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Sexual behavior of HIV-positive adults not accessing HIV treatment in Mombasa, Kenya: Defining their prevention needs
Avina Sarna, Stanley Luchters, Melissa Pickett, Matthew Chersich, Jerry Okal, Scott Geibel, Nzioki Kingola, Marleen Temmerman
AIDS Research and Therapy , 2012, DOI: 10.1186/1742-6405-9-9
Abstract: Using modified targeted snowball sampling, 698 PLHIV were recruited through community health workers and HIV-positive peer counsellors. Of the 59.2% sexually-active PLHIV, 24.5% reported multiple sexual partners. Of all sexual partners, 10.2% were HIV negative, while 74.5% were of unknown HIV status. Overall, unprotected sex occurred in 52% of sexual partnerships; notably with 32% of HIV-negative partners and 54% of partners of unknown HIV status in the last 6 months. Multivariate analysis, controlling for intra-client clustering, showed non-disclosure of HIV status (AOR: 2.38, 95%CI: 1.47-3.84, p < 0.001); experiencing moderate levels of perceived stigma (AOR: 2.94, 95%CI: 1.50-5.75, p = 0.002); and believing condoms reduce sexual pleasure (AOR: 2.81, 95%CI: 1.60-4.91, p < 0.001) were independently associated with unsafe sex. Unsafe sex was also higher in those using contraceptive methods other than condoms (AOR: 5.47, 95%CI: 2.57-11.65, p < 0.001); or no method (AOR: 3.99, 95%CI: 2.06-7.75, p < 0.001), compared to condom users.High-risk sexual behaviors are common among PLHIV not accessing treatment services, raising the risk of HIV transmission to discordant partners. This population can be identified and reached in the community. Prevention programs need to urgently bring this population into the ambit of prevention and care services. Moreover, beginning HIV treatment earlier might assist in bringing this group into contact with providers and HIV prevention services, and in reducing risk behaviors.HIV transmission remains a significant global concern; in 2009 there were an estimated 2.6 million new infections globally [1]. At the end of 2009, about 36% of the 15 million people in need of antiretroviral treatment (ART) in low- and middle income countries were receiving ART [1].People living with HIV (PLHIV) who receive ART are in regular contact with health workers and presumably exposed to prevention messages and commodities. Indeed, several studies have documen
The Contribution of Emotional Partners to Sexual Risk Taking and Violence among Female Sex Workers in Mombasa, Kenya: A Cohort Study
Stanley Luchters, Marlise L. Richter, Wilkister Bosire, Gill Nelson, Nzioki Kingola, Xu-Dong Zhang, Marleen Temmerman, Matthew F. Chersich
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0068855
Abstract: Objectives To assess sexual risk-taking of female sex workers (FSWs) with emotional partners (boyfriends and husbands), compared to regular and casual clients. Experiences of violence and the degree of relationship control that FSWs have with emotional partners are also described. Design Cohort study with quarterly follow-up visit over 12-months. Methods Four hundred HIV-uninfected FSWs older than 16 years were recruited from their homes and guesthouses in Mombasa, Kenya. A structured questionnaire assessed participant characteristics and study outcomes at each visit, and women received risk-reduction counselling, male and female condoms, and HIV testing. Results Four or more unprotected sex acts in the past week were reported by 21.3% of women during sex with emotional partners, compared to 5.8% with regular and 4.8% with casual clients (P<0.001). Total number of unprotected sex acts per week was 5–6-fold higher with emotional partners (603 acts with 259 partners) than with regular or casual clients (125 acts with 456, and 98 acts with 632 clients, respectively; P<0.001). Mostly, perceptions of “trust” underscored unprotected sex with emotional partners. Low control over these relationships, common to many women (36.9%), was linked with higher partner numbers, inconsistent condom use, and being physically forced to have sex by their emotional partners. Half experienced sexual or physical violence in the past year, similarly associated with partner numbers and inconsistent condom use. Conclusions High-risk sexual behaviour, low control and frequent violence in relationships with emotional partners heighten FSWs' vulnerability and high HIV risk, requiring targeted interventions that also encompass emotional partners.
