HIV Prevention In Kenya Research Articles

HIV /AIDs Knowledge and Factors Associated with Uptake of Contraceptives among Child Bearing Women in Bungoma County, Kenya

Uptake of contraceptives is generally low in Kenya.The study carried an investigation into the relationship between HIV/AIDs related knowledge and contraceptive uptake among married child-bearing women aged 15-34 .Female condom (FC) is the only safe and effective female-initiated method that provides simultaneous protection against unintended pregnancy as well as sexually transmitted infections (STIs), including HIV/AIDS. Knowledge of FC use among women and the perceptions and attitudes towards condom use can contribute to its uptake as an important public health strategy for HIV prevention in Kenya. Despite its effectiveness, the female condom use among Child –bearing women in Kenya remains low. The results of the study identify high levels of AIDS-related knowledge among women in Kimilili Sub-county, Bungoma County, Kenya. Unfortunately, this knowledge is yet to translate into practical and more so increased condom use. It suggested that the use of rationale choice models in AIDS prevention programs may not be adequate to change people’s sexual behavior, especially in societies where the prevailing cultural practices and norms encourage large families and discourage use of contraceptives of any type. In such settings, there is need to find appropriate mechanisms that could help increase the use of all types of contraceptives. As contraceptive use increases, it is likely that the use of condoms for AIDs prevention and also family planning purpose would increase in Kenya.

Women as Agents of Change: Male Circumcision and HIV Prevention in Kenya

Women as Agents of Change: Male Circumcision and HIV Prevention in Kenya

Persistence of oral pre-exposure prophylaxis (PrEP) among adolescent girls and young women initiating PrEP for HIV prevention in Kenya

ABSTRACT The Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) Initiative aims to reduce HIV infections among adolescent girls and young women (AGYW) in Africa. Oral pre-exposure prophylaxis (PrEP) is offered through DREAMS in Kenya to eligible AGYW in high burden counties including Kisumu and Homa Bay. This study examines PrEP persistence among AGYW in high burden community-based PrEP delivery settings. We evaluated PrEP persistence among AGYW in the DREAMS PrEP program in Kisumu and Homa Bay using survival analysis and programmatic PrEP refill data collected between March through December 2017. Among 1,259 AGYW who initiated PrEP during the study period, the median persistence time in the program was 56 days (95% CI: 49–58 days) and the proportion who persisted 3 months later was 37% (95% CI: 34-40%). Persistence varied by county (p < 0.001), age at PrEP initiation (p = 0.002), marital status (p = 0.008), transactional sex (p = 0.002), gender-based violence (GBV) experience (p = 0.009) and current school attendance (p = 0.001) at DREAMS enrollment. Persistence did not vary with orphan status, food insecurity, condom use, age at first sexual encounter or engagement in age-disparate sex at DREAMS enrollment. Targeted strategies are needed to improve AGYW retention in the PrEP program.

Short Message Service (SMS) Surveys Assessing Pre-exposure Prophylaxis (PrEP) Adherence and Sexual Behavior are Highly Acceptable Among HIV-Uninfected Members of Serodiscordant Couples in East Africa: A Mixed Methods Study.

Short message service (SMS) surveys are a promising data collection method and were used to measure sexual behavior and adherence to HIV pre-exposure prophylaxis (PrEP) among HIV-uninfected partners of serodiscordant couples enrolled in a sub-study of the Partners Demonstration Project (an open-label study of integrated antiretroviral therapy and PrEP for HIV prevention in Kenya and Uganda). Questionnaires were completed by 142 participants after study exit. Median age was 29years; 69% were male. Ninety-five percent (95%) felt SMS surveys were "easy" or "very easy", 74% reported no challenges, and 72% preferred SMS surveys over in-person study visits. Qualitative interviews involving 32 participants confirmed the ease of responding to SMS surveys. Participants also indicated that surveys acted as reminders for adherence to PrEP and condom use and were experienced as support from the study. SMS surveys were generally found to be acceptable in this population and provided real-time context of PrEP use.

Positioning Microbicides for HIV Prevention in Kenya

This case study describes the experience of developing communication messages and materials to position microbicide gel—a product still in clinical trials—for HIV prevention in Kenya. A robust development process included stakeholder and audience consultations, a national message development workshop, two rounds of pretesting, and an evaluation study to evaluate the impact of the materials on intentions and attitudes related to microbicide use. Awareness-raising and in-depth educational materials for both potential microbicide users and health care providers were developed. The project team tested two different ways of positioning microbicides—one focused primarily on the HIV prevention benefits of the product and the other focused on other benefits, such as increased sexual pleasure and intimacy. This experience presented a number of unique social marketing and communication challenges related to the inherent characteristics of microbicides, the fact that they are not yet licensed for use, and the potential for inadvertently stigmatizing the product and encouraging condom migration. The project confirmed that marketing microbicides to women in a wide variety of sexual contexts—and gaining support of male partners—will be critical for avoiding stigmatization of the product. It also confirmed that the positioning of the product can impact interest in using microbicides and that in-depth counseling of users will be critical for ensuring correct use.

