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MALE CIRCUMCISION AND SEXUAL RISK BEHAVIORS MAY CONTRIBUTE TO CONSIDERABLE ETHNIC DISPARITIES IN HIV PREVALENCE IN KENYA

Wednesday, 15th of October 2014

MALE CIRCUMCISION AND SEXUAL RISK BEHAVIORS MAY CONTRIBUTE TO CONSIDERABLE ETHNIC DISPARITIES IN HIV PREVALENCE IN KENYA: AN ECOLOGICAL ANALYSIS

• Chris Richard Kenyon, Lung Vu, Joris Menten, Brendan Maughan-Brown

• Published: August 29, 2014

Abstract below; full text, with figures, is at

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0106230

Background

HIV prevalence varies between 0.8 and 20.2% in the various ethnic groups of Kenya. The reasons underlying these variations have not been evaluated before.

Methods

We used data from seven national surveys spanning the period 1989 to 2008 to compare the prevalence of a range of risk factors in the ethnic groups of Kenya. Spearmans and linear regression were used to assess the relationship between HIV prevalence and each variable by ethnic group.

Results

The ethnic groups exhibited significant differences in a number of HIV related risk factors. Although the highest HIV prevalence group (the Luo) had the highest rates of HIV testing (Men 2008 survey: 56.8%, 95% CI 51.0–62.5%) and condom usage at last sex (Men 2008:28.6%, 95% CI 19.6–37.6%), they had the lowest prevalence of circumcision (20.9%, 95% CI 15.9–26.0) the highest prevalence of sex with a non-married, non-cohabiting partner (Men: 40.2%, 95% CI 33.2–47.1%) and pre-marital sex (Men 2008:73.9%, 95% CI 67.5–80.3%) and the youngest mean age of debut for women (1989 Survey: 15.7 years old, 95% CI 15.2–16.2). At a provincial level there was an association between the prevalence of HIV and male concurrency (Spearmans rho = 0.79, P = 0.04). Ethnic groups with higher HIV prevalence were more likely to report condom use (Men 2008 survey: R2 = 0.62, P = 0.01) and having been for HIV testing (Men 2008 survey: R2 = 0.47, P = 0.04).

Conclusion

In addition to differences in male circumcision prevalence, variation in sexual behavior may contribute to the large variations in HIV prevalence in the ethnic groups of Kenya. To complement the prevention benefits of the medical male circumcision roll-out in several parts of Kenya, interventions to reduce risky sexual behavior should continue to be promoted.