We analyzed questionnaire and blood testing data to identify significant correlates of HIV infection among sexually active adults. We collected blood specimens from 9, women and 6, men of which 6, women and 5, men were sexually active during the 12 months prior to the survey. HIV prevalence among sexually active adults was 7. Lack of a comprehensive understanding of national HIV epidemics remains a major challenge for targeting effective HIV programs. Antenatal clinic ANC sentinel surveillance has been useful to document trends of generalized epidemics but lacks adequate sexual-behavioral and other associated risk factors for HIV infection, and is not generalizable to men and non-pregnant women [ 1 ].
HSV-2 may also play a role. Copyright nyajza. Figure 2 Although the study was not powered for single year of age-specific estimates, HIV prevalence in adolescent females increased from 3. Women and hiv aids in nyanza, compounds were randomly selected from a DSS list of compounds housing residents aged years. The median age of first pregnancy was 18 years. The use of condoms in this group is an Kendra wilkinson lingerie pictures finding for HIV-positive prevention strategies but raises the question as to Wo,en current condom use campaigns are effective in reaching the general population with messages on the important benefits of correct and consistent condom use for HIV prevention.
Chloe james model photos. Introduction
Qualitative methods in evaluation. Epidemiology of human papillomavirus infection among fishermen along Lake Victoria Shore in the Kisumu District, Kenya. FGD participants were also asked to describe condom use scenarios for another similar fictional character that was inherited by her brother-in-law after her husband died. The use of new HIV prevention products must be situated within the cultural and societal contexts in which women at risk for What makes men ejaculate infection live Women and hiv aids in nyanza are potentially exposed to the virus. Sometimes, adolescents are forced into being sex workers to provide for themselves, resulting in an increased risk for HIV infection. Wandera, Juma crowned Kisumu Open champions. Minimum order asian gifts san-x York: Rutledge; HIV prevention [Internet]. Women not involved in jaboya relationships—that is, wives or relatives of fishermen—provide these forms of economic support to fishermen as well. Methods As part of a larger descriptive qualitative study to inform study procedures for FEM-PrEP, an HIV prevention pre-exposure prophylaxis clinical trial, we conducted 15 semi-structured interviews SSIs with widows, 15 SSIs with inheritors, and four focus group discussions with widows in the Ln and Rarieda districts in Nyanza Province to explore the HIV risk context within widow cleansing and inheritance practices. Sometimes this lady has to feed ahd like small babies so that by the time they go to the lake they are full throughout the night. Un is less well known, and what this study has revealed, is that the female traders involved in these transactions are highly mobile and at risk of HIV as well. Aside from the initial cleansing ritual, widows, as well as married women, are expected to observe other sexual norms common in the Luo community. Adult HIV prevalence is estimated to Women and hiv aids in nyanza fallen from 10 percent in the late s to about 4. The good news is that women who take HIV medicine called antiretroviral therapy Women and hiv aids in nyanza ART daily as prescribed and get and keep an undetectable viral load can stay healthy and have effectively no risk of transmitting HIV to an HIV-negative partner through sex.
Substantive reviews of manuscript drafts: CV.
- Prior research documented high mobility and HIV risks among fishermen; mobility patterns and HIV risks faced by women in fishing communities are less well researched.
- The good news is that women who take HIV medicine called antiretroviral therapy or ART daily as prescribed and get and keep an undetectable viral load can stay healthy and have effectively no risk of transmitting HIV to an HIV-negative partner through sex.
Substantive reviews of manuscript drafts: CV. To estimate HIV prevalence and characterize risk factors among young adults in Asembo, rural western Kenya. Consent procedures for non-emancipated minors required assent and parental consent. HIV voluntary counseling and testing was offered. Adjusted HIV prevalence was HIV prevalence was highest in women aged years HSV-2 prevalence was 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.
Further research on circumstances around HIV acquisition in young women and novel prevention strategies vaccines, microbicides, pre-exposure prophylaxis, HSV-2 prevention, etc. African youth are disproportionately affected by the global HIV pandemic. Asembo is a rural, subsistence farming community in Nyanza. DSS staff visit each compound every four months to collect demographic data and register all births, deaths, and in-, out-, and trans-migrations.
