Sixty-four percent of the estimated 40.3 million people currently living with HIV reside in sub-Saharan Africa. Few studies of the sexual behavior of seropositive individuals and the possible psycho-social factors associated with this behavior have been conducted in Africa. To describe sexual behavior post testing HIV-positive and to inform the development of prevention guidelines, we conducted a cross-sectional study of 1092 HIV-infected male and female clients of an AIDS support organization in Jinja, Uganda using a structured interview. A nested qualitative study of 39 respondents from this sample was then undertaken. In the quantitative analysis, demographic and psycho-social factors were examined in relation to sexual activity and condom use in the three months prior to the interview. In the multivariate analyses, factors found to be related to engagement in sexual activity in men included education, being married, higher CD4 count, employment, and engagement in masturbation or oral sex. For women, significant factors included being married, their own employment, disclosure of serostatus to partner, younger age, engagement in masturbation or oral sex, desire for biological children, and concern about HIV superinfection. Factors related to inconsistent condom use in gender-specific multivariate models included decreased confidence in using a condom (men and women), having sex with a spouse (men only), partner's desire for children (women only), and lack of concern about HIV superinfection (women only). Support for the theoretical constructs of perceived susceptibility, expectancies, and self-efficacy affecting condom use was found. In the qualitative interview, respondents reported reducing intercourse frequency, reducing number of partners and increasing condom use after testing HIV-positive. Respondents used a variety of strategies to effect these changes. Motivations for behavior change, in both men and women, included concerns for personal health and the health of others and loss of desire for sex. Gender-power inequities, negative attitudes toward condom use, forced sex and rape, and desire for children affected condom use in this population. Quantitative and qualitative data can each contribute essential, but at times conflicting, information when studying complex health behaviors. Social and structural factors must be taken into account in the development of future theoretical and conceptual models. In order to build a knowledge base in this area of research, minimum standards for outcomes should be identified for analysis in studies of the sexual behavior of HIV-positive individuals.
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