Education versus HIV Status
Level of education HIV Positive Percentage
Primary 6 8.2
Secondary 24 32,9
College and beyond 43 58.9
Total 73 100.0
Table 4.9 shows that the more highly educated the individual the higher the chances of
being infected with HIV. This survey result runs contrary to the belief held by many; that
individuals with high educational attainment have less chances of being infected with
HIV since they have a better understanding about the virus and how to protect
themselves. However; the result indicates the very opposite. It seems the likelihood of an
educated individual contracting HIV may be higher due to one having many social
networks and owing to the fact that one is economically empowered. Therefore, this
increases the chances of being infected with HIV, especially if one abuses drugs and
alcoholic substances.
As per the results of this study, unemployment was ranked as the second most important
factor influencing HIV prevalence in Kisii central sub-county. Interestingly, it is difficult
to sensibly discuss unemployment without touching on poverty and education as they are
closely tied together. For example, un-employment means lacking a source of income
which drives one into poverty. Research indicates that up to 45% of those infected with
HIV are unemployed (Jong et al., 2010). Worse still, HIV affects the physical and mental
functioning making it difficult for PLWHA to maintain regular employment.
Also, those infected with HIV sometimes find their work responsibilities competing
against their health care needs in terms of time. This is because persons suffering from
AIDS-related maladies require regular time to consult with Physicians. Eventually, this
may lead to their being terminated or forced to resign (APA, 2010). The data from the
HIV Experts— medical officers at KTRH noted that scheduling for clinics for PLWHA
was difficult since many defaulted appointments. Consequently, they had to result to
fixing appointments on market days so that they can attend to them as they visit the
market. This has worked somehow, only that the visits are so brief because they need to
go back to the market to sell their merchandise
Previous studies have suggested that low or no education and unemployment are the main
factors increasing the HIV prevalence. The reasoning was that since studies reported high
prevalence among young women who had not completed high school despite having only
one-lifetime partner (Pettifor et al., 2005); then, low education must be a factor in the
spread of HIV. The current thinking, however, is quite different arising from the
realization that HIV and poverty form a rather complex relationship. Due to poverty,
limited education, and unemployment; have conspired to make young women end up
choosing older male partners for survival. But, as a result of gender power inequities, the
relationship leads to reduced condom use, encouraging risky sexual practices, and
transactional sexual relationships (Woolf & Maisto, 2008).
Recent, studies by Bor, Herbst, Newell, & Bärnighausen, (2013) and that by Shisana et al.,
(2015) on the implications of low education and the spread of HIV have made interesting
observations. Both studies reported a high incidence of HIV among women of low education.
This has led researchers to argue that the likely option for lowering HIV infection is by
increasing awareness, information and knowledge of the general population. Certainly,
education plays a very important role when it comes to knowledge about HIV; unfortunately,
this is what most rural people lack leading to persistence of new HIV infections. In a study,
Peltzer and Ramlagan (2011) found HIV to be associated with the level of education; urban
settings and knowledge of HIV. It is out of this realization that Tladi (2006) warns about the
implications of lack of education in the context of HIV since it is likely to lead to decreased
decision-making power, particularly if, one is poor.
The data from FGDs also sought to find out the level of education of the CSWs it found
out that 26.7% had primary level education,66.7% secondary level of education but all
dropped before completing form four and only 6.7% completed secondary school and had
gone to a middle level college. When asked why they had not completed school all of
them said they lacked school fees to enable them complete secondary or clear primary.
This reason explains further on how they would respond to the question ‘if they had both
parents’. Among them; 26.7% had both parents alive but were poor to support them. A
further, 46.6% were survived by one parent and another 26.7% were total orphans.
Therefore, these two factors explain why they either dropped out of school or were
unable to complete since they had no one to support them financially.
The third rated factor, perceived to influence increased HIV prevalence in Kisii County
was alcohol and drug abuse. Of all substances, alcohol is most readily available, widely
consumed and widely abused recreational drug (Kirby, & Barry, 2012). It is common in
beer, wine, and liquor. Also, alcohol is availed under certain legalised conditions.
Unfortunately, some drug substances are proscribed and therefore consumed illegally.
These include cannabis sativa (Bhang), cocaine (including crack), heroin, amphetamines
(speed), and ecstasy. These drug substances have the potential of increasing one's risk of
contracting HIV and even leading to more serious problems for those already infected.
