The effects of HIV testing and counselling on behaviour change in the prevention of HIV among the military population in Kenya
Elmi, Ltcol Mohamed Yussuf
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HIV testing and counselling (HTC) is an important prevention intervention whose aim is to enable an individual know his/her HIV sero-status and is also an entry point to treatment, care and support. Kenya in the new KNASP (2009/13) envisions an HIV free society through universal access to HIV services such as knowledge of HIV status by 2015, where 80% of the Kenyan population would have been counselled and tested. In order to achieve the national universal access targets, utilization of HTC services should increase everywhere throughout the country including the Kenya military. However, HTC services remain underutilized with only 50% of Kenyan between the ages of 15 and 64 years possessing knowledge of their HIV status and up to 83% of those infected with HIV do not know their HIV status. AIDS is currently the leading cause of death globally in the military, accounting for more than half of in-service and post service mortality in some countries. Such attrition causes loss of continuity at command level and within the ranks, increasing recruitment and training costs for replacements, and generally contributes to reduction in military preparedness, internal stability and external security. HIV and AIDS is one of the worst epidemics with most far reaching health and developmental consequences the world has ever seen. In Kenya, HIV and AIDS was declared a national disaster in 1999. Kenya continues to have a severe, generalized and concentrated HIV epidemic and the estimated HIV prevalence in adults aged between 15 and 49 years was about 7.1% in 2007 reducing marginally to 6.3% in 2008/2009. Throughout the world, the military personnel are the most vulnerable population to HIV and AIDS including sexually transmitted diseases. This is due to demographic factors such as their population being predominantly youthful with highly mobile and sexually active males. Access to alcohol tends to exacerbate risky sexual behaviour and hence increased vulnerability to contracting HIV. Despite the military being a high risk group, no previous study has investigated the effects of HIV testing and counselling as a .prevention intervention in Kenya. A descriptive, retrospective and prospective cross sectional study was conducted in the Kenyan military between 2003 and 2006 to evaluate the effect of voluntary counselling and testing as a tool for behaviour change among military personnel in 7 barracks in Kenya. A total of 320 respondents were interviewed and 6 FGDs were held the latter consisting of 60 participants in total. The findings revealed that more males than female respondents participated in the study and that over 79% of them were aged between 18 and 40 years. There was a remarkable increase in the utilization of HTC services from 9% in 2003 to 58.8% in 2006. A number of respondent-related factors including sex, age, marital status, occupation, level of education, concurrent partnerships, STI and knowledge of partners HIV status were identified to promote positive sexual behaviour change. Several factors were significantly associated with utilization ofHTC as a behaviour change strategy at 95% confidence level. These included knowledge of partner's HIV status (X2 = 1.867, P > 0.010), occupation of males (l =2.583, P > 0.011), and engagement in risky sexual behaviour (X2 = 2.049, P > 0.017). The findings also showed that at 95% confidence interval, marital status (l = 2.651, P > 0.024) and knowledge of partners' HIV status cl =1.685, P > 0.047) were significantly associated with the utilization of HTC and PMTCT services as a behaviour change strategy. The findings from retrospective records indicated that the HIV prevalence in the Kenyan military personnel had declined from 13% in 2002 to 5.3% in 2007 as was also a decline in STI cases among the same population. This study indicated that there was a significant behaviour change in the military and a deeper understanding of the effects of HTC as strategic tools in HIV prevention.