title: Changes in sexual risk behavior in the Mombasa cohort: 1993-2007.
abstract: The Mombasa Cohort is an open cohort study following HIV-seronegative women reporting transactional sex. Established in 1993, the cohort provides regular HIV counseling and testing at monthly visits. Over time, HIV acquisition risk has declined steadily in this cohort. To evaluate whether this decline may reflect changes in sexual risk behavior, we investigated trends in condom use and partner numbers among women who participated in the Mombasa Cohort between 1993 and 2007. Multinomial logistic regression and generalized estimating equations were used to evaluate the association of calendar time and follow-up time with key risk behaviors, after adjustment for potential confounding factors. At enrollment visits by 1,844 women, the adjusted probability of never using condoms decreased over time, from 34.2% to 18.9%. Over 23,911 follow-up visits, the adjusted probabilities of reporting >2 partners decreased from 9.9% to 4.9% and inconsistent condom use decreased from 7.9% to 5.3% after ≥12 cohort visits. Important predictors of risk behavior were work venue, charging low fees for sex, and substance abuse. Women with a later sexual debut had less risky behavior. Although sexual risk has declined among women participating in the Mombasa Cohort, HIV acquisition continues to occur and interventions to promote and reinforce safer sex are clearly needed.
authors.affiliation: Departments of Medicine and Global Health, University of Washington, Seattle, Washington, United States of America; Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Graham
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Janet
authors.initials: J
authors.lastname: Raboud
authors.affiliation: Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.
authors.forename: Walter
authors.initials: W
authors.lastname: Jaoko
authors.affiliation: PathCare, Mombasa, Kenya.
authors.forename: Kishor
authors.initials: K
authors.lastname: Mandaliya
authors.affiliation: Departments of Medicine and Global Health, University of Washington, Seattle, Washington, United States of America; Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya; Department of Epidemiology, University of Washington, Seattle, Washington, United States of America.
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClelland
authors.affiliation: Centre for Research on Inner City Health, Keenan Research Centre of the Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Bayoumi
mesh_terms: D015331:Cohort Studies; D017280:Condoms / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D012309:Risk-Taking; D060386:Sex Workers / Q000523:psychology*; D012725:Sexual Behavior / Q000523:psychology*; D012747:Sexual Partners