Determinants of Risky Sexual Behaviors Among Patients Living with HIV in a Low-Income Environment

Background: High risk sexual practices among people living with HIV is a crucial public health issue due to increasing HIV incidence. This study describes factors that could be attributed to risky sexual behaviors among people living with HIV Methods: Self-reported patient characteristics were collected using a mobile-based data collection method from the HIV clinic in Dodoma, Tanzania. Risky sexual behavior was defined by the patient\u27s use of condoms during sexual intercourse. SAS 9.4 was used for all statistical analysis. Test of association was conducted between the use of condom and the patient\u27s characteristics using a univariate analysis. Significant associations were determined at p\u3c0.05. Multivariate analysis was further conducted to determine the factors that impacted risky sexual behavior among the study population. Results: 561 patients were interviewed in the HIV clinic with an average income per month of 126,000tsh (57USD). 56% (315) were sexually active of which 82% (257) used condoms during sexual intercourse. 76% (44) of the patients who do not use condoms earned less than 120,000tsh (54USD) and 83% (48) of the patients who did not use condoms were urban dwellers. 26% (15) of non-condom users reported more than 1 sexual partner and 33% (19) of the non-condom users had their first sexual intercourse at age less than 18 years. In a multiple logistic regression, condom use was 5.5 times more likely in patients who had HIV for 6-9 years when compared to patients who have had HIV for less than 3 years (95% C.I. 1.8-17.0). Homemakers living with HIV were less likely to use condoms when compared to regular workers (OR=0.0065, 95% CI: 0.01-0.6). Conclusion: The dangers of risky sexual behaviors based on condom use are perceived more in patients who were recently diagnosed. The conditions surrounding the non-use of condoms in HIV positive patients deserves a more global approach, including understanding access to condoms, the availability and cost on set incomes, and the power imbalances that may be at play for women without a regular job beyond access issues and this should be considered for future studies. Also, the early age of first intercourse may be best collected by determining if this was an early childhood sexual abuse with life-long exposure, or later teen onset up to the age of 18 years in order to understand the characteristics of patients who had their first sexual intercourse at age less than 18 years old