Sexual Risk Behavior And Associated Factors Among People Living With HIV/AIDS Over Different Time Period After Being Notified As Hiv Seropositive

Background and objectivesSexual risk behavior refers to all those behaviors that result in exchange of body fluids between sex partners when having sex. Sexual transmission has become the most common HIV transmission route in China. Besides the secondary transmission of HIV, sexual risk behaviors also make people living with HIV/AIDS (PLHA) infected with other pathogens that causes STDs and opportunistic infections or reinfected with HIV of other subtypes or drug resistance strains, which may decrease the effectiveness of antiretroviral therapy.By the end of October2007, the cumulative number of reported HIV positive cases in China was223,501. Data from behavioral investigations showed that sexual risk behaviors still commonly existed among those reported. With the strengthened implementation of HIV surveillance, epidemiological investigations and HIV voluntary counseling and testing, more HIV/AIDS cases will be detected, and use of antiretroviral therapy may prolong their life, which increase the probability of HIV transmission. Valid health care service and intervention strategies may reduce sexual risk behaviors among PLHA to prevent the spread of HIV.This study investigated the sexual risk behaviors and related factors of PLHA over different time period after being notified as HIV sero-positive to explore the impact of factors at individual, family and community level as well as health care services on the sexual risk behaviors and to construct the health behavior theory based model of sexual risk behavior through path analysis so as to provide data for HIV/AIDS estimation and projection as well as evidence for improve the health care services on PLHA.MethodsBoth quantitative and qualitative investigations were used in this study. During July to December2008, a face to face questionnaire survey on1120 PLHA aged18to49years old who were detected and notified as HIV sero-positive from2006to2008was conducted in Luxi city and Yingjiang County of Dehong Zhou, Yunnan province and Luzhai county of Liuzhou city and Babu district of Hezhou city, Guangxi province. Also in-depth interview and group interview were conducted respectively on38PHLA and20staffs at primary level.Between-group and within group comparison were used for quantitative survey. Only one of HIV infection couples was randomly involved in data analysis. Firstly, Sexual risk behaviors of974PHLA during the past6months were compared between those who were newly notified and those who had been notified as sero-positive at least6months to explore the difference of sexual risk behaviors between the2groups as well as the impact of individual, sex partner and frequency of sexual behavior.Secondly, sexual risk behaviors during the past6months of836PLHA who had been notified as sero-positive at least6months ago were analyzed to explore the difference of sexual risk behaviors among those over different time period after being notified and correlates of individual, sex partner, family and community and health care services as well. Also, a health behavior theory based model for sexual risk behavior of PLHA was constructed.Thirdly, sexual risk behavior of177PLHA during6months before and after being notified as sero-positive was compared to explore the difference of sexual risk behaviors within group. Moreover, correlates of individual, sex partner, family and community and health care services were also determined.In-depth interview targeted at PLHA aimed to learn about the status of health care services, HIV sero-positive disclosure and condom using behavior. Group interview on staffs include status of condom promotion, problems and suggestions as well as the needs of staffs.ResultsOf974participants,138(14.2%) were newly notified and836(85.8%) had been notified at least6months ago of whom174(20.8%) were notified during January to June2008,234(28.0%) during July to December2007,242(28.9%) during January to June2007and186人(22.2%) were notified in2006. Of974participants,652(66.9%) were from Yunnan with322(49.4%) from Luxi and 330(50.6%) from Yingjiang,322(33.1%) were from Guangxi with164(50.9%) from Luzhai and158(49.1%) form Babu;553(56.8%) were male and421(43.2%) were female. The age ranged18to49years old with mean of32.5+7.2and medium of32years old.Of974participants,704(72.3%) had had sex behavior during the past months with623(88.5%) having regular sex partner,50(7.1%) having casual sex partner and31(4.4%) having both。1. Sexual behavior over different time period after being notified as seropositive.Data from between group comparison showed that70.5%of those who had been notified had had sex behavior during the past6months, which was significantly less than that (83.3%) of those who were newly notified. And among those who had had sex, the proportion of consistent condom use was higher and the proportion of precontemplation stage of condom use was lower by those who had been notified than who were newly notified. Of those who had been notified, the proportion of condom use with regular and casual partner when having sex last time were72.7%and66.7%and of those who were newly notified, the proportion were16.2%and22.2%respectively.Within group comparison showed that during6months before and after being notified, the proportion of those who had not had sex behavior was27.7%and30.5%and the proportion of those who had use condom consistently was13.6%and36.2%, while the proportion of those at the second and precontemplation stage of condom use decreased from48.6%and10.2%to26.6%and6.8%. Both difference and agreement of distribution of sexual risk behavior before and after being notified had achieved statistical significance.Among the groups over different time period after being notified, the difference of proportion of those who had had sex behavior had not achieved significant. However, the proportion of precontemplation stage of condom use reported by participants notified during January to June,2007was lower than by those notified in2006, which implied that there was some difference on sexual risk behavior over different time period after being notified.2. Associated factors 2.1personal characteristicsIt is found that sexual risk behavior reported by participants from Yunnan province was higher than those from Guangxi who had higher level of perceived HIV susceptibility. The difference of2provinces may be related to environmental factors or information bias. Condom use self efficacy was lower among females, so was the condom using behavior. The older age group reported lower proportion of sexual behavior. But age was not significantly related to condom using behavior. Those who had lived