Voluntary HIV counseling and testing acceptance, sexual risk behavior and HIV incidence in Rakai, Uganda

OBJECTIVE: To assess the acceptance of voluntary HIV counseling and testing (VCT) and the effects of VCT on sexual risk behavior and HIV acquisition in Rakai, Uganda. METHODS: In a rural cohort, 10 694 consenting adults were interviewed, provided blood for HIV testing and were offered free VCT by community resident counselors. The proportions receiving VCT and the adjusted risk ratio (adj. RR) of VCT acceptance were estimated by log binomial regression. Risk behaviors and HIV incidence per 100 person-years (PY) in HIV-negative acceptors and non-acceptors of VCT were assessed prospectively. RESULTS: Although 93% initially requested HIV results, 62.2% subsequently accepted VCT. VCT acceptance was lower among persons with no prior VCT [Adj. RR = 0.88; 95% confidence interval (CI), 0.85-0.90], individuals with primary education (adj. RR = 0.94; 95% CI, 0.90-0.99) or higher (adj. RR = 0.91; 95% CI, 0.87-0.97), individuals who were HIV-positive (adj. RR = 0.72; 95% CI, 0.68-0.76), and persons reporting condom use in the past 6 months (inconsistent users, adj. RR = 0.95; 95% CI, 0.90-0.99; consistent users, adj. RR = 0.88; 95% CI, 0.82-0.95). VCT acceptance was higher among the currently married (adj. RR = 1.14; 95% CI, 1.08-1.20) and previously married (adj. RR = 1.11; 95% CI, 1.04-1.18). Receipt of results was not significantly associated with age, gender, and self-perception of HIV risk. There were no significant differences in sexual risk behaviors, or in HIV incidence between acceptors (1.6/100 PY) and non-acceptors (1.4/100 PY) of VCT. CONCLUSION: In this rural cohort where VCT services are free and accessible, there is self-selection of individuals accepting VCT, and no impact of VCT on subsequent risk behaviors or HIV incidence.     

Investigating the relationship between HIV testing and risk behaviour in Britain: National Survey of Sexual Attitudes and Lifestyles 2000

OBJECTIVES: To estimate the prevalence of, and identify factors associated with, HIV testing in Britain. DESIGN: A large, stratified probability sample survey of sexual attitudes and lifestyles. METHODS: A total of 12,110 16-44 year olds completed a computer-assisted face-to-face interview and self-interview. Self-reports of HIV testing, i.e. the timing, reasons for and location of testing, were included. RESULTS: A total of 32.4% of men and 31.7% of women reported ever having had an HIV test, the majority of whom were tested through blood donation. When screening for blood donation and pregnancy were excluded, 9.0% of men and 4.6% of women had had a voluntary confidential HIV test (VCT) in the past 5 years. However, one third of injecting drug users and men who have sex with men had a VCT in the past 5 years. VCT in the past 5 years was significantly associated with age, residence, ethnicity, self-perceived HIV risk, reporting greater numbers of sexual partners, new sexual partners from abroad, previous sexually transmitted infection diagnosis, and injecting non-prescribed drugs for men and women, and same-sex partners (men only). Whereas sexually transmitted disease clinics were important sites for VCT, general practice accounted for almost a quarter of VCT. CONCLUSION: HIV testing is relatively common in Britain; however, it remains largely associated with population-based blood donation and antenatal screening programmes. In contrast, VCT remains highly associated with high-risk (sexual or drug-injecting) behaviours or population sub-groups at high risk. Strategies to reduce undiagnosed prevalent HIV infection will require further normalization and wider uptake of HIV testing.     

Correlates of HIV Test Results Seeking and Utilization of Partner Counseling Services in a Cohort of Male Factory Workers in Zimbabwe

Correlates of individual HIV test results-seeking and utilization of partner counseling services were identified among male factory workers who participated in a longitudinal HIV prevention intervention study in Harare, Zimbabwe. Men working at participating factories were offered HIV voluntary counseling and testing (VCT) for themselves and their partners. While risk assessment counseling was offered in the workplace, result disclosure and partner counseling occurred at an off-workplace location. Of the 3,383 men undergoing risk assessment and testing, 1,903 (56%) chose to receive their test results and 230 (7%) brought their partners for VCT. Factors associated with receiving test results were history of STD and lower salary. Factors associated with bringing a partner for VCT were history of STD, being married, being employed at a factory with a peer educator, lower salary, and no prostitute contact. Incorporating VCT into STD treatment services is likely to reach a large number of men and their partners at highest risk for both types of infections. Because men are often the main decision-makers in sexual and reproductive matters, VCT must be easily accessible to urban, working African men.     