Mostly, addicts become unable to control their craving and therefore, are likely to trade sex
in order to procure more drugs. This behaviour puts them at greater risk of HIV infection,
especially since they do not always remember to practice safe sex while acting under the
influence of drugs. Indeed, when intoxicated, judgement is seriously impaired that there is
hardly any chance of negotiating for safe sex or even remembering to protect themselves
by using condoms (Allen, Myers, & Ray, 2015).
Additionally, toxic substances are produced whenever alcohol or other drugs interact with
medicines taken by PLWHA to stay well and whenever this happens, it increases the odds of
forgetting, especially taking medications, consulting their physicians, or taking steps to stay
well. Since the beginning of the epidemic, research has inextricably linked drug abuse and
addiction with HIV and AIDS. While the use of drugs intravenously is well recognised in this
regard, what is less appreciated is the role drugs play in the spread of HIV. They generally
increase the chances of being involved in highly risky sexual relationships with infected
partners (King, Nguyen, Kosterman, Bailey, & Hawkins, 2012).
In this regard, one study found condom use and safe injecting practices to be very low
among drug abusers and may be the cause of high rates of HIV transmission (NACC,
2014). In Kisii Central Sub County the gays attend a special clinic and pick condoms and
lubricants from peer educators. The proper use of the same cannot be ascertained since
some come for treatment for STIs an indication that they are not used or if used not
effectively used.
Furthermore, research has shown that HIV progression plus its consequences, especially
in the brain are likely to worsen in the context of drug addiction and abuse. In animal
studies, for instance, methamphetamine has been shown to increase the amount of the
virus present in the brain (Marcondes et al., 2010); while in humans, in the context of
HIV, methamphetamine abuse has been shown to cause greater damage to neurons and
cognitive impairment compared with non-abusers (Langford et al., 2003; Rippeth, 2004).
In Kisii Central Sub-County especially within the central business district, there is
heightened social activities. Bars and lodgings operate twenty fours seven. The numbers
of clients who visit the patient support centre to seek emergency post exposure
prophylaxis are about seven per day the worst day being Mondays where the numbers are
many. Bars seem to be a safe haven for those seeking sexual favours from clients. There
are also reported cases in the police where people have been drugged and found
themselves unconscious in the hospitals. Further, there are reported cases of rape of
ladies found unconscious in lodgings who end up in the hospital for treatment. The large
number of bars and lodgings seem to trigger the high prevalence rates of HIV in the sub-
county. There is also a high consumption of both legalised substances for example beer
and the illegal brews coupled with a heavy consumption of cannabis within the town.
The fourth-ranked factor perceived to influence the prevalence of HIV in Kisii Central
sub-county was increased Population of commercial sex workers. UNAIDS defines
commercial sex work as “the practice of trading sex” which can be either regularly or
occasionally (UNAIDS, 2012). Consequently, this means that sex work can vary between
and within communities and countries. For example, variations can be in terms of the
extent the practice is: (i) “formalized” or organized; (ii) differentiated from other social
and sexual relationships; and. (iii) associated with economic exchange
Significant variations in HIV prevalence exist among sex workers, between regions, and
countries. As of 2011, the prevalence in low- and middle-income countries was estimated
at 12% (Baral et al., 2012; Beyrer et al., 2012). In a study involving four countries,
UNAIDS (2014) reported that, compared with the general population, HIV prevalence
among CSWs was five times higher. However, when a similarly designed study expanded
the countries to 16 in the SSA; an average 37% prevalence was reported among CSWs.
For Nigeria and Ghana, HIV prevalence was estimated to be eight times higher among
CSWs compared to the rest of the population (The World Bank, 2013).
Among all population groups, the CWs are the most affected by HIV; but, they are also the
group which is likely to respond well to prevention and treatment programmes. This has been
successively demonstrated by studies conducted in Cambodia, the Dominican Republic, India
and Thailand. These countries have managed to reduce their national HIV prevalence through
the help of initiatives targeting CSWs and their clients. The risk of contracting HIV among
CSWs is high because of sharing common factors that expose them to HIV transmission,
regardless of their background (Asiki et al., 2011;). These include having sex with multiple
partners (comparatively higher numbers than the general population) and inconsistent use of
condoms (USAID, 2013b). From the FGDs participants agreed that condom use was not a
priority since it depended on the willingness of the client either to pay more and not use a
condom or pay less and use a condom.
In Kenya, HIV prevalence is reportedly highest among FSWs. For example, among this
group, an estimated 29.3% were reportedly living with HIV as of 2011 (NACC, 2014).
