By Stephanie Ogbonda
The human immunodeficiency virus (HIV) has been an issue of global concern for decades and remains so till today. Despite numerous attempts to stop the spread, not much has changed, particularly in African nations. HIV is mostly spread through sexual activity and happens when there is contact with blood, pre-ejaculate, semen, and vaginal secretions (Rodger et al., 2019; Eisinger et al., 2019).
There is still no authorised vaccine or treatment for HIV/AIDS. Risky sexual behaviours are one way that an individual can become easily exposed to body fluids. Sexual behaviours are typically described as risky actions by individuals that expose them to contracting infectious diseases.
These sexual behaviours include engaging in anal or transactional sex, having several sex partners, engaging in unprotected sex, and consuming alcohol before engaging in sexual activity (Papas et al., 2018).
According to empirical research, sexual behaviour is the primary driver of HIV transmission, hence efforts to lower the infection rate must focus on changing sexual behaviour. An ethnographic semi-longitudinal study was carried out by Erinosho et al. (2012) in three villages in Nigeria that had high or low rates of HIV/AIDS prevalence. The study aimed to identify the risky behavioural elements that continue to fuel the epidemic despite massive investments in prevention programs.
Nine factors such as transactional sex, age of first sexual experience and absence of parental guidance, false beliefs about HIV and AIDS, extramarital relationships beyond marriage and primary partners, mismatched sexual desire, fatalism, denial syndrome, condom use, and alcohol were identified as the main drivers of the infection.
Scott-Sheldon et al. (2013) conducted a meta-analysis to provide an overview of the state of research on the incidence of alcohol consumption, sexual risk behaviours, and the relationship between alcohol consumption and risky sexual behaviours among individuals living with HIV/AIDS (PLWHA). The results show that a significant percentage of PLWHA drink alcohol and participate in risky sexual behaviours. Alcohol consumption was strongly linked to unprotected sex among PLWHA (d +=0.23, 95% CI=0.05, 0.40; k = 5).
Also, in a high-risk sample of 507 HIV-positive sexually active drinkers in western Kenya, Papas et al. (2018) investigated associations with unprotected sex. They were enrolled in a study aimed at lowering alcohol consumption. They discovered a strong link between heavy drinking and unprotected sex.
Ayinde et al. (2021) conducted a study in Tanzania more recently. They made use of data from the 2016–2017 Tanzania HIV Impact Survey, a population-based cross-sectional national household survey that is accessible to the public. They discovered variations in sexual behaviours between the sexes, such as anal and transactional sex. They concluded that a person’s knowledge of their HIV status, which also affects sexual behaviour, is significantly influenced by socioeconomic circumstances.
Moving forward, several research suggests that discrimination and stigma contribute massively to risky sexual behaviour. To effectively combat HIV/AIDS, it is therefore necessary to intensify efforts against the aforementioned. To further enhance sexual behaviours and the uptake of HIV/AIDS testing and treatment, there should be an increased number of interventions aimed at the socioeconomic determinants of health (education, income, employment, housing, social inclusion, etc.). Studies indicate that lifestyle choices and health treatment may not impact health as much as social determinants of health (SDH).
Addressing this adequately is fundamental for improving health and reducing longstanding inequities in health, which requires action by all sectors and civil society.
Ogbonda is a resident physician at Brookdale University Medical Centre, New York, United States of America
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