Attitudes and beliefs about anti-retroviral therapy are associated with high risk sexual behaviors among the general population of Kisumu, Kenya

Abstract

Attitudes and beliefs about antiretroviral therapy (ART) may affect sexual risk behaviors among the general population in sub-Saharan Africa. We performed a cross-sectional population-based study in Kisumu, Kenya to test this hypothesis in October 2006. A total of 1655 participants were interviewed regarding attitudes and beliefs about ART and their sexual risk behaviors. The majority of participants, (71%) men and (70%) women, had heard of ART. Of these, 20% of men and 29% of women believed ART cures HIV. Among women, an attitude that “HIV is more controllable now that ART is available” was associated with sex with a non-spousal partner, increased lifetime number of sexual partners as well as a younger age at sexual debut. No significant associations with this factor were found among men. The belief that “ART cures HIV” was associated with younger age of sexual debut among women. The same belief was associated with an increased likelihood of exchanging sex for money/gifts and decreased likelihood of condom use at last sex among men. These findings were most significant for people aged 15–29 years. In high HIV seroprevalence populations with expanding access to ART, prevention programs must ensure their content counteracts misconceptions of ART in order to reduce high risk sexual behaviors, especially among youth.

Keywords:

• HIV-1
• antiretroviral therapy
• highly active
• behavioral risk factor surveillance system
• high risk sex
• Africa
• south of the Sahara
• factor analysis
• statistical

Acknowledgements

This study was supported by a Doris Duke Charitable Foundation Operations Research on AIDS Care and Treatment in Africa (ORACTA) grant. RMS was supported by the University of California, San Francisco (UCSF) Dean's Research Fund and the UCSF Social and Behavioral Science Area of Concentration Scholarship Fund.

Our success in completing this study was due to the tireless efforts of the research team in the field especially field team leaders (Solace Awuor Amboga, Vitalis Akora, John Marie Mbeche, and Juma G. Juma), the lab (Hannah Kimenyu and Albert Okumu), the data (Edmund Njeru Njagi and Hesbon Ooko), and administrative (Jacob Magige, Michael Mureithi, and Barrack Onyango) offices, as well as strong collaboration and support from the community leaders and residents of Kisumu. The authors also thank the following for their generous support: The Director KEMRI, the Director Centre for Microbiology Research; and the UNIM Project for their hospitality. This work is published with the permission of the Director KEMRI.