HIV mortality in urban slums of Nairobi, Kenya 2003–2010: a period effect analysis

Abstract

BackgroundIt has been almost a decade since HIV was declared a national disaster in Kenya. Antiretroviral therapy (ART) provision has been a mainstay of HIV treatment efforts globally. In Kenya, the government started ART provision in 2003 with significantly scale-up after 2006. This study aims to demonstrate changes in population-level HIV mortality in two high HIV prevalence slums in Nairobi with respect to the initiation and subsequent scale-up of the national ART program.MethodsWe used data from 2070 deaths of people aged 15–54 years that occurred between 2003 and 2010 in a population of about 72,000 individuals living in two slums covered by the Nairobi Urban Health and Demographic Surveillance System. Only deaths for which verbal autopsy was conducted were included in the study. We divided the analysis into two time periods: the “early” period (2003–2006) which coincides with the initiation of ART program in Kenya, and the “late” period (2007–2010) which coincides with the scale up of the program nationally. We calculated the mortality rate per 1000 person years by gender and age for both periods. Poisson regression was used to predict the risk of HIV mortality in the two periods while controlling for age and gender.ResultsOverall, HIV mortality declined significantly from 2.5 per 1,000 person years in the early period to 1.7 per 1,000 person years in the late period. The risk of dying from HIV was 53 percent less in the late period compared to the period before, controlling for age and gender. Women experienced a decline in HIV mortality between the two periods that was more than double that of men. At the same time, the risk of non-HIV mortality did not change significantly between the two time periods.ConclusionsPopulation-level HIV mortality in Nairobi’s slums was significantly lower in the approximate period coinciding with the scale-up of ART provision in Kenya. However, further studies that incorporate ART coverage data in mortality estimates are needed. Such information will enhance our understanding of the full impact of ART scale-up in reducing adult mortality among marginalized slum populations in Kenya.

Economic Context and HIV Vulnerability in Adolescents and Young Adults Living in Urban Slums in Kenya: A Qualitative Analysis Based on Scarcity Theory

“…Finally, a third implication relates to noting that HIV rates are lower in Kenya among the rural poor as compared to the urban poor [60, 68, 70], which suggests that economic scarcity alone is not the sole driver of HIV vulnerability. However, urban residents may perceive similar levels of resource scarcity differently than the rural poor given their proximity to urban amenities and wealthier urban residents which are less prominent in rural settings.…”

“…Two of the study’s investigators had prior experience and research relationships in these settings. Similar to many informal settlements, these slums lack basic services and infrastructure such as electricity, durable housing, and access to clean water [67, 68]. The majority of urban slum residents rely on low-skilled work (i.e., domestic labor, casual jobs, petty trading) in response to high levels of unemployment and income instability [67, 68].…”

“…Kenyan youth within the lowest wealth quintile also have higher HIV prevalence (3.1%) compared to youth in the highest wealth quintile (2.6%) [70]. In addition, over half of Kenya’s city dwellers live in urban slums with an HIV prevalence of 12% compared to 5% in non-slum urban areas [60, 68]. …”

Lessons learned from using respondent-driven sampling (RDS) to assess sexual risk behaviors among Kenyan young adults living in urban slum settlements: A process evaluation

“…Approximately 70% of people living with HIV live in Sub-Saharan African countries [1], and young adults living in Africa's urban slum settlements are disproportionately at risk for HIV infection [2]. Characterized by densely populated impoverished communities, urban slum settlements in many African countries lack basic services and infrastructure such as electricity, durable housing, and clean water [3,4]. The majority of urban slum residents rely on lowskilled work (i.e., domestic labor, casual jobs, petty trading) in response to high levels of unemployment and income instability [3,4].…”

“…Characterized by densely populated impoverished communities, urban slum settlements in many African countries lack basic services and infrastructure such as electricity, durable housing, and clean water [3,4]. The majority of urban slum residents rely on lowskilled work (i.e., domestic labor, casual jobs, petty trading) in response to high levels of unemployment and income instability [3,4]. In Kenya, over half of Kenya's city dwellers live in slums [3].…”