Using the DSS as a sampling platform, potential study participants were randomly selected through stratified sampling by sex and age group. First, compounds were randomly selected from a DSS list of compounds housing residents aged years.
Second, one individual per compound aged years was randomly selected for participation, through randomly assigned numbers, to minimize potentially non-independent HIV transmission. For analyses, individual sample weights were calculated to account for differences in sampling fractions by the 8 sex- and age-strata females: , , , and years; males: , , , and years which included adjustments for nonresponse.
These weights were used for all analyses labeled as being weighted. For sample size and power calculations, we assumed similar HIV prevalence rates to those in Kisumu. Written informed consent was obtained from all adults and mature minors before study participation.
Mature minors were married, pregnant, or a parent and could consent to study participation, as they can for HIV voluntary counseling and testing in Kenya. Data were collected from October through April Trained interviewers visited compounds to obtain informed consent from potential study participants. Participants were invited to a nearby site on a specified day for the interview and specimen collection.
Study clinicians conducted physical examinations to diagnose acute illnesses or symptomatic STIs and confirm male circumcision. All participants underwent pre-test HIV counseling by certified counselors before venipuncture. Participants received free clinical care for common, acute ailments including STIs and were referred for free tuberculosis diagnosis and treatment. Bray, Ireland rapid tests in parallel. Bray, Ireland. Urine pregnancy tests were conducted on-site for all consenting females not visibly pregnant using Randox, Inc.
Data were collected on optical character recognition enabled forms that were completed in the field through face-to-face interviews, transported to the research station, scanned into a database using Teleform version 8 Verity, Inc.
Questionnaires contained embedded internal consistency and validity checks. Data cleaning and statistical analyses using survey procedures were performed in SAS versions 8. HIV prevalence and univariate aggregate data were weighted to the population from which the study sample was drawn.
Standard errors were computed that accounted for the sampling design and the individual's sampling probability from the sampling strata. Analyses that are descriptive of the sample attributes are not weighted.
Analyses that are descriptive of the population are weighted and are labeled as such. All logistic regression models used weights to account for the probability of selection by age and sex strata. Separate analyses were conducted for females and males. Due to gender differences in age of life events e. Because of the strong association between HIV infection and marriage, bivariate and multivariate analyses were conducted separately for sexually active participants and those who had ever been married.
Marriage was defined as a legal, religious, or customary agreement or a man and woman living together as married. Anyone who had ever had sexual intercourse was considered sexually active.
Polygamy, widow inheritance, and cultural rituals involving sex are part of Luo culture. We evaluated factors associated with HIV infection through logistic regression modeling using software that incorporated the sampling weights. Using the forward stepwise selection method, four hierarchical models were constructed: ever sexually active females and males and ever-married females and males.
Upon finalization of the sociodemographic tier, the same approach was used to add sexual behavior, other HIV risk factors, and finally STI-related covariates. The likelihood ratio test was used to compare statistical models. Although not significant on bivariate analyses, male circumcision was included in all male models because of the protection conferred against HIV.
Among year olds in the sample, The median age of sexual debut was The median age of first pregnancy was 18 years. The median age of first marriage was 18 years for females and 23 years for males. Additionally, Only The median number of lifetime sexual partners for sexually active participants in our sample was 3 for females and 4 for males.
Among ever-married participants, condom use during the last sexual intercourse with spousal or non-spousal partners was rare in females 3. Of currently married individuals, 3.
The population, HIV prevalence for the study area, based on participants who provided blood specimens and complete data, weighted by age group and sex was Table 1 presents HIV prevalence of all study participants by demographic characteristics. Females became infected several years younger than males, and HIV prevalence was higher among females than males until the fourth decade. Figure 1 Weighted HSV-2 prevalence was Figure 2 Although the study was not powered for single year of age-specific estimates, HIV prevalence in adolescent females increased from 3.
Of females who denied ever having had sexual intercourse in our sample, 4 1. After adjustment for age group and stratification by sex, several demographic and risk variables were associated with HIV prevalence among sexually active participants Table 2. In multivariate analysis, HIV infection remained significantly associated with the following factors: older age, cash income, higher number of lifetime sexual partners, having received an injection in the prior six months, and scarification.