Buchdahl-Bondi limit in modified gravity: Packing extra effective mass in relativistic compact stars
Rituparno Goswami,Sunil D. Maharaj,Anne Marie Nzioki
Physics , 2015, DOI: 10.1103/PhysRevD.92.064002
Abstract: We generalise the Buchdahl-Bondi limit for the case of static, spherically symmetric, relativistic compact stars immersed in Schwarzschild vacuum in f(R)-theory of gravity, subject to very generic regularity, thermodynamic stability and matching conditions. Similar to the case of general relativity, our result is model independent and remains true for any physically realistic equation of state of standard stellar matter. We show that an extra-massive stable star can exist in these theories, with surface redshift larger than 2, which is forbidden in general relativity. This result gives a novel and interesting observational test for validity or otherwise of general relativity and also provides a possible solution to the dark matter problem.
Jebsen-Birkhoff theorem and its stability in f(R) gravity
Anne Marie Nzioki,Rituparno Goswami,Peter K. S. Dunsby
Physics , 2013, DOI: 10.1103/PhysRevD.89.064050
Abstract: We prove a Jebsen-Birkhoff like theorem for f(R) theories of gravity in order to to find the necessary conditions required for the existence of the Schwarzschild solution in these theories and demonstrate that the rigidity of such solutions of f(R) gravity is valid even in the perturbed scenario.
On the absence of the usual weak-field limit, and the impossibility of embedding some known solutions for isolated masses in cosmologies with f(R) dark energy
Timothy Clifton,Peter Dunsby,Rituparno Goswami,Anne Marie Nzioki
Physics , 2012, DOI: 10.1103/PhysRevD.87.063517
Abstract: The problem of matching different regions of spacetime in order to construct inhomogeneous cosmological models is investigated in the context of Lagrangian theories of gravity constructed from general analytic functions f(R), and from non-analytic theories with f(R)=R^n. In all of the cases studied, we find that it is impossible to satisfy the required junction conditions without the large-scale behaviour reducing to that expected from Einstein's equations with a cosmological constant. For theories with analytic f(R) this suggests that the usual treatment of weak-field systems as perturbations about Minkowski space may not be compatible with late-time acceleration driven by anything other than a constant term of the form f(0), which acts like a cosmological constant. In the absence of Minkowski space as a suitable background for weak-field systems, one must then choose and justify some other solution to perform perturbative analyses around. For theories with f(R)=R^n we find that no known spherically symmetric vacuum solutions can be matched to an expanding FLRW background. This includes the absence of any Einstein-Straus-like embeddings of the Schwarzschild exterior solution in FLRW spacetimes.
Concurrent sexual and substance-use risk behaviours among female sex workers in Kenya’s Coast Province: Findings from a behavioural monitoring survey
SP Tegang, S Abdallah, G Emukule, S Luchters, N Kingola, M Barasa, S Mucheke, P Mwarogo
SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance) , 2010,
Abstract: While many studies confirm the association between HIV, alcohol and injecting drug use by female sex workers (FSWs), little is known about their use of marijuana, khat and other substances and the association of these substances with HIV, risky sexual behaviour, and sexual violence. To better understand this association, data were analysed from a cross-sectional, behavioural survey of 297 FSWs in Mombasa, a well-known tourist destination and the second largest port in Africa and capital city of the Coast Province in Kenya. Among the FSWs, lifetime use of different substances was reported by 91% for alcohol, 71% for khat, 34% for marijuana, and 6% for heroin, cocaine, glue or petrol. The majority (79%) used more than one substance, and multiple-substance use was reported by all respondents who ever used marijuana, heroin, cocaine, glue and petrol. The risk of HIV acquisition was perceived as medium to high by 41% of respondents, 75% of whom attributed this risk to multiple partners. Sexual violence was reported by 48% of respondents, and 30% indicated that this happened several times. Despite HIV prevention programmes targeting FSWs in Mombasa, most of them continue to engage in risky sexual behaviours. This suggests that harm reduction strategies for substance use should be coupled with efforts to promote consistent condom use and partner reduction.
