Adherence and Risk Behaviour in Patients with HIV Infection Receiving Antiretroviral Therapy in Bangkok

Amanda Clarke*, 1, 2, Stephen Kerr1, 2, Adam Honeybrook1, David A Cooper1, 2, Anchalee Avihingsanon1, Chris Duncombe1, Praphan Phanuphak1, 3, Kiat Ruxrungtham1, 3, Jintanat Ananworanich1, 3, John Kaldor2
1 The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, 104 Ratchadamri Road, Bangkok 10330, Thailand
2 Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney NSW 2052, Australia
3 Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand

© Clarke et al.; Licensee Bentham Open.

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* Address correspondence to this author at the HIV-NAT, The Thai Red Cross AIDS Research Centre, 104 Ratchadamri Road, Pathumwan, Bangkok, 10330, Thailand; Tel: +66 2652 3040; Fax: +66 2252 5779; E-mail:


It could be postulated that due to lifestyle factors, patients with poor antiretroviral therapy (ART) adherence may also have risky sexual behaviour potentially leading to HIV transmission. There are limited data regarding unprotected sex risk and ART adherence in resource limited settings and our study set out to investigate these in an HIV clinic in Bangkok. Patients completed an anonymous questionnaire regarding their relationship details, ART adherence, sexual behaviour, alcohol and drug use and HIV transmission beliefs. Laboratory findings and medical history were also collected. Unprotected sex risk (USR) was defined as inconsistent condom use with a partner of negative or unknown HIV status. Five hundred and twelve patients completed the questionnaire. Fifty seven per cent of patients reported having taken ARV >95% of the time in the last month and 58% had been sexually active in the previous 30 days. Only 27 patients (5%) were classified as having USR in our cohort. Multivariate analysis showed USR was associated with female gender (OR 2.9, 95% CI 1.2-7.0, p0.02) but not with adherence, age, type or number of partners, recreational drug or alcohol use nor beliefs about HIV transmission whilst taking ART. Levels of USR in this resource limited setting were reassuringly low and not associated with poor ART adherence; as all USR patients had undetectable viral loads onward HIV transmission risk is likely to be low but not negligible. Nonetheless condom negotiation techniques, particularly in women, may be useful in this group.

Keywords: Adherence, Antiretroviral therapy (ART), HIV-1 infection, Unprotected sex risk, Thailand..