Nakiganda Lydia Jacenta, Nakigozi Gertrude, Kagaayi Joseph, Nalugoda Fred, Serwadda David, Sewankambo Nelson, Gray Ronald, Ndyanabo Anthony, Muwanika Richard, Asamoah Benedict Oppong
International Master Programme in Public Health, Faculty of Medicine, Lund University, Malmö, Sweden.
Rakai Health Sciences Program, Kalisizo, Uganda.
BMJ Open. 2017 Sep 11;7(9):e016954. doi: 10.1136/bmjopen-2017-016954.
To compare risky sexual behaviours between HIV-positive persons initiated on antiretroviral therapy (ART) (ART-experienced) and persons waiting to start on ART (ART-naive) and assess predictors of risky sexual behaviours among HIV-infected patients in rural Rakai district, Uganda.
This is a cross-sectional study that used data from the Rakai Community Cohort Study (RCCS) database between 2013 and 2014. A structured questionnaire was used for data collection. We used stepwise logistic regression as an index to estimate the adjusted ORs for the association between risky sexual behaviours and ART treatment status.
This study was conducted in Rakai district, located in south-western Uganda. The data for this study were extracted from the RCCS. RCCS is an open prospective cohort of approximately 15 000 consenting participants aged 15-49 years.
HIV-positive participants aged 18-49 years who had sex at least once a month with any partner prior to the start of the study.
Inconsistent/no condom use in the last 12 months, alcohol use at last sexual encounter, and two or more sexual partners.
ART-naive participants were more likely to report inconsistent condom use (OR=1.74, 95% CI 1.11 to 2.73) and more likely to drink alcohol at last sexual encounter (OR=1.65, 95% CI 1.11 to 2.46), compared with ART-experienced patients. ART treatment status (p<0.001) was a significant predictor of risky sexual behaviours. Both marital status (p=0.016) and occupation level (p=0.009) were positively associated with inconsistent condom use, while sex (p<0.001) correlated with alcohol use at last sexual encounter.
ART-naive participants were more likely to exhibit risky sexual behaviours than the ART-experienced participants. The intensity of risk reduction counselling should be increased for HIV-positive persons waiting to start ART but already in HIV care.
比较开始接受抗逆转录病毒治疗（ART）的HIV阳性者（有ART治疗经验者）和等待开始ART治疗的人（未接受过ART治疗者）之间的危险性性行为，并评估乌干达拉凯区农村地区HIV感染患者中危险性性行为的预测因素。
这是一项横断面研究，使用了2013年至2014年拉凯社区队列研究（RCCS）数据库中的数据。采用结构化问卷进行数据收集。我们使用逐步逻辑回归作为指标来估计危险性性行为与ART治疗状态之间关联的调整后比值比（OR）。
本研究在位于乌干达西南部的拉凯区进行。本研究的数据取自RCCS。RCCS是一个开放性前瞻性队列，约有15000名年龄在15 - 49岁的自愿参与者。
年龄在18 - 49岁的HIV阳性参与者，在研究开始前每月至少与任何性伴侣发生一次性行为。
过去12个月中避孕套使用不规律/未使用避孕套、最近一次性行为时饮酒以及有两个或更多性伴侣。
与有ART治疗经验的患者相比，未接受过ART治疗的参与者更有可能报告避孕套使用不规律（OR = 1.74，95%CI 1.11至2.73），并且在最近一次性行为时更有可能饮酒（OR = 1.65，95%CI 1.11至2.46）。ART治疗状态（p < 0.001）是危险性性行为的一个重要预测因素。婚姻状况（p = 0.016）和职业水平（p = 0.009）均与避孕套使用不规律呈正相关，而性别（p < 0.001）与最近一次性行为时饮酒相关。
未接受过ART治疗的参与者比有ART治疗经验的参与者更有可能表现出危险性性行为。对于等待开始ART治疗但已接受HIV护理的HIV阳性者，应加强降低风险咨询的力度。
