Effects Of Antiviral Therapy On High Risk Behaviors Among HIV-positive Methadone Maintenance Treatment Clients In China

ObjectivesTo understand whether there is a difference in risky sexual behavior and drug use among the HIV-positive patients undergoing ART(ART-experienced) and patients not undergoing ART(ART-na?ve) attending MMT; to analysis the potential factors associated with drug use and risky sexual behaviors during the last three months; to explore whether the ART initiation will lead to changes in high-risk behavior and the reasons for the changes / no change.MethodsThe combination of quantitative research and qualitative research methods were adopted. The quantitative research was conducted with a cross-sectional study of HIVinfected who were ART-experienced or ART-na?ve in 5 MMT clinics in Yunnan Honghe and Dehong Prefectures. A questionnaire was designed to collect socio-demographic characteristics and sexual and drug use behaviors within 3months before the investigation. Differences in sexual behavior and drug use between the ART-experienced and ART-na?ve respondents were assessed with χ2 tests. Logistic regression analyses were conducted to identify predictors for drug use and risky sexual behaviors. Individual in-depth interviews were conducted among 34 MMT clients who are undergoing ART to explore the reasons for the changes/ no change of high risk behaviors in terms of the ART initiation. The record data were transcribed to words and then were coded, inducted and analysed according to the keywords.Result1. Results of the quantitative research:Among 342 respondents, 328 met our inclusion criteria, 202 were ART-experienced and 126 were ART-na?ve. Their average age was 39.2±6.8 years. Most were male(77.1%), Han nationality(75.0%), and having an education background of junior high school or below(77.4%). In terms of the ART-related attitudes and beliefs, more respondents in the ART- experienced group agree that “It’s not safe to have sex without condoms regardless the viral load.” Of the 328 respondents, there was no significant difference by the ART status on the aspects of “having a history of sexual intercourse” “having a casual sexual partner” ”having more than 1 sexual partner.”176 respondents had a sexual partner in last three months, there was no significant difference between two groups(ART- experienced: 109(54.0%) vs ART –na?ve: 67(53.2%)). 152 people reported a history of sexual intercourse(sexually active) with their regular partner in the 3 months prior to the interview and the differences was not significant in the two groups. Respondents in the ART- experienced group more likely to inform their HIV–infection status to their regular partner(94.5%(103/109)vs82.1%(55/67)). ART-experienced respondents were less likely to report unprotected sex with their main partners than ART-na?ve respondents(54.1%), while their regular partners’ HIV – infection status were the same. Among those who were sexually active, there was no difference about STDs by ART status, but the ART-na?ve group(54.1%) was more likely to reported having unprotected sex(UPS) with their regular partners in the prior 3 months than the ART-experienced group(31.1%)(χ2=7.979,p=0.005).Multiple logistic regression analysis revealed that being younger than 35 years old(OR=3.6,95%CI:1.2~10.4),having a fertility desire(OR=4.5,95%CI:1.5~13.5), the regular partner was HIV-positive( OR=4.6, 95%CI:1.8~11.9), length of MMT attendance< 5 years(OR=2.9,95%CI:1.1~7.5)are risk factors for UPS in last three months, agree that it is not safe to have sex without condoms regardless the viral load is the protective factor.The ratios of self-reported drug use, injecting drug use, club drug use, urine test positive were lower than those in the ART- na?ve group without exception(37.1% vs 60.3%, 26.2% vs 38.1%, 28.7% vs 54.0%, 10.9% vs 19.8%).ART-na?ve group(73.0%, 97/206) was more likely to use drugs in the prior 3 months than the ART-experienced group(48.0%, 92/126). All the respondents reported that they never share needles(or cotton, needle washing water and vessel) with others during the last three months. In addition, more people in the ART –na?ve group(64.3%) had an experience of miss a methadone dose than the ART- experienced group(31.7%).Multiple logistic regression analysis revealed that being han nationality(OR=0.5,95%CI:0.2~0.9),feeling good health(OR = 0.4, 95% CI: 0.2 ~ 0.8), being rolled in ART(OR=0.3,95%CI:0.2~0.6) are protective factors for drug use in last three months, confirmed infection time between 5 and 8 years(OR=2.3,95%CI:1.2~4.2),having contact with drug using friends(OR=4.4,95%CI:2.3~8.3), having experience of missing an MMT dose(OR=3.5,95%CI:1.9~6.3), and not satisfaction with current MMT dose(OR=13.9,95%CI:3.2~59.9)are risk factors for drug use during last three months.2. Results of qualitative study:A total of 34 HIV-positive MMT clients who are also taking ART received the in-depth interview. 24 interviewees were male, the average age was 38.5(27-51)years old, the majority were han nationality. 16 interviewees were married, 3 interviewees werecohabitated but unmarried, 9 were unmarried and single, 6 were divorced or widowed. Interviewees who have junior middle school degrees or below accounted for 76.5%(26/34). Most of them reported that their possible infected routes were sharing needles with others or heterosexual transmission. The HIV confirmed infected time were from 2 to 17 years, the time enrolled in ART were 6 months to 9 years. After attending ART, part of the interviewees’ sexual partners numbers and sex frequency increased, the main reason was physical status improved, the main reason for decreased was taking ART medicine affected their mood.19 interviewees had sex experiences before and after taking participant in ART, 11 cases increased their condom use frequency to avoid STD and cross infection. More than 1/6 interviewees didn’t insist on 100% condom use for the reason that they were afraid to expose their infection status, or considered that there is no need to use condom between positive couples, or the condom would affect the pleasant sensation,or they hadn’t taken activities organized by ART doctor. Only 9 cases made it clear that it was necessary to use a condom with an undetectable viral load.Part of interviewees decreased their drug use frequency after attending ART for the reason that they paid more attention to physical health, and rediscover hope in life, and their mood improved. About a third of interviewees still use drugs occasionally, the major causes were psychological dependence, friends’ invitation, emptiness without job. All of them indicated that they didn’t share needles with others now. 15 interviewees thought that ART medication would dilute the methadone, when the methadone dose was not enough, part of them would reuse heroin, others may choose to increase the methadone dose.ConclusionART was not associated with risky sexual behavior and drug use in the prior 3 months in this population. While there are still many people have unprotected sex with regular partners and use of drugs. These suggest that we should expand the ART coverage, and we also need pay attention to the potential issues caused by the ART, provide continuing even strengthening interventions, encourage safer sex to prevent spread HIV and STDS to avoid crossing infection and drug-resistant strains, reduce drug use.