Sexual risk-reduction strategies among HIV-infected men receiving ART in Kibera,

February 23, 2011

Nairobi

Authors: Anders Ragnarssona; Thorsona; Doverb; Jane c; Festus

Ilakoc; Dorcas Indaloc; Mia Ekstroumlma

Abstract

This paper explores motivational factors and barriers to sexual behaviour change

among men receiving antiretroviral treatment (ART). Twenty in-depth interviews

were undertaken with male patients enrolled at the African Medical and Research

Foundation clinic in Africa's largest urban informal settlement, Kibera in

Nairobi, Kenya. All participants experienced prolonged and severe illness prior

to the initiation of ART. Fear of symptom relapse was the main trigger for

sexual behaviour change. Partner reduction was reported as a first option for

behaviour change since this decision could be made by the individual. Condom use

was perceived as more difficult as it had to be negotiated with female partners.

Cultural norms regarding expectations for reproduction and marriage were not

supportive of sexual risk-reduction strategies. Thus, local sociocultural

contexts of HIV-infected people must be incorporated into the contextual

adaptation and design of ART programmes and services as they have an over-riding

influence on sexual behaviour and programme effectiveness. Also, HIV-prevention

interventions need to address both personal, micro- and macro-level factors of

behaviour to encourage individuals to take on sexual risk-reduction strategies.

In order to achieve the anticipated preventive effect of ART, these issues are

important for the donor community and policy-makers, who are the major providers

of ART programme support within weak health systems in sub-Saharan Africa.

Keywords: HIV and AIDS; ART and prevention; gender; sexual risk reduction; men

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Affiliations: a Department of Public Health Sciences, Division of Global

Health (IHCAR), Karolinska Institutet, Stockholm, Sweden

b Swedish/Norwegian Regional HIV/AIDS Team for Africa Embassy of Sweden, Lusaka,

Zambia

c AMREF Kenya Country Programme, Nairobi, Kenya

DOI: 10.1080/09540121.2010.507753

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Published in: journal AIDS Care, Volume 23, Issue 3 March 2011 , pages 315 - 321

Publication Frequency: 12 issues per year

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February 23, 2011