title: Evidence of injection drug use in Kisumu, Kenya: Implications for HIV prevention.
abstract: BACKGROUND
  Injection drug use is increasingly contributing to the HIV epidemic across sub-Saharan Africa. This paper provides the first descriptive analysis of injection drug use in western Kenya, where HIV prevalence is already highest in the nation at 15.1%.
  
  
  METHODS
  We draw on quantitative data from a study of injection drug use in Kisumu, Kenya. We generated descriptive statistics on socio-demographics, sexual characteristics, and drug-related behaviors. Logistic regression models were adjusted for sex to identify correlates of self-reported HIV positive status.
  
  
  RESULTS
  Of 151 participants, mean age was 28.8 years, 84% (n = 127) were male, and overall self-reported HIV prevalence reached 19.4%. Women had greater than four times the odds of being HIV positive relative to men (Odds Ratio [OR] 4.5, CI: 1.7, 11.8, p = .003). Controlling for sex, ever experiencing STI symptoms (Adjusted Odds ratio [AOR] 4.6, 95% CI 1.7, 12.0, p = .002) and sharing needles or syringes due to lack of access (AOR 3.6, 95% CI 1.2, 10.5, p = .02) were significantly associated with HIV positive status. Lower education (AOR 2.3, 95% CI 0.9, 5.6, p=.08), trading sex for drugs (AOR 2.8, 95% CI 0.9, 8.8, p = .08), being injected by a peddler (AOR 2.9, 95% CI 1.0, 8.5, p = .05), and injecting heroin (AOR 2.3, 95% CI 1.0, 5.7, p = .06), were marginally associated with HIV.
  
  
  CONCLUSIONS
  This exploratory study identified patterns of unsafe drug injection and concurrent sexual risk in western Kenya, yet few resources are currently available to address addiction or injection-related harm. Expanded research, surveillance, and gender sensitive programming are needed.
authors: Department of Anthropology, The Ohio State University, 4046 Smith Laboratory 174W. 18th Ave., Columbus, OH 43210-1106, USA. Electronic address: Syvertsen.1@osu.edu.
authors: Jennifer L
authors: JL
authors: Syvertsen
authors: Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu, Kenya.
authors: Kawango
authors: K
authors: Agot
authors: Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu, Kenya.
authors: Spala
authors: S
authors: Ohaga
authors: Division of Global Public Health, University of California, San Diego, Central Research Services Facility (CRSF), La Jolla, CA 92093-0507, USA.
authors: Steffanie A
authors: SA
authors: Strathdee
authors: Department of Obstetrics, Gynecology & Reproductive Sciences and Center for AIDS Prevention Studies, University of California at San Francisco, 550 16th St., 3rd Floor [UCSF Mailcode 1224], San Francisco, CA 94158-2549 USA.
authors: Carol S
authors: CS
authors: Camlin
authors: Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu, Kenya.
authors: Eunice
authors: E
authors: Omanga
authors: Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu, Kenya.
authors: Petronilla
authors: P
authors: Odonde
authors: Kenya Medical Research Institute, P.O. Box 614-40100, Kisumu, Kenya.
authors: Grace
authors: G
authors: Rota
authors: Kenya Medical Research Institute, P.O. Box 614-40100, Kisumu, Kenya.
authors: Kelvin
authors: K
authors: Akoth
authors: Center for Biostatistics, The Ohio State University, 2012 Kenny Road, Columbus, OH 43221 USA.
authors: Juan
authors: J
authors: Peng
authors: School of Community Health Sciences, University of Nevada, Reno, 1664N. Virginia St. MS 0274, Reno, NV 89557, USA.
authors: Karla D
authors: KD
authors: Wagner
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006679:HIV Seropositivity / Q000453:epidemiology; D006556:Heroin Dependence / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D016485:Needle Sharing; D015995:Prevalence; D012309:Risk-Taking; D012737:Sex Factors; D012725:Sexual Behavior; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology* / Q000523:psychology; D019966:Substance-Related Disorders / Q000150:complications; D047568:Unsafe Sex
keywords: Gender; HIV interventions; Harm reduction; Heroin; Sexual risk; sub-Saharan Africa