Limited access to STI testing, asymptomatic infection, and low clinic attendance contribute to high prevalence of untreated STIs among men in sub-Saharan Africa (SSA). Few studies have obtained STI data or identified associated risk factors among men in SSA. In an on-going randomized trial of a savings intervention to reduce spending on alcohol and transactional sex among men in western Kenya (NCT05385484), we measured baseline STI prevalence and examined individual characteristics associated with STIs.
Methods
We enrolled men aged 18-39 years reporting steady income, alcohol use in the past month, and engagement in transactional sex in the past 3 months. A whole blood sample was collected for rapid HIV and HSV-2 ELISA testing. Urine was obtained for C. trachomatis (CT) and N. gonorrhoeae (NG) PCR testing. A baseline questionnaire obtained sociodemographic and behavioral data. Factors associated with prevalent STIs were analysed using unadjusted logistic regression.
Results
From July 2022-March 2023, we enrolled 1,376 participants. Mean age was 28 years, 62.2% were married/cohabitating, 60.5% had some secondary education, and 52.7% were heavy alcohol users (AUDIT-C≥4). Participants reported a mean of 4.1 sexual partners, 3.4 transactional partners, and 10.5 transactional sex encounters in the past 3 months. 9.8% of participants were HIV-seropositive, 40.6% were HSV-2-seropositive, 13.7% had CT, and 2.5% had NG.
Compared to HSV-2-seronegative participants, HSV-2-seropositive participants were significantly older, more likely to be married, less likely to have secondary education, and had different occupations. They were more likely to be HIV-positive and to report urethral discharge or genital sores/ulcers in the past year (see Table). Compared to CT/NG-negative participants, CT/NG-positive participants were significantly younger, had more sexual and transactional partners, reported less condom use with last sex, and were more likely to report an STI and/or urethral discharge in the past year.
Conclusions
Among Kenyan men engaged in transactional sex and alcohol use, prevalence of HSV-2 and CT/NG infection was high. These data fill a gap about STI prevalence and risk factors in African men, highlighting the risk of ongoing transmission, and the need for expanded access to testing and treatment. This research also provides data important for the development of targeted prevention programming.
