Opportunities for targeted HIV prevention in Kenya

Abstract

In 2007, an estimated 2.5 million [1.8 million - 4.1 million] persons became newly infected with HIV, most of these infections occurred in sub-Saharan Africa. Sub-populations that play an important role in fuelling the epidemic have been identified, and are among the most marginalized and discriminated people in society. Their behaviours put them at increased risk of becoming infected with HIV as well as spreading HIV to the population at large. Vulnerable groups include, but are not limited to, sex workers, men who have sex with men, orphans and vulnerable children, girls, migrant workers, uniformed services, victims of rape and sexual violence, intravenous drug users and discordant couples. Targeting these groups remains a key strategy for preventing HIV in both concentrated and generalized HIV epidemics. This thesis focuses on three of these key populations: sex workers; men who have sex with men; and people living with HIV. Currently, a better understanding is needed of the factors associated with increased sexual risk behaviour among these key populations to more effectively develop and implement targeted interventions. Also, assessment of existing interventions remains needed. The general objective of this work is to identify priorities in HIV prevention (acquisition and further transmission) and to assess prevention strategies among key populations. More specifically, the research aimed to identify factors associated with unprotected sex among key populations, and to assess the safety, acceptability and effectiveness of HIV prevention strategies among most-at-risk populations in Mombasa, Kenya. Taken together, seven studies were conducted in the period between March 2003 and December 2006, in Mombasa district, Kenya.