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Objectives: The epidemiology of human papillomavirus (HPV) infection in men in Kenya is largely uncharacterised. We set out to determine the prevalence and determinants of HPV infection among sexually active fishermen along Lake Victoria in the Kisumu district of Kenya. Methods: Genital swabs were obtained from 250 consenting fishermen from 18 beaches and a detailed sociodemographic questionnaire was administered. HPV positivity was determined by polymerase chain reaction amplification and detected by dot blot hybridisation with generic HPV and β-globin probes. HPV positive samples were genotyped using the Roche Linear array assay. Results: Overall, 144 (57.6%) fishermen had detectable HPV DNA, 106 (42.4%) were infected with oncogenic HPV types, with HPV-16 being the most frequent type (12.4%). Among HPV positive men, 105 (72.9%) were infected with more than one HPV type and 20 (13.9%) were infected with more than six different types. HIV seropositive men (PR 1.49, 95% CI 1.19 to 1.86) and those divorced or separated (PR 1.62, 95% CI 1.13 to 2.33) were more likely to be infected with HPV. HIV infection (PR 1.22, 95% CI 1.01 to 1.47) was the only factor independently associated with infection with multiple types of HPV. Conclusion: The prevalence of oncogenic HPV infection is high among this population and is associated with HIV serostatus and marital status. This community could benefit from enhanced sexually transmitted infection and HIV prevention interventions.

Background Prompt linkage to care, retention in care and adherence to medication are important in achieving the WHO’s 90–90–90 treatment target. Achieving these targets is important for treatment and prevention of new infections. We sought to establish the time to linkage to care, retention in care and adherence to HIV medications in a cohort of people testing HIV positive in the fishing communities on Lake Victoria. Methods We conducted a 2-year resurvey of 128 participants who had tested HIV positive in a previous study. These participants were asked to return to the study clinic to participate in a follow-up study. Returning participants were consented and invited for a face-to-face interview on enrolment into HIV care, time to enrolment, retention in care and adherence to HIV care instructions. We mainly used descriptive statistics to analyse the data. Results Of 128 participants, 47.7% were female and half were aged 33.5 (IQR, 29–38.7) with a median monthly income of $66 (IQR, 33–99). Eighty three percent had enrolled in HIV care within a median of 20 days (IQR, 7–60) after testing HIV positive. Women were more likely to enrol in care compared to men (91.8% vs 74.6%; p = 0.011) but no significant difference in time taken to enrol in care. Over 38% of the participants had ever missed their clinic appointments since they first enrolled into care with half having missed 2 appointments (IQR, 1–3.5) in the preceding 12 months. Similarly, 26% had ever missed taking medications as prescribed with half having missed twice (IQR, 1–8.5) in the preceding 12 months. The most common reason cited for both missing clinic appointments and taking medications prescribed was travelling away from home. Conclusion The numbers enrolled into care falls below the expected 90% to achieve 90–90–90 treatment target by WHO. More innovative ways need to be developed to achieve these targets. Disclosure of interest statement This research was supported by a grant from the Consortium for National Health Research. No pharmaceutical grants were received in the development of this study.

