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Risk Factors for HIV Acquisition in a Prospective Nairobi-Based Female Sex Worker Cohort

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Abstract

With two million new HIV infections annually, ongoing investigations of risk factors for HIV acquisition is critical to guide ongoing HIV prevention efforts. We conducted a prospective cohort analysis of HIV uninfected female sex workers enrolled at an HIV prevention clinic in Nairobi (n = 1640). In the initially HIV uninfected cohort (70 %), we observed 34 HIV infections during 1514 person-years of follow-up, i.e. an annual incidence of 2.2 % (95 % CI 1.6–3.1 %). In multivariable Cox Proportional Hazard analysis, HIV acquisition was associated with a shorter baseline duration of sex work (aHR 0.76, 95 % CI 0.63–0.91), minimum charge/sex act (aHR 2.74, 0.82–9.15, for low vs. intermediate; aHR 5.70, 1.96–16.59, for high vs. intermediate), N. gonorrhoeae infection (aAHR 5.89, 95 % CI 2.03–17.08), sex with casual clients during menses (aHR 6.19, 95 % CI 2.58–14.84), Depo Provera use (aHR 5.12, 95 % CI 1.98–13.22), and estimated number of annual unprotected regular partner contacts (aHR 1.004, 95 % CI 1.001–1.006). Risk profiling based on baseline predictors suggested that substantial heterogeneity in HIV risk is evident, even within a key population. These data highlight several risk factors for HIV acquisition that could help to re-focus HIV prevention messages.

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Acknowledgments

We would like to thank all of the staff at the SWOP City clinic and Kenya AIDS Control Project, University of Nairobi/Manitoba for their support. Funding was provided by US-PEPFAR (CDC-PEPFAR U62/CCU024510-01) to L.G. and J.K. and CIHR MOP-89983 to R.K. R.K. is supported by an OHTN Career Scientist Award. L.R.M. was supported by a CIHR fellowship and the International Infectious Diseases and Global Health Training Program.

Conflict of interest

The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya

    Lyle R. McKinnon, Preston Izulla, Julius Munyao, Tabitha Wanjiru, Richard Gichuki, Cecilia Kariuki, Festus Muriuki, Gloria Gakii, Lawrence Gelmon, Rupert Kaul & Joshua Kimani

  2. Department of Medicine, University of Toronto, Toronto, Canada

    Lyle R. McKinnon & Rupert Kaul

  3. Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 2nd floor DDMRI, 719 Umbilo Road, Congella, Private Bag X7, Durban, 4013, South Africa

    Lyle R. McKinnon

  4. Community Medicine, United Arab Emirates University, Al Ain, United Arab Emirates

    Nico Nagelkerke

  5. Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada

    Nico Nagelkerke, Lawrence Gelmon & Joshua Kimani

  6. National AIDS & STI Control Programme (NASCOP), Ministry of Public Health and Sanitation, Nairobi, Kenya

    Helgar Musyoki

  7. Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada

    Souradet Y. Shaw

  8. Division of Infectious Diseases, University Health Network, University of Toronto, Toronto, Canada

    Rupert Kaul

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  1. Lyle R. McKinnon
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  2. Preston Izulla
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Correspondence to Lyle R. McKinnon.

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Lyle R. McKinnon and Preston Izulla are Co-first authors.

Rupert Kaul and Joshua Kimani1 are Co-last authors.

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McKinnon, L.R., Izulla, P., Nagelkerke, N. et al. Risk Factors for HIV Acquisition in a Prospective Nairobi-Based Female Sex Worker Cohort. AIDS Behav 19, 2204–2213 (2015). https://doi.org/10.1007/s10461-015-1118-7

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