HIV transmission risk behavior among HIV-infected adults in Uganda: results of a nationally representative survey

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Abstract
Objective: Evaluate factors associated with HIV transmission risk behavior among HIV-infected adults in Uganda. Design: Cross-sectional and nationally representative study (2004–2005 Uganda HIV/AIDS Sero-Behavioral Survey) tested 18 525 adults (15–59 years old) for HIV and herpes simplex virus type 2 (HSV-2). Methods: Data were weighted to obtain nationally representative results. Sexual-risk behavior by HIV-infected individuals was defined as unprotected sex at last encounter. Using multivariate analysis, we identified factors associated with being sexually active, knowing HIV status, and using contraception and condoms. Results: Of 1092 HIV-infected respondents, 64% were female (median age was 33 years), 84% had HSV-2, and 13% reported one lifetime partner (1% of men and 23% of women). Twenty-one percent of adults knew their HIV status and 9% knew their partners'. Seventy-seven percent were sexually active, of whom 27% reported condom use at last sex. Of last unprotected sexual encounters, 84% were with spouses and 13% with steady partners. Of cohabitating persons, 40% had an HIV-negative spouse. Those who knew their HIV status were three times more likely to use a condom at last sex encounter [adjusted odds ratio (AOR), 3.0; 95% confidence intervals (CI), 1.9–4.7] and those who knew their partners' HIV status were 2.3 times more likely to use condoms (AOR, 2.3; 95% CI, 1.2–4.3). Conclusions: A minority of HIV-infected adults in Uganda knew they had HIV infection; nearly half were in an HIV-discordant relationship, and few used condoms. Knowledge of HIV status, both one's own and one's partner's, was associated with increased condom use. Interventions to support HIV-infected persons and their partners to be tested are urgently needed.