Estimation of the sexual transmission of HIV in Kenya and Uganda on the trans-Africa highway: the continuing role for prevention in high risk groups

Morris, Catherine; Ferguson, Alan

doi:10.1136/sti.2006.020933

Cited by 79 publications

(65 citation statements)

References 6 publications

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“…The most recent published estimates of HIV prevalence for FSW and truck drivers were 27.6 and 14.8% in Kenya and 47 and 13.5% in Uganda, respectively (Kissling et al 2005). Truck drivers are a mobile bridge group that connects to the general population, making this core especially suited to targeted interventions for control of the epidemic (Alary and Lowndes 2004;Morris and Ferguson 2006;Pisani et al 2003).…”

Section: Introductionmentioning

confidence: 98%

Sexual Behavior of Female Sex Workers and Access to Condoms in Kenya and Uganda on the trans-Africa Highway

Morris

Ferguson

2008

AIDS Behav

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Female sex workers and their clients remain a high risk core group for HIV in Africa. We measured sexual behavior of a snowball sample of female sex workers (FSW) along the Trans Africa highway from Mombasa, Kenya to Kampala, Uganda and surveyed the availability of male condoms at 1,007 bars and lodgings in Kenya along the highway trucking stops where transactional sex occurs. There were 578 FSW one month sex diaries analyzed, 403 from Kenya and 175 from Uganda. Kenyan FSW had a median of 45 sexual acts per 28 days compared to 39 sex acts per 28 days by Ugandan FSW (P < 0.05). Condom use by FSW for all sexual liaisons was 79% in Kenya compared to 74% in Uganda. In multivariate analysis, adjusting for repeated measures, Kenyan FSW were more likely to use a condom by an adjusted odds ratio of 2.54 (95% confidence interval 1.89-3.41) compared to Ugandan FSW. Condom use with regular clients was 50.8% in Uganda compared with 68.7% in Kenya (P < 0.01). The number of sex workers reporting 100% condom use was 26.8% in Kenya and 18.9% in Uganda (P < 0.01). Bars and lodges in Kenya compared to Uganda were more likely to: have condom dispensers, 25% versus 1%, respectively (P < 0.01); distribute or sell condoms, 73.9% versus 47.6% (P < 0.01); and have more weekly condom distribution, 4.92 versus 1.27 condoms per seating capacity (P < 0.01). Our data indicate that in both countries condom use for FSW is suboptimal, particularly with regular partners, and greater condom use by Trans African highway FSW in Kenya compared to Uganda may be related to availability. Targeted interventions are warranted for FSW and truck drivers to prevent transmission in this important core group.

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Section: Introductionmentioning

confidence: 98%

Sexual Behavior of Female Sex Workers and Access to Condoms in Kenya and Uganda on the trans-Africa Highway

Morris

Ferguson

2008

AIDS Behav

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“…Among women of low socio-economic status engaged in sex work in Nairobi, HIV prevalence over thrice the national prevalence has been found, confirming that sex work heightens women's risks for HIV in Kenya as elsewhere (Fonck et al 2000;Simonsen et al 1990). In addition, recent work has pointed towards continued concentrated epidemics in female sex workers (FSWs) and their clients and the need for targeted interventions in these groups (Morris and Ferguson 2006;Ferguson and Morris 2007). However, responses targeting economic dimensions of HIV vulnerability remain limited.…”

Section: Introductionmentioning

confidence: 99%

Effects of Micro-Enterprise Services on HIV Risk Behaviour Among Female Sex Workers in Kenya’s Urban Slums

et al. 2008

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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.

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“…The prevalence of HIV and other sexually transmitted infections (STIs) among FSWs remains high in most settings, with HIV prevalence of 33-37% reported among Ugandan FSWs 3,4 . Studies show that truckers engage in sex with multiple sexual partners along the transport routes that they ply, usually without using condoms 5,6 . As a result, HIV prevalence among truckers is equally high, ranging from 10% in Nigeria 6 , 26% in Kenya 7 and 56% among truckers in Southern Africa 8 .…”

Section: Introductionmentioning

confidence: 99%

“…Prior studies on condom use and other sexual behaviors of FSWs and truckers have been largely quantitative in nature [10][11][12][13][14] and conducted outside sub-Saharan Africa [16][17] , with limited qualitative assessments of the knowledge, attitudes and barriers to condom use in sub-Saharan African settings. At the moment, there is hardly any study that provides detailed qualitative information on the knowledge, attitudes and barriers to condom use among FSWs and truckers in Uganda despite evidence showing that FSWs contribute 11% of new HIV infections 18 and truckers form a greater proportion of their clientele 19 .…”

Section: Introductionmentioning

confidence: 99%

Knowledge, attitudes & barriers to condom use among female sex workers and truck drivers in Uganda: a mixed-methods study

Matovu¹,

Ssebadduka²

2014

Afr H. Sci.

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Background: There is limited documentation on knowledge, attitudes and barriers to condom use among female sex workers (FSWs) and truck drivers (truckers). Objective: To explore knowledge, attitudes and barriers to condom use among FSWs and truckers operating along major transport corridors in Uganda Methods: Structured questionnaires were administered to explore FSWs' and truckers' knowledge of and attitudes towards condom use among 259 FSWs and 261 truckers. Qualitative data were collected on barriers to condom use using focus group discussions. Quantitative data were analyzed using SPSS while qualitative data were audio-recorded, transcribed and thematically analyzed. Results: Condom knowledge was high with 97% of FSWs and 95% of truckers agreeing with the statement, "using condoms properly and consistently reduces risk of HIV infection". Attitudes towards condom use were generally favorable with 91% of FSWs and 82% of truckers agreeing with the statement, "condom use is the best method of HIV prevention". Qualitative findings show that poverty, refusal to use condoms by male partners, alcohol use before sex and beliefs that condoms 'kill the mood for sex' remain key barriers to consistent condom use. Conclusions: Consistent condom use among FSWs and truckers is still hampered by economic and relationship factors.

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Estimation of the sexual transmission of HIV in Kenya and Uganda on the trans-Africa highway: the continuing role for prevention in high risk groups

Abstract: In generalised epidemics there has been a debate as to the place of targeted interventions. In the current east African epidemic we show that a targeted intervention could have significant impact in averting HIV infections related to the trans-Africa highway.

Cited by 79 publications

References 6 publications

Sexual Behavior of Female Sex Workers and Access to Condoms in Kenya and Uganda on the trans-Africa Highway

Sexual Behavior of Female Sex Workers and Access to Condoms in Kenya and Uganda on the trans-Africa Highway

Effects of Micro-Enterprise Services on HIV Risk Behaviour Among Female Sex Workers in Kenya’s Urban Slums

Knowledge, attitudes & barriers to condom use among female sex workers and truck drivers in Uganda: a mixed-methods study

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