Kibera In Nairobi Research Articles

Flooding in the urban fringes: Analysis of flood inundation and hazard levels within the informal settlement of Kibera in Nairobi, Kenya

Overlapping conditions of rapid urbanisation and climate change across developing countries are threatening the capacity of cities to manage climate risks, especially in the flood-exposed low-income peripheral areas. Limited studies have applied hydrodynamic flood models in ascertaining flooding conditions, supportive of risk-informed decisions in such urban fringes. Against this backdrop, we assessed plausible flooding and hazard conditions in the low-lying villages of Lindi and Silanga in Kibera informal settlement. The coupled one-dimensional and two-dimensional hydrodynamic model, customised from the Hydrological Engineering Centre's River Analysis System (HEC-RAS) was parameterised for flood simulation under different hydrological regimes and scenarios associated with flooding in Kibera. Volumetric flow estimates and a computed energy slope were used to define the upstream and downstream modelling boundary conditions respectively. Trial-and-error adjustment of the flow resistance coefficients from land-use features was applied in model calibration, and the results compared to the surveyed flood of 23rd April 2019. Results show that proximal areas to the Ngong River and Nairobi dam face high flood risks. A flood volume of 11.7×105m3 from a 2.5h, 50 mm rainfall could potentially inundate about 2.0% and 8.3% of areas in Lindi and Silanga respectively, while a volume of 48.9×105m3 from a 100-year storm of 172 mm could inundate about 10.6% of Lindi and 29.1% of Silanga. Upstream steeply sloping topographies of the villages increase flood velocities and risk of drowning, while the lower reaches at relatively flatter topographies, experience attenuated flow and rapid accumulation of flood waters, hence, higher flood depths. These results can support policy interventions for integrated flood risk management in Kibera, as a way of mainstreaming the underserved urban communities in climate risk management.

Two Dimensions of Existence of the ‘Slum’ in the Global City: A Comparative Case Study of Informal Settlements in Nairobi and Mumbai

The cities of the Global South have been predominantly approached as dual cities being embedded within the formal/informal dichotomy. This article provides an analysis of the power dynamics of formal and informal, using an example of public space in two informal settlements: Kibera in Nairobi, Kenya, and Dharavi in Mumbai, India. Based on my middle-term ethnographic research conducted in both settlements, I argue that the former binarism of coloniser and colonised has been transformed into the post-independence binarism of formal and informal. I interpret my ethnographic data by using Frantz Fanon’s theory about space and psychology of colonialism. I associate the formal sphere with Fanonian whiteness and the informal sphere with Fanonian blackness. From this perspective, I interpret the development of informal settlements as forcible formalisation. In such a process, by being pushed by the demands of the formality, local patterns of the informality are largely omitted and the elite-designed solutions frequently fail or – even worse – lead to the deterioration of the inhabitants’ situation.

The theory of planned behaviour in exploring dietary diversity practices among mothers in informal settlements in Kenya

One of the leading causes of malnutrition, which contributes to morbidity and mortality in children, is lack of dietary diversity. Despite remarkable improvement in exclusive breastfeeding in Kenya, there are still poor dietary diversity practices among children aged 6-24 months. Limited studies have applied the Theory of Planned Behaviour (TPB) to examine the factors that influence dietary diversity practices in informal settlements in Kenya. The objective of this qualitative study was to explore behavioral, normative, control beliefs, intention, and dietary diversity practices, based on the TPB. The study sites were Kibera in Nairobi, Manyatta A in Kisumu, and Kaptembwo in Nakuru. Participants were 64 mothers of children aged 6-24 months selected using purposive sampling. Nine focus groups, each comprising of 5-10 mothers were conducted and the data analyzed using thematic analysis. Using a focus group guide, based on the TPB, mothers described salient beliefs regarding their attitude, subjective norms and perceived control of dietary diversity. Analysis of the data showed that some mothers had intended to introduce solid foods at six months. However, barriers such as mother not feeding well, baby’s hunger, perceived insufficient breast milk production, and return to work led to earlier introduction of foods. Most mothers indicated their intention to give a variety of foods to their children but were hindered by barriers such as poverty/inadequate money, non-availability of food at home, and inadequate knowledge about complementary feeding. Friends, health professionals, fathers, neighbours and friends were cited as most salient referents that influenced the dietary diversity practices. The most frequently provided starchy foods were chappatis, mandazis, potatoes, rice, weetabix, porridge, and ugali. In conclusion, the results indicate that mothers had positive attitude towards dietary diversity. The ‘significant others’ who mostly influenced dietary diversity practices were health professionals, fathers, and friends. Future interventions need to target mothers' perceived child-feeding responsibilities, influence subjective norms, and increase parents' perceived control over child feeding.

