Understanding ethnic variations in HIV prevalence in Kenya: the role of cultural practices

Abstract

Patterns of HIV prevalence in Kenya suggest that areas where various cultural practices are prevalent bear a disproportionate burden of HIV. This paper examines (i) the contextual effects of cultural practices (polygyny, male circumcision) and related sexual behaviour factors on HIV prevalence and (ii) the extent to which specific cultural practices in a community/county might explain existing ethnic variations in HIV prevalence in Kenya. The analysis applies multilevel logistic regression to data from the 2012/13 Kenya AIDS Indicator Survey. The results reveal striking ethnic variations in HIV prevalence in Kenya. The prevalence of polygyny in a community is positively associated with HIV prevalence, while a higher level of male circumcision in a county is protective for both men and women. The effects of these factors are stronger for men than women at both individual and contextual (community/county) levels. These cultural practices and associated risk factors partly explain existing ethnic differences in HIV prevalence in Kenya, but there remain significant ethnic variations that are not explained by these cultural practices or related sexual behaviour factors. These call for stronger empirical evidence to offer stronger theoretical explanations and inform effective policy and practice to address HIV epidemic in adversely affected communities in Kenya and similar settings in sub-Saharan Africa.

Keywords:

• HIV prevalence
• ethnic variations
• cultural practices
• contextual effects
• Kenya

Acknowledgements

The research forms part of a scoping study for the project on ‘The evolving HIV/AIDS epidemic in the most-affected communities of Eastern and Southern Africa: understanding the role of culture and global civil society’ undertaken by an international interdisciplinary team of researchers in the UK, Kenya, Malawi and South Africa. The authors acknowledge the contribution of network members for their invaluable comments/feedback on earlier drafts of the paper.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The research presented in this paper was made possible through the pump-priming Global Challenges Research Fund (GCRF) at the University of Hull, UK.