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Utilization of sexual and reproductive health services among young people living with HIV and attending selected HIV clinics in selected sub-counties of Nairobi, Kenya

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July 3, 2024

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https://doi.org/10.12688/openreseurope.17611.1

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July 25, 2025 (Version of Record 1.0)
July 3, 2024 (Published Manuscript Under Review 1.0)

European & Developing Countries Clinical Trials Partnership

Grant ID(s): CSA2020E-3129

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HIV, sexual reproductive health, youth, adolescent, health services

Abstract

Background

Young people living with HIV in Sub-Saharan Africa account for the largest proportion of the vulnerable population in the world. Kenya has little evidence to showcase the utilization of sexual and reproductive health services among young people living with HIV. Nairobi County has one of the highest HIV burdens among adolescents and youth in the country. Consequently, assessing the factors associated with the utilization of sexual and reproductive health services among young people aged 15–24 years living with HIV motivates this study.

Methods

A health facility-based cross-sectional study design with convergent parallel mixed methods technique was used. Purposive sampling with predetermined criteria was used to select six high-volume public health facilities in six high-burden sub-counties of Nairobi. A total of 253 participants completed the semi-structured questionnaires on utilization and associated factors.12 purposively selected healthcare workers were in key informant sessions on their perception of young people’s utilization. Stepwise binary logistic regression was used to analyse the quantitative data using Stata version 14. NVivo software was used to code and thematically analyse the data.

Results

47 % of the participants had utilized the services. Collection of condoms (45.7%) was the most utilized while treatment of sexually transmitted infections (8.2%) was the least utilized services. Female sex (AOR: 3.60 95%, Cl: 1.67-6.40), increase in age (AOR: 2.27 95%, Cl: 1.1C-4.65), HIV status disclosure to a sexual partner (AOR: 2.00 95%, Cl: 1.11-3.80) and privacy for sexual and reproductive health services at a health facility (AOR: 3.27 95%Cl: 1.42-7.60) were factors significantly associated with utilization.

Conclusions

Although this vulnerable population has frequent contact with healthcare providers, utilization of sexual and reproductive services is low. Stakeholders are recommended to put more emphasis on behavioural interventions to promote male involvement and HIV disclosure to sexual partners.

Corresponding author

Nomsa Phiri

0009-0006-7362-289X

nphirimd@gmail.com

Grant information

This research was funded by the Second European and Developing Countries Clinical Trials Partnership (EDCTP2) supplied by the European Union’s Horizon Europe research and innovation programme under grant agreement No CSA2020E-3129 (Strengthening capacity for epidemic preparedness and response in sub-Saharan Africa [SCEPRESSA]).

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

This work is licensed under a Creative Commons Attribution 4.0 International License.

First version published

July 3, 2024 (https://doi.org/10.12688/openreseurope.17611.1)

Latest version published

July 25, 2025 (https://doi.org/10.12688/openreseurope.17611.2)

Introduction

More than 50% of young people aged 15–24 globally have unmet needs in sexual and reproductive health yet more than 4 million of this population are living with HIV (Stackpool-Moore et al., 2017). Young people living with HIV in Sub-Saharan Africa account for the largest proportion of the vulnerable population in the world (UNAIDS, 2020). The rate of increase in poor sexual reproductive health outcomes experienced by young people in sub–Saharan Africa is quite concerningly high (Odo et al., 2018). The high incidence of poor sexual and reproductive health outcomes among the youth is due to the underutilization of sexual and reproductive health services (Erhabor et al., 2013). The poor outcomes include an increased risk of sexually transmitted infections, unintended pregnancies and abortions. The complication of poor sexual health is a leading cause of death among young people (Thongmixay et al., 2019). The consequences of poor sexual and reproductive health utilization outcomes are more compounded for young people living with HIV compared to their peers.

It has been recognized that the creation of a conducive environment leads to more effective health outcomes and interventions (WHO, 2017). This is why sexual and reproductive health for young people living with HIV has emerged as a global public health concern (Mkumba et al, 2021). Although there is global awareness of the importance of sexual and reproductive health and its services, there has been difficulty in promoting it, especially in middle- and low-income countries (Mkumba et al, 2021). There is currently a paucity of data on implementation of monitoring on how services like sexual and reproductive services for young people living with HIV are integrated and utilized in Africa (WHO, 2019).

Even though young people in general have been reported to have similar frequencies of sexual activities as their peers living with HIV, young people living with HIV face additional burden of factors that influence the utilization of these services. There are a variety of factors that influence the usage of sexual and reproductive services. Individual factors that can influence the uptake of sexual and reproductive services include education level, sexual history family support system, and religious and cultural background. Sociocultural beliefs around young people’s sexuality and gender inequality as barriers to utilizing sexual and reproductive health services (Stackpool-Moore et al., 2017). Health system factors that influence the uptake of sexual and reproductive health services include the attitude of the healthcare staff, communication skills and training of the health staff, and availability of sexual and reproductive health commodities (Erhabor et al, 2013).

