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Depression in the Pathway of HIV Antiretroviral Effects on Sexual Risk Behavior Among Patients in Uganda

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Abstract

HIV antiretroviral therapy (ART) can increase safe sex or lead to disinhibition and less condom use. We conducted one of the first controlled studies of ART effects on sexual risk behavior in sub-Saharan Africa, and the potential explanatory roles of physical and mental health. Participants (302 non-ART, 300 ART) were followed for the first 12 months of HIV care in Uganda. Multivariate intention-to-treat regression analysis showed that frequency of sex increased significantly in both groups, but more among ART patients; when added to the model in separate analyses, changes in physical health functioning and depression were both significant predictors, as was time in HIV care, but there was no longer an ART effect. Both ART and non-ART groups had similar dramatic increases in consistent condom use over time; however, change in depression, unlike physical health functioning, was a significant predictor of consistent condom use when added to this model, and there remained a similar level of increased condom use among ART and non-ART patients. HIV care and ART increase sexual activity and condom use, but depression undercuts the prevention benefits of ART, highlighting the need to integrate mental health services into HIV care.

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References

  1. United Nations Programme on HIV/AIDS (UNAIDS). Towards universal access: scaling up priority HIV/AIDS interventions in the health sector; Progress Report; 2009.

  2. Uganda AIDS Commission (UAC). Accelerating HIV prevention. The road map towards universal access to HIV prevention in Uganda. Kampala: UAC; 2006.

    Google Scholar 

  3. Mermin J, Were W, Ekwaru JP, et al. Mortality in HIV-infected Ugandan adults receiving antiretroviral treatment and survival of their HIV-uninfected children: a prospective cohort study. Lancet. 2008;371(9614):752–9.

    Article  PubMed  CAS  Google Scholar 

  4. Coetzee D, Hildebrand K, Boulle A, et al. Outcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa. AIDS. 2004;18(6):887–95.

    Article  PubMed  Google Scholar 

  5. Bussmann H, Wester CW, Ndwapi N, et al. Five-year outcomes of initial patients treated in Botswana’s national antiretroviral treatment program. AIDS. 2008;22(17):2303–11.

    Article  PubMed  Google Scholar 

  6. Quinn TC, Wawer MJ, Sewankambo N, et al. Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai project study group. N Engl J Med. 2000;342(13):921–9.

    Article  PubMed  CAS  Google Scholar 

  7. Donnell D, Kiarie J, Thomas K, et al. ART and risk of heterosexual HIV-1 transmission in HIV-1 serodiscordant African couples: a multinational prospective study. Abstract 136. Seventeenth Conference on Retroviruses and Opportunistic Infections. San Francisco, CA; 2010.

  8. Bunnell R, Ekwaru JP, Solberg P, et al. Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda. AIDS Behav. 2006;20(1):85–92.

    Google Scholar 

  9. Ostrow DE, Fox KJ, Chmiel JS, et al. Attitudes towards highly active antiretroviral therapy are associated with sexual risk taking among HIV-infected and uninfected homosexual men. AIDS. 2002;16(5):775–80.

    Article  PubMed  Google Scholar 

  10. Lakdawalla DN, Goldman D, Sood N. HIV treatment breakthroughs and risky sexual behavior. Q J Econ. 2006;121(3):1063–102.

    Article  Google Scholar 

  11. Pickett J. ‘HAART optimism’: is it really the problem with HIV prevention in developed countries? AIDS. 2003;17(Suppl 4):S20–2.

    PubMed  Google Scholar 

  12. Eisele TP, Mathews C, Chopra M, et al. Changes in risk behavior among HIV-positive patients during their first year of antiretroviral therapy in Cape Town South Africa. AIDS Behav. 2009;13(6):1097–105.

    Article  PubMed  Google Scholar 

  13. Olley BO, Seedat S, Gxamza F, Reuter H, Stein DJ. Determinants of unprotected sex among HIV-positive patients in South Africa. AIDS Care. 2005;17(1):1–9.

    Article  PubMed  CAS  Google Scholar 

  14. Wagner GJ, Holloway I, Ghosh-Dastidar B, Ryan G, Kityo C, Mugyenyi P. Factors associated with condom use among HIV clients in stable relationships with partners at varying risk for HIV in Uganda. AIDS Behav. 2010;14(5):1055–65.

    Article  PubMed  Google Scholar 

  15. Venkatesh KK, de Bruyn G, Lurie MN, Mohapi L, Pronyk P, Moshabela M, et al. Decreased sexual risk behavior in the era of HAART among HIV-infected urban and rural South Africans attending primary care clinics. AIDS. 2010;24:2687–96.

    Article  PubMed  Google Scholar 

  16. Kaida A, Gray G, Bastos FI, et al. The relationship between HAART use and sexual activity among HIV-positive women of reproductive age in Brazil, South Africa, and Uganda. AIDS Care. 2008;20(1):21–5.

    Article  PubMed  CAS  Google Scholar 

  17. Luchters S, Sarna A, Geibel S, et al. Safer sexual behaviors after 12 months of antiretroviral treatment in Mombasa, Kenya: a prospective cohort. AIDS Patient Care STDS. 2008;22(7):587–8.

    Article  PubMed  Google Scholar 

  18. Diabate S, Alary M, Kanga Koffi C. Short-term increase in unsafe sexual behavior after initiation of HAART in Cote d’Ivoire. AIDS. 2008;22:154–6.