Adding STI-related covariates to the model attenuated the positive association of HIV infection with age and lifetime number of sexual partners and rendered non-significant the positive association between HIV infection and scarification or prior STI treatment. Among sexually active males Table 2 , factors significantly associated with HIV infection included the following: being married or a widower, higher number of lifetime sexual partners, having received an injection in the previous six months, HSV-2 infection, and previous STI treatment.
In multivariate analysis, older age and higher number of lifetime sexual partners remained significantly associated with HIV infection. Marital status was an effect modifier necessitating separate analyses by gender and marital history. Because few never-married individuals were HIV-infected, we were unable to conduct adequate multivariate analyses in this group. For ever-married participants, univariate analyses of factors associated with HIV infection are presented in Table 3 and multivariate analyses in Table 4.
In multivariate analyses of ever-married females, widowhood, cash income, having received an injection in the prior six months, and HSV-2 infection were significantly associated with HIV infection. For ever-married males, a higher number of lifetime sexual partners and HSV-2 infection was significantly associated with HIV infection. Limited data were available on circumstances around injections.
Those aged years comprised the highest proportion receiving an injection This population-based study in rural Nyanza Province, Kenya, found a high prevalence of HIV infection among those aged years.
This substantial gender disparity is found in Kenya nationwide  ,  and other African countries. Having a first sexual partner much older in age was not significantly associated with HIV infection. HSV-2 may also play a role. Including HSV-2 infection in the multivariate model attenuated the positive association between HIV and a higher lifetime number of sexual partners. Being currently married was significantly associated with HIV infection.
HIV prevention efforts must target married couples. The KDHS found The potential contribution of unsafe injections to HIV transmission has been raised  -  , disputed  -  , and continues to be examined.
Additionally, for all participants there was no association between having received an injection in the prior six months and having ever had STI treatment. Given this study's cross-sectional design, this finding may represent reverse causality or confounding for which we could not control.
Further investigation through a prospective incidence cohort is warranted. HIV infection in Africa has been associated with urban-to-rural and intra-rural human mobility. Mobility may be a risk factor for HIV infection. The DSS data for Asembo showed substantial migration. Recent randomized clinical trials of male circumcision resulted in an approximate reduction of HIV acquisition by half.
Ritual sex around funerals, polygamy, and widow inheritance are traditional Luo practices that can facilitate HIV transmission. Traditionally, widow inheritance requires a widow to become the wife of her late husband's brother, assuring her and her children economic and social stability. Other data regarding HIV prevalence in Nyanza Province include a second cross-sectional study with different sampling methodology and age distribution was conducted from in the neighboring community of Gem.
This study of volunteers aged years showed a weighted HIV prevalence of Study limitations exist. Risk factor data in cross-sectional studies are associations and cannot identify causality. Ill individuals may have left the area seeking health care or returned home to die.
Healthy individuals may have left seeking employment or returned to care for ill relatives.
Their bodies may not respond as well to their herpes treatment, either. For this article, we analyzed data from participant observation at beaches and interviews with women and men engaged in fishing and fish trade. Clearly, the populations living in beach villages on Lake Victoria are in urgent need of accelerated access to HIV testing, treatment, and prevention services. They may be a symptom of HIV itself or the result of a concurrent infection or condition. The Standard.
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We analyzed questionnaire and blood testing data to identify significant correlates of HIV infection among sexually active adults.
We collected blood specimens from 9, women and 6, men of which 6, women and 5, men were sexually active during the 12 months prior to the survey. HIV prevalence among sexually active adults was 7. Lack of a comprehensive understanding of national HIV epidemics remains a major challenge for targeting effective HIV programs. Antenatal clinic ANC sentinel surveillance has been useful to document trends of generalized epidemics but lacks adequate sexual-behavioral and other associated risk factors for HIV infection, and is not generalizable to men and non-pregnant women [ 1 ].
Studies conducted in a number of sub-Saharan African countries showed that ANC data over-estimated prevalence in year olds and underestimated prevalence in older ANC clinic attendees [ 2 , 3 ]. Hospital-based studies have also been conducted in low prevalence areas to understand risk factors [ 4 ], but the findings are not easily generalizable to populations living in countries with high HIV prevalence. Thus, laboratory and risk factor analyses have been limited.
