Behaviour
Prevalence of unsafe sex with ones steady partner
1
INSERM, U912 (SE4S),
Marseille, France
2
Universite Aix Marseille, IRD,
UMR-S912, Marseille, France
3
ORS PACA, Observatoire
Regional de la Sante Provence
Alpes Cote dAzur, Marseille,
France
4
Socio-anthropological Research
Institute (IRSA), Catholic
University of Central African
States, Yaounde, Cameroon
5
Ministry of Public
HealthdCentral Hospital,
Yaounde, Cameroon
Correspondence to
Fabienne Marcellin, INSERM
UMR912/ORS PACA, 23 rue
Stanislas Torrents, Marseille
13006, France;
fabienne.marcellin@inserm.fr
Accepted 4 September 2009
148
either HIV-negative or of unknown HIV status
and associated determinants in Cameroon (EVAL
ANRS12-116 survey)
Assata Dia,1,2,3 Fabienne Marcellin,1,2,3 Renee-Cecile Bonono,4 Sylvie Boyer,1,2,3
Anne-Deborah Bouhnik,1,2,3 Camelia Protopopescu,1,2,3 Sinata Koulla-Shiro,5
Maria Patrizia Carrieri,1,2,3 Claude Abe,4 Bruno Spire,1,2,3 the EVAL Study Group
ABSTRACT
Objective Our study aimed at estimating the prevalence
of inconsistent condom use and at identifying its
determinants in steady partnerships among people living
with HIV/AIDS (PLWHA) in Cameroon.
Methods Analyses were based on data collected during
the national cross-sectional multicentre survey EVAL
(ANRS 12-116), which was conducted in Cameroon
between September 2006 and March 2007 among 3151
adult PLWHA diagnosed HIV-positive for at least
3 months. The study population consisted of the 907
survey participants who reported sexual activity during
the previous 3 months, with a steady partner either HIV-
negative or of unknown HIV status. Logistic regression
was used to identify factors associated with individuals
report of inconsistent condom use during the previous
3 months.
Results Inconsistent condom use was reported by
35.3% of sexually active PLWHA. In a multivariate
analysis adjusted for socio-demographic characteristics,
not receiving antiretroviral therapy (OR (95% CI): 2.28
(1.64 to 3.18)) was independently associated with
inconsistent condom use.
Conclusions The prevalence of unsafe sex remains high
among sexually active PLWHA in Cameroon. Treatment
with antiretroviral therapy is identified as a factor
associated with safer sex, which further encourages the
continuation of the national policy for increasing access
to HIV treatment and care, and underlines the need to
develop counselling strategies for all patients.
INTRODUCTION
HIV transmission through unsafe heterosexual
intercourse remains predominant in Sub-Saharan
Africa. However, socio-economic determinants of
inconsistent condom use among people living
with HIV and AIDS (PLWHA) in this region
have been rarely studied using representative
samples, and never in the context of a large
scaling-up programme.1e4 Moreover, the degree of
impact of access to ART on sexual behaviours in
developing countries still remains a matter of
debate.1 5e8 In 2006, a cross-sectional survey was
conducted on a representative sample of PLWHA
attending HIV-treatment centres in Cameroon,
which is among those western and central African
countries most affected by the AIDS epidemic.9
This survey was set up in the context of the
national programme for improving access to ART
through the decentralisation of HIV care. On the
basis of data collected, we aimed at determining
factors associated with PLWHAs report of incon-
sistent condom use with their steady partner either
HIV-negative or of unknown HIV status during the
previous 3 months.
PATIENTS AND METHODS
Study setting
According to the WHO Report on the global AIDS
epidemic,9 500 000 adults were living with HIV in
Cameroon in 2007. The national cross-sectional
survey EVAL (ANRS 12-116) was conducted in
Cameroon between September 2006 and March
2007 among a random sample of HIV-infected
individuals aged 21 or older and diagnosed HIV-
positive for at least 3 months, followed up in 27
HIV-treatment centres located in six provinces
around the country. The complete design of the
EVAL survey is detailed elsewhere.10
Sample size and study population
The survey was presented to 3488 eligible patients
attending healthcare structures, among whom 3170
(91%) agreed to participate, and 3151 effectively
completed the survey.
We focused our analysis on patients who
reported sexual activity in a regular partnership
during the 3 months prior to the survey, with
a steady partner who was either HIV-negative or of
unknown HIV status (study population).
Data collection and definition of variables
Socio-economic and psychosocial data (including
condom use) were collected using face-to-face
interviews with patients. Clinical data were
obtained from medical records. The survey also
involved a qualitative research section.
Definition of inconsistent condom use
As the pattern of factors associated with unsafe sex
may be different in regular and in casual partner-
ships, analysis was restricted to condom use with
the steady partner. Inconsistent condom use was
dened as reporting to have used condoms almost
always, sometimes or never with ones steady
Sex Transm Infect 2010;86:148e154. doi:10.1136/sti.2008.035147