Despite this being the Kenyan case, data from the Sex Workers Outreach Program (SWOP)
has contradicted this finding. It found more male sex workers (MSWs) estimated at 40%
living with the disease compared with FSWs estimated at 30% (UNAIDS, 2012). Of course,
data from SWOP is broader and more inclusive implying that the data supports the finding
that HIV is gender biased and has geographical variability. In addition, 14% of new
infections occurred among FSWs and their clients (NACC, 2010). However, their HIV
prevalence is near normal because FSWs are reportedly better than other groups such as
MSWs, MSM and PWIDs at protecting themselves from the infection. In fact, almost
86% of the FSWs were reportedly using a condom with their most recent clients (NACC,
2014). In certain instances, CSWs lack ways of accessing condoms or even, may not be
aware of their significance. In others, they simply lack the power to negotiate for safe
sex. For example, clients might refuse to pay for sex if they were coerced into using a
condom. Alternatively, clients may resort to using threats or violence to compel their
partner into accepting unprotected sex (Ghimire et al., 2011). But, clients wishing to be
viewed in a good light, turn to offering higher prices compared to the going rates to
entice their partner for unprotected sex – a proposal that is likely to resonate well with
most CSWs. Likewise, CSWs’ clients act as a 'bridge population'—responsible for
transmitting HIV between CSWs and the general population. Studies have detected a
heightened HIV prevalence among male clients (Gomes do Espirito Santo & Etheredge,
2005; Jin et al., 2010; Patterson et al., 2009).
An examination of data collected during FGDs from 20 participants aged 15-25 years
found that 80% of the CSWs had engaged in commercial sex work for the last three years
and 10% for the last one year. Sex workers reported that they work on daily basis but
some do a shift that is working during daytime or night time only. They have an average
of two clients a day and charge an average of Ksh. 300 per session. More than half of the
sex workers said their clients drink and nearly two-thirds said they are involved with
mostly repeat clients. Vaginal intercourse was reported by 98% of the sex workers.
Manual stimulation of the genitalia was reported by roughly 100% of sex workers. No
case of oral sex was reported; however, one reported anal sex.
The study also sought to find out the level of education of the CSWs, it found out that
26.7% had primary level education,66.6% had secondary level of education but all
dropped before completing form four and only 6.7% completed secondary school and had
gone to a middle level college. When asked why they did not complete school all of them
said they lacked school fees to enable them complete secondary or clear primary. This
reason would be explained further on how they responded to the question of if they had
both parents. Among them 26.7% had both parents alive but were poor and would not be
able to support them.46.7% were survived by one parent and 26.7% were total orphans.
These two factors explain why they either dropped out of school or were unable to
complete since they had no financial support from the parents. For those who had either
both or one parent only; it was one (6.7%) whose parent knew what business she was
doing but 14 (93.3%) of the parents didn’t know what business their daughter do.
Perhaps, they only knew she is a business lady in town.
The number of siblings or dependents would push one to look for extra resources to
support them. The study wanted to find out if the number of dependents would be a factor
and if CSWs supported them. When asked the question on how many siblings they
had,13.3% were the only child, 6.7% had one, 20% had two, 40% had three and 20% had
four and more. When asked if they supported them, 80% replied to the positive while
20% replied to the negative. Issues of alternative sources of income, safety for sex
workers and the conditions creating the necessity for sex work were discussed. However,
many were comfortable with the work since they were able to pay their bills and meet
their basic needs. Therefore, they saw no need for alternative source of income.
The sexual experience would be a factor that would push one to commercial sex work
and the research sort to find out if one exposure to sexual activities would have led them
to engage in sex work. Asked when they had their first had sex contact, 13.5% said when
aged below ten years, 40% between 11-15 years, 40% above 15 years and went straight
to prostitution, 6.7% were non-committal.
Are there any valid reasons as to why people engage in commercial sex? The research
wanted to find out what specific reasons forced them into engaging in commercial sex.
Among them 97% cited poverty, peer pressure, being orphaned, separated or divorced
and having turned HIV positive as the main reasons in that order. One participant said,” I
was divorced and we had had two children ulitaka ni do?” This meant the lady didn’t
have means to support the children and so the only alternative for her was to go into
prostitution. Another one said, “When I tested positive, I had no one to lean on since I
didn’t know who had infected me, the only way out was here”. Yet another said, “My
friends were making good money yet we were the same age so I decided to join them”.
The surprising response was from this participant who said, “I din’t want to die alone.
Since I was given by a man; what I did was to return to them, so that is why I am here.
