{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:20:01Z","timestamp":1787066401477,"version":"build-2736575974"},"reference-count":45,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2017,5,29]],"date-time":"2017-05-29T00:00:00Z","timestamp":1496016000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      Improved life expectancy and reduced transmission probabilities due to\n                      <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content>\n                      may result in behavioural disinhibition \u2013 that is an increase in sexual risk behaviour in response to a perceived lower risk of\n                      <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\n                      . We examined trends in sexual risk behaviour in the general population of sub\u2010Saharan African countries 1999\u20132015.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We systematically reviewed scientific literature of sexual behaviour and reviewed trends in Demographic and Health Surveys. A meta\u2010analysis on four indicators of sexual risk behaviour was performed: unprotected sex, multiple sexual partners, commercial sex and prevalence of sexually transmitted infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Only two peer\u2010reviewed studies met our inclusion criteria, while our review of\n                      <jats:styled-content style=\"fixed-case\">DHS<\/jats:styled-content>\n                      data spanned 18 countries and 16 years (1999\u20132015). We found conflicting trends in sexual risk behaviour. Reported unprotected sex decreased consistently across the 18 countries, for both sexes. In contrast, reporting multiple partners was decreasing over the period 1999 to the mid\u20102000s, yet has been consistently increasing thereafter. Similar trends were found for reported sexually transmitted infections and commercial sex (men only).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      In conclusion, we found no clear evidence of behavioural disinhibition due to expanded access to\n                      <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content>\n                      in sub\u2010Saharan Africa. Substantial increases in condom use coincided with increases in reported multiple partners, commercial sex and sexually transmitted infections, especially during the period of\n                      <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content>\n                      scale\u2010up. Further research is needed into how these changes might affect\n                      <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\n                      transmission.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/tmi.12885","type":"journal-article","created":{"date-parts":[[2017,4,27]],"date-time":"2017-04-27T18:10:01Z","timestamp":1493316601000},"page":"797-806","source":"Crossref","is-referenced-by-count":15,"title":["Behavioural disinhibition in the general population during the antiretroviral therapy roll\u2010out in Sub\u2010Saharan Africa: systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"22","author":[{"given":"Eva M.","family":"Legemate","sequence":"first","affiliation":[{"name":"Department of Public Health Erasmus MC \u2013 University Medical Center Rotterdam Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan A. C.","family":"Hontelez","sequence":"additional","affiliation":[{"name":"Department of Public Health Erasmus MC \u2013 University Medical Center Rotterdam Rotterdam The Netherlands"},{"name":"Department of Global Health and Population Harvard T.H. Chan School of Public Health Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caspar W. N.","family":"Looman","sequence":"additional","affiliation":[{"name":"Department of Public Health Erasmus MC \u2013 University Medical Center Rotterdam Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sake J.","family":"de Vlas","sequence":"additional","affiliation":[{"name":"Department of Public Health Erasmus MC \u2013 University Medical Center Rotterdam Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,5,29]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Global AIDS Update 2016","author":"Joint United Nations Programme on HIV\/AIDS","year":"2016"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60658-4"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.1230413"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1105243"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001245"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(13)70172-4"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001534"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)61697-9"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.332.7541.605"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/ip.4.2.89"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540120701203261"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/1742-6405-9-14"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.292.2.224"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200102160-00010"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1363\/3816206"},{"key":"e_1_2_7_17_1","first-page":"45","article-title":"Increases in unsafe sex and rectal gonorrhea among men who have sex with men \u2013 San Francisco, California, 1994\u20131997","volume":"48","author":"Centers for Disease Control and Prevention (CDC)","year":"1999","journal-title":"Morb Mortal Wkly Rep"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.287.5453.650"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1037\/0278-6133.26.5.650"},{"key":"e_1_2_7_20_1","unstructured":"Cochrane Review Group on HIV\/AIDS.The Cochrane Collaboration University of California San Francisco 2015. 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