No effect of test and treat on sexual behaviours at population level in rural South Africa

AIDS. 2019 Mar 15;33(4):709-722. doi: 10.1097/QAD.0000000000002104.


Context: Within the community-randomized ANRS 12249 Treatment-as-Prevention trial conducted in rural South Africa, we analysed sexual behaviours stratified by sex over time, comparing immediate antiretroviral therapy irrespective of CD4+ cell count vs. CD4+-guided antiretroviral therapy (start at CD4+ cell count > 350 cells/μl then >500 cells/μl) arms.

Methods: As part of the 6-monthly home-based trial rounds, a sexual behaviour individual questionnaire was administered to all residents at least 16 years. We considered seven indicators: sexual intercourse in the past month; at least one regular sexual partner in the past 6 months; at least one casual sexual partner in the past 6 months and more than one sexual partner in the past 6 months; condom use at last sex (CLS) with regular partner, CLS with casual partner, and point prevalence estimate of concurrency. We conducted repeated cross-sectional analyses, stratified by sex. Generalized Estimating Equations models were used, including trial arm, trial time, calendar time and interaction between trial arm and trial time.

Results: CLS with regular partner varied between 29-51% and 23-46% for men and women, respectively, with significantly lower odds among women in the control vs. intervention arm by trial end (P < 0.001). CLS with casual partner among men showed a significant interaction between arm and trial round, with no consistent pattern. Women declared more than one partner in the past 6 months in less than 1% of individual questionnaires; among men, rates varied between 5-12%, and odds significantly and continuously declined between calendar rounds 1 and 7 [odds ratio = 4.2 (3.24-5.45)].

Conclusion: Universal Test and Treat was not associated with increased sexual risk behaviours.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Retroviral Agents / therapeutic use*
  • Cross-Sectional Studies
  • Disease Management*
  • Disease Transmission, Infectious / prevention & control*
  • Female
  • HIV Infections / diagnosis
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology
  • HIV Infections / prevention & control*
  • Health Policy
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Risk-Taking*
  • Rural Population*
  • Sexual Behavior / statistics & numerical data*
  • South Africa / epidemiology
  • Surveys and Questionnaires
  • Young Adult


  • Anti-Retroviral Agents