HIV in Kenya: Sexual behaviour and quality of care of sexually transmitted diseases

This thesis describes three important determinants of HIV spread in Kenya: 1. Sexual behaviour of female sex workers, their clients, and young adults 2. Health care seeking behaviour for sexually transmitted diseases (STD) 3. Quality of STD care in the public and private health sector The first determinant was studied in urban and rural areas of Nyanza, the province in the west of Kenya which has the highest HIV prevalence. The latter two determinants were studied in the capital of Kenya, Nairobi. The main conclusions are: - HIV interventions regarding commercial sex should target clients of sex workers, and they should be implemented in bars, nightclubs and lodges in Nyanza. - HIV prevention programmes in Nyanza should promote condom use in regular sex worker-client relationships. - Long-term sex worker-client relationships are very important for the transmission of HIV in urban and rural Nyanza. - Sexual behaviour is high-risk especially in the rural areas of Nyanza. - Half of women in Nairobi who have STD complaints do not seek any care at all or wait very long before seeking care. - The majority of STD patients in Nairobi visit the private sector, in spite of its rather low quality of care and its high costs. - Providers in Nairobi insufficiently educate their STD patients on condom use and on the risk to contract HIV. - Attending an in-service course on STD management significantly improves the quality of STD treatment and STD health education in Nairobi.

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