Prevalence and determinants of sexual risk taking behavior in female sex workers on Haart: a case study at the sex workers outreach program at the city and Majengo clinics, Nairobi

Abstract

Background According to the Kenya modes of transmission study, sex workers and their clients are key drivers of new HIV infections. (Lawrence Gelmon, 2009). The main purpose of the study was to determine the prevalence and determinants to risk taking behaviour in HIV positive female sex workers in the SWOP clinics. It was carried out in two of the largest SWOP clinics, Majengo and city centre. The clinics in Nairobi provide comprehensive medical and behavioural change interventions to self-identified sex workers. Sex workers and their clients are key drivers of new HIV infections in Kenya and thus the study desired to look at the sexual risk taking action of HIV positive female sex workers and the drivers behind such behaviour Methods The study design adopted was cross sectional with both qualitative and quantitative arms. The overall study objective was to determine the prevalence and determents of sexual risk taking behaviour in HIV positive female sex workers The target population was 6340 HIV positive female sex workers enrolled at the two clinics as at January 2013. Participants were identified from the patient register at the clinic and sequentially called up and offered the opportunity to participate in the study until sample size was reached. Sample size was calculated as 393 participants. To cater for non-response and loss to follow up the sample size was beefed up by 10% making the final sample size 431 participants. Data was collected by use of a structured questionnaire administered to the respondents by the investigator. Three focus group discussions were conducted. The investigator moderated the discussions, which were tape recorded. Quantitative data was analysed using SPSS version 21. Descriptive and analytic statistics were conducted. Qualitative data was transcribed, summarized by identified themes. Selected verbatim quotes were used to supplement quantitative findings. Results A total of 431 individuals were interviewed. Of these, 339 were on HAART while 92 were on cotrimoxasole (septrin) prophylaxis only. It was established that most of the participants may engage in unprotected sexual activity on demand of the client provided he was ready to pay extra for the activity. Condom use was generally high at 62% of all respondents. A majority (73%) were in active sex work at the time of the study. During cross tabulation analysis, applying both Fishers exact test and Chi square test, those on HAART were found to be more likely to engage in risky sexual behaviour as compared to their counterparts who were not on HAART. This was shown in the areas of condom use ( X2= 4.73, p=0.05) and unprotected anal sex (p=0.0332). Conclusion and Recommendations The women expressed an increased chance of engaging in unprotected sexual activity if they were aware of the partners HIV positive status. Risk taking profile of an individual was not affected by her being on HAART or not and being on HAART does not increase the potential for risky sexual activity. The choice to or not to use the condom culminated from a ‘combination of decisions’ by the sex worker influenced by demands from the potential client. Contraceptive prevalence was quite high with over 90% of all the respondents reporting being on some method of family planning. The choice of a method was however influenced by the availability of the particular method, perceived added advantages like ease of use, fewer side effects and any effects on the menstrual cycle. The younger respondents reported enthusiasm to procure abortion in the event of unwanted pregnancy occurring, while the more mature group of respondents who often expressed encountering difficulties when trying to get pregnant often associated this with past termination of pregnancies. The study recommends upgrading health education in seminars, road shows and other venues such as adult education. The clinics should always make contraceptives available to the sex workers and involve regular client in the discussions on risk reduction. A framework can be formulated to enable the sex workers negotiate for safer sex practices with their clients to reduce episodes of engaging in risky sex