ANTIRETROVIRAL THERAPY

A Meta-analysis of the Effect of Antiretroviral Therapy and Sexual Risk Behaviour in Sub-Sahara Africa

A Meta-analysis of the Effect of Antiretroviral Therapy and Sexual Risk Behaviour in Sub-Sahara Africa

Background of the study

The emergence of human immunodeficiency virus (HIV) led to a lot of efforts in both human and material resources to fight the epidemic. There have been improvement in the understanding of the nature and spread of HIV, but the dilemma remains that no effective vaccine or cure has been found (Steven et al 2006). The drug treatment of HIV/AIDS is aimed at slowing the replication of the virus and boosting the body's immune system in order to improve quality of life and delay the progression to AIDS related deaths (Pratt, 2003).

Access to Antiretroviral therapy (ART) has expanded rapidly in low and middle income countries (WHO 2007). There is however concerns that sexual risk taking will increase with ART especially in the long run once health improves and people resume sexual activity (Kennedy et al.2007). The transmission and spread of the HIV has been shown to be associated to a number of sexually risky behaviours such as unprotected sexual intercourse, multiple sex partners and needle sharing amongst intravenous drug users (CDC 2008). Research in some African settings have found out that although some risk behaviour decrease with ART, a substantial portion continue to have unsafe sex, even with partners known to be HIV negative (Moatti et al.2003).

A meta-analysis of the relationship between ART and sexual risk behaviour showed that HIV positive individuals receiving ART did not exhibit increased sexual risk behaviour (Crepaz et al.2004). That analysis found 16 studies with 21 independent effect sizes reflecting that there is no association between receiving ART (versus not receiving ART) and risky sexual behaviour. However, all of the studies included in that meta-analysis were conducted in developed countries. Therefore, as HIV treatment becomes more widely available in sub-Sahara Africa, the relationship between treatment and sexual risk behaviour has become more important.

There has been only one systematic review (Kennedy et al.2007) conducted on this issue with respect to developing countries. Only 3 studies were used in that study after searching through available literature. The study documented a reduction in sexual risk behaviour among those on treatment with ART, and clearly highlighted the deficiencies in their report as there was limited data at the time. This reason has created an opportunity for more research on this issue. It is based on this gap in knowledge that prompts a need for more review to be done on the use of ART and sexual risk behaviour in Sub-Sahara Africa.

Furthermore, a study in Cote d'ivoire reported a short term increase in unsafe sexual behaviour commencing after initiation of ART (Diabate et al.2008). This finding can largely be attributed to the perceptions of some people living with HIV/AIDS that commencement of ART would eventually cure them of HIV since it is always emphasised that ART reduces viral load. Similarly, some evidences suggest that since ART became available, ...