Evaluating the effects of community-based organization engagement on HIV and AIDS-related risk behavior in Kenya

Figures & data

Table 1. List of criteria used to select communities that participated in the evaluation of the effects of the community response to HIV/AIDS in Kenya.

Level 1 criteria
The selected communities must each be identifiable as a community. It should be possible to geographically delineate each community and there should be some authoritative consensus on their classification as a community. Both the study and the comparison community should be classified similarly with regard to their status as urban, suburban, periurban, or rural communities. The study and comparison communities should be of similar size, as measured by number of households. The two communities should be similar in terms of their language, and cultural and ethnic diversity or homogeneity. There should be no glaring systematic difference in this regard. The communities should share a similar rate of employment. The communities should share a similar level of income per household.
Level 2 criteria
There should be no significant differences between communities in the makeup and size of households. The two communities should have a similar level of access to basic services, including water and sanitation, electricity supply, refuse removal and disposal, education, and any key social welfare services supplied by the state. The nature and state of housing should be similar in the study and comparison communities. Key health indicators, such as infant and maternal mortality rates, should be similar. The exception is seroprevalence rates, which do not have to be similar.
Level 3 criteria
The final matching procedure will examine the following criteria in addition to Levels 1 and 2. Cultural values and practices: Paired communities will share the same dominant ethnic group, equalizing, for example, cultural practices such as female circumcision and cultural values tolerant of multiple sexual partners. Prevalence of most-at-risk populations (MARPs): The proportionally higher infection rates of MARPs influence modes of transmission through bridging populations, for example, sex workers and their clients, the latter acting as a bridging vector for the disease into the rest of the population. The comparative economic status of communities and the vector of economic growth: This would be related to access to basic services but more significantly the relative prevalence of MARPs, including migrant labor. Proximity to major cities and commuting patterns: Not only does proximity to a major city correlate with higher levels of basic services and higher income levels, but there is the possibility of contagion as proximate communities take advantage of HIV and AIDS-related programs and services offered in the city, or city CBOs implement outreaches to neighboring communities. Proximity to major transport routes: Both the general literature and case data indicate correlates with a higher prevalence of MARPs and the associated elevation of infection rates and risk of infection to the general population through bridging populations.

Table 2. Characteristics of the communities participating in the evaluation of the effects of the community response to HIV/AIDS in Kenya.

Province	District	Community	Community assignment	HIV prevalence*	HIV incidence (PMTCT)^a	Rural/urban character	Main ethnic group	Population	Number of CBOs
Nyanza	Kisumu	1	Study	17.3	17.1	Urban	Mixed	10,000	10
		2	Study	17.3	17.1	Rural	Luo	2,000	10
		3	Study	17.3	17.1	Urban	Luo	4,000	10
	Nyando	4	Study	19	18.9	Rural	Luo	2,000	5
		5	Study	19	18.9	Rural	Luo	1,500	6
		6	Comparison	19	18.9	Urban	Luo	4,000	6
	Kisii	7	Comparison	5.9	7.2	Urban	Kisii	12,634	5
		8	Comparison	5.9	7.2	Rural	Kisii	6,027	2
	Nyamira	9	Comparison	5.2	4.0	Urban	Kisii	11,337	16
		10	Comparison	5.2	4.0	Rural	Kisii	8,676	14
Western	Butere-Mumias	11	Study	5.2	4.1	Urban	Luhya	9,545	5
		12	Study	5.2	4.1	Urban	Luhya	9,343	6
	Vihiga	13	Comparison	5.3	5.3	Urban	Luhya	6,307	6
		14	Comparison	5.3		Urban	Luhya	21,863	8

Note: ^aPrevalence estimates available only at the district level.

Table 3. Summary statistics of study and comparison communities.

Communities	Study (High level of CBO engagement) n=7 (%)	Comparison (Low level of CBO engagement) n=7 (%)
HIV prevalence	14.3	7.4
Gender distribution
Male	40.1	39.1
Female	59.9	60.9
Ever attended school	96.8	95.5
Engaged in paid work	69.9	45.3
Marital status
Married	70.5	77.3
Divorced	4.1	3.4
Widowed	7.4	6.1
Never married	18.1	13.2

Table 4. Results of multilevel regression analysis HIV knowledge and risk behavior.

