Abstract
Background: Despite its well known benefits, concerns over potential adverse impacts of human immunodeficiency virus (HIV) treatment on the sexual behavior of people living with HIV and those at risk of infection have recently been raised. It has been hypothesized that, among other things, beliefs about being non infectious while on treatment might lead to increased unsafe sex practices. Improvements in physical health and well-being due to treatment have also been cited as potential reasons for an increase in sexual practices among those affected by the illness.
The general objective of this study is to explore how anti-retroviral treatment influences the sexual behavior of patients with (HIV) receiving treatment in Addis Ababa, Ethiopia. The study also looks specifically into lay beliefs about transmission of HIV while on anti-retroviral treatment (ART). It explores the experiences of safe sex among these patients; and how being on ART impacted their sexual experiences. It also explores health professionals’ views of how ART use influences HIV patients’ sexual behavior.
Methods: A qualitative study using in-depth interviews with 28 patients and 10 health workers was conducted in the period between August and December 2010.
Results: The study found that participants had a high knowledge about the modes of transmission of HIV in general and the transmission of HIV while on ART, with few exceptions. Participants had no or limited experience with safe sex in the past. Most participants said that HIV treatment has not had any influence on their sexual drive. Few had either increased or decreased sexual desire. Most noted that they are currently abstaining from sex for several reasons including worries about adverse impact of sex on health when one is ill, the need to find a lifetime partner, and religious restrictions. Fear of discrimination made disclosure of HIV status difficult, including to intimate partners. No participant gave a history of increased sexual risk taking after initiation of ART. Health workers also noted that, although discussion of sexual matters with patients is extremely difficult in their set ups, many HIV patients receiving treatment give them a history of abstinence. They also said they did not experience an increase in reports of sexually transmitted diseases after the roll-out of the ART program.
Conclusion: There was no evidence from this study to suggest an increase in sexual risk taking after the initiation of ART in the study setting. There was a high level of knowledge among participants about HIV transmission including while on ART, which is encouraging but there was a low level of past safe sex practices. The latter should be addressed by health professionals. Difficulties addressing sexual matters with patients reported by health workers also necessitate immediate attention. Misperceptions about sex and health need to be addressed. Community level interventions to combat HIV related discrimination are needed.