Attitudes of serodiscordant couples towards antiretroviral-based HIV prevention strategies in Kenya: a qualitative study.

IntroductionTransmission in serodiscordant couples (SDCs) accounts for approximately half of all new HIV infections, both in Kenya and the wider sub-Saharan region [1]. With evidence to suggest inconsistent condom use within this population [2], the World Health Organization has recommended two new methods of HIV prevention for SDCs: Treatment as Prevention (TasP) and Pre-Exposure Prophylaxis (PrEP). However, there has been little research about the attitudes of SDCs towards these strategies [3, 4]; knowledge that is paramount for successfully predicting the acceptability and efficacy of each method, as well as for informing decisions regarding HIV policy changes in Kenya.MethodsAn exploratory, qualitative study was conducted in the Muhoroni constituency of Nyando district, Kenya from January to March 2013. Purposive sampling was predominately used to recruit 21 HIV-positive and 17 HIV-negative individuals in a serodiscordant relationship from four hospitals and health centres. During face-to-face semi-structured interviews, topic guides were used to elicit information about participants’ attitudes and preferences towards TasP and PrEP. Collected data underwent framework analysis, allowing the development of overarching categories, sub-themes and inductive interpretation.ResultsThe majority of participants, irrespective of gender and HIV status, found TasP more acceptable than PrEP. A key factor influencing this decision was HIV-negative participants’ limited motivation to take and adhere to antiretrovirals (ARVs), primarily due to a predominantly external health locus of control, a lack of cultural acceptance of prophylactic medication and concerns about side effects. In addition to this, the likely health improvements TasP offers HIV-positive partners, as well as the attitude that the sick individual should be the first to receive HIV medication, also contributed to this conclusion. Issues of risk compensation were raised, with some HIV-negative partners indicating a desire to stop using condoms if ARV-based prevention methods were available.ConclusionsFindings from the study indicate that TasP may represent a more viable approach to HIV prevention in Kenya than PrEP. Couples’ preferences, however, may differ depending on local attitudes towards prophylaxis and health locus of control.

Intimate partner violence is associated with HIV infection in women in Kenya: A cross-sectional analysis

BackgroundThe relationship between intimate partner violence (IPV) and women’s risk of HIV infection has attracted much recent attention, with varying results in terms of whether there is an association and what the magnitude of association is. Understanding this relationship is important for HIV surveillance and intervention programs.MethodsWe analyzed data from the 2008-2009 Demographic and Health Survey (DHS) in Kenya, on 1,904 women aged 15-49. A generalized linear mixed model was adapted to explore the relationship between IPV and HIV prevalence, controlling for sociodemographic variables, and treating DHS survey clusters, province and ethnicity as random effects. We used principal components analysis (PCA) to calculate a single IPV score for each woman. The effect of HIV risk behaviours on the association between IPV and HIV was also assessed.ResultsControlling for relevant sociodemographic factors, we found that HIV risk was significantly associated with IPV (P <0.01). After adjustment for risk factors as well as sociodemographic variables, the positive association between IPV and HIV remained significant (P=0.035). The estimated effect size of this model corresponds to an odds ratio of 1.55 for HIV infection comparing a woman who experienced no IPV and a woman at the 95th percentile for our IPV index.ConclusionThis study provides further evidence that IPV and HIV are associated. In addition, we found that this association remains even when we controlled for several HIV risk factors. This implies that IPV can be used as a marker of potential HIV risk, and may be causally associated with HIV risk. Further, these results suggest that IPV monitoring and prevention may have a useful role in HIV prevention in Kenya. Further research, ideally based on longitudinal observations, is needed to disentangle these relationships.

Spousal Communication about HIV Prevention in Kenya

High HIV rates among cohabiting couples in many African countries have led to greater programmatic emphasis on spousal communication in HIV prevention. This study examines how demographic and socioeconomic characteristics of cohabiting adults influence their dyadic communication about HIV. A central focus of this research is on how the position of women relative to their male partners influences spousal communication about HIV prevention. The authors analyze gaps in spousal age and education and females' participation in household decision making as key factors influencing spousal communication about HIV, while controlling for sexual behaviors of both partners as well as other individual and contextual factors. Data were obtained from the 2003 Kenya Demographic and Health Survey for 1,388 cohabiting couples. Information regarding spousal communication was self-reported, assessing whether both, either, or neither partner ever discussed HIV prevention with the other. Analyses showed higher levels of education for the female partner and participation in household decision making are positively associated with spousal communication about HIV prevention. With females' education and other factors controlled, couples with more educated male partners were more likely to have discussed HIV prevention than couples in which both partners have the same level of education. Spousal communication was also positively associated with household wealth status and exposure to the mass media, but couples in which male partners reported having nonspousal sex in the past year were less likely to have discussed HIV prevention with their spouses. Findings suggest HIV prevention programs should promote female empowerment and encourage male participation in sexual health discussion.