Condom use in multi-partnered males: importance of HIV and hepatitis B status

The objective of the research was to determine the demographic, sexual and social risk factors associated with condom use in 7,089 multi-partnered men attending the Sydney Sexual Health Centre. A review of computerized medical records from 1991 to 1999 was carried out. Males with two or more partners in the last three months were divided into three condom use groups: consistent, sometimes and never. Men reporting sex with men (MSM) were more likely to use condoms than men having sex with only women (p=0.001). HIV positive men were more likely to use condoms consistently than those who were negative (p=0.001). In HIV negative non-hepatitis-B carriers, factors independently associated with inconsistent condom use included alcohol consumption, intravenous drug use (odds ratio (OR) 0.6 (95% confidence interval (CI) 0.47-0.77)) and being married (OR 0.2 (95% CI 0.21-0.31)). Factors associated with consistent condom use were MSM (OR 1.8 (95% CI 1.26-2.49)) and having three or more partners in the last 3 months (OR 2.4 (95% CI 2.023-2.83)). In the 508 hepatitis B carriers, consistent condom users were less likely to be married or intravenous drug users (OR 0.4 (95% CI 0.23-0.85)). In the 200 HIV antibody positive men, those with three or more partners were less likely to be consistent condom users than those with two (OR 0.3 (95% CI 0.11-0.82)). The conclusions are that a small number of HIV positive men report unsafe sex with multiple partners. Health promotion activities should be directed at this group.     

HIV Risk Among Patients Attending Sexually Transmitted Disease Clinics in China

HIV and other sexually transmitted diseases (STDs) are spreading rapidly in China. However, little is known about HIV risk among STD patients. In October–November 1997, we recruited a consecutive sample of 1,371 STD clinic patients from 16 different provinces and municipalities across the country and examined their sexual practices and condom use. We found that the median age for sexual initiation was 22 years for men and 21 years for women, and only a small proportion of men (12%) and women (15%) had used a condom during this first sexual intercourse. Eighty-one percent of men and 53% of women had two or more sexual partners in the past year. During the same period, 78% of men and 44% of women had both steady and nonsteady partners; of those with both types of partners, only 1% of men and 7% of women always used a condom with these partners. Multiple sexual partnerships in the past year were more common among men, older men (over 35 years), and those who had initiated sex at an earlier age. More frequent condom use was associated with being younger, having nonsteady partners, and having used a condom during a first sexual encounter. Our findings underline a need for patient education and condom promotion among STD clinic patients as a part of efforts to prevent the spread of HIV in China.     

Voluntary counselling, HIV testing and sexual behaviour among patients with tuberculosis in a rural district of Malawi.

OBJECTIVES: A study was conducted in new patients registered with tuberculosis (TB) in a rural district of Malawi in order to 1) verify the acceptability of voluntary counselling and testing for human immunodeficiency virus (HIV) infection; 2) describe sexual behaviour and condom use; and 3) identify socio-demographic and behavioural risk factors associated with 'no condom use'. DESIGN: Cross-sectional study. METHODS: Consecutive patients diagnosed with TB between January and December 2000 were offered voluntary counselling and HIV testing (VCT) and were subsequently interviewed. RESULTS: There were 1,049 new TB patients enrolled in the study. Of these, 1,007 (96%) were pre-test counselled, 955 (91%) underwent HIV testing and 912 (87%) were post-test counselled; 43 (4%) patients refused HIV testing. The overall HIV infection rate was 77%. Of all HIV-positive TB patients, 691 (94%) were put on cotrimoxazole. There were 479 (49%) TB patients who reported sexual encounters, of whom only 6% always used condoms. Unprotected sex was associated with having TB symptoms for over 1 month, having had less than 8 years of school education, being single, divorced or widowed or having sex with the same partner. CONCLUSIONS: Offering VCT to TB patients in this setting has a high acceptance rate and provides an opportunity to strengthen and integrate TB and HIV programmes.     

