The authors conducted a prospective cohort study to assess changes in risky sexual behavior and estimated HIV transmission from HIV-infected adults in rural Uganda after six months of antiretroviral therapy (ART).

Between May 2003 and December 2004, 926 HIV-positive adults were enrolled and followed in a home-based ART program that included prevention counseling, voluntary counseling and testing (VCT) for cohabitating partners, and condom provision. The researchers then assessed participants' HIV plasma viral load and partner-specific sexual behaviors at baseline and follow-up. Risky sex rates were compared using a Poisson regression model, and per-partner transmission risk was estimated based on established viral load-specific transmission rates. Risky sex was defined as inconsistent or no condom use with HIV-negative partners or with partners of unknown serostatus in the preceding three months.

Six months after ART initiation, risky sexual behavior reduced by 70 percent [adjusted risk ratio, 0.3;95 percent confidence interval (CI),0.2-0.7;P=0.0017]. More than 85 percent of risky sexual acts occurred within married couples. Median baseline viral load among those reporting risky sex was 122,500 copies/ml, and at follow-up, <50 copies/ml. Estimated risk of HIV transmission from cohort members declined by 98 percent, from 45.7 to 0.9 per 1,000 person years.

"Providing ART, prevention counseling, and partner VCT was associated with reduced sexual risk behavior and estimated risk of HIV transmission among HIV-infected Ugandan adults during the first 6 months of therapy," the researchers concluded. "Integrated ART and prevention programs may reduce HIV transmission in Africa."

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