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An Examination of Two Young Female Cohorts' Sexual Behaviors and HIV Status in a Changing HIV Services Environment: Kisumu, Kenya 1997 and 2006


The primary purpose of this dissertation was to explain why HIV prevalence among young Kenyan women declined from 30% in 1997 to 16% in 2006. This was the period in which antiretroviral treatment (ART) and voluntary counseling and testing (VCT) became available in Kisumu, Kenya; therefore, the primary research hypothesis was that these services decreased HIV transmission among 2006 women.

Descriptive and quantitative analyses were performed. Service data and government reports were used to describe ART and VCT roll-out in Kisumu, and literature on globalization and state power were utilized as theoretical approaches. In 1997, 427 young women aged 15 to 24 in Kisumu, Kenya answered demographic and sexual history questions and were tested for HIV. In 2006, parallel data from 463 women were collected. These data were used in multivariate regression models created using Bronfenbrenner's Social Ecological model to examine changes in relationships between ethnicity, education, sexual behaviors, VCT access and HIV status over time.

Comparing 1997 and 2006 women, there were few overall differences in sexual behaviors. The primary finding was that in 2006, significantly more women had a secondary education (41%) than in 1997 (16%), which was associated with less sexual experience and decreased HIV risk. This was especially true among women with a secondary education who had never been married. The clearest services impact finding was that 2006 women who had ever been tested for HIV were significantly less likely than other women to be HIV-positive despite the fact that these women were more likely to have had two or more partners and to ever have been married. Future research should examine whether education policies in Kenya contributed to more 2006 women having a secondary education and how education and HIV testing protects young women from becoming HIV-positive.

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