Changes in sexual behaviour among HIV-infected women in west and east Africa in the first 24 months after delivery

Document Type



Obstetrics and Gynaecology (East Africa); Population Health (East Africa)


Objective: Describe changes in sexual behaviour and determinants of unsafe sex among HIV-infected women in the 24 months after delivery.

Design: Cohort analysis nested within a prevention of mother-to-child transmission trial in Burkina Faso (n = 339) and Kenya (n = 432).

Methods: Women were followed during pregnancy and until 12–24 months after delivery. At each visit, structured questionnaires were administered about sexual activity and condom use, and risk-reduction counselling and condoms were provided.

Results: At study entry, a median 2 months after HIV testing (interquartile range = 1–4), 411/770 (53.4%) of women reported partner disclosure, increasing to 284/392 (71.9%) at the final visit. Although most partners were supportive following disclosure, between 5 and 10% of disclosed women experienced hostile or unsupportive partner responses during follow-up visits. At each visit, about a third of sexually active women reported unsafe sex (unprotected sex with HIV-uninfected or unknown status partner). In multivariable logistic regression, unsafe sex was 1.70-fold more likely in Kenyan than in Burkinabe women [95% confidence interval (95% CI) = 1.14–2.54], and in those with less advanced HIV disease or aged 16–24 years. Compared with women who disclosed their status to partners and others, unsafe sex was over six-fold higher in nondisclosers (95% CI = 3.31–12.11), the effect size reducing with increasing disclosure.

Conclusion: HIV-infected women who recently delivered have a high potential for further HIV transmission, especially as HIV discordance is common in Africa. Longitudinal care for women, including positive-prevention interventions, is needed within new services providing antiretroviral prophylaxis during breastfeeding – this repeated interface with services could focus on reducing unsafe sex. Much remains unknown about how to facilitate beneficial disclosure.


This work was published before the author joined Aga Khan University.

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