Meta-analysis of the Effect of Antiretroviral Therapy on Sexual Risk Behavior - Case Study Example

Introduction and Background Information Human Immunodefiency Virus, or HIV is a pandemic and has affected all countries in the world irrespective of their development status. Thus, Sub-Sahara region of Africa is also inflicted with this pandemic. According to the 2008 statistics, "22.4 million adults and children were living with HIV in sub-Saharan Africa at the end of 2008. During that year, an estimated 1.4 million Africans died from AIDS. Around 14.1 million children have lost one or both parents to the epidemic, and in 2008 an estimated 1.8 million children were living with HIV" (Sub-Saharan Africa HIV and AIDS statistics, 2009). Several medicines have been developed to decrease the viral load in the patient, thereby increasing life span of the patients and and decreasing the risk of opportunistic infections. However, so far, neither an effective cure, not an useful vaccine has been developed due to the complexities involved in the structure and pathophysiology of the disease (Steven et al 2006). Thus, the only hope of treatment for those contracted with HIV infection remains pharmacotherapy to decrease the viral load in the blood. Due to these reasons, preventive strategies have become very important in the management of HIV pandemic world wide. However, despite rampant education and preventive startegies, both by public health authorities, governments and private organizations, the rise of incidence of HIV continues, all over the world, including Sub-Saharan African region. One of the main reasons for transmission of the virus is increase in risky sexual behaviour and practices by HIV-positive patients. Previously, before the advent of effective anti-retroviral therapy or ART, HIV infection led to rapid development of opportunistic infections, ultimately leading to Acquired Immunodeficiency Syndrome and Death. Thus, those contracted with the disease were weak and depressed with lack of libido and decreased sexual activity. However, the advent of ART, especially the Highly Active ART, also known as HAART, has improved the health of HIV patients, leading to increased libido and increased unsafe sexual activities. The more the rise in unsafe sexual activities, the more chances that the virus is transmitted to others. As such the most common mode of transmission of HIV infection is through risky sexual practices like multiple sex partners, unprotected sexual intercourse, and needle sharing amongst intravenous drug users (CDC 2008). Access to anti-retroviral therapy has advanced not only in developed countries (palella et al, 1998 and Detels et al, 1998), but also in developing and underdeveloped countries like Africa, thereby increasing the survival chances and quality of life in HIV positive patients residing even in these countries. However, the bad news is that these growing numbers of HIV positive people is a threat to non-HIV positive people, because theu are a potential source of transmission and also a source of development of drug-resistant viruses. Many researchers are of the opinion that improvement in the state of health of people on ART can increase their sexual desire and in turn lead to increased sexual behaviour and activity, including practice of unsafe sex not only with HIV positive individuals, but also with non-HIV positive people. One of the main reasons for such a behaviour is perception that HIV is a manageable chronic illness and since the load of viruses decreases with onset of ART, the chances of transmission of the virus also decreases (Lutchers et al, 2007). As discussed above, advances in anti-retroviral therapy have brought out highly active anti-retroviral therapies, commonly known as HAART, which include protease inhibitors. HAART is very effective and decreases the loads of HIV virus in the blood to undetectable levels, thus decreasing the incidence and prevalence of opportunistic infections in HIV patients and thereby improving the quality of life and prolonging life span (Deeks et al, 1997). However, recent research in the behaviour of HIV-patients on anti-retroviral therapy has raised concerns about the increase in sexual activity and behaviour in the patients, which are detrimental not only to the health of the partner, but also to the society, because of rampant scope for spread of the virus. Several studies conducted in the developed countries have shown increase in the risky sexual behaviours on the part of patients after initiation of ART. Although, an equal number of studies have disputed such an inference and have pointed that such an impression is wrong and can lead to improper treatment practices from the clinicians and public health personnel. Some others argue that though the perception of decreased viral transmission and simultaneous improvement in health can lead to increased unsafe sexual desire and activity, proper counseling of the patients and their partners can prevent unsafe practices and spread of virus. Bouhnik et al (2002) conducted a longitudinal analysis to examine the impact of HAART on the sex-related behaviour of HIV infected patients. The specific population they studied were injection drug users or IDU, who were participants of the MANIF 2000 study. 188 HIV IDU were studied and from the results of the study it was evident that increase in unsafe sexual behaviour after institution of HAART is not a concern. However, this study was conducted on IV drug abusers and the results cannot be generalized to other HIV patients, who contracted the disease due to sexual behaviour. According to a study by Lutchers et al (2007), unsafe sex among HIV positive patients in Kenya was associated with "nondisclosure of HIV status to partner, recent HIV diagnosis, not being married or cohabitating, stigma, depression and body mass index Read More