Anal Sex, Vaginal Practices, and HIV Incidence in Female Sex Workers in Urban Kenya: Implications for the Development of Intravaginal HIV Prevention Methods

Abstract

Multiple intravaginal HIV prevention methods, including microbicide gels, barriers, and intravaginal rings, are in clinical development in Africa. Development of intravaginal HIV prevention products requires an understanding of sexual behavior, sexually transmitted infection (STI), and vaginitis prevalences, and sexual and vaginal practices in potential target populations. We assessed these factors in a cohort of Kenyan female sex workers (FSW). Women who reported exchanging sex for money/gifts at least three times in the past month and who were HIV uninfected were enrolled and followed for 6 months. STI prevalence and HIV incidence were analyzed by multivariate logistic regression analysis, controlling for demographic and behavioral factors. Thirtyseven percent (74/200) reported having had anal sex. Frequency of anal sex was higher with regular and casual partners than with primary partners. Women were less likely to use condoms for anal sex than for vaginal sex with regular or casual partners. Vaginal washing was universal (100%). HIV incidence was 5.6 per 100 personyears (95% CI 1.62, 11.67). HIV incidence was not associated with any demographic or risk behavior. The relatively high rate of anal sex and universal vaginal washing may complicate both safety and efficacy evaluation of intravaginal products and should be taken into account in trial design. This FSW population had significant HIV incidence and needs continued HIV prevention interventions.

Anal sex and associated HIV-related sexual risk factors among female sex workers in Andhra Pradesh, India

“…This is supported by empirical research showing higher chances of condom breakage when a condom is used in anal sex. 13,14,43 Hence, even though many FSWs used condoms, the protection from STIs may be very minimal and resulting in STIs.…”

“…5,[10][11][12][13] Since condoms are generally manufactured for use in vaginal intercourse, the chances of condom breakage are higher if used in anal sex, thus resulting in an increased risk of exposure to HIV and other STIs. 13,14 Furthermore, a growing body of research also suggests that the high rates of anal cancer could be attributable to the practice of anal intercourse. [15][16][17] However, researchers often neglect the importance of anal sex as a determinant of STIs or as one of the outcomes in HIV prevention interventions.…”

Effects of the Frontiers Prevention Project in Ecuador on sexual behaviours and sexually transmitted infections amongst men who have sex with men and female sex workers: challenges on evaluating complex interventions

“…FSW have more sexual partners than the general population, lack access to healthcare services, have difficulty accessing condoms, use condoms inconsistently (Ghys, Jenkins, and Pisani 2001) and practice anal sex more often than the general population (Schwandt et al 2006;Priddy et al 2011;Tucker et al 2012). In addition, gender roles, violence and the exploitation and criminalisation of sex work contribute to the practice of unprotected and forced sex, increasing the risk of contracting STIs, including HIV (Panchanadeswaran et al 2008;Okal et al 2011).…”

Examining Targets for HIV Prevention: Intravaginal Practices in Urban Lusaka, Zambia

“…IVP that include insertion of products to promote dry sex leads to genital abrasions that can facilitate HIV acquisition and transmission. 3,4,7,8,[13][14][15] IVP are strongly influenced by social and cultural beliefs, introduced to women at an early age, and normally taught by older females (relatives, friends, or traditional marriage counselors). 15,16 Although IVP are female initiated and intended to be conducted without the explicit knowledge of men, many IVP are driven by male preferences.…”