title: Factors associated with HIV infection in married or cohabitating couples in Kenya: results from a nationally representative study.
abstract: BACKGROUND
  In order to inform prevention programming, we analyzed HIV discordance and concordance within couples in the Kenya AIDS Indicator Survey (KAIS) 2007.
  
  
  METHODS
  KAIS was a nationally representative population-based sero-survey that examined demographic and behavioral indicators and serologic testing for HIV, HSV-2, syphilis, and CD4 cell counts in 15,853 consenting adults aged 15-64 years. We analyzed interview and blood testing data at the sexual partnership level from married or cohabitating couples. Multivariable regression models were used to identify factors independently associated with HIV discordant and concordant status.
  
  
  RESULTS
  Of 3256 couples identified in the survey, 2748 (84.4%) had interview and blood testing data. Overall, 3.8% of couples were concordantly infected with HIV, and in 5.8% one partner was infected, translating to 338,000 discordant couples in Kenya. In 83.6% of HIV-infected Kenyans living in married or cohabitating couples neither partner knew their HIV status. Factors independently associated with HIV-discordance included young age in women (AOR 1.5, 95% CI: 1.2-1.8; p<0.0001), increasing number of lifetime sexual partners in women (AOR 1.5, 95% CI: 1.3-1.8; p<0.0001), HSV-2 infection in either or both partners (AOR 4.1, 95% CI: 2.3-7.2; p<0.0001), and lack of male circumcision (AOR 1.6, 95% CI: 1.0-2.5; p = 0.032). Independent factors for HIV-concordance included HSV-2 infection in both partners (AOR 6.5, 95% CI: 2.3-18.7; p = 0.001) and lack of male circumcision (AOR 1.8, 95% CI: 1.0-3.3; p = 0.043).
  
  
  CONCLUSIONS
  Couple prevention interventions should begin early in relationships and include mutual knowledge of HIV status, reduction of outside sexual partners, and promotion of male circumcision among HIV-uninfected men. Mechanisms for effective prevention or suppression of HSV-2 infection are also needed.
authors.affiliation: Center for Global Health, Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Nairobi, Kenya. rkaiser@ke.cdc.gov
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kaiser
authors.forename: Rebecca
authors.initials: R
authors.lastname: Bunnell
authors.forename: Allen
authors.initials: A
authors.lastname: Hightower
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Kim
authors.forename: Peter
authors.initials: P
authors.lastname: Cherutich
authors.forename: Mary
authors.initials: M
authors.lastname: Mwangi
authors.forename: Tom
authors.initials: T
authors.lastname: Oluoch
authors.forename: Sufia
authors.initials: S
authors.lastname: Dadabhai
authors.forename: Patrick
authors.initials: P
authors.lastname: Mureithi
authors.forename: Nelly
authors.initials: N
authors.lastname: Mugo
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mermin
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008393:Marriage / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D055815:Young Adult