Factors associated with high-risk sexual behavior among Kenyans: Implications for public health strategies and policy in combating HIV/AIDS.

摘要

Background. Sub-Saharan Africa, representing only 12% of the world population is home to nearly 23 million people, approximately 70% of all HIV positives worldwide. HIV/AIDS epidemic in Kenya is characterized by high-risk sexual behavior (HRSB) such as lack of condom use, multiple sexual partners, and prostitution. Objective. The study measures the associations between HRSB, HIV testing, and attitudes/stigma with variables measuring HIV/AIDS, psychosocial, demographic and, economic elements, and behaviors. Methods. Cross-sectional data from the Kenya Demographic and Health Survey-2003 were used for this study. Data were weighted for stratum and primary sampling units attaining linearized standard errors "robustness." Parametric testing using univariate and multivariate logistic regression was performed. Stata version 11 was utilized for all analyses with statistical significance set at p0.05. A sample size of 11,746 [8,171 (70%) women and 3,575 (30%) men] was retained for the analysis. For analysis involving HIV, three datasets representing women, men and HIV test results were merged together with a sample size of 6,190 [3,273 (53%) women and 2,917 (47%) men]. Both included women aged between 15-49 years (reproductive age) and men aged 15-54 years. Findings: HIV prevalence was 7% in Kenya [women (9%) and men (5%)]. Prevalence of negative attitudes/stigma towards HIV/AIDS and alcohol consumption among women and men in urban areas was 6%, p0.01 and 30%, p0.05 respectively. Prevalence of STDs and HIV tests among women and men was 8%, p0.01 and 9%, p0.001 respectively. Furthermore, the prevalence of uncircumcised men and HIV positive test was 48%, p0.001. Women who consumed alcohol and resided in urban areas were at lower odds (OR = 0.64, 95%CI: 0.39-1.05, p=0.079) of having negative attitudes/stigma towards sex education on condoms in schools. In addition, the odds of men who resided in rural areas and consumed alcohol were notably high for having negative attitudes/stigma towards HIV/AIDS (OR = 1.31, 95%CI: 1.05-1.63, p0.05). Also, men had higher odds (OR = 1.68, 95%CI: 1.39-2.04, p0.001) and (OR = 1.42, 95%CI: 1.19-1.69, p0.001) of having negative attitudes towards women for husband controlling attitudes and sexual attitudes respectively compared to those who did not. For wealth, in unadjusted results, the odds of richest men reporting HRSB were greater (OR = 1.08, 95%CI: 1.00-1.15, p0.05) compared to the poorest; however, for women, the odds were lower (OR = 0.94, 95%CI: 0.89-0.99, p0.05). For both women and men, the odds of testing positive for HIV was notably higher for those with an STD(s) (OR = 3.05, 95%CI: 1.34-6.96, p0.01) and (OR = 2.01, 95%CI: 0.92-4.40, p=0.082) respectively. This was (OR = 1.69, 95%CI: 1.00-2.86, p0.05) among women who were physically abused with a weapon and (unadjusted OR = 1.63, 95%CI: 1.08-2.47, p0.05) for emotional abuse respectively, and (OR = 4.23, 95%CI: 2.51-7.13, p0.001) among men who were uncircumcised. Conclusion. The findings suggest that HIV is prevalent in Kenya with intertwined complexities mainly driven by cultural and socioeconomic diversity. Implications for policy. Integration of services and other intervention programs with HIV/AIDS testing can reduce HIV incidence in Kenya. Policy recommendations. Eliciting key stakeholder support as equal partners in HIV/AIDS programs is critical. HIV/AIDS program appropriateness will instill ownership for such programs.