Determinants of Family Planning uptake among Female Sex Workers Enrolled in a HIV incidence study in Eldoret Kenya. Authors: J. Kipyego, E. Kaguiri, G. Mungai, A. Komen, J.Sawe, G.Kutwa, JB Ballidawa, P. Ayuo, E. Were. 1 st Dec 2015

Background Female sex workers (FSWs) have limited access to reproductive health services due to marginalization and stigmatization. This poses the risk of unintended pregnancies, HIV acquisition and transmission and vertical transmission. In Kenya, Family Planning services are free and so maximum uptake is expected The Contraceptive Prevalence rate (CPR) in Kenya is 58% (KDHS, 2014) 1

Objectives To identify the FP methods used by FSWs operating in Eldoret, Kenya. To determine the levels of FP uptake among FSWs in Eldoret. To determine the factors associated with uptake of FP services in the group. 2

Methods Setting – Eldoret; Urban area in Western Kenya Population – FSWs operating within Eldoret urban area, Peer identified between June and December 2013 Design - Cross-sectional, Data was collected prospectively. Procedure - Abstract data on demographics and FP Ethics - Approved by Moi Teaching and Referral Hospital- IRB Analysis - Descriptive statistics, cross tabulation and multiple regression done. Proportions, OR & CI reported. 3

FINDINGS 4 Demographic characteristics the FSWs (N=734) Mean (SD) age in years was 28.2 (6.78);median (IQR) of 26.9 ( ) 173(23.6%) were HIV positive 62(8.4%) had no Children 27(3.7%) were married 427 (58% had up to primary level of education; 71(9.7%) had no education Mean(SD) monthly income in Kshs was ( ) ;median (IQR) 7000 ( ) 471(64.2%) reported Alcohol intake 386 (52.6%) reported to have a regular sexual partner

Figure 1 : Distribution of FSW using different FP methods (N=734). 5

Table 2:Factors associated with FP uptake (1) N=734 VariableFP uptake P value UnadjustedAdjusted No Freq (%) Yes Freq (%) OR95%CI OR 95%CI Age in years Mean (std)29.1 (8.1)27.7 (5.7) HIV status N/A Negative Positive 5 (55.6) 204 (37) 73 (42.2) 4 (44.4) 348 (63) 100 (57.8) Have Children? No Yes 40 (64.5) 242 (36) 22 (35.5) 430 (64) < Married No Yes 265 (37.5) 17 (63) 442 (62.5) 10 (37) <

Table 2:Factors associated with FP uptake (2) N= VariableFP uptakeP valueUnadjustedAdjusted No Freq (%) Yes Freq (%) OR95%CI OR 95%CI Education level None Primary Secondary Post Secondary 26 (36.6) 164 (38.4) 87 (38.8) 5 (41.7) 45 (63.4) 263 (61.6) 137 (61.2) 7 (58.3) Income Mean (std) Median (IQR) (9873.7) 8000 ( ) (9577.4) 6000( ) 0.55 Alcohol intake No Yes 97 (36.9) 185 (39.3) 166 (63.1) 286 (60.7) Regular Partner No Yes 148 (42.5) 134 (34.7) 200 (57.5) 252 (65.3)

Conclusion & Recommendations The contraception prevalence rate in this study is slightly higher than the national prevalence in Kenya. Those with children were almost 5 times as likely to be on FP compared to those without children Older age and being married were found to be associated with low uptake of FP services. Focused counseling messages should be developed to target FSWs who are older, married and those with no children. Effort should also be geared towards provision of long acting FP methods. 8

Acknowledgements All the participants who participated in this study. Staff at Moi University PIPS clinic for their support. EDCTP for funding the study. THANK YOU 9