Exploring Infant Feeding Beliefs and Practices among Mothers in Major Urban Informal Settlements in Kenya

Appropriate infant feeding is a proxy indicator for the good health and nutritional status of infants. The objective of this qualitative study was to explore mother’s beliefs and practices of infant feeding practices up to two years of age or beyond in major urban informal settlements in Kenya. A total of nine focus groups were conducted in three randomly selected sites, namely: Kaptembwo in Nakuru, Manyatta ‘A’ in Kisumu, and Kibera in Nairobi. Sixty-four mothers of children aged 6-24 months were chosen purposively, and the results were thematically analyzed. Results showed that most mothers still breast-fed their children, but they intended to stop breastfeeding when the child is 18 months old. Generally, the mothers reported the benefits of breastfeeding for two years of age or beyond, such as protection against diseases, improving health, and making the child strong. They perceived barriers to breastfeeding up to two years or beyond such as child illness, child’s decision, return to work, baby addiction to breast milk, and inconvenience brought about by breastfeeding. The foods perceived by mothers as good for the baby included yogurt, groundnuts, pumpkins, bananas, pawpaw, watermelon, oranges, spinach, and traditional vegetables. While the foods perceived as not good for the baby were processed milk, eggs, and sweet foods such as sodas, biscuits, cakes. Participants had a positive attitude towards water treatment and handwashing practices. The most commonly reported method of treating water was boiling. The perceived barriers to water treatment and handwashing practices included lack of fuel and water, forgetfulness, inadequate money, not able to control children. The findings indicate that increasing awareness on the duration of breastfeeding may motivate more mothers to breastfeed for two years and beyond.

Empowering Kibera during political change: A case study through a Freirean lens

Empowerment is an often used concept and the work of Paulo Freire has helped to define the application and outcomes of approaches. The researchers visited Kibera in Nairobi, Kenya, during periods of political activity which had previously resulted in violence. Community members identified strategies employed in an attempt to curtail heightened risk. These factors were analysed to evaluate whether empowerment, as espoused by Freire, was still relevant in community development work. Empowerment strategies were multi-faceted and highlighted that they had created new issues for the community to address, suggesting strategy and outcomes need to be strong considerations in future work.

Does Tenure Security Reduce Disaster Risk? A Comparative Study of the Nairobi Settlements of Kibera and Kawangware

While scholarship suggests that improving tenure security and housing significantly reduces disaster risk at the household level within urban settings, this assertion has not been adequately tested. Tenure security can be conceived as being composed of three interrelated and overlapping forms: tenure security as determined by legal systems; de facto tenure security; and tenure security as perceived by residents. This article traces the relationship between tenure security, the quality of housing, and disaster risk on the basis of a mixed methods comparative case study of the settlements of Kawangware and Kibera in Nairobi. Although the findings suggest that owner-occupancy is associated with the structural integrity of dwellings to a greater extent than tenantship, no association was found between the length of occupancy by households and the structural integrity of the dwelling. Moreover, tenantship is not found to be closely associated with fires and flooding affecting the dwelling as extant scholarship would suggest. Formal ownership is linked with greater investment and upgrading of property with significant implications for disaster risk. Our findings highlight the complex relationship between tenure security and disaster risk in urban informal settlements and provide impetus for further investigation.

