1. Changes of Sexual Practices of
People Living with HIV after
initiation of antiretroviral therapy
in Albania
Redona Dudushi
Programi Kombëtar i HIV & IST

2. The prevention of HIV transmission to
sexual partner remains an important
component of comprehensive HIV
prevention strategy.
Programi Kombëtar i HIV & IST

3. HIV Situation of HIV
• 811 is the total reported number of persons diagnosed with HIV
• 70.1% are male
• 29.9% are female
• 82.3% are heterosexual
• 11.3% are bisexual
• 0.6 % IDU
• The age most effected is 25-45 years old
• 335 is the number of adults in ARV therapy
• 233 are male
• 102 are female
• 148 is the reported number of persons died from AIDS
• 81 new cases last year
• 65 of them enter at ARV therapy
• 49 are male
• 16 are female
Programi Kombëtar i HIV & IST

4. The aim of my paper is to obtain the insight into how
and why PLWH on antiretroviral treatment (ART) in
Albania changes their sexual practices over 12 month
period after initiation of ARV therapy
Programi Kombëtar i HIV & IST

5. Hypothesis 1
There is relationship between the adherence and sexual desire that is
moderated by the depression level
Hypothesis 2
ARV therapy increase the number of unprotected sexual relation.
Programi Kombëtar i HIV & IST

6. Adherence
Depresion
Unprotected
sex
Programi Kombëtar i HIV & IST

7. The methodology
• This is cross-sectional study
• There are twenty people on ART,participants received their
ART and counseling support from Ambulatory Clinical in
Tirana.
• The participants will selected randomly from the database
of PLWH who receive ARV for more than one year,
(will be stratification by sex, level of education, adherence
on ARV treatment and level of depression)
The study will be based on two types of standardized
interviews as: Adherence Interview and Sexual Practices
Interviews and Patient health Questionnaire (to assess the
level of depression as a moderating factor in the
relationship between the Adherence and Sexual Desire.
Programi Kombëtar i HIV & IST

8. Demographic date in 2014
81 is the number of new cases in 2014
65 of them have enter at ARV therapy
49 are male
16 are female
• The education level
41.3% has elementary level school,
37% has secondary level of education
19.6% has high level of education
2.2 has no education
• Civil status
73.6 % are married
17 % are single
3.8 % are divorced
5.7 % are engaged
Programi Kombëtar i HIV & IST

9. Demographic date in 2014
• Ethnicity
3.4% are roma
91.5% are albania
5.1% are others
• Level of employment
66.7% are not employed
33.3% are employed
• Residence
26.8 %live in rural zone
73.2% live in urban zone
• Receiving place of infection
67.3% inside the country
32.7% outside the country
Programi Kombëtar i HIV & IST

10. Demographic date in 2014
• The way of infection transmission
87.5% are heterosexual
10.5 % are homo-bisexual
1% are IDU
1 % are unknown
Programi Kombëtar i HIV & IST

11. What mean sexual desire
Sexual desire is a motivation state of interest in sexual
activities.
Sexual desire is an aspect of a person’s sexuality which varies
from one person to another, and also varies depending on
circumstances at a particular time. There is no single standard
of sexual desire. Sexual desire can be low for a vast variety of
reasons, many of them psychological and interpersonal. But
that doesn't necessarily make it a disorder. But that doesn't
necessarily make it a disorder. It becomes a diagnosable
condition only when it diminishes the quality of one's life and
creates distress
Programi Kombëtar i HIV & IST

12. What is adherence treatment
Adherence treatment means taking the correct does of your
medications every time, exactly as prescribe by your health care
provider. ARV therapy require strict adherence in order to prevent the
emergence of resistant HIV. Adherence can evaluate in several ways.
These include immunological test of CD4, blood test for viral loads
and clinical measures. There is no precise standard measurement of
compliance. Good adherence stops HIV replication and keep viral load
suppressed. But it is useful to find out how important patients
think adherence is to their well-being. How they feel about
taking breaks from their medication. How they believe it might
affect their life.
Programi Kombëtar i HIV & IST

13. Poor adherence to ARV treatment is influenced from many
factors include demographic and psycho-social factors and
medication-related issues. Non-adherence to antiretroviral
therapy has serious consequences for prognosis and lead to
the development of resistant strains of the virus.
Many studies show in ARV therapy, adherence of less than
95% has been linked with treatment failure and treatment
failure is associated with the increase of depression level.
Programi Kombëtar i HIV & IST

14. • From 335 patients in ARV therapy
82% have good adherence to HIV med and 18%
has not good adherence to HIV med
• From 65 patients that enters for the first time
in ARV therapy in 201
85% have good adherence
15% have not good adherence to HIV med.
Programi Kombëtar i HIV & IST

15. What is depression
• Depression is an illness that involves the body,
mood, and thoughts. It interferes with daily
life and normal functioning.
Programi Kombëtar i HIV & IST

16. HIV infection can lead to neuropsychiatric syndromes.
Depression is the most commonly observed psychiatric
disorder among patients with HIV infection.
Many studies show that the prevalence rate of depression in
HIV positive clinic populations ranges 3 to 5 times higher
than that in the general population.
This may be an underestimation as there is evidence that
depression may be under-diagnosed in the context of HIV
medical care. HIV increases the risk of developing
depressive symptoms such as: chronic stress,
stigmatization, worsening social isolation, intense
demoralization, feel sad, anxious, empty, hopeless,
helpless, worthless, guilty, irritable, ashamed etc.
Programi Kombëtar i HIV & IST

17. The comorbid depression in HIV patients is an
important factor that influence in reduction of
adherence to ARV therapy. On the other hand, the
poor adherence influence in increasing the level of
depression on HIV patients.
Depression reduces the sexual pleasure and interferes in
intimacy which emerged as significant predictors of
unprotected sex.
Programi Kombëtar i HIV & IST

18. The expected results
• Sexual desire diminished on ART.
• There is relationship between the low level of
adherence and high level of depression.
• The high level of depression is related with
diminished of sexual desires and increased
risky sexual practices.
• Increasing the role of mental health program
in treatment of PLWH in public health sector
will help in improvement of their sexual life.
Programi Kombëtar i HIV & IST