Population Council Research that makes a difference

Researchers from the Population Council and the International Centre for Reproductive Health (ICRH) undertook an exploratory study among people living with HIV (PLHIV) who were not on antiretroviral therapy (ART) in Mombasa, Kenya. Using a cross-sectional study design, researchers interviewed HIV-positive persons who were not accessing ART. A structured questionnaire was used. Researchers used modified snowball sampling to recruit study participants using two different approaches. In one, community health workers (CHWs) were asked to bring PLHIV from their communities, and in the second, HIV-positive peers were asked to recruit PLHIV from their contacts in the community. A total of 698 study participants were recruited into the study.

Key findings include:

• Important gaps in HIV-related knowledge and negative perceptions related to condom use were observed.
• Sexual activity was high and multiple sexual partners were reported.
• Although sex with regular partners was more common, sex with casual partners and sex workers also was reported.
• A significant proportion of sexual partners were untested or HIV-negative.
• Unprotected sex was prevalent, especially with regular partners of unknown HIV status or HIV-negative regular partners.
• Condom use was low in sexual intercourse during menstrual periods and with oral and anal sex.
• Perceived internalized stigma was frequently reported and influenced unprotected sex.
• High levels of unmet need for family planning were observed.
• Exposure to prevention messages was widespread; however, the messages were unfocused and varied.
• Unmet need for information and information, education, and communication (IEC) materials was large. 
  
  

Based on these findings, study researchers recommend:

• HIV prevention programs need to widen their focus to include prevention interventions targeting PLHIV who are not accessing treatment. It is possible that newly diagnosed clients may not be receptive to prevention-related information provided at the time of HIV testing and diagnosis, making it important to design ongoing support for this population with IEC interventions and condoms.
• Programs need to facilitate disclosure of HIV status to regular partners and emphasize the importance of getting partners tested for HIV. Condom use should be emphasized with all partners irrespective of their HIV status and type; a specific mention of regular partners is necessary. Prevention counseling should also include information on the need for protected sex during menstrual periods, sexually transmitted infection (STI) episodes, anal sex, and oral sex.
• Integrated HIV prevention and family planning services are needed to address unmet need for family planning services.
• Prevention programs must address internalized stigma related to being HIV-positive, as it is correlated with low condom use. Programs should promote living positively and having healthy relationships in the context of being HIV-positive.
• Mass-media programs offer an acceptable route for disseminating prevention information and can be accessed widely without stigma or confidentiality concerns. HIV prevention programs should develop and widen access to culturally appropriate IEC brochures in Kiswahili with pictorial materials for illiterate clients. One-to-one counseling to address queries and offer tailored information also is recommended.

Council researchers are using these findings to develop a prevention intervention study for PLHIV who are not accessing treatment in Mombasa. The study will use a combination of culturally appropriate IEC materials and CHWs and peer educators to deliver the intervention in the community.

Sexual behavior of HIV-positive adults not accessing HIV treatment in Mombasa, Kenya: Defining their prevention needs (abstract) (PDF) 
Sarna,Avina; Luchters,Stanley; Pickett,Melissa; Chersich,Matthew F.; Okal,Jerry; Geibel,Scott; King'ola,Nzioki; Temmerman,Marleen
AIDS Research and Therapy 9: 9-
Publication date: 2012


Prevention with positives: How do we reach them in the community? (PDF) 
Sarna,Avina; Okal,Jerry; Luchters,Stanley; King'ola,Nzioki; Geibel,Scott
Publication date: 2010


Sexual risk behaviours of HIV-positive persons not receiving HIV treatment in Mombasa
 (PDF) 
Poster presentation at 5th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention, Cape Town, 19-22 July
Sarna,Avina; Chersich,Matthew F.; Luchters,Stanley; Pickett,Melissa; Tun,Waimar; Okal,Jerry; Rutenberg,Naomi; Temmerman,Marleen
Publication date: 2009