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RESEA R C H ART I C L E Open Access
Porn video shows, local brew, and transactional
sex: HIV risk among youth in Kisumu, Kenya
Carolyne Njue
1*
, Helene ACM Voeten
1†
and Pieter Remes
2,3†
Abstract
Background: Kisumu has shown a rising HIV prevalence over the past sentinel surveillance surveys, and most new
infections are occurring among youth. We conducted a qualitative study to explore risk situations that can explain
the high HIV prevalence among youth in Kisumu town, Kenya
Methods: We conducted in-depth interviews with 150 adolescents aged 15 to 20, held 4 focus group discussions,
and made 48 observations at places where youth spend their free time.
Results: Porn video shows and local brew dens were identified as popular events where unprotected multipartner,
concurrent, coerced and transactional sex occurs between adolescents. Video halls - rooms with a TV and VCR -
often show pornography at night for a very small fee, and minors are allowed. Forced sex, gang rape and multiple
concurrent relationships characterised the sexual encounters of youth, frequently facilitated by the abuse of
alcohol, which is available for minors at low cost in local brew dens. For many sexually active girls, their
vulnerability to STI/HIV infection is enhanced due to financial inequality, gender-related power difference and
cultural norms. The desire for love and sexual pleasure also contributed to their multiple concurrent partnerships. A
substantial number of girls and young women engaged in transactional sex, often with much older working
partners. These partners had a stronger socio-economic position than young women, enabling them to use
money/gifts as leverage for sex. Condom use was irregular during all types of sexual encounters.
Conclusions: In Kisumu, local brew dens and porn video halls facilitate risky sexual encounters between youth.
These places should be regulated and monitored by the government. Our study strongly points to female
vulnerabilities and the role of men in perpetuating the local epidemic. Young men should be targeted in
prevention activities, to change their attitudes related to power and control in relationships. Girls should be
empowered how to negotiate safe sex, and their poverty should be addressed through income-generating
activities.
Background
Globally, the HIV epidemic is increasing faster amongst
young women than young men and nowhere is this
trend more apparent than in sub-Saharan Africa [1].
Statistics in sub-Saharan Africa remain disturbingly
high, with 75% of all young people living with HIV
being female [2-4]. The main form of HIV transmission
is heterosexual sex. Of the young women aged 15-24,
HIV prevalence is three times higher than HIV among
their male counterparts. The contrasting HIV prevalence
betweenboysandgirlsisapatternobservedinmany
parts of sub-Saharan Africa [4,5].
Kisumu town is found by the shores of Lake Victoria,
is the capital of Nyanza province and the third largest
town in Kenya. It is one of the most HIV/AIDS affected
areas in Nyanza with a prevalence of 18.5% [6]. Nyanza
province, in general, is the most severely affected, with
HIV rates as high as 15%, which is double the national
average [6,7]. Studies conducted in Kisumu in the late
nineties show that HIV prevalence among girls was very
high compared to boys (age group 15-19 years 23% ver-
sus 4%; age group 20-24 years 40% versus 13%) [6]. HIV
prevalence among female sex workers was also very
high, at 75% [8]. Although more recent figures for
Kisumu are slightly lower, the numbers are still
* Correspondence: ngari.w@gmail.com
†Contributed equally
1
Department of Public Health, Erasmus MC, University Medical Center
Rotterdam, the Netherlands
Full list of author information is available at the end of the article
Njue et al.BMC Public Health 2011, 11:635
http://www.biomedcentral.com/1471-2458/11/635
© 2011 Njue et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of t he Creative Commons
Attribution L icense (http://creati vecommons.org/licenses/by/2.0), which perm its unrestricted use, di stribution, and reproduction in
any medium, provided the original work is properly cited.
alarmingly high, and higher than in other parts of the
country [9,6]. High HIV prevalence rates (30%) as well
as very high rates of STIs have been noted among fish-
ing communities along the shores of Lake Victoria
[10,11]. These high rates of HIV/AIDS in Luo Nyanza
have left 40% of children under 18 without one parent,
and 11% without both parents [6,12]. Cultural norms
such as wife inheritance and widow cleansing, polygamy,
“jaboya”(in which female fishmongers develop sexual
relationships with fishermen and middlemen in
exchange for fish), and “chira”(a curse that comes from
breaking certain taboos and traditions), continue to have
a powerful hold on people in this lakeside province
[10,13,14].
