Male condom use among HIV sero-discordant couples, both where the HIV+ partner is on and not on ART in TASO Jinja, Uganda
M.H. Ngolobe1, S. Alinga2, J. Birungi3, S. Khanakwa4, A. Shen5, R. Mwesigwa6, K. Muldoon7, D. Moore8, S. Kate7,8
1The AIDS Support Organization (TASO), CAPTN, Kampala, Uganda, 2The AIDS Support Organisation (TASO), Medical, Kampala, Uganda, 3The AIDS Support Organisation (TASO), Research, Kampala, Uganda, 4The AIDS Support Organization (TASO) Uganda Ltd, Advocacy, Kampala, Uganda, 5BC Centre for Excellence in HIV/ AIDS, Data, Kampala, Uganda, 6The AIDS Support Organisation (TASO) Uganda Limited, PSI, Kampala, Uganda, 7University of British Colombia, Vancouver, Canada, 8British Columbia Center for Excellence in HIV/AIDS, Vancouver, Canada
Background: HIV serodiscordant couples are among the most at-risk for HIV transmission in sub-Saharan Africa. As such, we need to evaluate risky sexual patterns and ART use as HIV prevention among HIV sero-discordant couples.
Methods: In a prospective cohort of 246 HIV sero-discordant couples enrolled at TASO Jinja, participants completed baseline interview questionnaires. Participants were ≥18 years, in a stable relationship (>6months) and were sexually active. We compared condom use at last sex among male participants, both where the HIV+ index was on/not on ART
Results: In bivariate analyses, 54% (n=96) of the HIV+ index participants were male and 85 (48%) on ART. Older age (years) of both men (median age=44, [IQR: 39-50] vs 40 [33-47]) and their female partners (median age=41 [IQR: 36-48] vs 37 [IQR: 30-43]) were associated with male condom use at last sex, as was higher median age of sexual debut among men (18 [IQR: 16-19] vs 17 [IQR: 15-18] p=0.014). Contraceptive usage by female partner (IUD, injection and oral) was associated with reduced male condom use (8% vs 17%, OR=0.41 95%CI: 0.18-0.93) HIV+ men were marginally more likely to use a condom at last sex (61% Vs 39% p = 0.094) than HIV negative men with HIV+ female partners. A lower CD4 cell count (median=53 cells/µL [IQR:33 - 106] vs. 200 cells/µL [99 - 308], p = 0.070) and recent initiation of ART use within the last l2months (p=0.073) were marginally associated with male condom use.
Conclusions: The results highlight the need to implement HIV interventions for boys and young couples. Contraceptive usage in reducing male condom use underscores the need to integrate and scale up reproductive health programs within HIV care. While continued longitudinal evaluation is needed, it supports evidence of early ART initiation in promoting increased male condom use for prevention.
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