	People reduce HIV chances having 1 uninfected sex partner^a		People reduce chances of getting HIV by using a condom^a		Know of drugs to reduce MTC transmission^a		People CANNOT get the HIV virus from a mosquito or insect bite^a		People cannot get HIV by sharing utensils with a person who has AIDS^a		It is possible for a healthy looking person to have HIV^a		Have heard of VCT^a		Would accept VCT if a counselor came to the house^a		Know of drugs to control HIV^a		Condom use^a		Ever tested for HIV^a
Variables	(OR)	95% CI	(OR)	95% CI	(OR)	95% CI	(OR)	95% CI	(OR)	95% CI	(OR)	95% CI	(OR)	95% CI	(OR)	95% CI	(OR)	95% CI	(OR)	95% CI	(OR)	95% CI
Age	1.02	(1.01–1.03)	1.00	(0.99–1.00)	0.99	(0.98–1.00)	0.99	(0.99 – 1.00)	1.00	(0.99–1.00)	0.99	(0.98–1.00)	0.96	(0.95–0.98)	0.99	(0.98 – 0.99)	0.99	(0.98–0.99)	0.96	(0.94–0.98)	0.95	(0.95–0.96)
Female	0.85	(0.71–1.02)	0.65	(0.57–0.73)	1.92	(1.61–2.28)	0.68	(0.59 – 0.78)	1.04	(0.94–1.15)	0.73	(0.64–0.83)	0.66	(0.42–1.03)	1.19	(0.98 – 1.44)	0.96	(0.80–1.16)	0.74	(0.64–0.86)	1.98	(1.73–2.26)
Number of school	0.68	(0.47–0.97)	0.56	(0.45–0.70)	0.66	(0.51–0.86)	0.50	(0.42 – 0.60)	0.52	(0.41–0.65)	0.39	(0.30–0.50)	0.24	(0.19–0.31)	0.72	(0.51 – 1.02)	0.81	(0.53–1.22)	0.34	(0.09–1.24)	0.45	(0.35–0.58)
Secondary school	1.01	(0.84–1.21)	1.36	(1.17–1.58)	1.80	(1.5–2.17)	2.27	(1.94 – 2.66)	1.53	(1.32–1.76)	1.66	(1.39–1.99)	3.00	(2.17–4.15)	1.10	(0.95 – 1.28)	1.61	(1.20–2.16)	2.07	(1.51–2.82)	1.42	(1.26–1.60)
College	2.35	(1.57–3.50)	2.32	(1.72–3.14)	1.38	(1.01–1.90)	7.37	(5.32 – 10.23)	3.44	(2.50–4.73)	5.78	(3.62–9.23)	4.20	(2.19–8.05)	1.27	(0.94 – 1.72)	1.78	(1.12–2.84)	1.72	(1.10–2.67)	2.57	(2.01–3.28)
Divorced/separated	1.19	(0.84–1.69)	1.39	(1.07–1.79)	1.10	(0.88–1.37)	1.34	(1.10 – 1.62)	0.88	(0.65–1.19)	1.67	(1.06–2.62)	0.91	(0.46–1.79)	1.16	(0.79 – 1.71)	1.27	(0.83–1.94)	72.31	(23.43–223.18)	0.68	(0.48–0.97)
Widowed	0.80	(0.58–1.10)	0.98	(0.81–1.20)	1.10	(0.88–1.37)	1.08	(0.90 – 1.30)	1.10	(0.99–1.22)	1.52	(1.21–1.90)	0.96	(0.69–1.33)	0.88	(0.69 – 1.12)	3.22	(1.97–5.24)	72.89	(21.71–244.69)	0.93	(0.75–1.14)
Never married and never lived together	1.37	(0.99–1.88)	1.34	(1.08–1.68)	0.59	(0.48–0.72)	0.85	(0.71 – 1.02)	0.84	(0.73–0.96)	0.84	(0.70–1.02)	1.03	(0.61–1.76)	0.78	(0.66 – 0.91)	0.75	(0.54–1.04)	300.37	(115.01–784.46)	0.29	(0.24–0.36)
Engaged in any paid work	1.19	(0.95–1.50)	0.81	(0.68–0.97)	1.13	(0.96–1.34)	0.99	(0.86 – 1.12)	1.14	(0.94–1.39)	0.89	(0.78–1.02)	1.21	(0.80–1.81)	1.27	(1.08 – 1.5)	1.54	(1.19–1.98)	1.17	(0.91–1.49)	1.15	(1.01–1.30)
Household wealth index	0.97	(0.8–1.19)	1.05	(0.88–1.26)	1.34	(1.11–1.60)	1.19	(1.06 – 1.33)	1.34	(1.15–1.56)	1.13	(0.98–1.30)	0.85	(0.63–1.16)	0.81	(0.74 – 0.89)	1.06	(0.80–1.41)	0.80	(0.68–0.93)	1.08	(0.97– 1.19)
Rural	1.03	(0.57–1.86)	1.32	(0.98–1.78)	1.32	(0.86–2.02)	0.80	(0.59 – 1.09)	0.94	(0.70–1.26)	0.89	(0.63–1.26)	0.49	(0.33–0.72)	1.07	(0.71 – 1.60)	0.19	(0.05–0.69)	0.35	(0.23–0.53)	0.70	(0.57– 0.86)
HIV prevalence	0.95	(0.91–0.99)	0.95	(0.92–0.99)	0.98	(0.96–0.99)	0.98	(0.96 – 0.99)	0.96	(0.93–0.99)	0.98	(0.96–1.01)	1.15	(1.09–1.22)	1.03	(1.00 – 1.06)	1.16	(1.08–1.24)	1.16	(1.13–1.18)	1.09	(1.07–1.11)
Community assignment	9.26	(5.29–16.22)	14.67	(10.58–20.35)	3.85	(2.70–5.48)	1.09	(0.92 – 1.28)	1.78	(1.29–2.44)	1.27	(0.96–1.67)	1.89	(1.00–3.56)	1.02	(0.70 – 1.48)	3.54	(1.74–7.19)	4.09	(3.05–5.48)	1.53	(1.23–1.92)