Akitaka apewe.”. This clearly shows that the spread of HIV and AIDS is often intentional
and reducing it may be a futile exercise since others are out spreading it intentionally.
Further, when asked what they would wish to do in future, some (20%) said they want to
remain in the same business. One retorted, “Why should I struggle to sit in the sun to sell
tomatoes when I can comfortably sit on the bed and make money”
Clients’ occupations could be categorized into three main groups. The first is the
qualified professionals such as teachers, policemen, bank clerks, who earn enough money
to frequently visit CSWs. The frequent clients were the qualified professionals who
accounted for 60%, then drivers 20% and finally motorbike riders accounting for 20%.
Since, most CSWs have limited resources and low education level; they lack a language
and power to bargain for better pay. During, hard times, sex workers are forced to charge
as low as Ksh.50 per session. These same clients have other sexual partners making
efforts of curbing the spread of HIV more difficult as the chain is long.
Although most clients 93.7% use condoms as a protective way against HIV 7.3%
reported practicing the withdrawal method when not using a condom at all. One client
when asked if she uses protection she said she does but if a client requested not to use she
did not have a problem. This was a surprise since she had this to say: “I am HIV positive
but need more money, I charge around one hundred shillings per session but if the client
wants unprotected sex I charge two hundred shillings”. This means they don’t value
clients’ lives but their money. This may end up speeding the spread of HIV among the
general population.
Likewise, the study sought to find out whether the respondents knew their HIV status. The
study showed that 93.3% had taken an HIV test and knew their status. Among the ones who
had taken the HIV 67.7% were negative while 33.3 % were positive. Since there is sharing of
clients the percentage would even be higher than what was recorded since those who reported
having tested for HIV, it was more than three months earlier. Those who had not tested for
HIV, cited fear of facing the results if it turned positive, stigma and losing clients as the main
reasons for not testing for HIV. One participant remarked, “Mimi sitaki
kufa mapema kwa sababu nikijua niko HIV positive, sitakunywa dawa”. Meaning that she
does not want to die early since if she discovers she is HIV positive she won’t take any
medication.
Majority of the CSWs (60%) do not ask nor disclose their HIV status to their clients for
fear of being rejected either by their clients or colleagues. So, HIV negative worker will
end up infecting their clients and vice versa. However, if both the worker and the client
are positive, re-infection will occur. Many of those who are HIV positive are on drugs but
due to stigma and fear of discrimination they do not take their drugs in public or coming
out publicly to declare their status.
In conclusion, the study revealed that many CSWs have limited economic options,
dependents, marital disruption, and low education. Their HIV vulnerability has been
heightened by being inextricably linked to the occupational contexts of their work,
characterized most commonly by poverty, forced sex, criminalization, high mobility and
alcohol use. These, in turn, predict behaviours such as low condom use, anal sex and re-
infection with other sexually transmitted infections. Sex work in Kisii cannot be viewed
in isolation from other HIV-risk behaviours such as multiple concurrent partnerships—
there is often much overlap between sexual networks. Sex work is likely to have played
an important role in the spread of HIV in Kisii Central Sub-County based on the data
obtained from the focused group discussion. Although, condom use is fairly high; but,
there is no consistency, hence many clients are exposed to high risk of infection.
A poor attitude towards HIV testing was the fifth factor in influencing the prevalence of HIV.
The study found that out of the 366 study participants, 333 (91.2%) had tested for HIV for
various reasons: 38 (11.6%) for being involved in risky behaviour, 68 (20.7%) for not feeling
well, 23 (7.0%) for not trusting their partners, 42 (12.8%) for being advised by the doctor,
154 (47%) as a routine check, and 3 (0.9%) for being forced by their partners.
Furthermore, majority (about 47%) of HIV testers were aged between 24 and 49 years.
Considering that this is the most sexually active group within the population, it is
expected that the majority would test for HIV especially that in Kenya no one is allowed
to enter marriage without testing for HIV. The second largest group – 148(41%) that
tested for HIV was the under 24s. However, between the two age groups, there was a six
percentage point difference in favour of the older group aged between 24 and 49 years.
Of course, the group aged between 24 and 49 years led with 96% having tested for HIV.
In terms of gender, about 59% of females compared with41% of males reported having
tested for HIV. When compared within the groups, still females were leading at 93.3%
compared to Males at 88.3% testers. All widowed, divorced and majority of the married
(95.8%) persons had tested for HIV. In addition, a significant number of the singles
(about 86.3%) had also tested for HIV. Two groups – the married, widowed and divorced
led in terms of the number of persons who had ever tested for HIV probably due to the
requirement of presenting a certificate before being wedded.
