title: Unsafe sex among HIV-infected adults in Kenya: results of a nationally representative survey.
abstract: OBJECTIVE
  Assess factors associated with knowledge of HIV status, sexual activity, and unprotected sex with a partner of unknown or negative HIV status (unsafe sex) among HIV-infected adults in Kenya.
  
  
  METHODS
  Nationally representative Kenya AIDS Indicator Survey among adults aged 15-64 years in 2007.
  
  
  METHODS
  A standardized questionnaire was administered and blood samples tested for HIV. We assessed factors associated with knowledge of HIV infection, sexual activity, and unsafe sex. Analyses took into account stratification and clustering in the survey design and estimates were weighted to account for sampling probability.
  
  
  RESULTS
  Of 15,853 participants with blood samples, 1104 (6.9%) were HIV infected. Of these, 83.8% did not know their HIV status (56% had never tested; 27.8% reported their last HIV test was negative), and 80.4% were sexually active. Of 861 sexually active adults, 76.9% reported unsafe sex in the past year. Adults who did not know their HIV status were more likely to be sexually active [never tested adjusted odds ratio (AOR): 5.5, 95% confidence interval (CI): 2.8 to 10.7; ever tested, incorrect knowledge AOR: 6.5, CI: 2.1 to 19.6) and to report unsafe sex (never tested AOR: 51.7, CI: 27.3 to 97.6; ever tested, incorrect knowledge of status AOR: 18.6, CI: 8.6 to 40.5) than those who knew their status.
  
  
  CONCLUSIONS
  The majority of adults did not know they were infected and engaged in unsafe sex. Adults who knew their HIV status were less likely to be sexually active and report unsafe sex compared with those unaware of their infection. HIV prevention interventions that target HIV-infected adults are urgently needed.
authors.affiliation: US Centers for Disease Control and Prevention, Nairobi, Kenya. mmwangi@ke.cdc.gov
authors.forename: Mary
authors.initials: M
authors.lastname: Mwangi
authors.forename: Rebecca
authors.initials: R
authors.lastname: Bunnell
authors.forename: Raymond
authors.initials: R
authors.lastname: Nyoka
authors.forename: Anthony
authors.initials: A
authors.lastname: Gichangi
authors.forename: Ernest
authors.initials: E
authors.lastname: Makokha
authors.forename: Andrea
authors.initials: A
authors.lastname: Kim
authors.forename: George
authors.initials: G
authors.lastname: Kichamu
authors.forename: Lawrence
authors.initials: L
authors.lastname: Marum
authors.forename: Jared
authors.initials: J
authors.lastname: Ichwara
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mermin
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D011795:Surveys and Questionnaires; D047568:Unsafe Sex / Q000706:statistics & numerical data*; D055815:Young Adult