Notes: ^aBinomial outcome variable model.

Condom use=used condom consistently (with all sex partners) at last sex (12 months).

Table 5. Results of multilevel regression analysis: social capital.

	Know of institutions that protect children's rights^a		Voted in local election^a		Voted in general election^a		Participated in electoral campaign^a		Scale of attitudes towards own children^a		Respect opinion of children^a		Participated in community activities^a		Taken part in a march or demonstration^a		Cognitive social capital mean score^a		Cognitive social capital summative score^a		Participation in voluntary associations^a
Variables	Coefficient (SE)	P value	Coefficient (SE)	P value	Coefficient (SE)	P value	Coefficient (SE)	P value	Coefficient (SE)	P value	Coefficient (SE)	P value	Coefficient (SE)	P value	Coefficient (SE)	P value	Coefficient (SE)	P value	Coefficient (SE)	P value	Coefficient (SE)	P value
Age	0.00 (0.00)	0.41	0.00 (0.00)	0.33	0.00 (0.00)	0.83	−0.01 (0.01)	0.35	0.01 (0.01)	0.41	0.02 (0.01)	0.02	0.00 (0.00)	0.04	0.00 (0.00)	0.75	0.00 (0.00)	0.28	−0.01 (0.01)	0.28	0.00 (0.01)	0.70
Number of school	−0.42 (0.19)	0.03	0.45 (0.24)	0.06	0.28 (0.61)	0.64	0.82 (0.44)	0.06	−0.43 (0.29)	0.13	−0.20 (0.18)	0.28	0.07 (0.19)	0.72	0.68 (0.56)	0.23	0.04 (0.05)	0.43	1.25 (0.89)	0.16	−0.61 (0.32)	0.06
Secondary school	0.69 (0.11)	0.00	0.20 (0.13)	0.15	0.23 (0.12)	0.07	0.06 (0.19)	0.77	0.54 (0.09)	0.00	0.44 (0.10)	0.00	0.20 (0.09)	0.02	0.34 (0.21)	0.10	−0.04 (0.02)	0.02	−0.96 (0.37)	0.01	0.40 (0.08)	0.00
College	1.80 (0.24)	0.00	0.74 (0.32)	0.02	0.77 (0.37)	0.04	0.87 (0.21)	0.00	0.97 (0.18)	0.00	0.87 (0.17)	0.00	0.54 (0.09)	0.00	−0.31 (0.49)	0.52	−0.09 (0.03)	0.00	−1.75 (0.50)	0.00	0.60 (0.16)	0.00
Divorced/separated	−0.16 (0.16)	0.31	−0.90 (0.29)	0.00	−0.84 (0.37)	0.02	−0.71 (0.26)	0.01	−0.56 (0.21)	0.01	−0.25 (0.29)	0.39	−0.46 (0.23)	0.05	−0.76 (0.57)	0.18	0.11 (0.04)	0.00	2.38 (0.72)	0.00	−0.52 (0.19)	0.01
Widowed	0.06 (0.14)	0.68	−0.66 (0.14)	0.00	−0.74 (0.18)	0.00	−0.45 (0.20)	0.02	0.28 (0.23)	0.24	0.52 (0.14)	0.00	−0.15 (0.07)	0.05	−0.52 (0.31)	0.09	−0.02 (0.04)	0.63	−0.46 (0.68)	0.50	0.20 (0.12)	0.09
