Public Health Policy and Practice

Study objective: This study examined the impact of highly active antiretroviral therapies (HAART) on sexual risk behaviours of HIV infected injecting drug users (IDUs) included in the French MANIF 2000 cohort study. Design: Longitudinal analysis including baseline and last follow up characteristics using generalised estimating equations (GEE). Setting: Hospital departments for specialist AIDS care in south eastern France and inner suburbs of Paris. Patients: All patients antiretrovial treatment naive, who reported being sexually active at enrolment, and who had at least one follow up visit in the cohort between October 1996 and May 1998 (n=188). Main results: Of the 188 HIV infected IDUs who were antiretroviral treatment naive at enrolment, 34 were prescribed HAART during follow up. Proportion of patients who reported at least one episode of unprotected sexual intercourse in the previous six months only significantly decreased in the HAART treated group (from 47.1% to 23.5%, p=0.008, compared with 43.5% to 35.7% in the rest of the sample, p=0.10). GEE multivariate model confirmed that prescription of HAART was associated with reduced sexual risk. Conclusions: The concern that HAART might result in clinical improvement leading to resumption of high risk activities that could inadvertently result in HIV transmission was not supported by these data. Reasons for further reductions in HIV risk with taking HAART remain to be clarified.