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Sex Transm Dis. 2018 Apr 5. doi: 10.1097/OLQ.0000000000000847. [Epub ahead of print]

Sexual behaviors of HIV-infected pregnant women and factors associated with sexual transmitted infection in South Africa.

Author information

Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
Division of Infectious Disease, David Geffen School of Medicine, UCLA, Los Angeles, CA.
Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA.
Anova Health Institute, Johannesburg, South Africa.
Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Research Unit, Foundation for Professional Development, Pretoria, South Africa.



Sexual behaviors in HIV-infected pregnant women in South Africa are not well understood.


HIV-infected pregnant women were recruited into a prospective cohort at first antenatal care visit. Sociodemographic information and self-collected vulvovaginal swab samples were collected from participants. Vulvovaginal swab samples were tested for Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG) and Trichomonas vaginalis (TV) using GeneXpert®. We investigated sexual behaviors, alcohol use and factors associated with condomless sex during pregnancy and prevalent sexually transmitted infection (STI) among our cohort. We report descriptive, univariate and multivariable logistic regression results of sexual behaviors and alcohol use, factors associated with condomless sex at last sex, and having any STI during pregnancy adjusting for a priori confounders.


We recruited and enrolled 430 HIV-infected pregnant women. Median age was 30-years; median gestational age was 20-weeks. 89% of women reported sex during pregnancy. At last sex, 68% reported condomless sex; 18% reported having >1 sex partner in the past 12-months. Adjusting for age, income and relationship status, condom use at last sex was associated with prior knowledge of HIV status (aOR=2.46;95%CI=1.54-3.92) and being in a concordant HIV-positive (aOR=3.17;95%CI=1.84-5.50), or serodiscordant relationship (aOR=6.50;95%CI=3.59-11.80). The prevalence of any STI was 41% (95%CI=36%-45%). Adjusting for mothers' age and employment, odds of having a STI increased if the woman reported alcohol use during pregnancy (aOR=1.96;95%CI=1.06-3.64) or if the father of the child was a non-cohabiting or casual partner (aOR=1.42;95%CI=0.97-2.03).


Almost all HIV-infected pregnant women were sexually active during pregnancy and most women reported condomless sex at last sex. Condom use was associated with knowledge of serostatus and/or partner's serostatus before first ANC visit. Factors associated with having a STIs included: alcohol use during pregnancy and father of child being a non-cohabiting partner.

[Available on 2019-10-05]

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