Abstract

Objectives: Data from generalized epidemic settings have consistently found that
patients on antiretroviral therapy (ART) reduce sexual risk behaviours, but how sexual
behaviour changes in the general population in response to ART availability, including
amongst HIV-uninfected and undiagnosed adults, has not been characterized in these
settings.
Design: General population open cohort.
Methods: We report trends in sexual behaviour indicators for men aged 17–54 years
and women aged 17–49 years in rural KwaZulu-Natal province, based on annual
sexual behaviour surveys during ART scale-up from 2005 to 2011. Estimates are
adjusted for survey nonparticipation and nonresponse to individual survey items using
inverse probability weighting and multiple imputation. Trends are presented by HIV
status, knowledge of status, age and marital status.
Results: Reports of condom use at last sex with a regular partner increased by 2.6%
points per year [95% confidence interval (CI) 1.5%, 3.7%] for men and 4.1% per year
(3.0%, 5.3%) for women. Condom use at last sex with a casual partner was high and did
not change significantly over the period for both sexes. There were statistically
significant declines in the percentage reporting multiple partnerships in the last year
and the point prevalence of concurrency. Trends within subgroups were generally
consistent with overall estimates.
Conclusion: We find no evidence of increased sexual risk-taking following ART
availability and protective changes in some behaviours, suggesting that general trends
in sexual behaviour are not counter-acting preventive effects of HIV treatment.
Continued monitoring of population-level sexual behaviour indicators will be essential
to interpret the success of combination-prevention programmes.