Anal intercourse among female sex workers in East Africa is associated with other high-risk behaviours for HIV
Nienke J. Veldhuijzen A G , Chantal Ingabire B , Stanley Luchters C D , Wilkister Bosire C , Sarah Braunstein E , Matthew Chersich D F and Janneke van de Wijgert AA Academic Medical Center of the University of Amsterdam and Amsterdam Institute for Global Health and Development, PO Box 22700, 1100 DE Amsterdam, The Netherlands.
B Project Ubuzima, Rue Akagera 716, PO Box 4560, Kigali, Rwanda.
C International Centre for Reproductive Health, Tudor Mboya Avenue, PO Box 91109, Mombasa, Kenya.
D International Centre for Reproductive Health, Department of Uro-gynaecology, Ghent University, De Pintelaan 185-P3, 9000 Ghent, Belgium.
E Department of Epidemiology Columbia University, 722 W. 168th Street, New York, NY 10032, USA.
F Centre for Health Policy, School of Public Health, University of Witwatersrand, Private Bag 3, Wits 2050, South Africa.
G Corresponding author. Email: n.veldhuijzen@amc-cpcd.org
Sexual Health 8(2) 251-254 https://doi.org/10.1071/SH10047
Submitted: 15 April 2010 Accepted: 14 September 2010 Published: 18 May 2011
Abstract
Introduction: Epidemiological and HIV prevention studies in sub-Saharan Africa have almost exclusively focussed on vaginal transmission of HIV, the primary mode of transmission in the region. Little is known about the prevalence of heterosexual anal intercourse (AI), its correlates and its role in the spread of HIV. Prevention messaging seldom, if ever, includes AI. Methods: Sexual and other risk behaviours (including frequency of AI) were assessed in two cross-sectional surveys of female sex workers (FSW) in Kigali, Rwanda (n = 800) and Mombasa, Kenya (n = 820). In addition, a subset of FSW surveyed in Kigali attended seven focus group discussions and four in-depth interviews. Results: AI was reported by 5.5% and 4.3% of FSW in the cross-sectional surveys, in Kigali and Mombasa, respectively. FSW practising AI reported multiple risk factors for HIV transmission: inconsistent condom use (odds ratio (OR) Kigali 5.9 (95% CI 1.4–24.7); OR Mombasa 2.1 (1.1–4.2)); more than five sexual partners in the past week (OR Kigali 4.3 (1.5–12.4); OR Mombasa 2.2 (1.1–4.3)); alcohol use before sex (OR Kigali 2.8 (1.4–5.8)); more than 5 years of female sex work (OR Mombasa 2.4 (1.2–4.9)); and history of genital symptoms in the past year (OR Mombasa 3.6 (1.7–7.9)). AI was, however, not associated with HIV prevalence (OR Kigali 0.9 (0.5–1.9); OR Mombasa 0.5 (0.2–1.2)). Negative connotations and stigma associated with AI were expressed during qualitative interviews. Conclusions: AI was associated with several indicators of sexual risk behaviour. Prevalence of AI was probably underreported due to social desirability bias. Stigma associated with AI poses methodological challenges in obtaining valid data.
Additional keywords: epidemiology, Kenya, qualitative research, Rwanda.
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