McGrath, N., Eaton, J.W., Bärnighausen, T.W., et al. AIDS (July 2013). E-publication ahead of print.
Using annual surveillance data in KwaZulu-Natal, South Africa, the authors analyzed population-level trends in reported sexual behavior among men (aged 17-54) and women (aged 17-49) during the rollout of antiretroviral therapy (ART) from 2005 to 2011. They found no evidence of increased risky sexual behavior during this period. Further, after adjusting for missing data, trends indicated some evidence of reductions in reported risky sexual behaviors, e.g., reported reductions in the number of multiple and concurrent sexual partnerships. Knowledge of HIV status increased, especially among women. Condom use at last sex with a regular partner increased significantly (by nearly 3 percentage points and 4 percentage points per year among men and women, respectively); the average proportion of men and women reporting this behavior in 2005 (26 percent) increased to an average of 49 percent in 2011. Condom use at last sex with casual partners did not increase significantly, but condom use with these partners was already relatively high. Condom use was highest at younger ages and lowest among married persons. There are still opportunities to promote HIV testing and counseling and informed use of condoms. The authors concluded that continued monitoring of population-level sexual behavior is needed to further assess the effectiveness of combination prevention programs and the long-term impact of ART on risky sexual behavior.