Background:  Research from the developed world suggests the introduction of ART results in decreased concern about HIV that leads to increases in risky sexual behavior. No studies have assessed sexual risk behaviors in Sub-Saharan Africa during the scale-up of ART and HIV treatment.

Methods:  A cross-sectional population-based study was conducted in Kisumu, Kenya. Participants were interviewed regarding attitudes and beliefs about ART and their sexual behaviors. Factor analyses of attitudes and beliefs about ART produced 2 factors:  perceptions that HIV is controllable since the increased availability of ART; and increased risk compensation because ART is available. Logistic regression was used to determine associations of these factors, as well as the belief that ART cures HIV, with sexual behavior, controlling for age.

Results:  Of 1833 people, 1655 (90%) contacted consented to participate in the study. The majority of participants (71% men and 70% women) had heard of ART. Of these, 20% of men and 29% of women believed ART cures HIV. Among women a perception that HIV is controllable was associated with sex with a non-spousal partner in the last 12 months (adjusted (A)OR 1.4, 95%CI 1.1 to 1.9), younger age at sexual debut (β = –0.09, p <0.05) and increased number of sexual partners in the last 12 months (β = 0.09, p <0.05) with no significant associations found among men. The belief that ART cures HIV was associated with younger age of sexual debut (β = –0.14, p <0.05) among women and an increased likelihood of exchanging sex for money or gifts (AOR = 1.9, 95%CI 1.1 to 3.2) and decreased likelihood of condom use at last sex (AOR = 0.4, 95%CI 0.2 to 0.8) among men. These findings were most significant for people aged 15 to 29 years. Women aged 15 to 24 who perceived HIV was controllable had a younger age of sexual debut (β = –0.14, p <0.05) as did women 25 to 29 who believed that ART cured HIV (β = –0.25, p <0.05). Men aged 15 to 24 who believed that ART cures HIV were more likely to not have used a condom at last sex (AOR = 0.3, 95%CI 0.1 to 0.8) and men 25 to 29 were more likely to have exchanged gifts for sex in the last 12 months (AOR = 3.9, 95%CI 1.2 to 13). Perceptions of increased risk compensation were not associated with sexual risk behavior.

Conclusions:  In high HIV seroprevalence populations with expanding access to ART, prevention programs must ensure their content counteracts misperceptions of ART in order to reduce risk high risk sexual behaviors, especially among youth.