ABSTRACT
An increasing trend in sexual risk behavior has occurred in the era of antiretroviral therapy (ART) in Thailand. This study was conducted to identify sexual risk behavior and examine relationships between unprotected sex and CD4 levels among HIV-infected patients receiving ART in the National Antiretroviral Program. A cross-sectional survey was conducted in 460 HIV-infected patients age 18-49 years who visited the out-patient clinic of Bamrasnaradura Infectious Diseases Institute in February 2006 by using a standardized self-administered questionnaire. The results show that 60.4% of participants were men. The median most recent CD4 cell count during the prior 6 months was 261 cells/mm3. Twenty-three percent of the participants who had no sexual activity after they knew their HIV positive status started having sex again after receiving ART with a 12-week median duration period from starting ART to having first sex. There was a significant difference between the number of those having sexual activity before and after starting ART (p-value=0.013). Fifty-six percent of participants had sex during the previous 6 months. Of these, 26.5% had sex with commercial partners and 28.4% with non-regular partners. Inconsistent condom use, with commercial partners or non-regular partners, in females (35.3-36.8%) was higher than in males (7.8-11.1%). Participants with a known HIV-negative regular partner were 0.25 times more likely to have unprotected sex than those with a known HIV-positive regular partner (adjusted OR, 0.25; 95%CI, 0.09-0.73). No association between unprotected sex and CD4 levels was found. The findings support the need for reinforcing risk reduction programs among HIV-infected persons, particularly couple counseling, and promoting awareness of risk of acquirring sexually transmitted infections and drug-resistant strains of HIV.