Monday, March 14, 2016

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)
VariableUnadjusted RR (95 % CI)p valueAdjusted RR (95 % CI)ap value
Age group (years)
 18–24ReferentReferent
 25–291.6 (0.9, 3.1).12871.5 (0.8, 2.9).1808
 30–342.9 (1.6, 5.2).00052.4 (1.3, 4.3).0030
 35–622.3 (1.3, 4.1).00452.1 (1.2, 3.7).0124
Marital status
 Never marriedReferent
 Previously married0.9 (0.6, 1.3).4210
 Currently married1.3 (0.3, 6.4).7720
Education
 None/incomplete primaryReferent
 Completed primary0.5 (0.3, 0.8).0088
 Incomplete secondary0.8 (0.5, 1.5).5638
 Completed secondary+0.7 (0.4, 1.3).2301
Duration of sex work (years)
 4–9Referent
 10–141.0 (0.6, 1.7).9705
 15–451.3 (0.9, 2.1).1997
Sex as a main source of income
 NoReferent
 Yes0.8 (0.5, 1.4).4880
Client-seeking locationsb,d
 Bar1.0 (0.6, 1.5).8992
 Roadside0.7 (0.4, 1.1).1448
 At home1.8 (1.0, 2.9).0299
 Rented stall or shed1.2 (0.67, 2.1).5430
 Clients called participant1.3 (0.8, 2.0).3165
 Other locations0.8 (0.4, 1.9).6605
Number of paying partners (past 7 days)
 0–10Referent
 11–200.9 (0.5, 1.6).7278
 21–300.6 (0.3, 1.2).1514
 31+0.2 (0.02, 1.5).1119
Consistent condom use with paying partners (past 30 days)
 AlwaysReferentReferent
 Sometimes/never1.9 (1.3, 2.8).00152.1 (1.4, 3.0).0001
Condom use with last paying partner
 YesReferent
 No0.8 (0.4, 1.4).3788
Number of non-paying sex partner(s) (past 30 days)
 NoneReferent
 10.6 (0.4, 1.0).0613
 2+1.0 (0.6, 1.8).9442
Consistent condom use with nonpaying partner(s) (past 30 days)
 AlwaysReferent
 Sometimes/Never0.7 (0.4, 1.1).1380
Condom use with last nonpaying partner
 YesReferent
 No0.5 (0.2, 0.9).0287
Drug use (past 12 months)c,d
 Marijuana/bhang0.8 (0.5, 1.2).1981
 Khat/miraa0.8 (0.6, 1.3).3871
 Heroin1.3 (0.2, 6.8).7721
 Injection drug use1.2 (0.2, 5.9).8899
Alcohol consumption
 NeverReferent
 Once a month or less1.9 (0.9, 3.9).0973
 2–4 times a month1.1 (0.4, 2.5).8879
 2–3 times a week1.3 (0.7, 2.4).4658
 4 or more times a week1.3 (0.7, 2.4).4037
Contraception method (past 30 days)c
 Any contraception used1.2 (0.8, 1.9).4328
 Injection0.8 (0.5, 1.3).3901
 Male condom2.3 (1.6, 3.3)<.00012.5 (1.7, 3.5)<.0001
 Implant0.5 (0.1, 0.9).0322
 Pill0.3 (0.1, 1.0).0510
 Female condom0.5 (0.1, 1.8).2686
Practice douching
 NoReferent
 Yes1.1 (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

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




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