Does antiretroviral therapy initiation increase sexual risk taking in Kenyan female sex workers? A retrospective case–control study

Abstract

Although antiretroviral therapy (ART) prolongs life and reduces infectiousness, in some contexts, it has been associated with increased sexual risk taking.

Design

Retrospective case–control study.

Setting

Nairobi-based dedicated female sex worker (FSW) clinic.

Participants

HIV-infected FSWs before and after ART initiation (n=62); HIV-infected and -uninfected control FSWs not starting ART during the same follow-up period (n=40).

Intervention

Initiation of ART.

Primary outcome measures

Self-reported condom use, client numbers and sexually transmitted infection incidence over the study period (before and after ART initiation in cases).

Results

Sexual risk-taking behaviour with casual clients did not increase after ART initiation; condom use increased and sexually transmitted infection incidence decreased in both cases and controls, likely due to successful cohort-wide HIV prevention efforts.

Conclusions

ART provision was not associated with increases in unsafe sex in this FSW population.