Leadership Framework for Sustainable Housing Production in South Africa

A primary objective of the United Nation's Sustainable Development Goals (SDG-9) is providing quality, affordable, reliable, sustainable and resilient infrastructure, for every part of the global community by 2030. This is also a fundamental principle in the New Urban Agenda by the UN-Habitat. Studies have shown lack of adequate and affordable housing in many African cities, evident in slums such as Kyelitsha in Cape Town, Makoko in Lagos, and Kibera in Nairobi which house millions of urban dwellers. In South Africa, Section 26 of the constitution establishes the citizens' right to have access to adequate housing as incontrovertible. In order to achieve this, the South African government put in place several policies to ensure the attainment of the right. However, scholars acknowledge the poor rate of housing delivery by the government and view it as a symptom of an inadequate response to urban populism and a lack of leadership in the housing sector. This paper examines how leadership failures have impeded housing policy and practice implementation in South Africa. The study employs a systematic literature review and case studies in showing how lack of leadership affects the attainment of adequate housing provision. The paper proposes a leadership framework for sustainable housing provision and good governance in the housing sector.

Enteric pathogens from water, hands, surface, soil, drainage ditch, and stream exposure points in a low-income neighborhood of Nairobi, Kenya

Child exposure to fecal-oral pathogens occurs through several transmission pathways. However, the relative importance of different exposure points for pathogen transmission both inside and outside households is not well understood. We conducted a cross-sectional study in the urban slum of Kibera in Nairobi, Kenya, collecting 237 environmental samples from 40 households from source water, stored drinking water, caregiver hands, child hands, household surfaces, soil, standing water, open drainage ditches, and streams. We quantified the fecal indicator Escherichia coli and the enteric pathogens of adenovirus, Campylobacter jejuni, Shigella spp./enteroinvasive E. coli (EIEC), and Vibrio cholerae. At least one enteric pathogens was detected in 13% of household stored water, 47% of hand, 46% of table surface, 26% of plate surface, 75% of floor surface, 96% of soil, 56% of standing water, 77% of drainage ditch, and 100% of stream samples despite all households having access to a toilet or latrine. Our results provide evidence that children may be exposed to enteric pathogens from several exposure points, that domestic hygiene practices related to water treatment and child handwashing were associated with reduced pathogen detection in this setting, but household table and floor cleaning practices were not, that ownership or presence of chickens in the compound was associated with increased detection of C. jejuni inside households and on soil, that there were interactions among different transmission pathways for enteric pathogens, and that there were differential correlations between E. coli and enteric pathogens for different pathogens and environmental sample types. Additionally, V. cholerae was detected at several exposure points during a cholera outbreak. Overall, these results suggest that interventions that can disrupt many transmission pathways may be needed to reduce enteric pathogen exposure in this urban slum setting.

'Know that You are not Alone.' Influences of Social Support on Youth Newly Diagnosed with HIV in Kibera, Kenya: A Qualitative Study Informing Intervention Development.

The role of social support in assisting youth in developed countries cope with their HIV diagnosis has been examined through a vast body of research; yet, there remains a gap in research around the effects of social support among youth living in sub-Saharan African countries including Kenya. This study aimed to examine the role of social support among Kenyan youth living with HIV, specifically with regard to the variations in influences of this social support. We conducted semi-structured focus group discussions with youth (ages 18 to 27) living in the informal urban settlement of Kibera in Nairobi, Kenya (n = 53). Data analysis followed a phenomenological inquiry framework, and seven major categories of perceived social support influences were identified: (1) linkage to services, (2) antiretroviral (ARV) adherence, (3) self-acceptance of HIV status, (4) healthy and positive living, (5) understanding of what it means to be living with HIV, (6) HIV status disclosure, and (7) family and occupational strengthening. The findings from this study suggest that Kenyan youth living with HIV can benefit from social support in a multitude of ways and can occur across several socio-ecological levels. Future research should further examine these influences, specifically regarding intervention development across socio-ecological levels.

