The Economic, Health, and Social Context of HIV infection in Informal Urban Settlements of Nairobi
According to the 2003 Kenya Demographic and Health Survey, about 9% of adult women and 5% of men are infected with HIV. Urban areas are disproportionately affected (10%) compared to rural areas (6%) but these averages mask the huge inequalities in HIV prevalence rates and also the growing vulnerability and disadvantage among the urban poor. Research by the African Population and Health Research Center (APHRC, 2002) has shown that the urban poor have the worst health indicators compared with the rural poor and other urban dwellers.. The urban poor population is growing very rapidly so that unfavorable health outcomes among this sub-group will have adverse implications for the achievement of many of the Millennium Development Goals. We conducted a study on the economic, social, and health context of HIV/AIDS in informal urban settlements. To achieve this, population-based HIV testing was conducted annually in Korogocho and Viwandani slums in Nairobi City to estimate the prevalence and incidence of HIV/AIDS. APHRC has been conducting a demographic surveillance system (DSS) in these two slums since 2002. Data on HIV status was linked to individual data from the DSS to determine the social, health, economic, and demographic factors associated with HIV positive status. The project also assessed the impact of HIV/AIDS by following up a cohort of HIV positive and negative subjects for a period of two years. Being the first study of its nature in these communities, it was proposed to start with a study to assess acceptance rates for participation into the study and to estimate a baseline HIV prevalence rate. This feasibility phase took approximately 6-8 months and it informed the procedures for the main study. HIV prevalence among the urban poor was higher than the estimate of 10% for Nairobi, there were higher refusal rates in the urban slums, and that the impacts of HIV/AIDS was greater than those documented in the literature from rural studies. The findings had significance for the design of policies and programs for the urban poor and also for assessing the impact of HIV/AIDS.
Version 1.1, November 2014. Anonymized with DOI and Recommended Citation added.
The study was conducted in the two NUHDSS areas namely, Korogocho and Viwandani slums where APHRC runs a longitudinal demographic surveillance system (DSS).
Unit of Analysis
The study population consisted of all residents of Korogocho and Viwandani slums who met the eligibility criteria thus: residents are registered by the Nairobi Urban Demographic Surveillance System (NUHDSS); aged between 15 to 54 years for men and 15 to 49 years for females and were in relatively good health to respondent to the interview.
Producers and sponsors
Authoring entity/Primary investigators
African Population and Health Research Center
Dr Nyovani Madise
Dr Matilu Mwau
Population of Koroghocho and Viwandani
For the pilot phase of the project a sample of 800 was estimated to be adequate to answer the key question of prevalence of HIV and acceptability of community based testing of HIV in the slums. A computer assisted random sample of eligible individuals was selected. Following a successful pilot phase, an extra 3,380 sample was selected to try and characterize the HIV situation further including carrying out analyses to establish risk factors for HIV. This resulted into a total sample size of 4180 individuals to be drawn.
Total population interviewed = 6237 (3,876 women and 2,354 men).
Due to unforeseen circumstances, some the individuals who were initially sampled could not be interviewed for various reasons including death, and out migration. Therefore, a replacement random sample similar to those missed was drawn to make up the sample initially targeted.
The data are not weighted.
Dates of Data Collection (YYYY/MM/DD)
Mode of data collection
Type of Research Instrument
The questionnaire captured data on knowledge of HIV transmission and prevention, knowledge of HIV/AIDS related services and their availability in the community, behaviors associated with risks of HIV infection, attitudes and perceptions related to support and care of people living with AIDS.
More specifically, the themes covered by the questionnaire included :
2. Knowledge about HIV/AIDS
3. Testing history
4. Marriage and Sexual activity
a. Male circumcision this section to be administered to males only
b. Questions on pubic hair removal practice
Completed and edited questionnaires were returned to the office for data entry on a regular basis. About 10% of all questionnaires were manually re-checked by an office edit before data entry could be carried out.
The survey data was entered into a computer using SQL Server software at the APHRC offices. HIV status data were stored in secure password protected data base at KEMRI laboratories. Only authorized personnel had access to HIV status data.
African Population and Health Research Center
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African Population and Health Research Center, The Economic, Health, and Social Context of HIV infection in Informal Urban Settlements of Nairobi, October 2013. APHRC, Nairobi - Kenya. doi:11239/176-2006-002-1.1
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