following disclosure, between 5 and 10% of disclosed women experienced hostile or unsupportive partner responses during follow-up visits. At each visit, about a third of sexually active women reported unsafe sex (unprotected sex with HIV-uninfected or unknown status partner). In multivariable logistic regression, unsafe sex was 1.70-fold more likely in Kenyan than in Burkinabe women [95% confidence interval (95% CI) = 1.14-2.54], and in those with less advanced HIV disease or aged 16-24 years. Compared with women who disclosed their status to partners and others, unsafe sex was over six-fold higher in nondisclosers (95% CI = 3.31-12.11), the effect size reducing with increasing disclosure.
HIV-infected women who recently delivered have a high potential for further HIV transmission, especially as HIV discordance is common in Africa. Longitudinal care for women, including positive-prevention interventions, is needed within new services providing antiretroviral prophylaxis during breastfeeding - this repeated interface with services could focus on reducing unsafe sex. Much remains unknown about how to facilitate beneficial disclosure.
描述在布基纳法索（n=339）和肯尼亚（n=432）的母婴传播预防试验中，HIV 感染女性在产后 24 个月内性行为和不安全性行为的决定因素的变化。
在母婴传播预防试验中嵌套的队列分析（n=770）。
在怀孕期间和产后 12-24 个月期间对女性进行随访。每次就诊时，都会对性行为和避孕套使用情况进行结构化问卷调查，并提供风险降低咨询和避孕套。
在研究开始时，即 HIV 检测后 2 个月的中位数（四分位距=1-4），411/770（53.4%）的女性报告了伴侣披露，在最后一次就诊时增加到 284/392（71.9%）。尽管大多数伴侣在披露后表示支持，但在随访期间，仍有 5%至 10%的披露女性经历了敌对或不支持的伴侣反应。每次就诊时，约三分之一有性行为的女性报告不安全的性行为（与 HIV 未感染或未知状况的伴侣发生无保护性行为）。在多变量逻辑回归中，肯尼亚女性发生不安全性行为的可能性是布基纳法索女性的 1.70 倍[95%置信区间（95%CI）=1.14-2.54]，而 HIV 疾病程度较轻或年龄在 16-24 岁的女性发生不安全性行为的可能性是前者的 1.70 倍。与向伴侣和他人披露其状况的女性相比，未披露者发生不安全性行为的风险高出六倍（95%CI=3.31-12.11），随着披露程度的增加，这种效果大小会降低。
最近分娩的 HIV 感染女性具有进一步传播 HIV 的高风险，尤其是在非洲 HIV 不一致性很常见的情况下。需要为女性提供纵向护理，包括积极预防干预措施，在提供抗逆转录病毒预防哺乳期服务的新服务中提供服务 - 这种与服务的反复接触可以专注于减少不安全的性行为。关于如何促进有益的披露，仍有许多未知。
