Predictors of Risky Sexual Behavior among Sero Discordant Individuals Following HIV Status Disclosure in a Kenyan Hospital

Abstract

Introduction: Globally, Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) burden is a great public health concern. In Sub-Saharan Africa (SSA), majority of the infections and deaths occur due to lack of prompt interventions. HIV status disclosure can improve HIV testing uptake, increase HIV care enrollment and treatment outcomes and reduce stigma challenges. The study objective was to establish risky sexual behaviours associated with HIV status disclosure among HIV serodiscordant individuals in a Kenyan Hospital.
Materials and Methods: The recruitment of the study subjects was done through a systematic random sampling. A descriptive cross-sectional study was conducted. Semi-structured questionnaires and focus group discussions (FGD) were used to collect data. The data was entered on Microsoft Access and exported to Statistical Package for Social Sciences (SPSS) version 23.0 for analysis. Binary logistic regression analysis was used to measure the association between risky sexual behaviors and HIV disclosure among HIV serodiscordant individuals. Results were considered to be significant if p < 0.05 with a 95% confidence interval.
Results: Majority of the study participants (96.7%) used condoms to prevent HIV transmission. However, there was lack of consistency and correct use among 88.6% of respondents. Many study participants (n=58) reported engaging in sexual intercourse with multiple sexual partners. Among this, (39.7%) did not disclose their HIV status. Other HIV preventive behaviors were; staying away from their partners
(1.1%), abstinence (1.1%) and separation of beds (1.1%). Many study participants (36.1%) who did not use condoms each time they had sexual intercourse did not disclose their HIV status. The odds of disclosure were 4.31 times more among respondents who did not have sexual intercourse with other partners. Among the 58 (17.8%) participants who had engaged in sexual intercourse with other sexual partners, (21.0%) were under the influence of alcohol while 79.0% did not consume alcohol. Respondents who engaged in sexual  intercourse when not under influence of alcohol were 0.83 times more likely to disclose their status compared to those who had sexual relations under alcohol influence (OR, 0.83; 95% CI, 0.32–2.16). Alcohol consumption was significantly associated with unprotected sex among PLHIV (OR=1.98, CI=1.63-2.39).
Conclusion: The sexual partners in HIV serodiscordant relationships were at risk of HIV and other sexually transmitted infection due to risky sexual behaviors and in disclosure on HIV status. Many participants still engaged in risky sexual behaviors. Significant predictors of disclosure were absence of other sexual partners in the relationship, no alcohol use and consistent condom use during sexual intercourse.
Recommendation: The study recommends that healthcare workers should educate the public on the importance of HIV transmission prevention and advantages of status disclosure. Serodiscodant partners need to be encouraged to use condoms correctly, avoid sexual intercourse with multiple partners and alcohol consumption.

Keywords: Predictors, Status Disclosure, HIV, Kenya