Opportunity for Prevention of HIV and Sexually Transmitted Infections in Kenyan Youth: Results of a Population-Based Survey

Data from sentinel serosurveillance, while useful to estimate HIV infection in populations, may not be representative of the general populace. General population-based surveys attempt to avoid selection bias, and are the most appropriate means to track changes in exposure to the risk of HIV over time, and for assessing behavior changes following prevention interventions, according to the current study. The authors conducted a population-based survey with stratified sampling by age group from randomly selected households in a suburb of Mombasa, Kenya.

Between April and July 2000, the authors performed a cross-sectional survey of 1,497 adults between ages 15-49, studying parameters of sexual behavior and knowledge of HIV and sexually transmitted infections (STIs), assessing health-seeking behavior related to STIs, and measuring prevalances of gonorrhea, chlamydia, syphilis and HIV-1. The objective of the analysis was to provide baseline data for prevention interventions.

Of the 1,497 subjects interviewed for whom complete demographic data were available, 50.1 percent were men and 49.9 percent were women. Of those interviewed, 88 percent of men and 83 percent of women had ever had sexual intercourse. Sixty-eight percent of men reported one partner; 16 percent reported two partners, and 7 percent had had three partners during the past 12 months. Respective figures for women were 88 percent, 3 percent and 2 percent. Nearly half of those ages 15-19 reported sexual activity (56 percent of boys, 48 percent of girls). Consistent condom use was low and was lower for women than for men. Both men and women had a high rate of reported STI symptoms during the past 12 months. The subjects showed some knowledge of STI symptoms and HIV infection, but that knowledge was incomplete, the authors noted. Overall, the investigators found HIV seroprevalence to be 10.8 percent, with significantly higher rates among women (13.7 percent) than men (8.0 percent). HIV seroprevalence in the ages 15-19 group was 3.2 percent.

"In summary," the authors concluded, "this survey emphasizes the disproportionately high vulnerability of young adults, in particular young women, to HIV infection and the need for intensive intervention in this group. Relatively low HIV seroprevalence in the 15- to 19-year-old age group suggests prevention interventions in this age group may have a significant impact. The high number of annual partners for young men suggests partner reduction may be a useful strategy in this particular group. The low use of condoms, incomplete knowledge of HIV infection and STIs, and the high number of reported STIs in the past year in general present a large window of opportunity for appropriate, targeted STI and HIV prevention interventions."

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