Empowering HIV testing as a prevention tool: targeting interventions for high-risk men who have sex with men

In France, HIV testing can be easily performed in free and anonymous voluntary counselling testing (VCT) centres. The recent national study among French men who have sex with men (MSM) showed that 73% of those already tested for HIV had been tested in the previous two years. Nothing is known about the risk behaviours of MSM attending VCT centres. This study aimed to characterize sexual risk behaviours of MSM tested for HIV in such centres and identify factors associated with inconsistent condom use (ICU). A cross-sectional study was conducted from March to December 2009 in four VCT centres where a self-administered questionnaire was proposed to all MSM about to have a HIV test. ICU was defined as reporting non-systematic condom use during anal intercourse with casual male partners. Among the 287 MSM who fully completed their questionnaire, 44% reported ICU in the previous six months. Among those who had been already tested, 63% had had their test in the previous two years. Factors independently associated with ICU included: never avoiding one-night stands, not having been recently HIV tested, experiencing difficulty in using condoms when with a HIV negative partner or when under the influence of drugs or alcohol and finally, reporting to have had a large number of casual male partners in the previous six months. The rate of recently tested MSM was high in our study. Nevertheless, this rate was lower than that found in the last national study. Furthermore those not recently tested were significantly more likely to report high risk behaviours. We therefore recommend that further efforts be made to adapt the offer of both HIV testing and counselling to meet the specific needs of hard-to-reach MSM. Accordingly, an additional community-based offer of HIV testing to reach most-at-risk MSM is forthcoming in France.     

山东省男男性行为人群艾滋病梅毒感染率及其影响因素

目的了解山东省男男同性性行为人群(MSM)艾滋病病毒(HIV)、梅毒感染状况及其影响因素,为进一步做好MSM艾滋病防治工作提供依据。方法 2010年4-7月,按照多阶段整群随机抽样方法选取MSM人群,由经过统一培训的调查员对MSM进行面对面问卷调查,抽取静脉血检测艾滋病、梅毒抗体,对影响HIV、梅毒感染的因素进行Logistic回归分析。结果共调查3 200名MSM,收集有效问卷3 086份,有效问卷率96.44%,采集血液标本3 073份。调查对象最小15岁,最大74岁,平均年龄为(26.36±6.38)岁。最近六个月与同性发生过肛交性行为者占72.68%(2 243/3 086),其中每次都使用安全套者占32.59%(731/2 243);最近六个月与同性发生商业性行为者占11.83%(365/3 086),最近六个月与异性发生性行为者占22.72%(701/3 086)。HIV抗体阳性检出率1.01%(31/3 073),梅毒抗体阳性检出率4.69%(144/3 073)。Logistic回归分析显示,年龄较大、最近六个月发生同性肛交性行为、最近一年患过性病、没有接受安全套宣传发放服务,是HIV/梅毒感染的危险因素。结论山东省MSM人群HIV感染率较低,但梅毒感染率较高,提示MSM人群存在HIV广泛传播的可能性,需要在MSM人群中进一步加强艾滋病宣传和行为干预。     

Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda

BACKGROUND: The impact of antiretroviral therapy (ART) on sexual risk behavior and HIV transmission among HIV-infected persons in Africa is unknown. OBJECTIVE: To assess changes in risky sexual behavior and estimated HIV transmission from HIV-infected adults after 6 months of ART. DESIGN AND METHODS: A prospective cohort study was performed in rural Uganda. Between May 2003 and December 2004 a total of 926 HIV-infected adults were enrolled and followed in a home-based ART program that included prevention counselling, voluntary counseling and testing (VCT) for cohabitating partners and condom provision. At baseline and follow-up, participants' HIV plasma viral load and partner-specific sexual behaviors were assessed. Risky sex was defined as inconsistent or no condom use with partners of HIV-negative or unknown serostatus in the previous 3 months. The rates of risky sex were compared using a Poisson regression model and transmission risk per partner was estimated, based on established viral load-specific transmission rates. RESULTS: Six months after initiating ART, risky sexual behavior reduced by 70% [adjusted risk ratio, 0.3; 95% confidence interval (CI), 0.2-0.7; P = 0.0017]. Over 85% of risky sexual acts occurred within married couples. At baseline, median viral load among those reporting risky sex was 122 500 copies/ml, and at follow-up, < 50 copies/ml. Estimated risk of HIV transmission from cohort members declined by 98%, from 45.7 to 0.9 per 1000 person years. CONCLUSIONS: Providing ART, prevention counseling, and partner VCT was associated with reduced sexual risk behavior and estimated risk of HIV transmission among HIV-infected Ugandan adults during the first 6 months of therapy. Integrated ART and prevention programs may reduce HIV transmission in Africa.     

