Sexual behavior, sexually transmitted diseases, male circumcision and risk of HIV infection among women in Nairobi, Kenya.
ABSTRACT To study risk factors for HIV infection among women in Nairobi, Kenya, as the epidemic moves beyond high-risk groups.
A cross-sectional case-control study among women attending two peri-urban family planning clinics.
A total of 4404 women were enrolled after giving written informed consent. Information on risk factors was obtained by interview using a structured questionnaire. Blood was taken for HIV and syphilis testing, and genital specimens for gonorrhea and trichomoniasis screening.
Two hundred and sixteen women (4.9%; 95% confidence interval, 4.3-5.5) were HIV-1-positive. Although risk of HIV was significantly increased among unmarried women and among women with multiple sex partners, most seropositive women were married and reported only a single sex partner in the last year. Women with a history or current evidence of sexually transmitted disease were at significantly increased risk; however, the prevalence of these exposures was low. Women whose husband or usual sex partner was uncircumcised had a threefold increase in risk of HIV, and this risk was present in almost all strata of potential confounding factors. Only 5.2% of women reported ever having used a condom.
These data suggest that, among women who are not in high-risk groups, risk of HIV infection is largely determined by their male partner's behavior and circumcision status. Interventions designed to change male sexual behavior are urgently needed.
- SourceAvailable from: Robert S Van Howe
- [Show abstract] [Hide abstract]
ABSTRACT: Lack of male involvement and support for sexual and reproductive health services is seen by many Papua New Guinean women as a barrier to accessing services. Poor utilization of services by both men and women is reflected in high maternal mortality and high rates of HIV/AIDS and sexually transmitted infections in the Southern Highlands Province. It is therefore important to understand the type of services provided, men's perceptions of these services and the Health Sector's capacity to involve men in its programs. Information from interviews of married men, officers in charge of health facilities, and information from a focus group discussion with village leaders was collected to assess possible constraints to reproductive and sexual health care delivery. Although many men had heard about antenatal care, supervised births, family planning and sexually transmitted infections including, HIV/AIDS, many were unaware of their importance and of the types of services provided to address these issues. There was a very strong association between men's literacy and their knowledge of Sexual and Reproductive Health (SRH) issues, their discussion of these issues with their wives and their wives' utilisation of sexual and reproductive health services.. Some men considered SRH services to be important but gave priority to social obligations. Although men made most decisions for sexual and reproductive issues, pregnancy, child birth and rearing of children were regarded as women's responsibilities. Knowledge of HIV/AIDS appeared to have changed sexual behaviour in some men. Services for men in this rural setting were inadequate and service providers lacked the capacity to involve men in reproductive health issues. Poor knowledge, socio-cultural factors and inadequate and inappropriate services for men hampered utilization of services and impaired support for their wives' service utilization. Programmatic and policy initiatives should focus on improving service delivery to accommodate men in sexual and reproductive health.Reproductive Health 09/2013; 10(1):46. · 1.62 Impact Factor
- The Pan African medical journal. 01/2014; 18:161.