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Session 115 Poster Abstracts
Risk Behavior
Tuesday, 1:30 - 3:30 pm
Poster Hall


847    
Association between Unprotected Sex and Antiretroviral Use and Adherence in HIV Clinic Patients
C Diamond*1, J L Richardson2, J Milam2, S Stoyanoff2, J A McCutchan3, C Kemper4, R A Larsen2, H Hollander5, P Weismuller6, R Bolan2, and The California Collaborative Treatment Group
1Univ. of California, Irvine, USA; 2Univ. of Southern California, Los Angeles, USA; 3Univ. of California, San Diego, USA; 4Santa Clara Valley Med. Ctr., San Jose, CA, USA; 5Univ. of California, San Francisco, USA; and 6Orange County Hlth. Care Agency, Santa Ana, CA, USA

Background:  We wanted to determine the relationship between unprotected sex and antiretroviral use and adherence.

Methods:  This was a cross-sectional survey conducted in 1998 to 1999 in 874 randomly selected, sexually active patients at 6 public HIV clinics in California. Patients completed a standardized interview regarding sociodemographics, HIV-related characteristics, sexual behavior, use of illicit drugs or alcohol, depression and health beliefs, experience with the medical system, and antiretroviral use and adherence. We defined unprotected sex as anal or vaginal sex without a condom over the past 3 months.

Results:  The majority of patients (79%) took antiretrovirals. One third reported having unprotected sex and one quarter reported <95% adherence to antiretroviral therapy. Antiretroviral use was associated with decreased odds of unprotected sex, OR 0.5 (95%CI:  0.4 to 0.7, p <0.001); this negative relationship persisted in most stratified analyses, but was not significant in multivariate analysis, OR 0.8 (95%CI:  0.5 to 1.1, p = 0.19). HIV RNA status, marijuana use, and site and duration of clinic attendance confounded the relationship between unprotected sex and antiretroviral therapy in multivariate analysis; an undetectable viral load was associated with decreased odds of unprotected sex, OR 0.7 (95%CI:  0.5 to 1.0, p = 0.03). Adherence to antiretroviral therapy of ≥95% was associated with decreased odds of unprotected sex, OR 0.6 (95%CI:  0.4 to 0.8, p = 0.001); this negative relationship persisted in most stratified analyses but was not significant in multivariate analysis, OR 0.8 (95%CI:  0.5 to 1.2, p = 0.22). Number of sexual partners and amphetamine use confounded the relationship between antiretroviral adherence and unprotected sex in multivariate analysis. Of this group 7% (n = 57) of patients agreed with a statement that a low viral load would protect against HIV transmission and these patients had higher rates of unprotected sex than patients who disagreed with the statement. However, even among these 57 patients, those taking antiretrovirals still reported less unprotected sex than those who were not taking antiretrovirals (39% vs 63%, p = 0.22); similarly, those were ≥95% adherent with antiretroviral therapy were less likely to have unprotected sex than those were less adherent (31% vs 70%, p = 0.03).

Conclusions:  Use of and better adherence to antiretroviral therapy are associated with decreased unprotected sex but multiple factors confound these relationships.

 

Keywords: Antiretroviral Therapy; Adherence; Sexual Behavior