SEXUAL-BEHAVIOR IN KENYA - IMPLICATIONS FOR SEXUALLY-TRANSMITTED DISEASE TRANSMISSION AND CONTROL

Sexual behaviour in Kenya in relation to STD transmission was investig ated with a view to forming a basis for the more rational design of ST D/HIV control interventions. Questionnaires were administered to a sam ple of 762 men and women attending eight health facilities in two urba n centres. Equal numbers of STD patients (cases) and non-STD related c linic attenders (clinic controls) were selected, matched by gender and clinic. Another sample of 427 men and women was obtained from a rando m sampling of households in a slum area in Nairobi (community controls ). Male STD patients who were unmarried, or married but living apart f rom their wives, reported a higher mean number of sex partners in the previous three months than did male clinic or community controls. Unma rried female STD patients reported a higher mean number of sex partner s in the previous three months than did unmarried female clinic or com munity controls. Both male and female STD patients were more likely to report having been involved in commercial sex transactions in the pre vious three months than clinic or community controls. Considerable het erogeneity in sexual behaviour was apparent. In multivariate analysis, the most important predictor of STD acquisition for both men and wome n was the number of reported sex partners in the previous three months . In addition, for men only, marital status (unmarried, or married but living apart from their wives) and purchasing sex were significant pr edictors of being an STD patient. These data confirm the importance of commercial sex in STD transmission, and suggest that men play a bridg ing role between female sex workers and the general population of wome n. This behaviour pattern is central to STD transmission and is highly vulnerable to intervention.