Efficient lighting uptake among the urban poor: evidence from a Kenyan informal settlement

Based on an original dataset of 651 households in the informal settlement of Kibera in Nairobi, Kenya, this article examines household electricity use, drivers of uptake and willingness to pay (WTP) for efficient compact fluorescent lamp (CFL) lighting technology. Informal and illegal electricity consumption, euphemistically referred to by residents as “electricity borrowing”, is common. This removes the metered electricity price lever upon which to influence consumer behaviour and demand for energy-efficient technologies. However, as this study demonstrates, the comparative durability of efficient lighting technologies presents economic benefits for uptake even in a context of fixed-rate electricity payments. While bulb uptake and stated WTP are independent of demographic characteristics such as income activity, gender, education and other factors, they are significantly correlated with informal electricity consumption, beliefs related to bulb durability, knowledge of past energy efficiency outreach, and other contextual factors, underlining a need for tailored approaches to energy efficiency in informal settlements.

The Adolescent Girls Initiative-Kenya (AGI-K): study protocol.

BackgroundMany adolescent girls in Kenya and elsewhere face considerable risks and vulnerabilities that affect their well-being and hinder a safe, healthy, and productive transition into early adulthood. Early adolescence provides a critical window of opportunity to intervene at a time when girls are experiencing many challenges, but before those challenges have resulted in deleterious outcomes that may be irreversible. The Adolescent Girls Initiative-Kenya (AGI-K) is built on these insights and designed to address these risks for young adolescent girls. The long-term goal of AGI-K is to delay childbearing for adolescent girls by improving their well-being.InterventionAGI-K comprises nested combinations of different single-sector interventions (violence prevention, education, health, and wealth creation). It will deliver interventions to over 6000 girls between the ages of 11 and 14 years in two marginalized areas of Kenya: 1) Kibera in Nairobi and 2) Wajir County in Northeastern Kenya. The program will use a combination of girl-, household- and community-level interventions. The violence prevention intervention will use community conversations and planning focused on enhancing the value of girls in the community. The educational intervention includes a cash transfer to the household conditioned on school enrollment and attendance. The health intervention is culturally relevant, age-appropriate sexual and reproductive health education delivered in a group setting once a week over the course of 2 years. Lastly, the wealth creation intervention provides savings and financial education, as well as start-up savings.Methods/DesignA randomized trial will be used to compare the impact of four different packages of interventions, in order to assess if and how intervening in early adolescence improves girls’ lives after four years. The project will be evaluated using data from behavioural surveys conducted before the start of the program (baseline in 2015), at the end of the 2-year intervention (endline in 2017), and 2 years post-intervention (follow-up in 2019). Monitoring data will also be collected to track program attendance and participation. Primary analyses will be on an intent-to-treat basis. Qualitative research including semi-structured interviews of beneficiaries and key adult stakeholders in 2016 and 2018 will supplement and complement the quantitative survey results. In addition, the cost-effectiveness of the interventions will be assessed.DiscussionAGI-K will provide critical evidence for policy-makers, donors and other stakeholders on the most effective ways to combine interventions for marginalized adolescent girls across sectors, and which packages of interventions are most cost-effective.Trial registrationISRCTN77455458, December 24, 2015Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-2888-1) contains supplementary material, which is available to authorized users.

Crowd-sourced data for geospatial sanitation planning in informal settlements

Crowd-sourced geospatial data from OpenStreetMap and the Map Kibera project were used to model and optimise a proposed road-based sanitation network for the settlement of Kibera in Nairobi, Kenya. ...

