University of Nairobi

Publications (74 Records)

• Antiretroviral therapy in a core transmission group of Kenyan female sex workers is not associated with increased sexual risk taking. - 2010

  Although antiretroviral therapy (ART) prolongs life and reduces infectiousness, in some contexts it has been associated with increased sexual risk taking. We compared self-reported condom use, client numbers, and STI incidence in HIV-infected Kenyan female sex workers (FSW) before and after starting ART (n=62), as well in control FSWs not starting ART (n=40). Sexual behaviour with casual clients did not change after ART initiation; condom use increased and STI incidence decreased in both cases and controls, likely due to successful cohort-wide HIV prevention efforts. ART provision was not associated with increases in unsafe sex in this core transmission group.

• ENTERING SEX WORK IN THE INFORMAL URBAN SETTLEMENT OF KIBERA, NAIROBI, KENYA - 2010

  Female sex work has long been recognized as an important factor in the urban sub-Saharan Africa HIV/AIDS pandemic, and in some cities remains a driving force for HIV transmission. However, despite a long history of epidemiological studies, there are still gaps in our knowledge of the social epidemiology of African female sex work. For example, the basic question of why some women enter into sex work, while others in the same socio-economic environment never do, remains under researched. We investigated this question for two samples of same-aged women, one of whom is currently practicing commercial sex, and another who has never done so. Both come from the informal urban settlement of Kibera, located in Nairobi, Kenya. Inclusion of another sample of women who can serve as comparisons to female sex workers is a notable feature of our research design, and one missing from many ecological and intervention studies. Using respondent driven sampling, we collected socio-economic and sexual behavioural data for a total for 320 women, evenly divided between female sex workers and Kibera women working in other occupations (e.g. hair-dressing, tailoring, hotel workers and food servers) from all ten Kibera communities to test the hypothesis that past and present family ties and structure are important predictors of entry into sex work. Results of univariate and multivariate analyses testing this hypothesis are discussed with respect to the African cultural practice of child fostering and future interventions.

• Preparing for HIV-prevention trials: Population characteristics, HIV incidence and retention rates in most-at-risk populations in Kilifi and Nairobi, Kenya, and Cape Town, South Africa. - 2010

  Objective: To describe HIV incidence, HIV risk and volunteer retention of most-at-risk populations (MARPs) at three clinical research centers (CRCs) in Africa. Design: Volunteers reporting multiple sex partners, transactional sex, sex with an HIV positive partner, and, if male, sex with men (MSM) in the previous 3 months were enrolled. Risk behavior, clinical and laboratory data were obtained at prospective study visits. Rates of retention and HIV infection were calculated. Cox regression models were used to assess predictors of HIV infection in MSM only. Results: 1,846 volunteers contributed follow-up time, 728 (39.4%) in Kilifi, 653 (35.4%) in Nairobi, and 465 (25.2%) in Cape Town. MSM had the highest HIV incidence rates with 6.8 (95% CI: 4.9-9.2) cases/100PY. Incidence was similar for women in Kilifi and Cape Town (2.7 cases/100PY, 95% CI: 1.7-4.2). No incidence was observed in women from Nairobi, or non-MSM men in Nairobi or Cape Town. In 325 MSM, predictors of HIV infection included alcohol use (adjusted hazard ratio [HR]: 2.9, 95%CI: 1.1–7.9), genital sore (HR: 4.3, 95%CI: 1.5–11.8), and report of receptive anal intercourse only (HR: 6.6, 95%CI: 1.8–24.7). Paying for sex was inversely associated with HIV infection (HR: 0.1, 95%CI: 0.01–0.7, p = 0.02). Retention varied by CRC and ranged from 10.4 drop-outs/100PY in Nairobi to 21.8 in Cape Town (p<0.001). Conclusions: MSM and at-risk women in Kenya and South Africa had a high HIV incidence. African MSM are potentially a new MARP for HIV prevention trials.

• Reproductive Health of Female Sex Workers in the Urban Informal Settlement of Kibera, Nairobi, Kenya - 2010

  Female sex workers (FSWs) have long been recognized as important factors in the sub-Saharan HIV/AIDS epidemic. Because of their large number of sexual partners and high rate of partner change they may act as core groups that keep incidence rates high and as bridge populations, linking high-risk with low-risk sub-populations. What is far less recognized and researched are the roles that African FSWs fulfill as lovers and mothers. In these roles they are epidemiologically important due to mother-child HIV transmission while socially FSWs must provide childcare when they work outside the home. Building upon recently analyzed data for FSWs in the urban informal settlement of Kibera, Nairobi, Kenya, this proposal outlines a pilot study employing a social epidemiological perspective to: 1) delineate and analyze FSWs reproductive histories, future fertility plans, and knowledge, access and usage of contraception methods and, 2) explore possible family-based intervention programs to provide child care for FSWs.

• Effects of Micro-Enterprise Services on HIV Risk Behaviour Among Female Sex Workers in Kenya’s Urban Slums.Willis Omondi Odek1 , Joanna Busza2, Chester N. Morris3, John Cleland2, Elizabeth N. Ngugi1 and Alan G. Ferguson4 - 2009

  This study assessed individual-level effects of adding micro-enterprise services to a peer-mediated HIV/AIDS intervention among 227 female sex workers (FSWs) in Kenya. Survey data were collected in May–July 2003 and July–August 2005. Two-thirds of participants had operational businesses by end-line survey. Nearly half reported to have stopped sex work. Self-reported weekly mean number of all sexual partners changed from 3.26 (SD 2.45) at baseline to 1.84 (SD 2.15) at end-line survey (P < 0.001). Weekly mean number of casual partners did not change significantly. Weekly mean number of regular partners changed from 1.96 (SD 1.86) to 0.73 (SD 0.98) over the follow-up period (P < 0.001). Consistent condom use with regular partners increased by 18.5% and remained above 90% with casual partners. Micro-enterprise services may empower FSWs by giving them an alternative livelihood when they wish to exit or reduce reliance on sex work. Determinants of successful business operation by FSWs deserve further research.

  Keywords  Microfinance - Kenya - Female sex workers - Regular partners - Sex work

     AIDS and Behavior;Volume 13, Number 3 / June, 2009

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