Marseille 2007
| Abstract #89 - Sexual prevention of HIV within the couple in Africa: Experience from a PMTCT program in Abidjan, Cote dIvoire, 2001-2005 | ||||
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Session: 25.6: Couples (Parallel) on Monday @ 16.30-18.30 in PR Chaired by Jose Catalan, Giovanna Meystre-Agustone Authors: Presenting Author: Mr Hermann Brou - ENSEA, Cote D'ivoire |
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| Additional Authors: Mr Grard Djohan, Mr Grard Allou, Dr Didier K. Ekouevi, Dr Renaud Becquet, Dr Valriane Leroy, Dr Annabel Desgres-du-Lu, The Ditrame Plus Study Group ANRS 1201-1202-1253, | ||||
| Aim: The prevention of sexual transmission of HIV within the couple involves HIV-testing for each couple member and the systematic use of condoms if one of the couple members is HIV-infected or until both couple members have been tested HIV-negative and have adopted safe sex practices. But in Africa, these simple principles are unfortunately rarely implemented. Indeed HIV-testing has remained till now infrequent in Africa and sexual relations with the regular partner are rarely protected. With the implementation of prevention of mother-to-child transmission of HIV (PMTCT) programmes in African countries, prenatal HIV counselling and testing is proposed to many pregnant women. For women who became aware of their HIV-status during pregnancy, the resumption of sexual activity after delivery becomes a key of the management of the risk of sexual HIV transmission within the couple. In this study, we investigate among these HIV-tested women consistent condom use during the resumption of sexual activity and its evolution over time. | ||||
| Method / Issue: Within the Ditrame Plus ANRS PMTCT project in Abidjan, 546 HIV-infected and 393 HIV-negative women were tested during pregnancy and followed-up for two years after delivery. During pre and post-test counselling and follow-up, all women were informed on Sexually Transmitted Infections (STIs) including HIV/AIDS and the using of condom. They were also offered free provision of condoms. During each follow-up visit, standardised questionnaires were administered to all women to document the disclosure of HIV status to the male partner, the resumption of sexual activity and frequency of condom use. We analysed consistent condom use during the two-year follow-up among women resuming sexual intercourse and according to womens HIV-status. | ||||
| Results / Comments: Most of HIV-negative women (96%) disclosed their HIV-test result to their partners compared to 46% of HIV-infected women (p<0.001). During the two-year follow-up period, most of HIV-negative women (93%) and HIV-infected women (84%) declared having had at least one sexual intercourse since delivery (p<0.001). The median duration of post-partum abstinence among HIV-infected women was 19 weeks [Inter-quartile range (IQR): 8 40] versus 17 weeks [IQR: 9 29] among HIV-negative women (p=0.75). Partners of HIV-infected women were more likely to be tested for HIV before resuming sexual activity than partners of HIV-negative women (11.7% versus 7.4%, p=0.04). Less than a third of women reported systematically using condoms during the resumption of sexual activity, without any difference between HIV-infected and HIV-negative women (p=0.39). During follow-up, proportions of HIV-infected women and HIV-negative women having consistently used condom were respectively 13.8% and 23.2% (p<0.01) at 6 months post-partum, 12.2% and 16.4% (p=0.12) at 12 months post-partum, 9.7% and 11.1%, (p=0.53) at 18 months post-partum. | ||||
| Discussion: After prenatal HIV-testing, women rarely applied the post-test advices they received in order to prevent sexual HIV transmission: male partners HIV-testing doesnt appear as a condition for resumption of sexual activity after delivery and few couples systematically use condoms. In addition, preventive sex behaviour seems to diminish over time. | ||||
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