广西龙州县男性多性伴人群性行为特征和安全套使用影响因素

目的 分析农村地区成年男性多性伴人群的性行为学特征,探讨影响其坚持使用安全套的因素,为今后性病,尤其是艾滋病的防控工作提供科学依据.方法 于2017-2019年在广西壮族自治区龙州县农村地区招募男性多性伴人群,获取知情同意后对其进行面对面问卷调查或电子问卷调查,同时采集5 mL静脉血检测艾滋病病毒(HIV)抗体、梅毒抗...     

Changes in sexual behaviors following diagnosis with HIV: patterns and correlates among people living with HIV (PLHIV) in China

Effective secondary prevention of HIV infections requires knowledge about changes in sexual behaviors after diagnosis among people living with HIV (PLHIV), yet there is a dearth of literature assessing gender-specific patterns and correlates of such changes among heterosexual PLHIV in China. Data used in the current study were derived from a cross-sectional survey conducted from 2012 to 2013 among 1212 heterosexual sexually active PLHIV in Guangxi, China. Most participants reduced sexual frequency (71.2%), reduced or maintained the same number of sexual partners (96.6%), and increased or maintained same frequencies of condom use (80.6%). Gender difference was found in changes in sexual frequency, but not in the number of sexual partners or condom use. For males, decrease in sexual frequency was associated with having no desire to have children (OR?=?2.03, 95% CI 1.20, 3.44), being virally suppressed (OR?=?0.27, 95% CI 0.079, 0.94), and social support (OR?=?1.44, 95% CI 1.06, 1.96). Health promoting behaviors in condom use (i.e., increased or maintained same frequencies of condom use) for males was associated with being 45 years of age or older (OR?=?0.35, 95% CI 0.21, 0.61), having an HIV-negative main partner (OR?=?1.80, 95% CI 1.11, 2.92), and physical health-related quality of life (OR?=?1.02, 95% CI 1.00, 1.04). For females, decrease in sexual frequency was associated with having no desire to have children (OR?=?1.58, 95% CI 1.01, 2.47). Health promoting behaviors in condom use for females was associated with having an HIV-negative main partner (OR?=?3.24, 95% CI 1.63, 6.45) and social support (OR?=?0.75, 95% CI 0.57, 0.99).

Future intervention efforts need to target PLHIV who need extra support in making health-improvement efforts and to facilitate gender-specific behavioral changes in sexual risk reduction after HIV diagnosis.     

HIV-related characteristics among female partners of injecting drug users in Kelantan,Malaysia: a descriptive study

Kelantan, a northeastern state in Peninsular Malaysia, is one of the states that has been acutely hit by injecting drug user (IDU)-driven HIV epidemic, in addition to having a high number of infected women in Malaysia. This cross-sectional study describes the socio-demographic characteristics, HIV risk factors, risk perception, and adoption of preventive behaviors among female partners of IDUs in Kelantan. Out of 101 women, the majority of them are from low socioeconomic background and have no other risk factors besides heterosexual HIV transmission from their male IDU partners. Although 45.5% have not been tested for HIV and more than half (53.5%) of them did not use condoms during sexual intercourse, only 44.6% of the women perceived themselves to be at risk of being infected with HIV. Most of the women (86.1%) were willing to undergo voluntary counseling and testing (VCT). Female partners of IDUs continue to be vulnerable to HIV due to having sexual contact with IDUs, and also due to their socioeconomic position in the community. To prevent HIV transmission among female partners of IDUs, consolidating HIV prevention efforts from multiple approaches is needed.     

Sexual Risks Among Southern Thai Drug Injectors

Sexual risks for HIV transmission among injection drug users (IDUs) in Thailand are not well characterized. We surveyed 272 male IDUs about their background, sexual behaviors, and drug use at drug treatment clinics in southern Thailand. HIV seroprevalence was determined using enzyme immunoassay. Fifty-six percent of participants were sexually active, of whom 88% had sex mostly with a noninjecting regular partner (wife or steady girlfriend), reporting low rates (34%) of condom use. Among sexually active IDUs, 43% were HIV infected and only a few were aware of their HIV serostatus. Condom use was associated with history of HIV voluntary counseling and testing (VCT) and poor perceived health status in multivariate analysis. Unprotected sex with regular sexual partners is frequent among IDUs in southern Thailand, where most IDUs have not sought VCT services. AIDS prevention efforts should address access to VCT and condom promotion to sexually active couples to prevent sexual transmission of HIV.     

