Abstract
BackgroundOur intention was to analyze demographic and contextual factors associated with sexual risk taking among HIV-infected patients on antiretroviral treatment (ART) in Africa's largest informal urban settlement, Kibera in Nairobi, Kenya.MethodsWe used a cross-sectional survey in a resource-poor, urban informal settlement in Nairobi; 515 consecutive adult patients on ART attending the African Medical and Research Foundation clinic in Kibera in Nairobi were included in the study. Interviewers used structured questionnaires covering socio-demographic characteristics, time on ART, number of sexual partners during the previous six months and consistency of condom use.ResultsTwenty-eight percent of patients reported inconsistent condom use. Female patients were significantly more likely than men to report inconsistent condom use (aOR 3.03; 95% CI 1.60-5.72). Shorter time on ART was significantly associated with inconsistent condom use. Multiple sexual partners were more common among married men than among married women (adjusted OR 4.38; 95% CI 1.82-10.51).ConclusionsInconsistent condom use was especially common among women and patients who had recently started ART, i.e., when the risk of HIV transmission is higher. Having multiple partners was quite common, especially among married men, with the potential of creating sexual networks and an increased risk of HIV transmission. ART needs to be accompanied by other preventive interventions to reduce the risk of new HIV infections among sero-discordant couples and to increase overall community effectiveness.
Highlights
Our intention was to analyze demographic and contextual factors associated with sexual risk taking among HIV-infected patients on antiretroviral treatment (ART) in Africa’s largest informal urban settlement, Kibera in Nairobi, Kenya
Patients who have recently started on ART are especially important in terms of risk of transmission, and the results indicate a strong need to focus more on this vulnerable grouMoreover, we cannot account for patients who have dropped out from the treatment programme, and hypothetically there might be an association between staying in the programme and adapting to preventive messages; these issues merit further research focusing on programme drop outs
We found a higher proportion of married men than women reporting multiple partners during the previous six months
Summary
Our intention was to analyze demographic and contextual factors associated with sexual risk taking among HIV-infected patients on antiretroviral treatment (ART) in Africa’s largest informal urban settlement, Kibera in Nairobi, Kenya. Recent systematic reviews did not show any association between ART initiation and increased sexual risk taking [22,23]. There are still relatively few studies undertaken in low-income settings, but among those published, there is an indication of many underlying contextual factors that hinder the individual from taking on sexual risk-reduction strategies [26,27]. The majority of ART patients in resource-poor settings are diagnosed at a very late stage of their HIV infection, implying high viral loads at the start of treatment [14,15,26,28]. As shown in another study recently undertaken in South Africa, almost half the participants just initiated on ART had unprotected sex at last intercourse [29]
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