Kenya has wide variability in the distribution of HIV infection by geographic, demographic, sexual-behavioral, and biological factors. The Kenya Demographic and Health Survey KDHS conducted in included HIV serology but was limited in the scope and depth of sexual-behavioral and biological indicators collected, and included consenting adults aged years [ 15 ].
In this era of expansion of prevention, care and treatment programs for HIV, additional variables of interest are needed to facilitate accurate interpretation of HIV prevalence data and associated risk factors [ 16 ].
In addition to providing national prevalence estimates for HIV and sexually transmitted infections, these data provided the opportunity to link HIV status with key demographic, behavioral, and biologic information to identify significant correlates associated with HIV infection in Kenya. We examined factors independently associated with the risk of HIV infection among individuals who were sexually active during the 12 months prior to the survey.
Respondents provided consent separately for the interviews and blood draws. KAIS was conducted among a nationally representative sample of households selected from all the eight provinces in Kenya, covering both rural and urban areas. Various studies show that Nyanza province continues to have the highest HIV prevalence in Kenya [ 15 , 17 , 18 ]. Nairobi province is the capital city and has a cosmopolitan population with diverse ethnic groups and cultures.
Nyanza on the other hand is predominantly inhabited by the Luo ethnic group. In order to reflect the population distribution, we sampled and clusters in rural and urban areas respectively. We collected data between August and December, We administered household and individual questionnaires and collected venous blood from respondents. Partner-specific information on HIV status, testing history, disclosure, condom use and family planning preference were collected for up to four sex partners in the last year.
For population size estimates, we used census data from the Kenya National Bureau of Statistics, using the sampling frame based on the census. Full details of methods used in KAIS have been published elsewhere [ 18 ]. CD4 cell count enumeration was conducted for HIV-infected participants. Data from questionnaires were entered into a CSPro database version 3. To obtain nationally representative estimates, we calculated sampling weights for each individual and household based on selection probability and taking into account cluster-level non-participation.
In addition, special weights were calculated for those who participated in the blood draw to take into account cluster-level non-participation. For the purposes of this paper, we restricted analysis to a sub-set of questions from the individual questionnaire among participants who were sexually active in the last year before the survey.
Sexually active individuals were those who self-reported having had sexual intercourse. Additionally, we conducted a sub-analysis to further investigate correlates of HIV infection that were specific to Nyanza province, the province with the highest HIV prevalence rate for men and women compared to all other provinces. We used the Rao-Scott chi-square test which allowed adjusting for the cluster survey design when testing for associations between categorical variables and HIV infection.
Bivariate analysis was used to quantify the association between the demographic, behavioral and biological variables and HIV infection. We conducted multivariate logistic regression by constructing separate models for males and females to assess factors independently and significantly associated with HIV infection among sexually active persons.
All variables were first included in the models and model selection was carried out using a backward elimination procedure. All variables that had a p-value of greater than 0. Variables were then removed sequentially from the models starting with the one with the highest p-value until all variables had a p-value of less than 0.
All confounders were retained in the model irrespective of the p-value. We collected information from 9, households. We found ethnicity to be co-linear with province and circumcision and choose to present differential risks with a focus on circumcision status and province rather than with a focus on ethnicity.
Overall, HIV prevalence among all adults aged years was 7. Among sexually active adults aged years old, 7. HIV prevalence increased with age, with the highest prevalence Among year olds, HIV prevalence was Prevalence among individuals aged was 2.
Although there was no difference in HIV prevalence between rural and urban areas,, prevalence varied greatly across provinces Table 1. Women had higher HIV prevalence than men in all provinces.
In Nyanza Province HIV prevalence was higher among married or cohabitating 7. We observed no difference in HIV prevalence by wealth status for women and men; however, men who were currently employed had higher prevalence 6.
Among sexually active men, HIV prevalence was HIV prevalence in uncircumcised men rose sharply between the year age group 3. Among participants who reported being sexually active in the last 12 months, consistent condom use with the last sex partner was associated with higher HIV prevalence compared to no condom use with the last sex partner Table 1. Syphilis prevalence was 1.
