TY - JOUR
T1 - Sexual behavior of HIV-positive adults not accessing HIV treatment in Mombasa, Kenya
T2 - Defining their prevention needs
AU - Sarna, Avina
AU - Luchters, Stanley
AU - Pickett, Melissa
AU - Chersich, Matthew
AU - Okal, Jerry
AU - Geibel, Scott
AU - Kingola, Nzioki
AU - Temmerman, Marleen
N1 - Funding Information:
We acknowledge the contribution of our colleagues from the Population Council: Ms Susan Kaai in Nairobi, in proposal development and training and Dr Waimar Tun, in Washington DC, for her inputs into proposal development and review of the report. We recognize the contribution of our team of research interviewers: Nicodemus Kisengese, Mariam Kassim, Jacqueline Chokwe, Dorothy Mubweka, Caleb Muasya and Nancy Kingola. The study could not have been done without a team of dedicated Community Health Workers and Post Test Club Peers led by Chorongo Salee and Peter Kimani respectively, our thanks to them. Lastly, we thank all study participants for their invaluable contribution. This work was undertaken by the Population Council and was funded by the generous support of the American people through the US Agency for International Development (USAID), Cooperative Agreement Award No: HRN-A-00-97-00012-00. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID.
PY - 2012/3/19
Y1 - 2012/3/19
N2 - Background: HIV spread continues at high rates from infected persons to their sexual partners. In 2009, an estimated 2.6 million new infections occurred globally. People living with HIV (PLHIV) receiving treatment are in contact with health workers and therefore exposed to prevention messages. By contrast, PLHIV not receiving ART often fall outside the ambit of prevention programs. There is little information on their sexual risk behaviors. This study in Mombasa Kenya therefore explored sexual behaviors of PLHIV not receiving any HIV treatment.Results: Using modified targeted snowball sampling, 698 PLHIV were recruited through community health workers and HIV-positive peer counsellors. Of the 59.2% sexually-active PLHIV, 24.5% reported multiple sexual partners. Of all sexual partners, 10.2% were HIV negative, while 74.5% were of unknown HIV status. Overall, unprotected sex occurred in 52% of sexual partnerships; notably with 32% of HIV-negative partners and 54% of partners of unknown HIV status in the last 6 months. Multivariate analysis, controlling for intra-client clustering, showed non-disclosure of HIV status (AOR: 2.38, 95%CI: 1.47-3.84, p < 0.001); experiencing moderate levels of perceived stigma (AOR: 2.94, 95%CI: 1.50-5.75, p = 0.002); and believing condoms reduce sexual pleasure (AOR: 2.81, 95%CI: 1.60-4.91, p < 0.001) were independently associated with unsafe sex. Unsafe sex was also higher in those using contraceptive methods other than condoms (AOR: 5.47, 95%CI: 2.57-11.65, p < 0.001); or no method (AOR: 3.99, 95%CI: 2.06-7.75, p < 0.001), compared to condom users.Conclusions: High-risk sexual behaviors are common among PLHIV not accessing treatment services, raising the risk of HIV transmission to discordant partners. This population can be identified and reached in the community. Prevention programs need to urgently bring this population into the ambit of prevention and care services. Moreover, beginning HIV treatment earlier might assist in bringing this group into contact with providers and HIV prevention services, and in reducing risk behaviors.
AB - Background: HIV spread continues at high rates from infected persons to their sexual partners. In 2009, an estimated 2.6 million new infections occurred globally. People living with HIV (PLHIV) receiving treatment are in contact with health workers and therefore exposed to prevention messages. By contrast, PLHIV not receiving ART often fall outside the ambit of prevention programs. There is little information on their sexual risk behaviors. This study in Mombasa Kenya therefore explored sexual behaviors of PLHIV not receiving any HIV treatment.Results: Using modified targeted snowball sampling, 698 PLHIV were recruited through community health workers and HIV-positive peer counsellors. Of the 59.2% sexually-active PLHIV, 24.5% reported multiple sexual partners. Of all sexual partners, 10.2% were HIV negative, while 74.5% were of unknown HIV status. Overall, unprotected sex occurred in 52% of sexual partnerships; notably with 32% of HIV-negative partners and 54% of partners of unknown HIV status in the last 6 months. Multivariate analysis, controlling for intra-client clustering, showed non-disclosure of HIV status (AOR: 2.38, 95%CI: 1.47-3.84, p < 0.001); experiencing moderate levels of perceived stigma (AOR: 2.94, 95%CI: 1.50-5.75, p = 0.002); and believing condoms reduce sexual pleasure (AOR: 2.81, 95%CI: 1.60-4.91, p < 0.001) were independently associated with unsafe sex. Unsafe sex was also higher in those using contraceptive methods other than condoms (AOR: 5.47, 95%CI: 2.57-11.65, p < 0.001); or no method (AOR: 3.99, 95%CI: 2.06-7.75, p < 0.001), compared to condom users.Conclusions: High-risk sexual behaviors are common among PLHIV not accessing treatment services, raising the risk of HIV transmission to discordant partners. This population can be identified and reached in the community. Prevention programs need to urgently bring this population into the ambit of prevention and care services. Moreover, beginning HIV treatment earlier might assist in bringing this group into contact with providers and HIV prevention services, and in reducing risk behaviors.
KW - Africa
KW - PLHIV
KW - Prevention of sexual transmission of HIV
KW - Sexual behavior
KW - Unsafe sex
UR - http://www.scopus.com/inward/record.url?scp=84858302731&partnerID=8YFLogxK
U2 - 10.1186/1742-6405-9-9
DO - 10.1186/1742-6405-9-9
M3 - Article
AN - SCOPUS:84858302731
SN - 1742-6405
VL - 9
JO - AIDS Research and Therapy
JF - AIDS Research and Therapy
M1 - 9
ER -