We conducted a qualitative study on the sexual beha-
viour of young people in Kisumu, to further explore
results from an earlier population survey on factors
determining the differential spread of HIV in four Afri-
can cities: two with a relatively low and stable HIV pre-
valence (Cotonou and Yaoundé) and two where the
spread of HIV has been explosive (Kisumu and Ndola)
[15]. This study showed that girls in Kisumu had older
sexual partners than boys and higher rates of herpes
simplex type 2, which are both risk factors for HIV
transmission. But most girls reported very few sexual
encounters, and HIV prevalence was very high even
among girls reporting one lifetime partner and few epi-
sodes of sexual intercourse. This may be due to under-
reporting, but also may indicate high transmission
during loss of virginity [5]. Our aim was to deepen our
understanding of the dynamics of sexual interactions of
adolescents, in order to explain the high HIV prevalence
among Kisumu youth in general and specifically among
girls. We triangulated data from in-depth interviews,
focusgroupdiscussions(FGD),andobservations,to
generateaholisticdescription of the contexts and
dynamics of sexual interactions among youth.
Methods
We conducted 150 in-depth interviews with adolescents
aged 15-20 in Kisumu, held 4 FGDs, and performed 48
observations at places where youth spend their free
time. The Institute of Tropical Medicine in Antwerp,
Belgium, and the Ethical Review Board in Kisumu
approved this study.
For the in-depth interviews, a convenience sample of
75 boys and 75 girls aged 15-20 years were interviewed
at their households. Usingthesamplingframeworkof
the multicentre study, quota sampling was used to
ensure diversity in age, socio economic status (SES) of
household, and education [9]. A qualitative interview
guide was developed in English and translated into Swa-
hili and Luo. Trained fieldworkers pre-tested the guide
in communities neighboring the study sites. The
interviews were held in Luo, Swahili or English by
same-sex interviewers, and tape-recorded; they took
about 45 minutes to one hour. Prior to the in-depth
interviews, verbal informed consent/assent was obtained
from all adolescents, in addition to parental consent for
minors.
Four focus group discussions (FGDs) were held by
same-sex interviewers in preparation for the in-depth
interviews (i.e. with in-school males, in-school females,
out-of-school males, out-of-school females). A topic
guide was used, that was pre-tested for face and con-
struct validity. The FGDs mainly focused on youth’s atti-
tudes, risk perception and socio-cultural norms
regarding sexuality. Each FGD had 8 to 12 participants
aged 15-20, and the discussions took about one and half
hour.
We made 48 observations of young people’s beha-
viour at places where youth spend their free time
‘hanging around’, such as nightclubs/bars, video halls,
shopping malls, local brew dens, and funerals. We
sought permission from the persons in charge and
ensured confidentiality of all collected information.
The field workers tried to get an inside view of reality
without the participants’knowledge that they were
being observed. Short notes were taken during the 2-
to-3 hour observations when possible, and detailed
notes were compiled afterwards describing the physical
setting, the activities taking place, socio-demographics
of participants (estimated age, gender), and their verbal
and non verbal behaviour.
The audio-taped interviews and FGDs were tran-
scribed verbatim and translated into English where
necessary [16]. Data analysis of the in-depth inter-
views, FGDs and observations followed grounded the-
ory principles, which allows analytical themes to
emerge during the process of (re)reading transcripts
and exploring and coding responses [17]. This
approach is based on inductive analysis and consists
of carefully reading/rereading interviews and observa-
tions, exploring and coding responses, and allowing
new themes, issues and questions to emerge during
theprocess.UsingATLAS.ti4.1,aqualitativedata
analysis software program, the first and third author
coded the transcripts, categorizing the data into
themes, and identified the properties and dimensions
of themes and subthemes. The following themes relat-
ing to risky sexual behaviour emerged from the inter-
views, FGDs and observations and are discussed
below: young age at first sex, large age difference with
male partners, multiple/concurrent partnerships, porn
video shows, forced sex, low condom use, local brew/
alcohol use and transactional sex. Where quotes are
used in the Results section, they are from the in-depth
interviews unless indicated otherwise.
