Nairobi's Poorest Women Have Highest Level of Risky Sexual Behavior, Least Knowledge of HIV Prevention. (Digests)
Hollander, D., International Family Planning Perspectives
Women living in the slums of Nairobi engage in riskier sexual behavior than women living in less-deprived areas of the city. (1) They began having intercourse at a younger age and are more likely to have had multiple partners in the recent past. Residents of slums and other women are equally familiar with basic facts about HIV and AIDS, but knowledge of how to prevent HIV infection is markedly lower among the most disadvantaged group. These are among the key findings of an analysis pooling data from the 1989, 1993 and 1998 Kenya Demographic and Health Surveys.
The analysts pooled data from the three surveys to obtain a large enough sample to represent both Nairobi overall and its slum areas; in all, they had information on 1,645 women aged 15-49. They classified women who reported having neither running water, electricity nor a flush toilet in their household as slum residents, and those who had all three as nonslum residents; women reporting one or two of these amenities were classified in an intermediate category. Using a variety of analytic strategies, the researchers compared the risk-related behavior of slum residents and other Nairobi women; multivariate analyses examined independent associations between residence and risky behaviors by controlling for women s education, age, childhood residence, length of time in their current home, religion and marital status, and the sex of the head of their household.
Ninety-four percent of women living in slums were sexually experienced, compared with 79% of nonslum dwellers. Among 15-24-year-olds, the proportions who had ever had sex were 89% and 58%, respectively. Women living in slums had begun having intercourse earlier (at age 15.6, on average) than those in the least-disadvantaged households (17.6).
Using life-table calculations, the analysts found that overall, 14% of slum residents and 5% of nonslum residents had begun having intercourse by age 12; by 14 years of age, 55% and 23%, respectively, were sexually experienced. By the time they were 18 years old, 90% of women living in slums and 62% of those from nonslum households had had intercourse. The median age at first intercourse was 15.0 years for slum residents and 18.0 years for nonslum residents.
To control for potential bias from responses of women who migrated from rural areas or small towns, the analysts performed separate life-table calculations for women who had grown up in cities. These results showed even starker contrasts by residence than the findings for the overall sample. In this subgroup, 18% of slum residents and 3% of nonslum dwellers were sexually experienced by age 12; 65% and 10%, respectively, had had intercourse by age 14. Virtually all women who had grown up in cities and were living in slums when surveyed had had sex by age 18, compared with half of those living in nonslum dwellings. The median age at first intercourse was five years younger for slum residents (15.0) than for nonslum residents (20.0).
Findings from hazards analyses confirm that residence is significantly associated with age at first intercourse. Overall, women living in nonslum areas were about half as likely as slum residents to be sexually experienced (hazards ratio, 0. …