The KTRH experts noted that Stigma has played a great role in the spread of HIV and
mentioned internalized stigma as being a major issue. This is where an individual does
not want to get an HIV test for fear of the result turning positive. If they are put under
care and treatment they do not want to disclosure to their partners or relatives and friends.
Social stigma then follows where those who are infected do not want to be associated
with those who are HIV negative. There are reported cases of job discrimination on the
basis of one’s HIV status, making it difficult for people to seek care and treatment.
Lastly, the study found little or no association between testing for HIV and educational
attainment, and income. However, there are several theoretical considerations that may be
expected to lead the more-educated into testing for HIV than the less educated. Typically,
the more-educated tend to have not only stronger socio-cognitive abilities to better
appreciate the risks involved (having been exposed to HIV in school, social settings and
the media) but also, have higher Self-efficacy that enables them to act on such
knowledge. In addition, the more-educated have more income compared with the less-
educated enabling them to exercise more control over their own lives.
Since less-educated persons tend not to value their future much, they are therefore not
motivated to take preventative measures (Cutler & Lleras-Muney, 2008; Jukes, Simmons,
& Bundy, 2008). Yet, in most times, these advantages are easily offset with factors brought
about by having wealth and mobility, particularly greater capability to appeal to and retain
multiple sexual partners, as well as gaining greater access to risky sexual networks, such as
CSWs, MSM and PWIDs. When preventative knowledge is limited, individuals can engage
in risky behaviours like early in a new epidemic (Hargreaves et al., 2008).
To provide insights into the empirical association between HIV and education, two
approaches have been suggested. The first focuses on the place while the second focuses on
changes in HIV knowledge. The first approach aims at examining the interaction between
education and the place. For example, even when increasing community-level education is
generally protective against HIV (Kayeyi, Sandoy, & Fylkesnes, 2009), research has shown
that personal education is more beneficial particularly in urban settings (Magadi & Desta,
2011; Magadi, 2013). The second approach focuses on the role of education in adjusting
behaviours to the epidemic, or education’s role in changing the HIV knowledge over
time.
The theoretical basis for the second approach is anchored on the proposition that education
and HIV are inversely related indicating that more-educated individuals can learn
preventative measures faster and adopt them without much difficulty (Hargreaves, Davey,
& White, 2013). This theory is supported by empirical evidence that during the past 30 years
or so of the epidemic, advancements in adopting less risky behaviours such as having one
sexual partner, using condoms and avoiding intergenerational marriages by the more-
educated individuals have transformed education from being a risk factor into becoming a
protection factor against HIV (Duflo, Dupas & Kremer, 2015; Gummerson, 2013; Iorio &
Santaeulàlia-Llopis, 2011; Hargreaves, Slaymaker, Fearon, & Howe, 2012).
The results from the FGDs in terms of level of education of the CSWs, found out that
26.7% had primary level education, 66.7% had secondary level of education but all
dropped before completing form four and only 6.7% completed secondary school and
went to a middle level college. The inability to continue was due to lack of someone to
support them financially.
Among the factors perceived as influencing HIV prevalence in Kisii sub-county, the study
ranked intergenerational sex, at position six. This is a phenomenon defined as any sexual
relationship contracted between an adolescent and a much older partner, usually by 10 or
more years. The phenomenon is associated with several life-long consequences. For example,
premature sex can trap girls into adverse poverty cycles and vulnerability as they may
become adolescent mothers (Pitso & Kheswa, 2014); may force them to drop out of school
(Holley, 2011); risks entering into early marriage to preserve the honour and dignity of their
family and themselves (UNICEF, 2010); and, risk contracting sexual diseases, including
HIV due to high exposure (Gregson, Nyamukapa, Garnett, & Mason, 2002). In the
majority of the cases, inter-generational sex relationships are in a sense a form of
commercial sex – in that the younger partner is allured with gifts and financial rewards.
Literature on inter-generational sex in the SSA region, suggest that adolescents are driven
into forming sexual unions with older partners for a variety of overlapping reasons;
among them, gifts and other financial rewards (Wamoyi, Fenwick, Urassa, Zaba, &
Stones, 2011). The underlying reasons for receiving financial benefits are complicated,
ranging from an attempt to survive economically to a desire for status and becoming rich.
In this study, poverty was perceived as the driving force behind the spread of HIV due to
its complex demands.
Some studies have suggested that economic motivation may qualify as a factor for
receiving financial rewards, depending on the level of poverty of the adolescent involved.