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Results
Of the 150 interviewed adolescents, 55% were attending
school (18 primary and 64 secondary school) whereas
45% were out-of-school youth (51 were unemployed and
17 were working in small micro-enterprise businesses,
in domestic service, or as bicycle taxi operators). Over
85% of adolescents were born in Kisumu or had lived
there for 10 years or more. The average age of adoles-
cents interviewed in the study was 17.5 among boys and
17.0 among girls.
Of the youth interviewed, 79% of boys and 49% of
girls reported they ever had had sex. Of these, 37% of
boys (22/59) and 59% of girls (22/37) had their first sex-
ual intercourse at age 15 or younger. A 15-year-old girl
from a low-SES area stated: “In this area of ours, many
girls...get pregnant while they are very young because of
starting sexual relationships very early, maybe like my
age, you will find one has a boyfriend and later on she is
made pregnant and then she is left which is not good.”
Most girls reported a large age difference with first
and current partners. Sixteen of the 28 girls who men-
tioned the age of their first partner reported that he was
25 years or older. All girls with a current partner had a
partner who was over 20 years old (ranging from 2 to
17 years older). One girl stated: “...well if I am 20 I will
go for a guy who is older than me by six years or some-
thing like three... because you cannot move [date] aguy
whoisthesameageasyou....”Older men were pre-
ferred, as they proved to be more mature, could provide
for their needs, and offer advice to solve problems. Dur-
ing the observations, older men were often seen with
girls as young as 15.
Of the sexually active adolescents, over half of the
girls reported having had 2-3 partners; over half of the
boys indicated having had 3-5 partners and about a
third reported more than 10 girlfriends. A few boys
found it difficult to count all sexual partners: “Some you
can meet, you talk, have sex, then it just ends there so
remembering them is difficult”. Some of the bicycle taxi
transporters reportedly had sex daily, with different
partners. Girls mostly reported serial monogamy and
rarely stated outright that they had concurrent partners.
In contrast, many sexually active boys casually reported
having overlapping partnerships: “...the first is the one we
talked about, ...the second is the one who was here, and
the third is the one I connect with at the video hall.”
Even among young men with a steady partner, it was
common to have brief sexual encounters on the side, for
example while at the video halls or attending a disco
funeral. These ‘disco funerals’are parties held by the
relatives of a person recently deceased, in order to raise
funds for the funeral. The disco funerals are charac-
terised by loud music, singing, dancing, bidding games
and risky sexual behaviour. Because we have described
these events (in which Kisumu youth engage in risky
sexual behaviour) in a separate paper, we do not elabo-
rate on it here [18].
A third of the youth interviewed (49) report porn
video shows either from personal attendance or as an
influence on youth sexuality. Some also report watching
porn at home or at the home of a friend: “Whenever I
used to go to the neighbour’s to watch movies, she [a 14-
year old domestic worker] could steal some tapes of
‘pono’, put them on,then try to convince me why don’t
we try that one“(17 year-old boy). Video show halls are
basically rooms with a television and VCR, they are pop-
ular leisure spots, where youth pay to watch movies.
The fieldworkers did a dozen of random observations in
videohalls:8outof12wereshowingpornographyat
night. Most attendees were young men, but some girls
also attended. The fee ranged from €0.05-0.15, and any
youngster with a little money (even a 12-year old) was
able to enter. The movies ranged from non-violent to
violent pornography, and the scenes revolved around
group sex, anal sex, and oral and vaginal intercourse.
Youth said that the owner of a video hall most times
disguises the announcement of a featured film and
writes “on-por": in such a way youth know that “porno”
will be shown. During one observation, several adoles-
cents engaged in sex in the darkness of the hall.
Reports of forced sex were many: 15 of 37 sexually
active interviewed girls reported some degree of force/
persuasion during first sex. Some girls were lured into
secluded places such as a boy’s cube [separate living
quarter for boys], and were forced to have sex: “This
boy told me to visit him so when I went, he put the
radio on... then later he just held me by force.”A17-
year-old boy reported: “Say you’ve been dancing with her
and you’ve told her that thing [sex] and she has refused,
you just hold her and pull her by force till you go with
her... to the bush or darkness where people don’tgoto...”
