Prevalence of HIV, Sexually Transmitted Infections, and Risk Behaviours among Female Sex Workers in Nairobi, Kenya: Results of a Respondent Driven Sampling Study

We conducted a respondent driven sampling survey to estimate HIV prevalence and risk behavior among female sex workers (FSWs) in Nairobi, Kenya. 

Women aged 18 years and older who reported selling sex to a man at least once in the past 3 months were eligible to participate. Consenting FSWs completed a behavioral questionnaire and were tested for HIV and sexually transmitted infections (STIs). Adjusted population-based prevalence and 95 % confidence intervals (CI) were estimated using RDS analysis tool. Factors significantly associated with HIV infection were assessed using log-binomial regression analysis. 

A total of 596 eligible participants were included in the analysis. Overall HIV prevalence was 29.5 % (95 % CI 24.7–34.9). Median age was 30 years (IQR 25–38 years); median duration of sex work was 12 years (IQR 8–17 years). The most frequent client-seeking venues were bars (76.6 %) and roadsides (29.3 %). The median number of clients per week was seven (IQR 4–18 clients). HIV testing was high with 86.6 % reported ever been tested for HIV and, of these, 63.1 % testing within the past 12 months. Of all women, 59.7 % perceived themselves at ‘great risk’ for HIV infection. Of HIV-positive women, 51.0 % were aware of their infection. In multivariable analysis, increasing age, inconsistent condom use with paying clients, and use of a male condom as a method of contraception were independently associated with unrecognized HIV infection. Prevalence among STIs was low, ranging from 0.9 % for syphilis, 1.1 % for gonorrhea, and 3.1 % for Chlamydia. 

The data suggest high prevalence of HIV among FSWs in Nairobi. Targeted and routine HIV and STI combination prevention strategies need to be scaled up or established to meet the needs of this population.

Below:  Respondent driven sampling recruitment profile of female sex workers by Constituency Nairobi, Kenya, 2010

Bivariate and multivariable log-binomial analysis of predictors of unrecognized HIV infection among female sex workers, Nairobi, Kenya, 2010 (N = 480)

Variable	Unadjusted RR (95 % CI)	p value	Adjusted RR (95 % CI)a	p value
Age group (years)
18–24	Referent	–	Referent	–
25–29	1.6 (0.9, 3.1)	.1287	1.5 (0.8, 2.9)	.1808
30–34	2.9 (1.6, 5.2)	.0005	2.4 (1.3, 4.3)	.0030
35–62	2.3 (1.3, 4.1)	.0045	2.1 (1.2, 3.7)	.0124
Marital status
Never married	Referent	–
Previously married	0.9 (0.6, 1.3)	.4210
Currently married	1.3 (0.3, 6.4)	.7720
Education
None/incomplete primary	Referent	–
Completed primary	0.5 (0.3, 0.8)	.0088
Incomplete secondary	0.8 (0.5, 1.5)	.5638
Completed secondary+	0.7 (0.4, 1.3)	.2301
Duration of sex work (years)
4–9	Referent	–
10–14	1.0 (0.6, 1.7)	.9705
15–45	1.3 (0.9, 2.1)	.1997
Sex as a main source of income
No	Referent	–
Yes	0.8 (0.5, 1.4)	.4880
Client-seeking locationsb,d
Bar	1.0 (0.6, 1.5)	.8992
Roadside	0.7 (0.4, 1.1)	.1448
At home	1.8 (1.0, 2.9)	.0299
Rented stall or shed	1.2 (0.67, 2.1)	.5430
Clients called participant	1.3 (0.8, 2.0)	.3165
Other locations	0.8 (0.4, 1.9)	.6605
Number of paying partners (past 7 days)
0–10	Referent	–
11–20	0.9 (0.5, 1.6)	.7278
21–30	0.6 (0.3, 1.2)	.1514
31+	0.2 (0.02, 1.5)	.1119
Consistent condom use with paying partners (past 30 days)
Always	Referent	–	Referent	–
Sometimes/never	1.9 (1.3, 2.8)	.0015	2.1 (1.4, 3.0)	.0001
Condom use with last paying partner
Yes	Referent	–
No	0.8 (0.4, 1.4)	.3788
Number of non-paying sex partner(s) (past 30 days)
None	Referent	–
1	0.6 (0.4, 1.0)	.0613
2+	1.0 (0.6, 1.8)	.9442
Consistent condom use with nonpaying partner(s) (past 30 days)
Always	Referent	–
Sometimes/Never	0.7 (0.4, 1.1)	.1380
Condom use with last nonpaying partner
Yes	Referent	–
No	0.5 (0.2, 0.9)	.0287
Drug use (past 12 months)c,d
Marijuana/bhang	0.8 (0.5, 1.2)	.1981
Khat/miraa	0.8 (0.6, 1.3)	.3871
Heroin	1.3 (0.2, 6.8)	.7721
Injection drug use	1.2 (0.2, 5.9)	.8899
Alcohol consumption
Never	Referent	–
Once a month or less	1.9 (0.9, 3.9)	.0973
2–4 times a month	1.1 (0.4, 2.5)	.8879
2–3 times a week	1.3 (0.7, 2.4)	.4658
4 or more times a week	1.3 (0.7, 2.4)	.4037
Contraception method (past 30 days)c
Any contraception used	1.2 (0.8, 1.9)	.4328
Injection	0.8 (0.5, 1.3)	.3901
Male condom	2.3 (1.6, 3.3)	<.0001	2.5 (1.7, 3.5)	<.0001
Implant	0.5 (0.1, 0.9)	.0322
Pill	0.3 (0.1, 1.0)	.0510
Female condom	0.5 (0.1, 1.8)	.2686
Practice douching
No	Referent	–
Yes	1.1 (0.9, 1.2)	.1315

aAdjusted for all variables or individual categories within variables that were found to be significant at p ≤ .20 or lower in bivariate analysis. Variables found to be significant at the p ≤ .05 are displayed

bRespondents could have selected several client-seeking locations

cRespondents could have used selected several drugs in the past 12 months

dReferent group for multi-response variables were women who did not report the response

Full article at:   http://goo.gl/lCBqtV

By:  Helgar Musyoki, Timothy A. Kellogg, Scott Geibel, Nicholas Muraguri, Jerry Okal, Waimar Tun, H. Fisher Raymond,Sufia Dadabhai, Meredith Sheehy, and Andrea A. Kim

Helgar Musyoki, National AIDS and Sexually Transmitted Infection Control Programme, Ministry of Health, P.O. Box 19361-00202, Nairobi, Kenya;

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