Sexual activity and condom use among people living with HIV in Swaziland

A number of studies have shown strong evidence of the association between HIV testing and an increase in consistent condom use. These studies have shown that HIV testing has contributed to a reduction in risk behaviours, since knowledge of HIV status can motivate both HIV-positive and HIV-negative people to practise safer sex. However, the extent to which knowledge of one's HIV status contributes to behavioural change among people living with HIV (PLHIV) has not been comprehensively documented. Drawing on an analysis of 37 in-depth interviews and five focus group discussions with PLHIV, this paper examines the nature of sexual activity and condom use among PLHIV in Swaziland. The paper explores issues pertaining to behavioural change and safer sex, and how these are influenced by the individual's HIV-positive status and the prevailing social-structural forces. Several factors inhibit the adoption of protective sexual behaviour among HIV-positive sexual partners, some of whom have access to life-saving drug therapy. These factors include a lack of adequate social support structures and prevailing gender power imbalances that deny women control over their sexual lives. To promote behavioural change among PLHIV, the paper proposes the expansion of the scope of information, education and communication strategies to include activities aimed at continually sensitising PLHIV regarding safer sex, as well as activities geared towards improving communication between PLHIV and their health-caregivers with regard to HIV-protective behaviours.