Anothergirlsaidthataboygrabbedandpinnedher
down and forced her to have sex at age 13. Some boys
were said to waylay prostitutes and force them to have
sex: “Especially when it is night you meet a lot of girls
hijacked by a group of men, being pulled to some place...
they know these girls are prostitutes, they sell for money.
But these groups of boys don’t have any cash, they just
get them and hijack them yah,”(FGD, out-of-school
boys).
Few adolescents reported condom use at first sex (12
girls and 15 boys out of 96 sexually active adolescents).
Condom use was neither common nor consistent: “I
have four girlfriends...I use a condom but not every
time.”Reasons cited by boys for non-use included trust,
discomfort, reduction of pleasure, and not having any
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condoms. For most girls, non-use was related to their
limited ability to request condom use, ideals of intimacy
and pleasure, and mixed messages about safety: “Well...
some don’t use condoms because they tend to say that
they will have side effects”. Some young people also held
the belief that very young boys and girls could not have
STIs. Some adolescents only used condoms during the
unsafe period in the menstrual cycle. Others reported
they usually stop using condoms in a new relationship
when they have become more used to each other or, as
a few reported, after getting a negative HIV test.
Heavy alcohol intake and in particular illicit brews and
drugs reinforced and mostly accompanied these sexual
risk behaviours, as illustrated by this 15-year-old girl:
“So he asked me to have sex... but at first I didn’taccept
it ...so one day when I went, he bought this local brew
‘kumi kumi’[locally brewed gin] and he persuaded me
to take [it], afterwards I couldn’t control myself and we
found ourselves indulging in sex....”Fieldworkers did ran-
dom observations in local bars and brew dens and
found that illicit brews such as chang’aa (cheap local
spirit), kumi kumi and busaa (cheap local beer) and
drugs such as khat, cannabis, and tobacco/betel quid
were available especially in the low SES neighbourhoods.
The illicit brew sold at a price of about €0.01 a cup.
During interviews over a third (56) of youth interviewed
(mostly boys) said they have gone to drink in these local
brew dens. The brew was often made by widows who
depend on the trade for their livelihood. It was reported
that in environments where a parent(s) made local
brews, girls started having sex at an early age and some
progress to trade sex for money: “... may be the mother
is not steady, she moves from one man to another or
may be she drinks...so when the woman is not around
and men come to drink at her place, men start messing
with her daughters... (FGD, out-of-school girls). One girl
said in an interview that she had her first sexual
encounter at the age of fourteen, after her older sister
described to her what the men were doing to her when
she went to serve them (namely having sex for money).
The younger girl got pregnant and gave birth at the age
of fifteen. Another girl stated that she had sex several
times with a client who promised to build her widowed
mother a house.
Many interviewed youth reported to have had transac-
tional sex. There were reports of young women going to
local brew dens or disco funerals hoping the men would
buy them drinks or give them money, in exchange of
sexual favours. Often only a little money was required:
buying a girl a soda was already seen as down payment
for sex. Bicycle-taxi operators were reportedly popular,
offering a few shillings, some food, or free transport to
young women in exchange for sex: “as long as you can
buy her [something], maybe you buy her chips, you give
her ten bob, you give her even a place to sleep, because
she is not wanted at their place, you will just have sex
with her“(19-year old bicycle taxi-operator). Only occa-
sionally did a boy receive gifts from his girlfriend(s). An
18-year-old girl from a low-SES area described how she
decided to have sex with her 24-year old boyfriend: “...
after giving me gifts I just felt I should have sex with
him.”Many of the young women interpreted receipt of
money or gifts (like body lotion, soap, underpants and
clothing) from their partners as loving gestures. Many
young men acknowledged that their ability to provide
for their girlfriends affected both the longevity and
exclusivity of their relationships: “...most girls go for men
who can give everything, otherwise she’ll get another per-
son...”(FGD, out-of-school boys). Eight of the 75 inter-
viewed boys reported that that they had had contacts
with a prostitute. Not much money was involved in
such encounters: a 17 year-old young man from a mid-
dle-SES area said he paid €0.50 for two hours of sex
with a prostitute when he was 16.
