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Background:  With availability of highly active antiviral therapy (HAART), preventive and protective sexual behavior of persons on ART is of special concern. A diagnostic study was undertaken in Pune and Delhi, India, to assess adherence to therapy and the sexual behavior of clients on ART.

Methods:  Using a cross-sectional study design, we interviewed 310 clients at 1 private- and 3 public-sector hospitals using a semistructured questionnaire designed for a 6-month recall reference period. Key themes of analysis included:  disclosure of HIV status, knowledge of partner’s HIV status, and condom use at last sex. We used univariate and bivariate analyses with χ² tests to assess significance.

Results:  We interviewed 261 men and 49 women, 61% of whom reported sex. More clients with higher baseline CD4 counts (70% with CD4 > 200 vs 53% with CD4 < 100/mm³; χ² 6.585, p = 037); less depression (69% with minimal vs 54% with severe depression; χ² 10.435, p = 0.015) and currently married patients (69% married, 33% single, 8% separated, χ² 42.402, p =0.000) reported sex. Most sexual activity was with regular partners (96%); 82% knew their partner’s HIV status, and 39% had HIV^– partners. Disclosure was lowest with partners of unknown HIV status (83% with HIV⁺ partners; 74% with HIV^– partners; 52% with partners of unknown status; χ² 11.690, p = 0.003) and lower baseline CD4 counts (64% with CD4 < 100 vs 74% with CD4 > 200/mm³; χ² 6.439, p = 0.040). Respondents reported 89% condom use at last sex. Condom use was higher with less depression (94% with mild vs 78% with moderate-severe depression; χ² 9.193, p = 0.002); higher education (93% with university education vs 65% with < 5 years of school; χ² 14.980, p = 0.001); negative partners (96% with HIV^– partners; 83% with HIV⁺ partners; 87% with partners of unknown status; χ² 5.947, p = 0 051) and 4-day self-reported adherence > 90% (92% with > 90% vs 72% with < 90%; χ² 10.235, p = 0.001). Respondents reported 80% consistent condom use. 3% reported sex with casual partners and 1% with sex workers. All respondents were male; and did not disclose their HIV status but reported using a condom at last sex.

Conclusions:  While most subjects reported sexual activity is with regular partners with high condom use at last sex, consistent condom use is low. Lower levels of disclosure and condom use are reported with partners of unknown status. Results indicate the need for interventions directed at regular partner relationships to encourage disclosure of HIV status and consistent condom use, with special focus on patients with less education, depression, and lower adherence.

Keywords: sexual risk behaviour; antiretroviral therapy; condom use