'Regular' partners of female sex workers : a potential bridging population in the Kenyan HIV epidemic
Document type: mthesis
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Abstract:
BACKGROUND: Prevention strategies aimed at reducing STI and HIV transmission have been successful at improving the acceptability of condoms within FSWs client partnerships, yet they have been less successful within FSWs relationships with their steadier partners, also referred to as ‘regular’ partners (RPs). The phenomenon of poor acceptability of condom use is not unique to higher risk regular partnerships like FSWs-RPs, but is also found in lower risk regular partnerships, such as husbands-wives in the Kenyan general population. Studies from other settings indicate FSWs’ RPs are known to have higher levels of HIV and other STIs, greater number of concurrent partners with whom they have unprotected sex with their RP suggests that FSWs’ RPs may act as a bridge for HIV and other STIs into the general population. MAIN OBJECTIVES AND METHODS: To describe sexual behaviour characteristics within and outside of FSW-RP relationships, a cross sectional study was conducted on FSWs and their RPs in Nairobi, Kenya. Once enrolled, FSWs and their RPs were surveyed using a behavioural questionnaire, and they provided biological samples to assess HIV-1, syphilis, N. Gonorrhoea, C. trachomatis, and Herpes Simplex type 2 levels. Condom use was reported on semi-quantitative scale: where 1=Never (0%), 2= Rarely (1-24%), 3= Sometimes (25-49%), 4=Often (50-74%), 5=Almost always (75-99%), 6= Always (100%). RESULTS: Thirty-four FSW-RP couples were enrolled in the study. FSW-RP relationships were long standing, with a mean duration of 6.6 years. Self perception of HIV risk infection was low among the majority of RPs. Twenty-three RPs reported concurrent partners (23/34; 68%), and they reported a mean of 5.5 women (range; 2-21). The majority of FSW-RP couples never used condoms, significantly associated with perceived level of trust within the relationship. Both FSW and RP reports a gradient of condom use related to perceived intimacy level of partners. Active FSWs reported lower condom use with RPs than with casual clients or regular clients. A similar pattern is reported by RPs’ never use of condoms, with never use the highest among wives, followed by FSW partners, regular girlfriends, other FSW partners, and lastly, by occasional partners. With the exception of HSV-2, were 94.1% (32/34) FSWs and 61.8% (21/34) RPs were infected, conventional STIs were rare. Prevalence of HIV-1 in FSWs was 35% (12/34) and in RPs was 27% (9/34). In total 13 FSW-RP couples are living with HIV/AIDS, 8 are concordant and 5 are discordant. Compared to RPs’ whose FSW partner was HIV negative, RPs were 42 times more likely to be HIV positive if their FSW partner was also HIV positive. CONCLUSION AND RECOMMENDATIONS: Based on this study’s findings of high background HIV prevalence rates in both FSWs and their RPs, as well as RPs reported low levels of condom use with their concurrent partners, it is quite plausible that RPs are a potential bridging population in Kenya’s HIV epidemic. As such, the Kenya’s existing one size fits all policy of abstinence, be faithful and condomize with casual partners, may do little to improve condom use within regular partnerships. Before developing a new prevention response, further research needs to be done on the relationship between perceived trust and intimacy levels on condom use within regular partnerships, in order to identify new prevention strategies which take into account the realities of more intimate relationships found both within higher risk FSW-RP and lower risk husband-wife relationships.
Authors:
Chakkalackal, M.
Country:
Kenya
Category:
Research
Department:
Development Policy & Practice
Institute:
KIT (Royal Tropical Institute)
Keywords:
HIV and AIDS
,
disease prevention and control
,
reproductive health
Language:
eng
Organization:
KIT - Royal Tropical Institute
PAGE:
x, 119
Year:
2009
Region:
East Africa
Right:
© 2009 Chakkalackal
Subject:
Health and Nutrition
Title:
'Regular' partners of female sex workers : a potential bridging population in the Kenyan HIV epidemic
Training:
Master of Public Health / International Course in Health Development (ICHD)