“When we are together I feel at home.” Types and sources of social support among youth newly diagnosed with HIV in Kenya: implications for intervention

Social support helps youth manage psychosocial stress. Though many studies have investigated the role of social support in helping youth in developed countries cope with their HIV status, such research is lacking among youth living in sub-Saharan African countries, including Kenya. The importance of research on youth living with HIV in Kenya is enhanced given young people's unique developmental stages and the HIV prevalence rate of 8.8% among Kenyans aged 25 to 29 years. To gain further insight, qualitative focus group interviews were conducted with 53 youth aged 18 to 27 years who lived in the informal urban settlement of Kibera in Nairobi, Kenya. A phenomenological approach was used to analyse the data from which four major types of social support were identified: 1) emotional; 2) informational; 3) appraisal; and 4) instrumental. Within each of these overarching themes more specific sub-themes were identified. The youth also reported receiving social support from eight main sources: 1) family; 2) friends; 3) clinicians and clinical services; 4) counsellors; 5) support groups; 6) religious sources; 7) partners; and 8) other. These findings suggest that various forms of social support, provided by diverse sources, which may fall outside of those commonly involved in interventions, can help youth living with HIV cope with their diagnosis and promote healthy lifestyles. Future research should investigate the roles and interactions of different types and sources of support, specifically as they relate to interventions aiming to ameliorate the experiences of youth newly diagnosed with HIV.

When families fail: shifting expectations of care among people living with HIV in Nairobi, Kenya

The availability of free antiretroviral treatment in public health facilities since 2004 has contributed to the increasing biomedicalization of AIDS care in Kenya. This has been accompanied by a reduction of funding for community-based care and support organizations since the 2008 global economic crisis and a consequent donor divestment from HIV projects in Africa. This paper explores the ways that HIV interventions, including support groups, home-based care and antiretroviral treatments have shaped expectations regarding relations of care in the low-income area of Kibera in Nairobi, Kenya, over the last decade. Findings are based on 20 months of ethnographic research conducted in Nairobi between January 2011 and August 2013. By focusing on three eras of HIV treatment – pre-treatment, treatment scale-up, and post-crisis – the authors illustrate how family and community-based care have changed with shifts in funding. Many support groups that previously provided HIV care in Kibera, where the state is largely absent and family networks are thin, have been forced to cut services. Large-scale HIV treatment programmes may allow the urban poor in Nairobi to survive, but they are unlikely to thrive. Many care needs continue to go unmet in the age of treatment, and many economically marginal people who had found work in care-oriented community-based organizations now find themselves jobless or engaged in work not related to HIV.

Detection of viral respiratory and gastrointestinal pathogens among healthy adults and children of an informal settlement (Kibera) in Nairobi, Kenya

Background: Asymptomatic individuals (AIs) serve as reservoirs of pathogens associated with disease transmission. The objective of this study was to identify the presence and diversity of selected viral respiratory and gastrointestinal (GI) pathogens in AIs among residents of an informal settlement in Nairobi, Kenya. Methods & Materials: In 2006, KEMRI/CDC established a population-based infectious disease surveillance site within Kibera in Nairobi, Kenya. AIs (healthy controls) were enrolled as part of the system among persons who presented to the study’s referral facility (Tabitha Medical Clinic). Persons presenting without current or previous 2 weeks history of fever, respiratory or diarrheal symptoms were eligible for enrollment as healthy controls. Following consent, participants provided stool and nasopharyngeal/oropharyngeal (NP/OP) specimens. Stool samples were tested by culture for bacterial pathogens and rotavirus by enzyme-linked immunoassay. Respiratory viruses were detected in NP/OP swabs by real time PCR. Results:Between01st November 2008 and31st December 2011, 384 stool samples and 779 NP/OP swabs were obtained from AIs. Pathogenswere found in23 (6.0%) of the384 stool samples. Shigella, 10 (43.5%), was the predominant bacterial pathogen isolated; S. dysenteriae (10%), S. flexneri (70%), and 2 unsubtypable Shigella species. Other bacterial species identified included Campylobacter coli (4.3%) and C. jejuni (17.3%). Rotavirus was the only viral pathogen targeted for isolation; however, it was only detected in <2% of the participants (n=384; 1.8%). Of the 779 NP/OP swabs, adenovirus (11%), respiratory syncytial virus (RSV) (2.8%), human metapnuemovirus (hMPV) (2.7%), influenza virus type A and B (2.3 and 0.5%, respectively), parainfluenza (PIV) type 1, 2 and 3 (0.9, 1.0 and 1.9%, respectively) were detected. Adenovirus, hMPV, RSV, and influenza B were found more frequently in ages 5-17 years (28.1%, 33.3%, 45.5%, and 75% respectively). Adenovirus (78.9%) and all cases of RSV and PIV 1-3 in 18-34 years were identified more among females.Within the same age group Influenza A (85.7%) and hMPV (60%) were more common among males. Conclusion: AIs did show evidence of infection and could serve as reservoirs for thesepathogens throughclose contact in thisurban settlement especially among immunocompromised individuals.

