title: Sexual risk taking among patients on antiretroviral therapy in an urban informal settlement in Kenya: a cross-sectional survey.
abstract: BACKGROUND
  Our intention was to analyze demographic and contextual factors associated with sexual risk taking among HIV-infected patients on antiretroviral treatment (ART) in Africa's largest informal urban settlement, Kibera in Nairobi, Kenya.
  
  
  METHODS
  We used a cross-sectional survey in a resource-poor, urban informal settlement in Nairobi; 515 consecutive adult patients on ART attending the African Medical and Research Foundation clinic in Kibera in Nairobi were included in the study. Interviewers used structured questionnaires covering socio-demographic characteristics, time on ART, number of sexual partners during the previous six months and consistency of condom use.
  
  
  RESULTS
  Twenty-eight percent of patients reported inconsistent condom use. Female patients were significantly more likely than men to report inconsistent condom use (aOR 3.03; 95% CI 1.60-5.72). Shorter time on ART was significantly associated with inconsistent condom use. Multiple sexual partners were more common among married men than among married women (adjusted OR 4.38; 95% CI 1.82-10.51).
  
  
  CONCLUSIONS
  Inconsistent condom use was especially common among women and patients who had recently started ART, i.e., when the risk of HIV transmission is higher. Having multiple partners was quite common, especially among married men, with the potential of creating sexual networks and an increased risk of HIV transmission. ART needs to be accompanied by other preventive interventions to reduce the risk of new HIV infections among sero-discordant couples and to increase overall community effectiveness.
authors.affiliation: Karolinska Institutet, Department of Public Health Sciences, Division of Global Health (IHCAR), Stockholm, Sweden. anders.ragnarsson@ki.se
authors.forename: Anders
authors.initials: A
authors.lastname: Ragnarsson
authors.forename: Anna Mia
authors.initials: AM
authors.lastname: Ekström
authors.forename: Jane
authors.initials: J
authors.lastname: Carter
authors.forename: Festus
authors.initials: F
authors.lastname: Ilako
authors.forename: Abigail
authors.initials: A
authors.lastname: Lukhwaro
authors.forename: Gaetano
authors.initials: G
authors.lastname: Marrone
authors.forename: Anna
authors.initials: A
authors.lastname: Thorson
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014505:Urban Population
chemical_list: D019380:Anti-HIV Agents