Population Council Research that makes a difference

Kenya National AIDS Control Council
First National Biennial HIV and AIDS Research Conference
17–20 May 2011

Abstract

"HIV and STI prevalence among female sex workers in Nairobi: Results from a respondent-driven sampling study"
Jerry Okal, Waimar Tun, Meredith Sheehy, D. Broz, H. Mutua, N. Muraguri, H.F. Raymond, B. Mundia, A. Kim, R. Kaiser, S. Dadabhai, J. Kimani, 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 with FSWs aged 18 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 prevalence 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 (inter-quartile range: 24.3–38.0).  Most participants 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 trichomoniasis 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 trichomoniasis 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.

Conclusions
HIV prevalence among FSWs is higher than among Nairobi’s general population. 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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