Discussion
In this qualitative study on sexual behaviour of youth in
Kisumu, Kenya, we found that the majority had sex at a
young age, sometimes with multiple and concurrent
partners, mostly without using a condom. Drugs and
local alcohol often facilitated these encounters [19-22].
Some girls had transactional sex for material gain, not
only for themselves but also for parents/guardians. Find-
ings point strongly to the role of men in perpetuating
the HIV epidemic (forcing sex, gang rape, multiple con-
current relationships). Many young people were exposed
to pornography in video halls, which seemed to increase
their sexual risk behavior. Peer influence was a great
motivator for these risk behaviors.
There are a number of limitations that should be con-
sidered when interpreting the results. Because we used
purposive quota sampling, it cannot be concluded that
our results are fully representative for the total Kisumu
youth population. Age was difficult to estimate from
observation. We relied on participants’self-reports and
there is a possibility of social desirability bias particu-
larly among girls who may have underreported sexual
experiences [23]. Caution is also suggested when gener-
alizing our findings to other settings and populations,
because the urban environment may have influenced
youth norms regarding sexuality. Despite these limita-
tions, the study was able to generate rich, descriptive
data obtained through method triangulation, including
new knowledge on a previously unstudied aspect of HIV
risk- pornographic video shows. The high number of
interviews held and the use of quota sampling ensured
that the views of diverse youth (both girls and boys, in
and out-of-school, in different SES) were incorporated.
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Our findings point to gender-related power differences
that expose young girls to HIV risk. Power-related dif-
ferences manifest themselves not only in relationships,
but also in the belief and structure of society [24]. For
example, pre-marital and multi-partner sex, while typi-
cally portrayed (in Kisumu and elsewhere) as a breach
of social norms, is also said to be a fundamental dimen-
sion of gendered social organization [25]. Men in set-
tings like Kenya generally are expected to conform to a
range of behavioural norms that confirm the hegemonic
masculinity [26]. People consider it as a right and neces-
sity, and part of the tradition, that men have more than
one partner [27]. Pressure to be sexually adventurous
and aggressive to prove manhood is quite pervasive in
Africa. These norms allow men to have more sexual
partners than women, encourage older men to have sex-
ual relations with younger women, and increase the
acceptance and justification of violence against women.
It is not surprising therefore that our findings show that
male partners force sex, perform gang rape, and have
multiple concurrent relationships. Such norms and soci-
etal power relations consistently tend to disadvantage
young women, as evidenced by the high incidence of
transactional and coerced sex in many sub-Saharan
countries [28].
The subordinate position of women, including the lack
of control over finances and resources, has motivated
girls to engage in multiple concurrent partnerships pri-
marily for economic reasons, but at times the desire for
love and sexual pleasure contributes to these partner-
ships [29-31]. Girls look at these partnerships in light of
future plans, hoping for a steady relationship or mar-
riage with an affluent older man. But also young men
have a stronger socio-economic position than young
women, enabling them to use money/gifts as leverage
for sex. The material exchange accompanying sexual
encounters may be interpreted as a loving gesture, but it
may also express an unloving and calculating
relationship.
The subordinate position of women may further force
girls to endure abusive and violent relationships in order
to secure economic gains. A high number of youth
reported that either their mother or father had died, or
sometimes both parents had passed away. These children
are often left in the household with limited or no
resources, where they often sink into poverty, forfeit their
education, suffer from unattended psychological trauma,
and become infected with HIV themselves [31,32]. A
relationship with an older man (who is more likely to
have a steady income than their age-mates) can provide
them with the necessary livelihood support. There were
reports of girls exchanging sex for money in order to
feed their elderly parents and siblings, including access to
material wealth such as expensive clothes and shoes.
