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Factors Associated With Self-Reported Unprotected Anal Sex Among Male Sex Workers in Mombasa, Kenya

Geibel, Scott MPH*; Luchters, Stanley MD, MSc; King'ola, Nzioki MA; Esu-Williams, Eka PhD; Rinyiru, Agnes BA; Tun, Waimar PhD§

Sexually Transmitted Diseases: August 2008 - Volume 35 - Issue 8 - p 746-752
doi: 10.1097/OLQ.0b013e318170589d

Objectives: To identify social and behavioral characteristics associated with sexual risk behaviors among male sex workers who sell sex to men in Mombasa, Kenya.

Methods: Using time-location sampling, 425 men who had recently sold, and were currently willing to sell sex to men were invited to participate in a cross-sectional survey. A structured questionnaire was administered using handheld computers. Factors associated with self-reported unprotected anal sex with male clients in the past 30 days were identified and subjected to multivariate analysis.

Results: Thirty-five percent of respondents did not know HIV can be transmitted via anal sex, which was a significant predictor of unprotected anal sex [adjusted odds ratio (AOR) 1.92; 95% confidence interval (95% CI), 1.16-3.16]. Other associated factors included drinking alcohol 3 or more days per week (AOR, 1.63; 95% CI, 1.05-2.54), self-report of burning urination within the past 12 months (AOR, 2.07; 95% CI, 1.14-3.76), and having never been counseled or tested for HIV (AOR, 1.66; 95% CI, 1.07-2.57). Only 21.2% of respondents correctly knew that a water-based lubricant should be used with latex condoms.

Conclusions: Male sex workers who sell sex to men in Mombasa are in acute need of targeted prevention information on anal HIV and STI transmission, consistent condom use, and correct lubrication use with latex condoms. HIV programs in Africa need to consider and develop specific prevention strategies to reach this vulnerable population.

A survey of male sex workers in Mombasa, Kenya, found that unprotected anal sex with male clients is associated with poor knowledge of anal HIV transmission, high alcohol consumption, and recent self-report of burning urination.

From the *Population Council, Nairobi, Kenya; †International Centre for Reproductive Health, Mombasa, Kenya; ‡Population Council, Johannesburg, South Africa; and §Population Council, Washington, DC

The authors thank Dr. A. Kahindi, Coast Provincial Medical Office, for his administrative support. Eduard Sanders of the Kenya Medical Research Institute and Susan Graham of the University of Washington provided technical advice and assistance relating to medical referral of respondents and sharing of staff resources. Peter Aggleton of the Thomas Coram Research Unit, Institute of Education, University of London, through the Ford Foundation, Office of East Africa, provided technical support to the conceptualization and writing of this article. Tim Lane of the Center for AIDS Prevention Studies, University of California San Francisco and Scott Kellerman of the Population Council provided useful comments on the article. The study would not have been possible without the advice of W. Onyango-Ouma of the Institute of African Studies, University of Nairobi, and the dedication of the interviewing team. The authors greatly appreciate the commitment of 12 MSM mobilizers, as well as the trust and effort of the male sex workers who participated in this research.

Supported by the President's Emergency Plan for AIDS Relief through the Office of HIV/AIDS, Bureau of Global Health, US Agency for International Development (USAID), through the Population Council's Horizons Program cooperative agreement of Award No. HRN-A-00-97-00012-00.

The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID.

Correspondence: Scott Geibel, MPH, Population Council, Box 17643-00500, Nairobi, Kenya. E-mail:

Received for publication November 15, 2007, and accepted February 22, 2008.

© Copyright 2008 American Sexually Transmitted Diseases Association