HIV prevalence was significantly higher among those infected with syphilis Prevalence among sexually active adults in Nyanza province was highest in the toyear-old age group for women In multivariate analysis, factors independently associated with HIV prevalence among recently sexually active women were age group years vs years AOR 1. Factors associated with HIV infection among recently sexually active men were age group years vs years AOR In , an estimated 7. Correlates of HIV infection among women and men were age, number of lifetime sex partners, residence in Nyanza province, HSV-2 infection, consistent condom use with the last sex partner and lack of circumcision among men.
The strongest independent predictors for HIV infection for both women and men were HSV-2 co-infection and higher number of lifetime sex partners.
HIV prevalence was highest in Nyanza Province, where In a sub-analysis for Nyanza Province, we found that age, HSV-2 infection, multiple lifetime sex partners, consistent condom use with the last sex partner and lack of male circumcision were independently associated with HIV. Many of these factors are similar to predictors of HIV infection found at the national level and are consistent with findings from other studies [ 1 , 8 , 16 , 19 ].
Unfortunately, randomized controlled trials that have examined daily acyclovir treatment of HSV-2 among persons with HIV co-infection, or acyclovir prophylaxis among persons without HIV have not demonstrated a protective effect [ 23 ]. The potential increase in HIV prevalence may be in part due to the survival effects of antiretroviral therapy. It may also indicate increasing incidence and a need to improve and expand HIV prevention programs throughout Kenya, and particularly in Nyanza Province.
Appropriate messages on delaying sexual debut, knowledge of HIV status, male circumcision, consistent and correct use of condom with partner of unknown HIV status or known discordant HIV status, and reduction of number of sex partners should be reinforced [ 8 , 24 , 25 ].
Our study showed that widowhood and divorce were significantly associated with higher HIV prevalence. Ethnicity and province influence both the distribution of circumcision practice and HIV prevalence. Several studies have showed that male circumcision reduces the risk of HIV acquisition among men [ 28 ].
High prevalence in Nyanza province could be attributed to low male circumcision rates. In addition, cultural practices such as widow inheritance practiced among the Luo community the predominant ethnic group in Nyanza may be a factor [ 28 , 29 ]. Widow inheritance is a traditional practice in which a designated man takes social and economic responsibility over a woman following the death of her husband [ 30 ].
A study by Agot et al. If the spouse of the deceased is HIV-infected, the cleanser acts as a bridge for HIV transmission to other widows hence putting widowed women at a high risk [ 31 ]. Though the association between condom use and HIV infection was not expected, the finding may reflect the success of positive prevention interventions and condom promotion efforts to increase condom use by people living with HIV.
Our study was limited by several factors. Although we do not expect that there is significant participation bias, we were not able to conduct these analyses; however, appropriate weighting was applied to adjust for non-response. Additionally, key sexual behavior indicators were based on self reported data. Though KAIS interviewers were trained on asking sensitive questions around sexual behavior and ensuring respondent confidentiality, there is a possibility that these questions were not accurately answered.
We did not ask how long after circumcision the men engaged in sexual intercourse. The cross-sectional design of the study limited our interpretation of the temporality of association between the factors examined and HIV infection. The survey also did not ask questions on men having sex with men or injecting drug use activities that are practiced in Kenya and may contribute to new HIV infections [ 13 ]. We did not include children due to the relatively low HIV prevalence among this group.
HIV remains a major public health challenge in Kenya. Although various prevention, care and treatment programs have been initiated and expanded in Kenya, evidence based prevention efforts that target known behavioral and biologic factors such as reduction of sex partners, condom use, delayed sexual debut and male circumcision should be enhanced. The wide regional variation in HIV prevalence reinforces the need for targeted prevention interventions focusing on provinces with high infection rates, while at the same time addressing the key behavioral factors that are associated with the risk of HIV infection nationally.
Special thanks to Professor George Rutherford of the University of California, San Francisco, for his useful comments and assistance in editing this paper. The findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Bentham Open ensures speedy peer review process and accepted papers are published within 2 weeks of final acceptance. We believe that a dedicated and committed team of editors and reviewers make it possible to ensure the quality of the research papers.
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