Opportunity for prevention of HIV and sexually transmitted infections in Kenyan youth: Results of a population-based survey

Background: Data from sentinel serosurveillance are useful to estimate HIV infection in populations but may not be representative of the general population. General population-based surveys attempt to avoid selection bias and are the most appropriate for tracking changes in exposure to risk of HIV infection over time and assessing changes in behavior following prevention campaigns. Objectives: To provide baseline data for targeted sexually transmitted infection (STI) and HIV infection prevention interventions by studying parameters of sexual behavior and knowledge of HIV infection and STIs, measuring health-seeking behavior related to STIs, and measuring gonorrhea, Chlamydia, syphilis, and HIV-1 prevalences. Design: Population-based survey with stratified sampling by age group from randomly selected households in a suburb of Mombasa, Kenya. Methods: A standard questionnaire was administered to 1497 consenting adults between the ages of 15 and 49 years who lived in randomly selected households. Urine and blood samples were obtained for the estimation of gonorrhea, chlamydial infection, syphilis, and HIV-1 infection prevalences. Results: Sexual activity in the past 12 months was limited to one partner in all age groups for most sexually active men (68%) and women (88%). More men than women reported two or more partners in the past 12 months (23% vs. 5%, respectively). Almost one half of those persons in the 15- to 19-year-old age group (56% of boys and 48% of girls) were sexually active. Condom use was low with all sexual partners, more so for women than for men. Reported STI symptoms in the past 12 months were high for both men and women. Knowledge of STI symptoms and HIV infection was present but incomplete. Overall HIV seroprevalence was 10.8%, with significantly higher rates among women (13.7%) than among men (8.0%). HIV seroprevalence in the 15- to 19-year-old age group was 3.2%. Female gender, Protestant religion, Catholic religion, and being divorced, separated, and widowed were significantly associated with HIV seroprevalence. Prevalences of gonorrhea, chlamydial infection, and syphilis were 0.9%, 1.5%, and 1.3%, respectively. Conclusions: This study emphasizes the vulnerability of young adults, in particular young women, to HIV infection and the need for intensive interventions in this group. The low use of condoms, incomplete knowledge of HIV infection and STIs, the high number of reported STIs, and the relatively low HIV-1 seroprevalence among the 15- to 19-year-old group indicate a large need for intensive STI and HIV infection prevention programs, especially for the 15- to 19-year-old age group.