AIDS and Behavior

, Volume 13, Issue 5, pp 860–865 | Cite as

Sexual Behavior of Female Sex Workers and Access to Condoms in Kenya and Uganda on the trans-Africa Highway

  • Chester N. Morris
  • Sheldon R. Morris
  • Alan G. Ferguson
Original Paper


Female sex workers and their clients remain a high risk core group for HIV in Africa. We measured sexual behavior of a snowball sample of female sex workers (FSW) along the Trans Africa highway from Mombasa, Kenya to Kampala, Uganda and surveyed the availability of male condoms at 1,007 bars and lodgings in Kenya along the highway trucking stops where transactional sex occurs. There were 578 FSW one month sex diaries analyzed, 403 from Kenya and 175 from Uganda. Kenyan FSW had a median of 45 sexual acts per 28 days compared to 39 sex acts per 28 days by Ugandan FSW (P < 0.05). Condom use by FSW for all sexual liaisons was 79% in Kenya compared to 74% in Uganda. In multivariate analysis, adjusting for repeated measures, Kenyan FSW were more likely to use a condom by an adjusted odds ratio of 2.54 (95% confidence interval 1.89–3.41) compared to Ugandan FSW. Condom use with regular clients was 50.8% in Uganda compared with 68.7% in Kenya (P < 0.01). The number of sex workers reporting 100% condom use was 26.8% in Kenya and 18.9% in Uganda (P < 0.01). Bars and lodges in Kenya compared to Uganda were more likely to: have condom dispensers, 25% versus 1%, respectively (P < 0.01); distribute or sell condoms, 73.9% versus 47.6% (P < 0.01); and have more weekly condom distribution, 4.92 versus 1.27 condoms per seating capacity (P < 0.01). Our data indicate that in both countries condom use for FSW is suboptimal, particularly with regular partners, and greater condom use by Trans African highway FSW in Kenya compared to Uganda may be related to availability. Targeted interventions are warranted for FSW and truck drivers to prevent transmission in this important core group.


HIV Sexual behavior Sex workers Transport workers Africa 


  1. Alary, M., & Lowndes, C. M. (2004). The central role of female sex workers in the dynamics of heterosexual transmission in sub-Saharan Africa. AIDS (London, England), 18, 945–946. doi: 10.1097/00002030-200404090-00013.Google Scholar
  2. Cheluget, B., Baltazar, G., Orege, P., Ibrahim, M., Marum, L., & Stover, J. (2006). Evidence for population level decline in adult HIV prevalence in Kenya. Sexually Transmitted Infections, 82(Suppl. 1), i21–i26. doi: 10.1136/sti.2005.015990.PubMedCrossRefGoogle Scholar
  3. Ferguson, A. G., & Morris, C. N. (2007). Mapping transactional sex on the Northern Corridor highway in Kenya. Health & Place, 13, 504–519. doi: 10.1016/j.healthplace.2006.05.009.CrossRefGoogle Scholar
  4. Ferguson, A., Morris, C., & Kariuki, C. (2006). Using diaries to measure parameters of transactional sex: An example from the Trans-Africa highway in Kenya. Culture, Health & Sexuality, 8, 1–11. doi: 10.1080/13691050600665006.CrossRefGoogle Scholar
  5. Hallett, T. B., Aberle-Grasse, J., Bello, G., Boulos, L. M., Cayemittes, M. P., Cheluget, B., et al. (2006). Declines in HIV prevalence can be associated with changing sexual behaviour in Uganda, urban Kenya, Zimbabwe, and urban Hairti. Sexually Transmitted Infections, 82(Suppl. 1), i1–i8. doi: 10.1136/sti.2005.016014.PubMedCrossRefGoogle Scholar
  6. Kenya Demographic Health Survey. (1998).Google Scholar
  7. Kenya Demographic Health Survey. (2003).Google Scholar
  8. Kenya HIV/AIDS Data Booklet. (December 2005). National AIDS Control Commission.Google Scholar
  9. Kissling, E., Allison, E. H., Seeley, J. A., Russell, S., Bachmann, M., Musgrave, S. D., et al. (2005). Fisherfolk are among groups most at risk of HIV: Cross-country analysis fo prevalence and numbers affected. AIDS (London, England), 19, 1939–1946. doi: 10.1097/01.aids.0000191925.54679.94.Google Scholar
  10. Lowndes, C. M., Alary, M., Meda, H., Gnintoungbe, C. A., Mukenge-Tshibaka, C., Adjovi, C., et al. (2002). Role of core and bridging groups in the transmission dynamics of HIV and STIs in Contonou, Benin, West Africa. Sexually Transmitted Infections, 78, i69–i77.PubMedCrossRefGoogle Scholar
  11. Morris, C. N., & Ferguson, A. G. (2006). Estimation of the sexual transmission of HIV in Kenya and Uganda on the trans-Africa highway: Continuing role for prevention in high risk groups. Sexually Transmitted Infections, 82, 368–371. doi: 10.1136/sti.2006.020933.PubMedCrossRefGoogle Scholar
  12. Orubuloye, I. O., Caldwell, P., & Caldwell, J. C. (1993). The Role of High-Risk Occupations in the Spread of AIDS: Truck Drivers and Itinerant Market Women in Nigeria. International Family Planning Perspectives, 19(2), 43–48. doi: 10.2307/2133418.CrossRefGoogle Scholar
  13. Pisani, E., Garnett, G. P., Grassly, N. C., Brown, T., Stover, J., Hankins, C., et al. (2003). Back to basics in HIV prevention: Focus on exposure. British Medical Journal, 326, 1384–1387. doi: 10.1136/bmj.326.7403.1384.PubMedCrossRefGoogle Scholar
  14. Plummer, F. A., Nagelkerke, N. J. D., Moses, S., Ndinya-Achola, J., Bwayo, J., & Ngugi, E. (1991). The importance of core groups in the epidemiology and control of HIV-1 infection. AIDS (London, England), 5(Suppl. 1), S169–S176.Google Scholar
  15. Ramjee, G., & Gouws, E. (2002). Prevalence of HIV among truck drivers visiting sex workers in KwaZulu-Natal, South Africa. Sexually Transmitted Diseases, 29(1), 44–49. doi: 10.1097/00007435-200201000-00008.PubMedCrossRefGoogle Scholar
  16. Stoneburner, G. L., & Low-Beer, D. (2004). Population-level HIV declines and behavioural risk avoidance in Uganda. Science, 304, 714–718. doi: 10.1126/science.1093166.PubMedCrossRefGoogle Scholar
  17. Uganda HIV Behavioral Health Survey. (2005).Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Chester N. Morris
    • 1
    • 2
  • Sheldon R. Morris
    • 3
  • Alan G. Ferguson
    • 1
  1. 1.Department of Medical MicrobiologyUniversity of ManitobaWinnipegCanada
  2. 2.Aurum Institute for Health ResearchJohannesburgSouth Africa
  3. 3.Division of Infectious Diseases, Department of MedicineUniversity of CaliforniaSan DiegoUSA

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