Background Inaccurate suspicions of infidelity among married couples can affect trust and intimacy in a relationship. We sought to establish the prevalence, accuracy and correlates of infidelity suspicions among married couples. Methods We conducted a cross-sectional survey of 545 couples. We contacted a proportion to size simple random sample of fishermen on each beach as our index participants and asked them to enrol with their spouses. The consenting couples were separated into different private rooms for simultaneous gender-matched interviews. In addition to socio-economic and behavioural data, we collected information on extra-marital sex partners and infidelity suspicions among spouses. We used descriptive statistics and multivariate logistic regression for analysis. Results A quarter (27.2%) of the women and 16.9% of the men suspected their spouses of infidelity but only 6.2% of the women and 32.1% of the men reported extra-marital relationship. Overall, 43.2% of the women and 6.5% of the men accurately suspected their spouses with sensitivity of 36.6% and 17.6% respectively. Correlates of women accurately suspecting their spouses were: men being mobile (OR, 0.58; 95% CI: 0.39–0.85), couple being in polygamous marriage (OR, 0.48; 95% CI: 0.25–0.90), taking longer time during sexual intercourse (OR, 0.97; 95% CI: 0.95–0.99), men’s higher score on male dominance sex roles (for all our scales, higher score better) (OR, 1.08; 95% CI: 1.03–1.13) and higher score on domestic violence scale (OR, 1.27; 95% CI: 1.12–1.44). Conversely, correlates of men accurately suspecting their spouses of infidelity were: women being denied preferred sex position (OR, 0.50; 95% CI: 0.26–0.98), couple being in polygamous marriage (OR, 2.51; 95% CI: 1.01–6.23) and higher score on domestic violence - higher e scale (OR, 1.33; 95% CI: 1.15–1.54). Conclusion High rates of inaccurate infidelity suspicions in this community may be detrimental to marital relationships. Couples need to consider correlates that aid accurate suspicion before bring up the issue for discussion.

Background Extra-marital partnerships have been associated with the spread of STIs including HIV among married couples. We sought to establish the actor and partner effects of relationship and sexual satisfactions on extra-marital partnerships among married couples. Methods We conducted a cross-sectional survey of 545 couples. We contacted a proportion to size simple random sample of fishermen on each beach as our index participants and asked them to enrol with their spouses. The consenting couples were separated into different private rooms for simultaneous gender-matched interviews. In addition to socio-economic and behavioural data, we collected information on extra-marital sex partners as well as the scores of participants on a 7-item relationship satisfaction scale and 25-item sexual satisfaction scale. We analysed data using multilevel modelling under the framework of actor-partner interdependent model (APIM). Results Men had a median score of 56 (IQR 52–61) and women 53 (IQR 47–59) on sexual satisfaction scale. Both men and women had same median score of 16 (IQR 14–18) on relationship satisfaction scale. We found a significant partner effect of men’s relationship satisfaction on their spouses number extra-marital partnerships such that the more men are satisfied in their relationship the fewer the number of extra-marital partners their spouses report (B = –0.10; p = Conclusion Inculcating and maintaining good relationship and sexual satisfaction within couples in this community reduces their own and their partners’ number of extra-marital partnerships.

Background Population mobility has long been associated with frequency and variety of sexually transmitted infections including HIV. People9s mobility tends to disrupt their traditional social constraints and control of sexual behaviour by giving them opportunity, isolation and the desire for unique experiences. Fishermen being one of the highly mobile populations, we sought to evaluated the extent to their mobility predicts their involvement in high risk sexual behaviour. Methods During a Phase I randomised double-blind placebo-controlled cross over trial evaluating the safety and acceptability of ethanol in emollient gel as a topical male microbicide, we collected data on fishermen9s socio-economic and demographic characteristics, mobility patterns and sexual practices including extra-marital partnerships. We pre- and post-test counselled for STIs, obtained blood samples for HIV, HSV-2 and syphilis serologies and provided appropriate treatment and referrals. We analysed the data using descriptive statistics and then bivariate and multivariate logistic regression. Results Of the 167 fishermen screened, over a half (52%) were mobile defined as travelling and spending at least one night away from home in the month preceding the study). Two-thirds (63%) had active extra-marital relationships with only 5% consistently using condoms in these sexual encounters. During travel, a quarter (24%) drank alcohol and a similar number (25%) had sex with a third (32%) reporting new casual sex partners. At bivariate level, those travelling in the month preceding the study were more likely to be HIV+ (OR 2.08; 95% CI 1.01 to 4.28), have an active extra-marital relationship (OR 3.69; 95% CI 1.57 to 8.68), and have multiple sex partners in the six month preceding the study (OR 2.04; 95% CI 1.06 to 3.95). Mobility among fishermen was independently associated with having an active extra-marital relationship (AOR 3.64; 95% CI 1.11 to 12.00). Conclusion Mobile fishermen exhibit high risk sexual behaviour that include extra-marital sex and low condom use. This population is likely to benefit from STI/HIV prevention intervention.