Never married and never lived together	−0.59 (0.12)	0.00	−0.11 (0.16)	0.52	−0.11 (0.14)	0.44	−0.47 (0.24)	0.05	−1.37 (0.25)	0.00	−0.94 (0.23)	0.00	−0.26 (0.09)	0.01	−0.08 (0.28)	0.79	0.09 (0.03)	0.00	1.74 (0.57)	0.00	−0.61 (0.19)	0.00
Engaged in any paid work	0.33 (0.09)	0.00	−0.24 (0.18)	0.20	−0.74 (0.19)	0.00	−0.01 (0.20)	0.95	0.25 (0.09)	0.01	0.20 (0.18)	0.26	0.08 (0.10)	0.43	0.29 (0.21)	0.17	−0.01 (0.02)	0.81	−0.04 (0.42)	0.92	0.26 (0.13)	0.04
Household wealth index	0.14 (0.10)	0.13	−0.27 (0.13)	0.04	−0.10 (0.27)	0.70	−0.07 (0.17)	0.67	0.19 (0.10)	0.05	0.00 (0.11)	0.97	−0.24 (0.06)	0.00	0.03 (0.11)	0.77	−0.02 (0.02)	0.40	−0.35 (0.40)	0.39	−0.06 (0.10)	0.57
Rural	−0.15 (0.32)	0.64	0.90 (0.52)	0.08	1.90 (0.85)	0.03	0.06 (0.57)	0.92	4.87 (0.39)	0.00	−0.19 (0.74)	0.80	0.01 (0.19)	0.96	0.03 (0.40)	0.93	0.18 (0.03)	0.00	69.62 (12.21)	0.00	−0.06 (0.39)	0.88
HIV prevalence	0.00 (0.03)	0.95	−0.02 (0.04)	0.57	−0.07 (0.09)	0.40	0.06 (0.04)	0.13	0.01 (0.07)	0.93	0.04 (0.07)	0.59	0.08 (0.01)	0.00	0.05 (0.02)	0.03	−0.00 (0.01)	0.82	−0.03 (0.17)	0.88	0.05 (0.03)	0.10
Community assignment	1.25 (0.39)	0.00	1.83 (0.56)	0.00	1.71 (0.86)	0.05	1.28 (0.33)	0.00	−0.60 (0.81)	0.46	−0.35 (0.75)	0.64	0.04 (0.15)	0.79	0.38 (0.27)	0.16	−0.21 (0.11)	0.07	−4.04 (2.30)	0.08	0.38 (0.32)	0.23

Note: ^aOrdinal outcome variable model.

Table 6. Results of multilevel regression analysis: gender ideology.

	Gender ideology 1^a		Gender ideology 4^a
Variables	(OR)	95% CI	(OR)	95% CI
Age	0.99	(0.98–1.00)	0.97	(0.96–0.98)
Female	3.00	(2.65–3.40)	0.86	(0.61–1.22)
Number of school	0.41	(0.31–0.55)	1.02	(0.89–1.17)
Secondary school	1.71	(1.48–1.97)	1.24	(1.00–1.54)
College	1.92	(1.56–2.38)	0.46	(0.38–0.56)
Divorced/separated	1.02	(0.70–1.49)	0.22	(0.15–0.31)
Widowed	0.65	(0.52–0.81)	0.40	(0.28–0.57)
Never married and never lived together	0.50	(0.42–0.61)	1.13	(0.98–1.31)
Engaged in any paid work	1.28	(1.10–1.49)	1.17	(1.02–1.34)
Household wealth index	1.24	(1.14–1.35)	1.38	(1.05–1.81)
Rural	1.16	(0.94–1.41)	0.97	(0.95–1.00)
HIV prevalence	0.95	(0.93–0.96)	1.25	(1.04–1.50)
Community assignment	1.10	(0.90–1.33)	0.97	(0.96–0.98)

Notes: ^aBinomial outcome variable model.

Gender ideology 1 = it's right for women to use modern family planning.

Gender ideology 4 = uses modern family planning method (women only).