Fewer than one in five people with HIV in Kenya and Malawi know they are infected

Between 2003 and 2005, fewer than one in five people infected with HIV in Kenya and Malawi were aware of their infection status, research published in July 31^st edition of AIDS shows. High levels of sexual risk behaviour were reported by HIV-positive individuals unaware of their infection, and many women with HIV had unwanted or unplanned pregnancies.

“Our results…demonstrate the urgent need to improve HIV testing uptake, which is a necessary first step to access prevention, care and treatment services”, write the researchers.

People living with HIV are an important focus of HIV prevention interventions. Research conducted in a number of African countries has shown that individuals increase their condom use on finding out that they have HIV. Other studies demonstrate that contraceptive use is higher amongst women with HIV who know that they are infected with the virus.

Researchers therefore analysed the results of nationally representative surveys conducted in Kenya and Malawi to determine sexual risk behaviours, awareness of HIV status, and contraceptive use amongst people with HIV.

Individuals participating in both these studies provided information about their sexual risk behaviours and were tested for HIV, and women provided information on their use of contraception and stated whether their last pregnancy was unwanted or unplanned.

The majority of individuals with HIV were either married or cohabiting (Kenya, 62%; Malawi, 78%).

Only 3% of HIV-positive individuals in Kenya and 6% in Malawi said that their last sexual intercourse with their spouse or cohabiting partner was protected.

Few HIV-positive individuals were aware that they had the infection (Kenya, 20%; Malawi, 16%). Most of the individuals who were unaware they had HIV knew of a facility where they could be tested for the virus. The investigators suggest that "HIV program planners may need to implement innovative approaches to increase utilization of HIV testing services."

Almost three-quarters of HIV-positive individuals in Kenya who were unaware that they had the infection considered themselves to be at no or small risk of HIV infection.

Large numbers of HIV-infected individuals (Kenya, 50%; Malawi, 40%), had an HIV-negative spouse or cohabiting partner, "highlighting the importance of ensuring that couples receive HIV prevention programs", comment the investigators. They add, “although it may be challenging to design prevention strategies for discordant couples, they present a significant risk group as most new infections in sub-Saharan Africa occur in discordant couples.”

Information about HIV was provided to a third of HIV-positive women in Kenya during their last pregnancy and 66% of women with HIV during their last pregnancy in Malawi. Only 14% of women in Malawi were tested for HIV during their last pregnancy.

Contraceptive use was low and was reported by 26% of HIV-infected women in Malawi and 19% in Kenya. The majority (54%) of HIV-positive women in Kenya and 40% of women with HIV in Malawi said that their last pregnancy was unplanned or unwanted. “Our findings underscore the need for integrated family planning services with HIV services.”