Impact of HIV Treatment on Risk Behavior

Antiretroviral Therapy (ART) has revolutionized HIV treatment. ART, which now includes a wide range of selfand clinically administered medications, can significantly improve the physical health and quality of life for people living with HIV by reducing the level of the virus in their bodies. However, as access to and availability of ART increases globally, there are questions about how access to HIV treatment might affect sexual behavior. Improvements in health and life expectancy of HIV-infected people may lead to a belief that HIV is no longer a serious and deadly disease, or that people living with HIV are no longer infectious. In addition, improvements in physical health may enable individuals to resume sexual activity, including unsafe sex. People may also experience “safer sex burnout” and exhibit difficulty sustaining safer sex behavior over their lifetime. These issues have commonly been referred to as treatment optimism or behavioral disinhibition. Conversely, HIV-infected individuals who have more contact with health systems to receive ART and possibly increased access to support systems may be encouraged to both enact and maintain positive changes in their sexual risk behavior. Effect of Treatment on Risk Behaviors The systematic review by Kennedy et al.1 assessed the impact of access to treatment on risk behaviors in developing countries.2-4 Four outcomes were evaluated in three studies: sexual abstinence, frequency of sexual intercourse, condom use, and type of partner.