Emergence of murine typhus in Reunion Island, South West Ocean Indian Island: Epidemiological, clinical, laboratory features of 10 cases

Background: Asymptomatic individuals (AIs) serve as reservoirs of pathogens associated with disease transmission. The objective of this study was to identify the presence and diversity of selected viral respiratory and gastrointestinal (GI) pathogens in AIs among residents of an informal settlement in Nairobi, Kenya. Methods & Materials: In 2006, KEMRI/CDC established a population-based infectious disease surveillance site within Kibera in Nairobi, Kenya. AIs (healthy controls) were enrolled as part of the system among persons who presented to the study’s referral facility (Tabitha Medical Clinic). Persons presenting without current or previous 2 weeks history of fever, respiratory or diarrheal symptoms were eligible for enrollment as healthy controls. Following consent, participants provided stool and nasopharyngeal/oropharyngeal (NP/OP) specimens. Stool samples were tested by culture for bacterial pathogens and rotavirus by enzyme-linked immunoassay. Respiratory viruses were detected in NP/OP swabs by real time PCR. Results:Between01st November 2008 and31st December 2011, 384 stool samples and 779 NP/OP swabs were obtained from AIs. Pathogenswere found in23 (6.0%) of the384 stool samples. Shigella, 10 (43.5%), was the predominant bacterial pathogen isolated; S. dysenteriae (10%), S. flexneri (70%), and 2 unsubtypable Shigella species. Other bacterial species identified included Campylobacter coli (4.3%) and C. jejuni (17.3%). Rotavirus was the only viral pathogen targeted for isolation; however, it was only detected in <2% of the participants (n=384; 1.8%). Of the 779 NP/OP swabs, adenovirus (11%), respiratory syncytial virus (RSV) (2.8%), human metapnuemovirus (hMPV) (2.7%), influenza virus type A and B (2.3 and 0.5%, respectively), parainfluenza (PIV) type 1, 2 and 3 (0.9, 1.0 and 1.9%, respectively) were detected. Adenovirus, hMPV, RSV, and influenza B were found more frequently in ages 5-17 years (28.1%, 33.3%, 45.5%, and 75% respectively). Adenovirus (78.9%) and all cases of RSV and PIV 1-3 in 18-34 years were identified more among females.Within the same age group Influenza A (85.7%) and hMPV (60%) were more common among males. Conclusion: AIs did show evidence of infection and could serve as reservoirs for thesepathogens throughclose contact in thisurban settlement especially among immunocompromised individuals.