For example, very poor adolescents might engage in certain sexual relationships in an
attempt to meet their basic needs. However, those not as poor might do so not as a means
of survival, but, as a way of gaining access to ‘luxury goods' or through peer pressure
(Hawkins, Price, & Mussa, 2009; Stewart, 2008). In that regard, poor girls, particularly
from the rural areas, might consent into engaging in sex with older men in exchange for
foodstuffs, but, the not so needy, particularly from the urban areas, with more diverse
livelihoods, might consent as a way of accessing items they may otherwise not afford
such as certain clothes or perfume.
From a child protection perspective, the power differential inherent in such relationships
is a risk factor for abusive tendencies and can be linked to violence and greater exposure
to sexually transmitted Infections (STIs) as girls (usually the younger partner) are not
able to negotiate for safe sex, such as using a condom. In any event, Girls end up being
coerced into engaging in risky sexual behaviours (Teitelman, Ratcliffe, Morales-Aleman,
& Sullivan, 2008). The majority of those engaged in intergenerational sex, find sexual
behaviours compulsive and are less-likely to deny any sexual advance. Of the participants
interviewed in this study, 188(55.1%) indicated Willingness to deny some sexual
advances; meaning they were willing to enter sexual relationships discriminatively.
Besides, in Kenya, sexual relationships are legally contracted between parties aged over
18 years. Therefore, any sexual relationship contracted by parties under the prescribed
age is defined as ‘sexual abuse' since minors are incapable of giving consent legally.
Further insights from the CSWs indicated that majority of those trading sex, do so under
intense economic pressure as poverty leads them to drop out of school due to lack of
school fees. Therefore, due to low educational attainment, most CSWs are Unemployed,
thus lacking a source to economically sustain their livelihood as well as that of their
families as some are orphaned and have dependents. Yet, some have engaged in trading
sex due to early initiation occurring as early as 10 years. Other factors include peer
pressure, a desire to revenge for being infected, divorce, and anger at testing positive.
Kisii Central Sub-county has a large proportion of young people as compared to the old
population. Many of these are in schools and colleges and a few in the work force. Within the
central business centre there are a number of schools, middle level colleges and universities.
These young populations are frequent visitors to the hospital seeking medical advice or
treatment for STIs or post exposure prophylaxis. There seems to be a lot of
intergenerational sex since the older generation who are working are their main clients.
Cheap and affordable accommodation also seems to be a problem within the environs of
Kisii Central Sub-County. Many young ladies have found a way of earning a living
through sex work. This definitely will raise the incidence rates.
From interviewing CSWs, it emerged that the spread of HIV is at times intentional as if
to revenge—I don’t want to die alone, Akitaka Apewe or since I was infected by a man, I
also return it to them—attitude. Reducing prevalence while dealing with these attitudes
may prove problematic. What is worse, some of the CSWs (about 20%) have no intention
of quitting sex work as they retorted: “Why should I struggle to sit in the hot sun to sell
tomatoes when I can comfortably sit on bed and make money?" Perhaps, more
importantly, the type of clients the trade attracts is what fuels it. They include people
having decent jobs and position in society such as teachers, policemen, businessmen and
bankers – all who make good money and can frequent the brothels.
Considering that CSWs charge an average of about Kshs. 300 per session and that they have
on average two clients per day, the income derived from this occupation seems unattractive
to persuade one to continue with the practice, especially that the pre-occupation is likely to
lead to infection, illness and eventual death. One wonders, what magic is in the trade that
compels an individual to take the risk engaging in an occupation that has such dire
consequences? Why is it so difficult to dissuade one to abandon trading sex? Although this
group engages in risky sexual behaviour, yet, they are the most careful in protecting
themselves. For instance, over 90% of them admitted using condoms as a way
of protecting themselves and take pills such as morning after. Still, others practice the
withdrawal method to guard against pregnancies.
In sum, therefore, it is still possible to contain the occurrence of a human catastrophe
arising from the HIV and AIDS pandemic, even in the absence of a cure by implementing
strategies that minimize or eliminate poverty, unemployment, alcohol and substance
abuse, commercial sex work, and intergenerational sex. But, it looks clear that the
primary way to succeed is by improving peoples' attitudes toward testing for HIV. By
doing this, it may be possible to eliminate up to 68% of the risk factors that influence the
prevalence of HIV in Kisii sub-county. Also, it seems plausible to empower people to
fight the pandemic by enhancing their knowledge about HIV and how to avoid the
disease by making informed choices.
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