Factors Associated with HIV Infection in Married or Cohabitating Couples in Kenya: Results from a Nationally Representative Study

Abstract

BackgroundIn order to inform prevention programming, we analyzed HIV discordance and concordance within couples in the Kenya AIDS Indicator Survey (KAIS) 2007.MethodsKAIS was a nationally representative population-based sero-survey that examined demographic and behavioral indicators and serologic testing for HIV, HSV-2, syphilis, and CD4 cell counts in 15,853 consenting adults aged 15–64 years. We analyzed interview and blood testing data at the sexual partnership level from married or cohabitating couples. Multivariable regression models were used to identify factors independently associated with HIV discordant and concordant status.ResultsOf 3256 couples identified in the survey, 2748 (84.4%) had interview and blood testing data. Overall, 3.8% of couples were concordantly infected with HIV, and in 5.8% one partner was infected, translating to 338,000 discordant couples in Kenya. In 83.6% of HIV-infected Kenyans living in married or cohabitating couples neither partner knew their HIV status. Factors independently associated with HIV-discordance included young age in women (AOR 1.5, 95% CI: 1.2–1.8; p<0.0001), increasing number of lifetime sexual partners in women (AOR 1.5, 95% CI: 1.3–1.8; p<0.0001), HSV-2 infection in either or both partners (AOR 4.1, 95% CI: 2.3–7.2; p<0.0001), and lack of male circumcision (AOR 1.6, 95% CI: 1.0–2.5; p = 0.032). Independent factors for HIV-concordance included HSV-2 infection in both partners (AOR 6.5, 95% CI: 2.3–18.7; p = 0.001) and lack of male circumcision (AOR 1.8, 95% CI: 1.0–3.3; p = 0.043).ConclusionsCouple prevention interventions should begin early in relationships and include mutual knowledge of HIV status, reduction of outside sexual partners, and promotion of male circumcision among HIV-uninfected men. Mechanisms for effective prevention or suppression of HSV-2 infection are also needed.

Prevalence of Transmitted Drug Resistance Mutations in HIV-1-Infected Drug-Naive Patients from Urban and Suburban Regions of Kenya

“…This figure is higher than reported in other studies. 18,19 This might be due to (1) reporting bias, since actual testing was not done to confirm the reported serostatus or/and (2) the small sample size employed in this study as compared to other previous studies.…”

Age-disparate Partnerships and Risk of HIV-1 Acquisition among South African Women Participating in the VOICE Trial

“…4 Engagement in age-disparate relationships, where the male partner is substantially older than the female partner, has been hypothesized as one of the drivers of this higher burden of HIV-1 among young women. [5][6][7][8][9][10] Evidence in support of this hypothesis comes from surveillance data showing consistent sex-age disparities in HIV prevalence, 2,3,11,12 where the prevalence of HIV is greater among young women compared to young men, and from epidemiologic studies that report that age-disparate relationships are common among young women. 3,13,14 In South Africa, a country which continues to have the greatest HIV-1 burden globally, 2 population based surveys of women aged [15][16][17][18][19][20][21][22][23][24] reported that 33-39% of respondents had a partner >5 years older.…”

Disclosure, Knowledge of Partner Status, and Condom Use Among HIV-Positive Patients Attending Clinical Care in Tanzania, Kenya, and Namibia

“…PLHIV who have not disclosed their HIV status to their partners are less likely to know their partner's HIV status 17 and between 20-45% of PLHIV in clinical care in sub-Saharan Africa do not know the HIV status of their partners. [16][17][18] These findings are particularly troubling, given the high rates of HIV serodiscordance among PLHIV in stable relationships. Estimates suggest that approximately half of PLHIV in married or cohabitating couples live with an HIV-negative partner.…”