HIV/AIDS RISK FACTORS IN THE CONTEXT OF INCREASING ACCESS TO ENHANCED HIV/AIDS TREATMENT Stella Neema, PhD Department of Sociology Makerere University Jan 2008

Research Team Stella Neema Lynn Atuyambe Simon Kasasa Erasmus Otolok-Tanga Gakenia Wamuyu-Maina Edson Muhwezi Fred Wabwire-Mangen

Introduction Although there is sufficient biological evidence for decline in HIV prevalence and incidence, data on behaviour evidence is limited Behavioral Surveillance is becoming a major component of the surveillance system for HIV/AIDS in the country especially in light of the HIV/AIDS declining trends and the scale up of ARVs Since 2001 ART been intrgrated as part of the national program for comprehensive HIV/AIDS care and support in Uganda It has been speculated that wide scale availability of ARVS is likely to erode behaviour change achieved by ABC, IEC, VCT

Hypotheses Increased access to ARVs could lead to: –Development of false sense of security and increased risk behavior –HIV-infected persons become healthier and more sexual active Risk behavior leads to increased HIV infections among the HIV +, HIV – and the unknown HIV status

Methods: Study Design – A prospective cohort study with a follow-up period of 3 months for 3 data collection phases Study Sites & Study Populations – HIV+ patients (split into subgroups of patients on ARVs (182) and not on ARVs (262) recruited at the IDC aged 18+ –A sample of adult community members (266) of 12 randomly selected parishes in Kawempe of unknown status

Key findings: Sexual behavior patterns [I] Sexual partners Approximately 90% of the respondents gave a history of sexual intercourse with a regular partner in the previous 3 months 10% had a non-regular partner in the previous 3 months, 63% of whom reported one non-regular partner Only one third of the clinic attendees on ARVs (33%) reported that availability of ARVs had made them to have more non-regular sexual partners in the previous three months 23% of these non-regular partners were identified to be older

Findings: Sexual behavior patterns [II] Condom use with non-regular partner 24% who gave a history of sexual intercourse with a non-regular partner had never used a condom All the clinic attendees on ARVs that gave a history of sexual intercourse with a non-regular partner in the previous 3 months had used a condom for the last sexual intercourse This evidenced that respondents on ARVs were taking the necessary precautions to avoid infecting others and/or getting cross infections 11% of the clinic attendees not on ARVs and 22% of the community population reported non-condom use with a non-regular partner during the last sexual intercourse

Findings: Sexual behavior patterns [III] Overall, 14% of the respondents had never used a condom with the non- regular partner This signified the continued existence of risk behaviour amongst these populations

Findings:Qualitative data: Effect of ARVs on sexual behavior [IV] –Sexual promiscuity (nearly all FGDs) –Difficulty to distinguish between the + and –ves “What I have seen, peoples sexual behavior has changed. Long before the advent of ARVs, people used to fear AIDS so much and feared having several partners. Now they have relaxed. They no longer fear being infected or being HIV +”. Out of Sch. Adol. Komamboga

Conclusions [I) More females and literate clients seek HIV care and treatment services at Infectious Disease Institute Clinic Respondents had high levels of knowledge about HIV transmission but limited knowledge on all the three key methods of prevention (abstinence, be faithful and condom use) as well as HIV care and treatment Respondents perceived ARVs to be effective in HIV care and treatment specifically in prolonging life, leading to better quality life and being superior to traditional medicine in the treatment of HIV/AIDS and associated opportunistic infections.

Conclusions [II) HIV testing amongst the community members was low Community members were more likely to have sex in the last three months with both regular and non regular partners Risk sexual behaviors were more common amongst the community members and the clinic members not on ARVs (lack of condom use with non-regular sexual partners and sexual intercourse with CSWs) Availability of ARVs did not significantly influence patients to have non-regular sexual partners in the previous 3 months or non-use of condoms with non- regular partners Respondents were thus not less mindful of prevention strategies or behave significantly in a manner likely to increase risk of transmission

Recommendations Strategies that ensure more men seek HIV/AIDS care and treatment services need to be explored and designed such as through their female sexual partners and setting up more community outreach centers Information, education and communication focusing on risk sexual behaviours and practices, HIV transmission, key prevention strategies, care and treatment issues needs to be continued especially in the communities Widespread sensitization on the benefits, effectiveness and source of ARVs should continue to be a priority so as to avoid myths and misconceptions arising