HIV This Week

Mattson CL, Bailey RC, Agot K, Ndinya-Achola JO, Moses S. A nested case-control study of sexual practices and risk factors for prevalent HIV-1 infection among young men in Kisumu, Kenya. Sex Transm Dis 2007 Oct;34(10):731-6.

Mattson and colleagues’ objectives were to investigate sexual practices and risk factors for prevalent HIV infection among young men in Kisumu, Kenya. The goal of this study was to identify behaviours associated with HIV in Kisumu to maximize the effectiveness of future prevention programs. In this study, lifetime sexual histories were collected from a nested sample of 1337 uncircumcised participants within the context of a randomized controlled trial of male circumcision to reduce HIV incidence. The results showed that sixty-five men (5%) tested positive for HIV. Multiple logistic regression revealed the following independent predictors of HIV: older age, less education, being married, being Catholic, >4 lifetime sex partners, prior treatment for an STI, sex during partner’s menstruation, ever practicing bloodletting, and receipt of a medical injection in the last 6 months. Prior HIV testing and post-coital cleansing were protective. In conclusion, this analysis confirms the importance of established risk factors for HIV and identifies practices that warrant further investigation.

Editors’ note: Some things can’t be changed, other things can, and yet other things could. If all uncircumcised men reduced their numbers of sexual partners, avoided sex during menstruation, used condoms correctly and consistently, and had ready access to water and used it after sex (does it help?), HIV transmission from women to men would fall. Adding ‘know your status’ campaigns along with male circumcision in hyperendemic areas would reduce risk for young men even further.

The effectiveness of a serosorting strategy for HIV prevention depends on the accuracy of individuals’ serostatus disclosures. Butler and Smith modelled the risks of sexual transmission of HIV under various circumstances differing by the type of disclosures made. Accounting for rates of unrecognized HIV infection, treatment status and differences in infectivity by stage of infection, they found that serosorting can increase the transmission risk for some groups.

Editors’ note: Although serosorting sounds like a common sense HIV prevention strategy, it has not been proven to be effective. Partner turnover and concurrent partnerships increase the risk of undiagnosed primary HIV infection. Better strategies are to avoid penetration, reduce the number of partners and use condoms correctly and consistently each time.