Population Council Research that makes a difference

16th International Conference on AIDS
and Sexually Transmitted Infections in Africa (ICASA)
4–8 December 2011

Abstract

"HIV and STI prevalence among female sex workers in Nairobi: Results from a respondent-driven sampling study"
Helgar Musyoki, Jerry Okal, Waimar Tun, Meredith Sheehy, Nicolas Muraguri, Henry Fisher Raymond, Ben Mundia, Andrea Kim, Sufia Dadabhai, Tom Oluoch, Reinhard Kaiser, and Scott Geibel

Background
Numerous research activities have been conducted in Nairobi among female sex workers (FSWs). These studies—primarily utilizing targeted or selective recruitment methods—have provided useful information over the years. To date, however, representative estimates of HIV and STI prevalence among FSWs in Nairobi have not been measured.

Methods
In late 2010, a cross-sectional survey was conducted among FSW aged 18 years and older, using respondent-driven sampling (RDS) in Nairobi. Consenting FSWs completed a behavioral questionnaire and were tested for HIV (fingerstick rapid test); syphilis (venous blood); and chlamydia, gonorrhea, trichomoniasis, candidiasis, and bacterial vaginosis (BV) (vaginal swabs). Population-based prevalences and 95% confidence intervals (CI) were estimated using RDS Analysis Tool (RDSAT). Associations (unadjusted for RDS) between HIV and STI prevalence were examined using univariate logistic regression.

Results
Among 596 FSWs, the median age was 30 years (IQR: 24.3–38.0 years). Most FSW were unmarried (95.9%; CI: 91.6-98.3%), lived with at least one of their children (86.5%; CI: 81.8-90.4%), and reported no source of income other than sex work (91.2%; CI: 87.3-94.6%). HIV prevalence was 29.3% (CI: 24.6-34.9%), syphilis 0.8% (unadjusted for RDS), gonorrhea 1.1% (CI: 0.4-2.1%), chlamydia 3.1% (CI: 1.5-5.3%), and trichomaniasis 10.3% (CI: 6.9-14.5%). For candidiasis, yeast cell counts measured few (28.1%; CI: 23.1-33.3%) to moderate (0.3%; CI: 0.0-0.7%). Positive indication of BV was estimated at 15.3% (CI: 11.6-19.5). Respondents testing positive for trichomaniasis or BV were respectively 2.1 (CI: 1.2-3.8) and 1.6 (CI: 1.0-2.6) times more likely to be HIV-infected.

Conclusion
HIV prevalence among FSWs is higher than among Nairobi's general population (8.8%; 2007 KAIS). Health programs need to prioritize FSWs and their clients for HIV and STI prevention and care, and for economic empowerment opportunities. We recommend continued, periodic surveillance to monitor HIV and STI prevalence and behavioral risks among FSWs in Nairobi, and expansion to other areas in Kenya.

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