Voices unheard: Youth and sexuality in the wake of HIV prevention in Kenya

Objective The aim of the study was to explore the concerns of young people on sexuality in its social contexts in the era of HIV/AIDS in three districts in Kenya. Study design Young people in Kajiado, Kirinyaga and Meru Districts were requested to write questions on sexuality and related problems that later formed the basis for discussion in community dialogue meetings with adults. The social ecological conceptual model (SEM) was used to illuminate the contextual factors and actors influencing sexual behaviours among young people. Results The study suggests that young people and adults are concerned about honest and open communication on sexuality. Predominant concerns for the young people were love, sexual urge, desires or sexual wellness and condom use. Their questions suggest that young people are sexually active, yet have little knowledge on sexual matters. The results describe a prohibitive silence from adults, an issue reflected in the questions from the school youth. Conclusion This study suggests the need to move from seeing sexuality as a problem and focus on sexual wellness and the positive aspects of sexuality. The adult participants suggested that bringing men and women together for reflection and discussion in a participatory mode, transformative learning and change could be achieved. It is vital that the youth and adults have open communication as a foundation for youth to mature into adults. This can be achieved, if interventions including research address multiple contextual factors such as cultural norms, gender differences, as well as communication barriers.

Opportunities for targeted HIV prevention in Kenya

In 2007, an estimated 2.5 million [1.8 million - 4.1 million] persons became newly infected with HIV, most of these infections occurred in sub-Saharan Africa. Sub-populations that play an important role in fuelling the epidemic have been identified, and are among the most marginalized and discriminated people in society. Their behaviours put them at increased risk of becoming infected with HIV as well as spreading HIV to the population at large. Vulnerable groups include, but are not limited to, sex workers, men who have sex with men, orphans and vulnerable children, girls, migrant workers, uniformed services, victims of rape and sexual violence, intravenous drug users and discordant couples. Targeting these groups remains a key strategy for preventing HIV in both concentrated and generalized HIV epidemics. This thesis focuses on three of these key populations: sex workers; men who have sex with men; and people living with HIV. Currently, a better understanding is needed of the factors associated with increased sexual risk behaviour among these key populations to more effectively develop and implement targeted interventions. Also, assessment of existing interventions remains needed. The general objective of this work is to identify priorities in HIV prevention (acquisition and further transmission) and to assess prevention strategies among key populations. More specifically, the research aimed to identify factors associated with unprotected sex among key populations, and to assess the safety, acceptability and effectiveness of HIV prevention strategies among most-at-risk populations in Mombasa, Kenya. Taken together, seven studies were conducted in the period between March 2003 and December 2006, in Mombasa district, Kenya.

Emerging discourse: Islamic teaching in HIV prevention in Kenya

Islamic values portraying sex outside of marriage as sinful are often believed to contribute to HIV transmission as they reject safe-sex practices. Moreover, stigma associated with sinful behaviour is frequently assumed to interfere with access to care for those infected. In contrast, adherence to religious values such as abstinence is viewed as an explanation for the relatively low incidence of HIV infection in Islamic populations. Inspired by this debate, a study was conducted into the possibilities of using Islamic texts as a starting point for health promotion addressing HIV infection and HIV/AIDS-related stigma in Lamu, a Muslim community in Kenya. The study also explored the potential role of Lamu's Islamic leaders in the delivery of that health promotion. In collaboration with Islamic leaders, texts were identified that applied to sexual conduct, health, stigma and the responsibilities of Islamic leaders towards their congregations. In spite of the association of HIV with improper sexual behaviour, Islamic texts offer a starting point for tackling HIV transmission and HIV/AIDS-related stigma. Under particular conditions, the identified Islamic texts may even justify the promotion of safer-sex methods, including condom use.

Saying No to Forced Early Retirement from Sex: Time to broaden the scope of HIV prevention in Kenya

Grafts of quail zones of polarizing activity (ZPA), treated with 10000 rad gamma-radiation, tend to remain at the base of a limb. Their signalling ability is not passed on to more distal tissue, but the limb goes on to produce a reduplication. This suggests that the effect of a ZPA can be remembered in its absence, and explains why a normal limb can develop if its ZPA is removed.

Opportunities for targeted HIV prevention in Kenya

Opportunities for targeted HIV prevention in Kenya