High HIV risk in a cohort of male sex workers from Nairobi, Kenya

Lyle R. McKinnon, Gloria Gakii, Jennifer A. Juno, Preston Izulla, Julius Munyao, Naomi Ireri, Cecilia W. Kariuki, Souradet Y. Shaw, Nico J.D. Nagelkerke, Lawrence Gelmon, Helgar Musyoki, Nicholas Muraguri, Rupert Kaul, Rob Lorway, Joshua Kimani

Research output: Contribution to journalArticlepeer-review

57 Citations (Scopus)


Objectives: Men who have sex with men (MSM) are at high risk of HIV-1 acquisition and transmission, yet there remains limited data in the African context, and for men who sell sex to men (MSM SW) in particular. Methods: We enrolled 507 male sex workers in a Nairobi-based prospective cohort study during 2009-2012. All participants were offered HIV/STI screening, counselling and completed a baseline questionnaire. Results: Baseline HIV prevalence was 40.0% (95% CI 35.8% to 44.3%). Prevalent HIV infection was associated with age, less postsecondary education, marijuana use, fewer female partners and lower rates of prior HIV testing. Most participants (73%) reported at least two of insertive anal, receptive anal and insertive vaginal sex in the past 3 months. Vaginal sex was reported by 37% of participants, and exclusive MSM status was associated with higher HIV rates. Condom use was infrequent, with approximately one-third reporting 100% condom use during anal sex. HIV incidence was 10.9 per 100 person-years (95% CI 7.4 to 15.6). Predictors of HIV risk included history of urethral discharge (aHR 0.29, 95% CI 0.08 to 0.98, p=0.046), condom use during receptive anal sex (aHR 0.05, 95% CI 0.01 to 0.41, p=0.006) and frequency of sex with male partners (aHR 1.33/sex act, 95% CI 1.01 to 1.75, p=0.04). Conclusions: HIV prevalence and incidence were extremely high in Nairobi MSM SW; a combination of interventions including increasing condom use, pre-exposure prophylaxis and access to effective treatment is urgently needed to decrease HIV transmission in this key population.

Original languageEnglish
Pages (from-to)237-242
Number of pages6
JournalSexually Transmitted Infections
Issue number3
Publication statusPublished - May 2014
Externally publishedYes

ASJC Scopus subject areas

  • Dermatology
  • Infectious Diseases


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