HIV Disclosure,Condom Use,and Awareness of HIV Infection Among HIV-Positive,Heterosexual Drug Injectors in St. Petersburg,Russian Federation

We examined the prevalence of HIV disclosure to sexual partners by HIV-positive drug injectors (IDUs) in St. Petersburg, Russia and compared the magnitude and direction of associations of condom use with awareness of one’s HIV infection and disclosure to partners. Among 157 HIV-infected participants, awareness of infection at time of last intercourse was associated with condom use with partners perceived to be HIV-negative (aOR 6.68, 95% CI 1.60–27.88). Among the 70 participants aware of their infection prior to enrolment, disclosure to potentially uninfected sexual partners was independently and negatively associated with condom use (aOR 0.13, 95% CI 0.02–0.66). Disclosure was independently associated with having injected ≥9 years (aOR 6.04, 95% CI 1.53–23.77) and partnership with another IDU (aOR 3.61, 95% CI 1.44–9.06) or HIV-seropositive (aOR 45.12, 95% CI 2.79–730.46). Scaling up HIV testing services and interventions that increase the likelihood of individuals receiving their test results is recommended.     

Repeat Voluntary HIV Counseling and Testing (VCT), Sexual Risk Behavior and HIV Incidence in Rakai,Uganda

We examined the effects of repeat Voluntary HIV counseling and testing (VCT) on sexual risk behaviors and HIV incidence in 6,377 initially HIV-negative subjects enrolled in a prospective STD control for HIV prevention trial in rural Rakai district, southwestern Uganda. Sixty-four percent accepted VCT, and of these, 62.2% were first time acceptors while 37.8% were repeat acceptors. Consistent condom use was 5.8% in repeat acceptors, 6.1% in first time acceptors and 5.1% in non-acceptors. A higher proportion of repeat acceptors (15.9%) reported inconsistent condom use compared to first-time acceptors (12%) and non-acceptors (11.7%). Also, a higher proportion of repeat acceptors (18.1%) reported 2+ sexual partners compared to first-time acceptors (14.1%) and non-acceptors (15%). HIV incidence rates were 1.4/100 py (person-years) in repeat acceptors, 1.6/100 py in first time acceptors and 1.6/100 py in non-acceptors. These data suggest a need for intensive risk-reduction counseling interventions targeting HIV-negative repeat VCT acceptors as a special risk group.     

Protective Factors and HIV Risk Behavior Among South African Men

The primary mode of HIV transmission in South Africa is heterosexual sexual behavior. HIV prevention research specifically focusing on men in South Africa is limited. We assessed self-reported HIV risk behaviors in 1,181 men ages 18 to 45 years in randomly selected neighborhoods in Eastern Cape Province, South Africa. Older men were less likely to report having multiple partners. Religiosity was a protective factor for condom use and unprotected sex with steady partners. Discussing using condoms was a protective factor for condom use and unprotected sex with both steady and casual partners. Having a child was associated with decreased condom use with steady partners and employment was associated with decreased condom use with casual partners. The findings suggest the need for HIV risk-reduction behavioral interventions tailored for South African men with regard to age, religiosity, and types of sexual partners. Implications for the development of such interventions are discussed.     