    Article  PubMed  Google Scholar 

  19. Bunnell R, Opio A, Musinguzi J, et al. HIV transmission risk behavior among HIV-infected adults in Uganda: results of a nationally representative survey. AIDS. 2008;22(5):617–24.

    Article  PubMed  Google Scholar 

  20. Seeley J, Russell S, Khana K, Ezati E, King R, Bunnell R. Sex after ART: sexual partnerships established by HIV-infected persons taking anti-retroviral therapy in Eastern Uganda. Cult Health Sex. 2009;11(7):703–16.

    Article  PubMed  Google Scholar 

  21. Stall R, Mills TC, Williamson J, et al. Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. Am J Public Health. 2003;93(6):939–42.

    Article  PubMed  Google Scholar 

  22. Collins PY, Holman AR, Freeman MC, Patel V. What is the relevance of mental health to HIV/AIDS care and treatment programs in developing countries? A systematic review. AIDS. 2006;20(12):1571–82.

    Article  PubMed  Google Scholar 

  23. Crepaz N, Marks G. Towards an understanding of sexual risk behavior in people living with HIV: a review of social, psychological, and medical findings. AIDS. 2002;16(2):135–49.

    Article  PubMed  Google Scholar 

  24. Kalichman SC. HIV transmission risk behaviors of men and women living with HIV-AIDS: prevalence, predictors, and emerging clinical interventions. Clin Psychol Sci Pract. 2000;7(1):32–47.

    Article  Google Scholar 

  25. Comulada WS, Rotheram-Borus MJ, Pequegnat W, et al. Relationships over time between mental health symptoms and transmission risk among persons living with HIV. Psychol Addict Behav. 2010;24(1):109–18.

    Article  PubMed  Google Scholar 

  26. Stangl AL, Wamai N, Mermin J, Awor AC, Bunnell RE. Trends and predictors of quality of life among HIV-infected adults taking highly active antiretroviral therapy in rural Uganda. AIDS Care. 2007;19(5):626–36.

    Article  PubMed  CAS  Google Scholar 

  27. Beard J, Feeley F, Rosen S. Economic and quality of life outcomes of antiretroviral therapy for HIV/AIDS in developing countries: a systematic literature review. AIDS Care. 2009;21(11):1343–56.

    Article  PubMed  Google Scholar 

  28. Pearson CR, Micek MA, Pfeiffer J, et al. One year after ART initiation: psychosocial factors associated with stigma among HIV-positive Mozambicans. AIDS Behav. 2009;13(6):1189–96.

    Article  PubMed  CAS  Google Scholar 

  29. Grosh M, Glewwe P. Designing household survey questionnaires for developing countries: lessons from 15 Years of the living standards measurement study. vol. 1, 2, and 3. Washington, DC: The World Bank; 2000.

    Google Scholar 

  30. Mast TC, Kigozi G, Wabwire-Mangen F, et al. Measuring quality of life among HIV-infected women using a culturally adapted questionnaire in Rakai district, Uganda. AIDS Care. 2004;16(1):81–94.

    Article  PubMed  CAS  Google Scholar 

  31. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.

    Article  PubMed  CAS  Google Scholar 

  32. Monahan PO, Shacham E, Reece M, et al. Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in western Kenya. J Gen Intern Med. 2009;24(2):189–97.

    Article  PubMed  Google Scholar 

  33. American Psychiatric Association. American psychiatric association, diagnostic statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.

    Google Scholar 

  34. Kalichman SC, Simbayi LC, Jooste S, et al. Development of a brief scale to measure AIDS-related stigma in South Africa. AIDS Behav. 2005;9(2):135–43.

    Article  PubMed  Google Scholar 

  35. Kakaire O, Osinde MO, Kaye DK. Factors that predict fertility desires for people living with HIV infection at a support and treatment center in Kabale, Uganda. Reprod Health. 2010. doi:10.1186/1742-4755-7-27.

  36. Sarna A, Pujari S, Sengar A, et al. Exploring sexual behavior of HIV-infected persons on antiretroviral therapy: experiences from India. Abstract 982. 12th Conference on Retroviral Opportunistic Infections. Boston, MA; 2005.

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Acknowledgments

We would like to thank the study coordinators (Tonny Kizza, Joseph Bebe, Mark Magina), the clinic directors (Drs. William Tamale and Grace Namayanja), nurse Erina Turya, and counselors (Hellen Nakyambadde, Rose Byaruhanga, Grace Barungi) who helped to identify and refer participants, and the client participants who gave so generously of their time and their personal information.This research is supported by a grant from the Rockefeller Foundation (Grant No. HE 007; PI: G. Wagner).

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Authors and Affiliations

  1. RAND Corporation, 1776 Main St, Santa Monica, CA, 90407, USA

    Glenn J. Wagner & Bonnie Ghosh-Dastidar

  2. University of Southern California School of Social Work, Los Angeles, CA, USA

    Ian W. Holloway

  3. Joint Clinical Research Centre, Kampala, Uganda

    Cissy Kityo & Peter Mugyenyi

Authors
  1. Glenn J. Wagner
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  2. Bonnie Ghosh-Dastidar
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  3. Ian W. Holloway
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  4. Cissy Kityo
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  5. Peter Mugyenyi
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Correspondence to Glenn J. Wagner.

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Wagner, G.J., Ghosh-Dastidar, B., Holloway, I.W. et al. Depression in the Pathway of HIV Antiretroviral Effects on Sexual Risk Behavior Among Patients in Uganda. AIDS Behav 16, 1862–1869 (2012). https://doi.org/10.1007/s10461-011-0051-7

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