together with their sex partner(married of cohabitated) reported higher proportion of sexual behavior and condom use as well.Among those who had been notified, PLHA with education background of primary school reported more second stage of condom use than those with education of high school. The probability of have sex and consistent condom use were higher among those with larger income. The between group comparison showed that there was no significant difference on sexual risk behavior between those who were infected through injection drug use and through sexual risk behavior, but sexual risk behavior was higher among those transmitted trough other routes than through injection drug use. However, in consideration of small sample size of PLHA transmitted through other routes, it still need further evidence to determine the relationship between transmission route and sexual risk behavior. In addition, no statistically significant relation was found between drug of alcohol use and sexual risk behavior.Perceived HIV/AIDS severity, susceptibility, benefit and barrier of condom use, self efficacy and social norms may influence the stages of condom use directly or indirectly through other personal beliefs. The effect of perceived barriers was most significant, followed by HIV susceptibility, self efficacy and social norms. Perceived HIV severity and benefit only had little indirect effect on condom use. Level of perceived HIV susceptibility and benefit of condom use and social norms of AIDS patients was higher than asymptomatic HIV infections and perceived HIV severity, susceptibility and social norms was higher among those who was aware of HIV/AIDS knowledge, so the2groups said above inclined to use condom consistently. Besides, perceived HIV severity and barriers of condom use were higher and HIV susceptibility lower among those who had high level of negative emotion and sexual risk behavior as well.2.2sex partner and sexual behaviorIt is found that PLHA reported higher proportion of sexual risk behavior with HIV seropositives than with seronegatives. But no statistically significant difference of sexual risk behaviors was found between PLHA with seropositive partner and with partner of unknown serostatus. The probability of sexual risk behavior was lower between PLHA and their regular sex partner, especially those with longer relationship. PLHA who had casual sex partners inclined to report precontemplation stage of condom use. Also, those who had both types of sex partner reported more risk behavior than those who had only casual sex partners. Indepth interview showed that some PLHA who had regular sex partner seek to have unsafe sex with casual sex partners because of unwilling to use condom. Regular sex partners of most PLHA learn about their seropositive status but casual sex partners of most PLHA not. However, sex partner notification was not found be to significantly related to sexual risk behavior. Also, Sexual risk behavior was not related to types of sex partners. In addition, the proportion of consistent condom use was higher for those with less frequent sexual episode.2.3Family and social supportsConcerned about social discrimination, PLHA were not willing to disclosure seropositive status to others except those with whom they had intimate relationship. Seropositive status of78.7%of those who had been notified was learned by relatives and27.2%by others. And72.7%gained support and23.1%experienced discrimination. It is found that PLHA who had not gained supports reported higher proportion of precontemplation stage of sexual risk behaviors and experience of discrimination increased the risk of inconsistent condom use. In addition, PLHA who participated the group activities of PLHA reported lower proportion of precontemplation stage of condom use behavior and social economic support raised the proportion of have sex, but was not significantly associated with condom use.2.4Health care servicesIt is indicated that PLHA who got standardized HIV counseling and testing service reported higher proportion of consistent condom use. In this study, standardized HIV counseling and testing service was defined as informed consent and sufficient information provided before HIV testing and being notified by health care workers face to face privately and sufficient information provided after HIV tesing.The result of the interview showed that there were some problems with condom provided for free on the quality, function, style and casing as well, which decreased the acceptability. Besides, taking thought of social discrimination, some PLHA refused to accept free condom. Of those who had been notified as sero-positive,65.3%accepted free condom during the past6months. Moreover, PLHA who had accepted free condom reported higher proportion of having sex but lower proportion of sexual risk behaviors, which may because of the enhanced accessibility of condom through providing condom for free or the bias of selection and social desire.Data from this study showed that PLHA who got face to face communication service reported higher proportion of the second stage of condom using behavior and lower proportion of precomtemplation stage, which indicated that face to face communication help raise the intention of condom use but not use of condom consistently. The probability of sexual risk behavior was higher for those who acquired HIV related information through mass media and who participated HIV/AIDS awareness campaign, which may be the result of selection bias. Getting condom use information was not relate to the stage of condom use but with having sex behavior, which is related to more attention on condom use information for those who had had sex behavior.Among those who had been notified,58.9%(492/836) had accepted antiretroviral therapy (ART). The probability of maintenance stage of condom using behavior among those who had accepted ART was higher and the probability of precontemplation stage was lower. But data form multivariate analysis showed that relation between ART and sexual risk behavior had not achieved significance.ConclusionsAfter being notified as sero-positive, PLHA decreased their sexual risk behavior. Sexual risk behavior was determined comprehensively by factors at individual, sex partner, family and community level as well as health care services. It is suggested that HIV counseling and testing, notification of testing results and following up of PLHA be strengthened and improved; Intervention strategy should be tailor to different characteristics of PLHA and their stage of sexual risk behaviors and personal beliefs should be focused on; Family and community based awareness campaign should be carried out to reduce HIV related discrimination and promote social support for PLHA.