Antiretroviral Treatment and Sexual Risk Behavior in South Africa

The sexual behavior of individuals living with HIV determines the onward transmission of HIV. With the understanding that antiretroviral therapy (ART) prevents transmission of HIV, the sexual behaviors of the individuals not on ART with unsuppressed viral loads becomes of the greatest importance in elucidating transmission. We assessed the association between being on ART and sexual risk behavior among those living with HIV in a nationally representative population-based cross-sectional survey of households in South Africa that was conducted in 2012. Of 2237 adults (aged 15–49) who tested HIV-seropositive, 667 (29.8 %) had detectable antiretroviral drugs in their blood specimens. Among males, 77.7 % of those on ART reported having had sex in the past year contrasted with 88.4 % of those not on ART (p = 0.001); among females, 72.2 % of those on ART reported having had sex in the past year while 80.3 % of those not on ART did (p < 0.001). For males and females, the odds of reporting consistent condom use and condom use at last sex were statistically significantly higher for individuals on ART compared to those not on ART (males: consistent condom use aOR 2.8, 95 % CI 1.6–4.9, condom use at last sex aOR 2.6, 95 % CI 1.5–4.6; females: consistent condom use aOR 2.3, 95 % CI 1.7–3.1, condom use at last sex aOR 2.3, 95 % CI 1.7–3.1), while there were no statistically significant differences in odds of reporting multiple sexual partners in the past year. In this nationally representative population-based survey of South African adults, we found evidence of less risky sexual risk behavior among people living with HIV on ART compared to those not on ART.     

Patterns of Self-reported Behaviour Change Associated with Receiving Voluntary Counselling and Testing in a Longitudinal Study from Manicaland, Zimbabwe

Voluntary counselling and testing (VCT) is promoted as a potential HIV prevention measure. We describe trends in uptake of VCT for HIV, and patterns of subsequent behaviour change associated with receiving VCT in a population-based open cohort in Manicaland, Zimbabwe. The relationship between receipt of VCT and subsequent reported behaviour was analysed using generalized linear models with random effects. At the third survey, 8.6% of participants (1,079/12,533), had previously received VCT. Women who received VCT, both those positive and negative, reduced their reported number of new partners. Among those testing positive, this risk reduction was enhanced with time since testing. Among men, no behavioural risk reduction associated with VCT was observed. Significant increases in consistent condom use, with regular or non-regular partners, following VCT, were not observed. This study suggests that, among women, particularly those who are infected, behavioural risk reduction does occur following VCT.     

静脉吸毒人群HIV自愿咨询检测对其性行为影响的初步研究

目的　了解静脉吸毒人群接受艾滋病病毒 (HIV)自愿咨询检测 (VCT)前后其高危性行为的变化情况。方法　以社区为基础招募HIV阴性的静脉吸毒人群 ,采用前瞻性队列研究 ,比较HIVVCT前后 6个月研究对象的性行为变化情况 ,调查的内容包括人口学特征、在近 6个月及近 1个月高危性行为情况。结果　HIV阴性的静脉吸毒者 2 4 7人 ,接受HIVVCT前后 6个月性行为特征变化为 :研究对象在近 1个月与主要或固定的性伙伴与其他性伙伴的非保护性性行为 ,分别从 78人 (31 6 % )下降到 39人 (15 8% ) ,从 5 4人 (2 1 9% )下降到 34人(13 8% ) ,其P值分别为 <0 0 0 0 1和 <0 0 0 4 8;在近 1个月与其他的性伙伴性交时从未使用、每次都使用安全套的比例 ,分别从 6 5 6 %下降到 4 6 9% ,从 11 5 %上升到 30 6 % ,其P值为 0 0 36 4。结论　HIVVCT可减少静脉吸毒人群的高危性行为。     

A Venue-Based Approach to Reaching MSM,IDUs and the General Population with VCT: A Three Study Site in Kenya

A venue-based HIV prevention study which included Voluntary Counseling and Testing (VCT) was conducted in three diverse areas of Kenya-Malindi, Nanyuki and Rachounyo. Aims of the study were to: (1) assess the acceptability of VCT for the general population, men who have sex with men (MSM), and injecting drug users (IDUs) within the context of a venue-based approach; (2) determine if there were differences between those agreeing and not agreeing to testing; and (3) study factors associated with being HIV positive. Approximately 98% of IDUs and 97% of MSM agreed to VCT, providing evidence that populations with little access to services and whose behaviors are stigmatized and often considered illegal in their countries can be reached with needed HIV prevention services. Acceptability of VCT in the general population ranged from 60% in Malindi to 48% in Nanyuki. There were a few significant differences between those accepting and declining testing. Notably in Rachuonyo and Malindi those reporting multiple partners were more likely to accept testing. There was also evidence that riskier sexual behavior was associated with being HIV positive for both men in Rachounyo and women in Malindi. Overall HIV prevalence was higher among the individuals in this study compared to individuals sampled in the 2008-2009 Kenya Demographic and Health Survey, indicating the method is an appropriate means to reach the highest risk individuals including stigmatized populations.