Review: Design with the Other 90%: Cities; Design with the Other 90%: Cities; Design with the Other 90%: Cities; and Design with the Other 90%: Cities

Design with the Other 90%: Cities Cooper-Hewitt National Design Museum at the United Nations Visitor Center, New York City 15 October 2011–9 January 2012 Museum of Contemporary Craft and Action Center at Mercy Corps, Portland, Oregon 17 August 2012–5 January 2013 Mildred Lane Kemper Art Museum, Washington University, St. Louis, Missouri 14 September 2012–7 January 2013 David J. Sencer CDC Museum, Centers for Disease Control and Prevention, Atlanta 4 February–24 May 2013 A street vendor in Durban partners with an architect and a “social art and architecture” collective to build a prototype mobile vending cart (Spaza-de-Move-on) that serves as table, chair, and storage. Mobile phone programs are used to provide access to HIV information and testing kits (Text to Change, Uganda), transfer money from migrant workers back to their families (M-Pesa in Kenya), and provide a job listing network (Babajob.com in Bangalore). Modified river boats in Bangladesh become floating schools, libraries, and health clinics in flood-prone districts. In Caracas an Integral Urban Project replaces precarious resident-built stairways that climb the steep hills to the informal settlements above the city with concrete stairs whose public landings provide new spaces of social interaction while carrying beneath them critical infrastructure (water, sewage electricity, gas, and water lines). Architects and engineers working with community partners fashion new building materials out of local and recycled materials—insulation panels in Pakistan using straw and sludge from a nearby paper factory; bamboo loofah wall panels in Paraguay; cow dung bricks in Indonesia; stabilized soil blocks in Uganda. Grassroots Mapping in Lima and Map Kibera in Nairobi combine local data gathering with sophisticated digital applications to facilitate comprehensive planning. Incremental Housing in Iquique, Chile, provides the serviced half of a house (structure, wet areas, stairs, roof), allowing the resident to complete the adjacent part gradually with limited means. Guangzhou Bus Rapid Transit links outlying villages to the city center. Shack/Slum Dwellers International, a membership organization led by women operating in thirty-four countries, builds capacity among the urban poor with an emphasis on local credit and savings. These are some of the sixty projects from forty countries documented in Design with the Other 90%: Cities …

Using GPS and recall to understand water collection in Kenyan informal settlements

This paper uses interviews and Global Positioning System (GPS) loggers to measure the time taken to collect water in two large informal settlements in Kenyan cities. Collection times were measured, and collection paths mapped, in two low-income urban settlements, comparing water access conditions in Nyalenda in Kisumu (where the utility has introduced a new piped water system) with Kibera in Nairobi (where no such improvement has been made). The use of GPS tracking provides a better understanding of time spent collecting water compared to interview data, but the two methods combined provide insights that neither could have suggested alone.

Sexual risk-reduction strategies among HIV-infected men receiving ART in Kibera, Nairobi

This paper explores motivational factors and barriers to sexual behaviour change among men receiving antiretroviral treatment (ART). Twenty in-depth interviews were undertaken with male patients enrolled at the African Medical and Research Foundation clinic in Africa's largest urban informal settlement, Kibera in Nairobi, Kenya. All participants experienced prolonged and severe illness prior to the initiation of ART. Fear of symptom relapse was the main trigger for sexual behaviour change. Partner reduction was reported as a first option for behaviour change since this decision could be made by the individual. Condom use was perceived as more difficult as it had to be negotiated with female partners. Cultural norms regarding expectations for reproduction and marriage were not supportive of sexual risk-reduction strategies. Thus, local sociocultural contexts of HIV-infected people must be incorporated into the contextual adaptation and design of ART programmes and services as they have an over-riding influence on sexual behaviour and programme effectiveness. Also, HIV-prevention interventions need to address both personal, micro- and macro-level factors of behaviour to encourage individuals to take on sexual risk-reduction strategies. In order to achieve the anticipated preventive effect of ART, these issues are important for the donor community and policy-makers, who are the major providers of ART programme support within weak health systems in sub-Saharan Africa.

Sexual risk taking among patients on antiretroviral therapy in an urban informal settlement in Kenya: a cross‐sectional survey

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.