Use of AUDIT, and measures of drinking frequency and patterns to detect associations between alcohol and sexual behaviour in male sex workers in Kenya
Stanley Luchters, Scott Geibel, Masila Syengo, Daniel Lango, Nzioki King'ola, Marleen Temmerman, Matthew F Chersich
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-384
Abstract: A cross-sectional survey in 2008 recruited male sex workers who sell sex to men from 65 venues in Mombasa district, Kenya, similar to a 2006 survey. Information was collected on socio-demographics, substance use, sexual behaviour, violence and STI symptoms. Multivariate models examined associations between the three measures of alcohol use and condom use, sexual violence, and penile or anal discharge.The 442 participants reported a median 2 clients/week (IQR = 1-3), with half using condoms consistently in the last 30 days. Of the approximately 70% of men who drink alcohol, half (50.5%) drink two or more times a week. Binge drinking was common (38.9%). As defined by AUDIT, 35% of participants who drink had hazardous drinking, 15% harmful drinking and 21% alcohol dependence. Compared with abstinence, alcohol dependence was associated with inconsistent condom use (AOR = 2.5, 95%CI = 1.3-4.6), penile or anal discharge (AOR = 1.9, 95%CI = 1.0-3.8), and two-fold higher odds of sexual violence (AOR = 2.0, 95%CI = 0.9-4.9). Frequent drinking was associated with inconsistent condom use (AOR = 1.8, 95%CI = 1.1-3.0) and partner number, while binge drinking was only linked with inconsistent condom use (AOR = 1.6, 95%CI = 1.0-2.5).Male sex workers have high levels of hazardous and harmful drinking, and require alcohol-reduction interventions. Compared with indicators of drinking frequency or pattern, the AUDIT measure has stronger associations with inconsistent condom use, STI symptoms and sexual violence. Increased use of the AUDIT tool in future studies may assist in delineating with greater precision the explanatory mechanisms which link alcohol use, drinking contexts, sexual behaviours and HIV transmission.Globally, researchers and policy makers are increasingly giving attention to the effects of alcohol use on sexual behaviour; with many making a strong case that heavy alcohol use is an important cause of unsafe sexual behaviour and consequent HIV transmission in sub-Sahara
Male Sex Workers Who Sell Sex to Men Also Engage in Anal Intercourse with Women: Evidence from Mombasa, Kenya
Priya Mannava, Scott Geibel, Nzioki King’ola, Marleen Temmerman, Stanley Luchters
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0052547
Abstract: Objective To investigate self-report of heterosexual anal intercourse among male sex workers who sell sex to men, and to identify the socio-demographic characteristics associated with practice of the behavior. Design Two cross-sectional surveys of male sex workers who sell sex to men in Mombasa, Kenya. Methods Male sex workers selling sex to men were invited to participate in surveys undertaken in 2006 and 2008. A structured questionnaire administered by trained interviewers was used to collect information on socio-demographic characteristics, sexual behaviors, HIV and STI knowledge, and health service usage. Data were analyzed through descriptive and inferential statistics. Bivariate logistic regression, after controlling for year of survey, was used to identify socio-demographic characteristics associated with heterosexual anal intercourse. Results From a sample of 867 male sex workers, 297 men had sex with a woman during the previous 30 days – of whom 45% did so with a female client and 86% with a non-paying female partner. Within these groups, 66% and 43% of male sex workers had anal intercourse with a female client and non-paying partner respectively. Factors associated with reporting recent heterosexual anal intercourse in bivariate logistic regression after controlling for year of survey participation were being Muslim, ever or currently married, living with wife only, living with a female partner only, living with more than one sexual partner, self-identifying as basha/king/bisexual, having one’s own children, and lower education. Conclusions We found unexpectedly high levels of self-reported anal sex with women by male sex workers, including selling sex to female clients as well as with their own partners. Further investigation among women in Mombasa is needed to understand heterosexual anal sex practices, and how HIV programming may respond.
A new framework for studying spherically symmetric static solutions in f(R) gravity
Anne Marie Nzioki,Sante Carloni,Rituparno Goswami,Peter K. S. Dunsby
Physics , 2009, DOI: 10.1103/PhysRevD.81.084028
Abstract: We develop a new covariant formalism to treat spherically symmetric spacetimes in metric} f(R) theories of gravity. Using this formalism we derive the general equations for a static and spherically symmetric metric in a general f(R)-gravity. These equations are used to determine the conditions for which the Schwarzschild metric is the only vacuum solution with vanishing Ricci scalar. We also show that our general framework provides a clear way of showing that the Schwarzschild solution is not a unique static spherically symmetric solution, providing some incite on how the current form of Birkhoff's theorem breaks down for these theories.
A Geometrical Approach to Strong Gravitational Lensing in f(R) Gravity
Anne Marie Nzioki,Peter K. S. Dunsby,Rituparno Goswami,Sante Carloni
Physics , 2010, DOI: 10.1103/PhysRevD.83.024030
Abstract: We present a framework for the study of lensing in spherically symmetric spacetimes within the context of f(R) gravity. Equations for the propagation of null geodesics, together with an expression for the bending angle are derived for any f(R) theory and then applied to an exact spherically symmetric solution of R^n gravity. We find that for this case more bending is expected for R^n gravity theories in comparison to GR and is dependent on the value of n and the value of distance of closest approach of the incident null geodesic.
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