These findings are consistent with recent studies in
sub-Saharan Africa that show that factors such as cul-
tural norms and gender roles place young women at
risk of HIV infection [33,34]. They also show that men
areexpectedtobedominantinarelationship,and
many young girls may submit to men’s sexual demands
because they are expected to be subordinate, especially
when they are (much) younger [33-35]. Moreover, such
young girls are at a disadvantage in negotiating safe sex
during such partnerships [36-38]. Young girls are
coerced into sexual activities with older men for survival
and to access material goods [34,39-42]. Sometimes the
sexual exchange is to the benefit of the parent or guar-
dian, and not the victim herself [43].
Our findings show how exposure to pornography in
video halls encourages liberal sexual attitudes and beha-
viour among young people. The current phenomenon of
porn video shows has not been described in literature.
Studies on the effects of adults’exposure to pornogra-
phy in developed countries show that repeated exposure
to nonviolent pornography promotes more permissive
sexual attitudes [44-46]. Findings also show that in the
sprawling low SES neighbourhoods of urban Kisumu,
alcohol use for young people is often synonymous with
the locally brewed alcoholic beverages, due to their low
price and wide availability. Alcohol is commonly used as
a disinhibitor and a symbol of masculinity; it thus plays
an important role in risky sexual behaviour [47]. Reports
show the devastating effects of alcoholism: high rates of
school dropouts, careless sexual behaviour, shattering of
families, high rates of crime, and low productivity at
work [47-49].
Conclusions
Our findings have important implications for youth
interventions. First, intervention strategies should
engage young men in HIV prevention. Men in settings
like Kenya generally control the terms and conditions of
sexual relationships. Thus, we need better strategies to
engage men, and effective interventions to change their
attitudes and behaviours related to power and control in
relationships. Interventions should promote more posi-
tive and safe actions like having respect for women, hav-
ing one sexual partner, using condoms, and knowing
their HIV status. Second, young girls should be empow-
ered in several ways. They should be taught how to
negotiate safe sex as part of the transactions in transac-
tional sex. Their poverty should be addressed, e.g.
through income generating activities or programs that
keep them in school. For example, there are indications
that programs which give loans to young women or
youth groups, such as the Youth Enterprise Develop-
ment Fund by the Kenyan government, are reducing the
number of young women who have to exchange sex for
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money or who become teenage mothers [50]. Third, the
government should regulate and monitor video shows
and local brew dens, to prevent the exposure of young
adolescents to pornography, drugs and alcohol. Legal
action should be enforced on video hall and local brew
den owners who promote pornography and/or alcohol
consumption to youth. Instead, risk-free leisure activities
should be developed for youth, such as sports facilities.
Further research is needed to study the generalizability
of our findings. More insight is needed on the effects of
youth’s exposure to pornography and the ways in which
leisure spots such as video halls and local-brew dens
can be used to promote safe sex practices.
Acknowledgements
This study was supported by the Wellcome Trust [no.061189/Z/00/A] and by
NUFFIC, the Netherlands organization for international cooperation in higher
education, through a personal grant to the principal author.
The authors acknowledge and thank Dr. Anne Buvé, Institute of Tropical
Medicine in Antwerp, for directing the study and for her comments on
previous drafts; and former Nyanza Provincial Medical Officer Dr A.O. Misore
for his support during the fieldwork. The authors extend great appreciation
to the adolescents for the insightful information that they have reported.
Finally we give special thanks to the data collection team for their
determination, dedication and professionalism that made it possible to
collect these data.
Author details
1
Department of Public Health, Erasmus MC, University Medical Center
Rotterdam, the Netherlands.
2
Social & Public Health Sciences Unit, Medical
Research Council, Glasgow, UK.
3
Institute of Tropical Medicine, Antwerp,
Belgium.
Authors’contributions
Each of the authors contributed to the article: CN: carried out the study,
analysis and interpretation of data, drafting and revising of the manuscript;
HACM V: revising the manuscript for substantial intellectual content and
coordination, and PR: design, analysis and interpretation of data, involved in
drafting and revising the manuscript. All authors have read and approved
the final manuscript.
Competing interests
The authors declare that they have no competing interests.
Received: 9 March 2011 Accepted: 8 August 2011
Published: 8 August 2011
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Cite this article as: Njue et al.: Porn video shows, local brew, and
transactional sex: HIV risk among youth in Kisumu, Kenya. BMC Public
Health 2011 11:635.
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