objective To investigate the relationship between unsafe sexual behaviours and poor self-perceived health among people living with HIV and AIDS (PLWHA) in western Africa. methods In March 2006, a survey was conducted among patients continuing their participation in the TRIVACAN trial (ANRS 1269) in Coˆ te d’Ivoire, in which patients had been randomized to either continuous or interrupted antiretroviral therapy (ART) (2-months-off ⁄ 4-months-on cycles [2 ⁄ 4-ART]) after 6–18 months of continuous ART (C-ART). Socio-demographic and psychosocial information, including data on sexual behaviours during the previous 6 months, was collected using face-to-face interviews. Sexually active patients with either a steady partner (serodiscordant or of unknown HIV status) or casual partners were considered to have unsafe sexual behaviours if they reported inconsistent condom use (ICU). results Seventy-seven of the 192 patients reported ICU. In multivariate logistic regression, men were significantly less likely to report ICU than women (OR [95% CI] = 0.45 [0.20–0.98]). After adjustment for educational level and reduced sexual activity since ART initiation, concealment of HIV status (2.08 [1.02– 4.25]) and poor self-perceived health (2.32 [0.97–5.52]) were independently associated with ICU. conclusion HIV prevention strategies in resource-limited settings should take into account self-perceived health and difficulties to disclose HIV status. Counselling interventions need to be developed to help PLWHA to adopt or negotiate safe behaviours respecting their individual cultures.