The effect of antiretroviral therapy (ART) scale­up in Africa on sexual risk behaviors and the prevention of new HIV infections is unknown. Models demonstrating that ART can reduce HIV incidence also show that small increases in risky sexual behaviors can mask and reverse gains achieved by therapy. Studies from the developed world suggest that prevalence of unprotected sex and incidence of sexually transmitted infections have increased since the introduction of ART. It is possible that misperceptions about ART or reduced concern about HIV because of ART availability lead to more permissive sexual behavior in both HIV­infected persons and the general population.

The purpose of this study is to examine the association of ART expansion and ART­related beliefs with risky sexual behaviors and prevalence of sexually transmitted infections (STI) and HIV in the general population of Kisumu, the municipality with the highest HIV seroprevalence in the country. Similarly, the association of ART expansion and ART­related beliefs with risky sexual behaviors in HIV­infected persons receiving ART will also be explored. We will conduct cross­sectional surveys at baseline and one­year later to assess changes in knowledge and beliefs about ART and the impact of these changes on sexual risk behaviors. Surveys of the general population will be conducted by sampling 20 sentinel clusters within the Municipality of Kisumu. Surveys of HIV positive patients on ART will be conducted at our PEPFAR­funded ART rollout program in Kenya, entitled Family AIDS Care and Education Services (FACES). FACES began delivering comprehensive care to the HIV­ affected population in Kisumu in March 2005. Understanding public perceptions of ART and their effects on sexual risk behaviors that lead to an increased risk of STI and HIV is essential for designing prevention interventions that address the changing landscape of HIV with the availability of ART. The results of this study will be widely disseminated throughout Kenya, as well as in international publications, so that our results may guide treatment programs in their efforts to improve incorporation of prevention services into HIV care programs.