Abstract
ObjectivesTo estimate HIV prevalence and characterize risk factors among young adults in Asembo, rural western Kenya.DesignCommunity-based cross-sectional survey.MethodsFrom a demographic surveillance system, we selected a random sample of residents aged 13-34 years, who were contacted at home and invited to a nearby mobile study site. Consent procedures for non-emancipated minors required assent and parental consent. From October 2003 - April 2004, consenting participants were interviewed on risk behavior and tested for HIV and HSV-2. HIV voluntary counseling and testing was offered.ResultsOf 2606 eligible residents, 1822 (70%) enrolled. Primary reasons for refusal included not wanting blood taken, not wanting to learn HIV status, and partner/parental objection.Females comprised 53% of 1762 participants providing blood. Adjusted HIV prevalence was 15.4% overall: 20.5% among females and 10.2% among males. HIV prevalence was highest in women aged 25-29 years (36.5%) and men aged 30-34 years (41.1%). HSV-2 prevalence was 40.0% overall: 53% among females, 25.8% among males. In multivariate models stratified by gender and marital status, HIV infection was strongly associated with age, higher number of sex partners, widowhood, and HSV-2 seropositivity.ConclusionsAsembo has extremely high HIV and HSV-2 prevalence, and probable high incidence, among young adults. Further research on circumstances around HIV acquisition in young women and novel prevention strategies (vaccines, microbicides, pre-exposure prophylaxis, HSV-2 prevention, etc.) are urgently needed.
Highlights
African youth are disproportionately affected by the global HIV pandemic
In 2003, Kenya Medical Research Institute (KEMRI), Centers for Disease Control and Prevention (CDC), ITM, and the London School of Hygiene and Tropical Medicine (LSHTM) initiated the first HIVspecific study in Asembo to measure the prevalence of HIV and sexually transmitted infections (STIs), identify factors associated with HIV infection, provide a baseline to evaluate a new adolescent prevention intervention, and inform sample size calculations for a prospective HIV-incidence cohort
The entire population of approximately 65,000, over 95% of whom are Luo, participates in an ongoing demographic surveillance system (DSS) maintained by KEMRI/CDC
Summary
African youth are disproportionately affected by the global HIV pandemic. Of 10 million HIV-infected persons aged 15-24 years, 62% live in sub-Saharan Africa; the majority are female. [1] The 2007 Kenya Aids Indicator Survey (KAIS) demonstrated a national HIV prevalence of 7.4% among Kenyans aged 15-49 years; 8.8% in females and 5.5% in males. [2] Among adolescents aged 15-19 years, HIV prevalence was 3.5% in females and 1.0%in males, increasing to 7.4% and 1.9% respectively among those aged 20-24 years. [2] Nyanza Province in western Kenya continues with Kenya’s highest HIV prevalence of 15.0%; 17.6% in women and 11.4% in men. [2] The KAIS HIV prevalence data varied slightly, a non-statistically significant difference, from the 2003 Kenya Demographic Health Survey (KDHS). [3]In Nyanza Province, the Kenya Medical Research Institute (KEMRI) and the U.S Centers for Disease Control and Prevention (CDC) have conducted infectious disease research since 1988 in Asembo, a rural community. [4] An ongoing demographic surveillance system (DSS) in this area reports a life expectancy at birth of 38 years and high adult mortality rates likely attributable to AIDS. [5] In 2002 the Institute of Tropical Medicine in Antwerp, Belgium (ITM), with KEMRI/CDC, initiated a multi-component adolescent prevention intervention in Asembo. [1] The 2007 Kenya Aids Indicator Survey (KAIS) demonstrated a national HIV prevalence of 7.4% among Kenyans aged 15-49 years; 8.8% in females and 5.5% in males. [5] In 2002 the Institute of Tropical Medicine in Antwerp, Belgium (ITM), with KEMRI/CDC, initiated a multi-component adolescent prevention intervention in Asembo. This intervention was in response to a needs assessment, conducted by ITM and KEMRI/CDC among Nyanza youth, and to findings from a 1997-1998 study [6] demonstrating an HIV prevalence of 23% and 3.5% among females and males aged 15-19 years, respectively, in Kisumu, Nyanza’s capital. We present HIV and HSV-2 prevalence and associated factors for 13-34 year old Asembo residents
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