Association of attitudes and beliefs towards antiretroviral therapy with HIV-seroprevalence in the general population of Kisumu, Kenya

• Published in: PloS one 2009-03, Vol.4 (3), p.e4573-e4573
• Main Authors: Cohen, Craig R, Montandon, Michele, Carrico, Adam W, Shiboski, Stephen, Bostrom, Alan, Obure, Alfredo, Kwena, Zachary, Bailey, Robert C, Nguti, Rosemary, Bukusi, Elizabeth A
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; AIDS; AIDS treatment; Analysis; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Compensation; Cures; Demographics; Demography; Disease prevention; Disease transmission; Female; Health aspects; Health Knowledge, Attitudes, Practice; Health risks; Highly active antiretroviral therapy; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - psychology; HIV Seroprevalence; HIV tests; Human immunodeficiency virus; Humans; Infectious Diseases/HIV Infection and AIDS; Kenya - epidemiology; Male; Men; Middle Aged; Mortality; Prevention; Public Health and Epidemiology/Global Health; Public Health and Epidemiology/Infectious Diseases; Regression analysis; Risk factors; Risk taking; Serology; Sexual behavior; Sexually transmitted diseases; Socioeconomic Factors; Stability; STD; Surveys; Therapy
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0004573

Since antiretroviral therapy (ART) became available in the developed world, the prevalence of unprotected sex and the incidence of sexually transmitted infections (STIs) and HIV have increased. We hypothesized that a similar phenomenon may be occurring in sub-Saharan Africa concomitant with the scale-up of HIV treatment. We conducted a general population-based survey in Kisumu, Kenya. Participants completed an interview that included demographics as well as ART-related attitudes and beliefs (AB) and then underwent HIV serological testing. Exploratory and confirmatory factor analyses of AB about ART indicated two factors: 1) ART-related risk compensation (increased sexual risk taking now that ART is available); and 2) a perception that HIV is more controllable now that ART is available. Logistic regression was used to determine associations of these factors with HIV-seroprevalence after controlling for age. 1,655 (90%) of 1,844 people aged 15-49 contacted, including 749 men and 906 women, consented to participate in the study. Most participants (n = 1164; 71%) had heard of ART. Of those who had heard of ART, 23% believed ART was a cure for HIV. ART-related risk compensation (Adjusted (A)OR = 1.45, 95% CI 1.16-1.81), and a belief that ART cures HIV (AOR = 2.14, 95% CI 1.22-3.76) were associated with an increased HIV seroprevalence in men but not women after controlling for age. In particular, ART-related risk compensation was associated with an increased HIV-seroprevalence in young (aged 15-24 years) men (OR = 1.56; 95% CI 1.12-2.19). ART-related risk compensation and a belief that ART cures HIV were associated with an increased HIV seroprevalence among men but not women. HIV prevention programs in sub-Saharan Africa that target the general population should include educational messages about ART and address the changing beliefs about HIV in the era of greater ART availability.