Impact of male sex worker peer education on condom use in Mombasa, Kenya

Background: Over 700 male sex workers are estimated to be actively seeking male clients in Mombasa, Kenya. A 2006 baseline survey of 425 male sex workers found poor knowledge of anal HIV transmission and low consistent condom use with male clients. Methods: After the baseline survey, interventions were implemented including: (a) the opening of a drop-in centre where male sex workers could receive HIV information and testing, (b) the training of 40 peer educators trained in prevention and basic counseling skills, and (c) the distribution of condoms and water-based lubricants. After 14 months, a follow-up behavioural survey of 442 male sex workers was conducted. Pre- and post-intervention measurements were compared, and multivariate logistic regression was used to determine intervention impact on consistent condom use with male clients in the past 30 days. Results: Male sex workers reported improvements in correct knowledge of anal HIV transmission (65% to 73%, P< 0.01) and consistent condom use with male clients in the past 30 days (36% to 50%, P< 0.01). In the follow-up survey, 33% of male sex workers reported exposure to peer educators in the Mombasa area. In multivariate analysis, increasing exposure to peer educators (range: 0 to 5+ yearly contacts) was a key predictor of consistent condom use (OR: 1.14, 95%CI=1.03-1.27, P=0.01), as was having ever been counseled or tested for HIV (OR: 1.70, 95%CI=1.11-2.60, P=0.01). Visiting a drop-in centre failed to be a predictor of consistent condom use (OR: 1.07, 95%CI=0.68-1.69, P=0.77) Conclusions: Exposure to peer education increased consistent condom use among male sex workers in Mombasa. Further strategies to increase peer educator coverage and effectiveness are recommended, including: (a) utilization of peers as outreach HIV counselors, (b) involvement in mobile testing, and (c) increasing referrals to friendly community testing centres. Drop-in centre attendance was not associated with condom use in the multivariate model

Heavy episodic drinking among Kenyan female sex workers is associated with unsafe sex, sexual violence and sexually transmitted infections

This study examined patterns of alcohol use and its association with unsafe sex and related sequelae among female sex workers in Mombasa, Kenya. A community-based cross-sectional study was conducted using snowball sampling. Binge drinkers (≥5 alcoholic drinks on ≥1 occasion in the previous month) were compared with non-binge drinkers. Of 719 participants, 22.4% were lifetime-alcohol abstainers, 44.7% non-binge and 33.0% binge drinkers. Compared with non-binge drinkers, binge drinkers were more likely to report unprotected sex (adjusted odds ratio (AOR)=1.59, 95% confidence interval [CI]=1.00–2.53; P=0.047) and sexual violence (AOR=1.85, 95% CI=1.27–2.71; P=0.001) and to have either syphilis, Neisseria gonorrhoeae or Trichomonas vaginalis infection (AOR=1.56, 95% CI=1.00–2.41; P=0.048). HIV prevalence was higher among women having ever drunk (39.9%) than lifetime abstainers (23.2%;

'Are you on the market?': a capture-recapture enumeration of men who sell sex to men in and around Mombasa, Kenya.

BACKGROUND: Men who have sex with men (MSM) are highly vulnerable to HIV infection, but this population can be particularly difficult to reach in sub-Saharan Africa. We aimed to estimate the number of MSM who sell sex in and around Mombasa, Kenya, in order to plan HIV prevention research. METHODS: We identified 77 potential MSM contact locations, including public streets and parks, brothels, bars and nightclubs, in and around Mombasa and trained 37 MSM peer leader enumerators to extend a recruitment leaflet to MSM who were identified as 'on the market', that is, a man who admitted to selling sex to men. We captured men on two consecutive Saturdays, 1 week apart. A record was kept of when, where and by whom the invitation was extended and received, and of refusals. The total estimate of MSM who sell sex was derived from capture-recapture calculation. RESULTS: Capture 1 included 284 men (following removal of 15 duplicates); 89 men refused to participate. Capture 2 included 484 men (following removal of 35 duplicates); 75 men refused to participate. Of the 484 men in capture 2, 186 were recaptures from capture 1, resulting in a total estimate of 739 (95% confidence interval, 690-798) MSM who sell sex in the study area. CONCLUSIONS: We estimated that 739 MSM sell sex in and around Mombasa. Of these, 484 were contacted through trained peer enumerators in a single day. MSM who sell sex in and around Mombasa represent a sizeable population who urgently need to be targeted by HIV prevention strategies