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Knowledge of HIV status, sexual risk behaviors and contraceptive need among people living with HIV in Kenya and Malawi

Anand, Abhijeeta,b; Shiraishi, Ray Wc; Bunnell, Rebecca Ed; Jacobs, Kristae; Solehdin, Nadiac; Abdul-Quader, Abu Sc; Marum, Lawrence Hc; Muttunga, James Nf; Kamoto, Kelitag; Aberle-Grasse, John Mc; Diaz, Theresac

doi: 10.1097/QAD.0b013e32832cb10c
Epidemiology and social

Background: Several studies support the need for effective interventions to reduce HIV transmission risk behaviors among people living with HIV/AIDS (PLWHAs).

Design: Cross-sectional nationally representative demographic health survey of Kenya (2003) and Malawi (2004–2005) that included HIV testing for consenting adults.

Methods: We analyzed demographic health survey data for awareness of HIV status and sexual behaviors of PLWHAs (Kenya: 412; Malawi: 664). The analysis was adjusted (weighted) for the design of the survey and the results are nationally representative.

Findings: Eighty-four percent of PLWHAs in Kenya and 86% in Malawi had sex in the past 12 months and in each country, 10% reported using condoms at last intercourse. Among sexually active PLWHAs, 86% in Kenya and 96% in Malawi reported their spouse or cohabiting partner as their most recent partner. In multivariate logistic regression models, married or cohabiting PLWHAs were significantly more likely to be sexually active and less likely to use condoms. Over 80% of PLWHAs were unaware of their HIV status. Of HIV-infected women, nearly three-quarters did not want more children either within the next 2 years or ever, but 32% in Kenya and 20% in Malawi were using contraception.

Interpretation: In 2003–2005, majority of PLWHAs in Kenya and Malawi were unaware of their HIV status and were sexually active, especially married or cohabiting PLWHAs. Of HIV-infected women not wanting more children, few used contraception. HIV testing should be expanded, prevention programs should target married or cohabiting couples and family planning services should be integrated with HIV services.

aEpidemic Intelligence Service, Office of Workforce and Career Development, USA

bGlobal Immunization Division, National Center for Immunization and Respiratory Diseases, USA

cGlobal AIDS Program, National Center for HIV, Viral Hepatitis, STD and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia, USA

dGlobal AIDS Program, NCHHSTP, Centers for Disease Control and Prevention, Nairobi, Kenya

eInternational Center for Research on Women, Washington, District of Columbia, USA

fKenya Medical Research Institute (KEMRI), Nairobi, Kenya

gClinical HIV Unit, Ministry of Health, Lilongwe, Malawi.

Received 24 December, 2008

Revised 30 March, 2009

Accepted 8 April, 2009

Correspondence to Dr Abhijeet Anand, Global Immunization Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E05, Atlanta, GA 30333, USA. Tel: +1 404 639 1970; fax: +1 404 639 8573; e-mail: aanand@cdc.gov

© 2009 Lippincott Williams & Wilkins, Inc.