In response to the global campaign Kenya has favourable policies that promote sexual and reproductive rights. The policies include the constitution (2010), the National youth policy (2007) and the national adolescent sexual and reproductive health policy 2016. Despite the guidelines, Kenya has little evidence to showcase the utilization of the services among the young population especially adolescents and young people living with HIV (USAID, 2011). Nairobi County has one of the highest HIV burdens among adolescents and youth in the country. There is a paucity of literature on Nairobi County yet it’s one of the counties in Kenya with the highest number of young people living with HIV (National AIDS Control Council, 2018). To fill this gap, primary data collection and analysis were investigated on utilization of sexual and reproductive services among young people living with HIV aged 15–24 in Nairobi County. This paper focuses on assessing the determinants of utilization of sexual and reproductive health services among young people living with HIV in Nairobi County. This study expands on the current knowledge base of understudied utilization of sexual and reproductive services among young people living with HIV.

Methods and materials

Study design

This was a health facility based cross-sectional study design with mixed method convergent parallel technique that was conducted in Nairobi between 1–30^th June 2023.

Study setting

The study was conducted in Nairobi, the capital city of Kenya. Nairobi is one of the 47 counties of Kenya. It has 17 sub counties. It is situated in the south-central part of the country at an elevation of about 5500 feet (Kenya National Bureau of Statistics, 2023). It is one of the top counties leading with a high number of young people with HIV. It was estimated to be 24,918 young people living with HIV (National AIDS Control Council, 2018).

Participants

The study population was young people aged 15–24 years living with HIV, residing in Nairobi and attending HIV clinics.

Inclusion criteria

a) The youth must be aged 15–24 years

b) Provide signed informed consent for those above 18 years

c) Provide written parental consent and assent for those below 18 years

d) Must have a documented HIV positive status

Exclusion criteria

a) The youth that are mentally incapacitated to answer the study questions

b) The youth that are too sick to answer questions at the time

c) Youth who have been less than a month in HIV clinic after HIV diagnosis was made

Sampling technique

Multistage sampling was used. Out of 17 sub-counties, there are six high burden HIV sub-counties which are contributing 50% of the total population of young people living with HIV. In each subcounty, a government health facility was selected. Thus, six health facilities were selected. The criteria for selection will include the presence of comprehensive care clinic services (HIV clinics), the volume of the study population attending the clinic and the distribution of the catchment areas involved. Sampling proportional to size was used to determine exact numbers per facility.

Systematic random sampling was used at the health facility level. A pre-existing register list from the HIV clinics was used to create a sampling frame of all clients who were within the required age range. A random starting point on the sampling frame was selected, and consecutive participants were selected at a fixed interval.

Purposive sampling techniques were used to select health care 12 providers that are involved in treatments and managers of the six selected comprehensive care clinics (HIV clinics) in the six selected sub counties.

Sample size calculation

The sample size for the quantitative arm calculated was 253. Calculations was done using the prevalence of 32.8 % by a similar study in Ethiopia (Amaje et al., 2022) at 95% (confidence), Z = 1.96 where p = 0.328 (prevalence) e= 0.05 (the margin of error).

Data collection methods and tools

Trained interviewers used pretested semi structured questionnaires to conduct the face to face interviews. The interviews took place in a private location of the selected HIV clinics and lasted about 30–45 minutes. Four weeks were needed for recruitment and to collect data from participants in the month of June 2023. All young people fitting the criteria were then approached face to face for interviews. Written informed consent was obtained before participation. Informed parental and assent consent was obtained for those who were underage.

The pretested semi structured questionnaire included sociodemographic, sexual, behavioral and facility factor questions. Sociodemographic variables included age, sociocultural, orphan status and socioeconomic status. The variables in the sexual behavior section included age at sexual debut, number of sexual partners in the last 12 months, type of current partner, disclosure of HIV status, partners’ HIV status, history of sexually transmitted infections and contraception use. The facility-level questions focused on privacy for services, physical access, the attitude of the health workers and the availability of commodities.

Regarding the key informant sessions for the healthcare providers, they were conducted by the lead author with prior experience of conducting interviews. The face-to-face interviews took place in a quiet place of the selected HIV clinic and written informed consent was obtained before participation. This also involved obtaining consent for audio recordings to be done. The interviews lasted 30–40 minutes. The interview guides had open-ended questions that focused on healthcare workers’ perception on sexual reproductive services utilization and associated factors among the youth living with HIV. Data saturation concluded interview sessions.

Data processing and data analysis

Quantitative data was exported to data analytical software Stata version 14. Data cleaning and data coding was done. Descriptive statistics was used to describe the respondent baseline data, including sociodemographic profile information, sexual behavioral profile information, and level of sexual and reproductive utilization validated by the type of service used. The outcome variable utilization was coded “non-utilization” if one used 0-1 service in the last 6 months and “utilization” if one used the service more than once in the last 6 months. This was adapted from a study by Akerman et al. (2016).

Since the outcome variable was binary in nature, binary logistic regression was used to determine the association between the independent variables and dependent variable. Independent variables that were statistically significant at 95% confidence in univariate analysis and p value of less than 0.05 were taken for multivariate step wise regression analysis.

For qualitative data, audio recordings were transcribed verbatim to generate transcripts. NVivo version 14 was used to thematically analyze the transcripts. The responses from the open-ended questionnaires were analyzed using thematic analysis in NVivo version 14.

Ethical clearance and consent statement

Ethical approval and a research permit were sought before the start of this study. The ethical clearance to conduct the study was obtained from the ethical review committee of the Jomo Kenyatta University of Agriculture and Technology ethical review committee (JKU/2/41896B) on 25^th April 2023. A research permit was sought and obtained from the National Commission for Science Technology and Innovations (NACOSTI/P/23/25733) on 11^th May 2023. Nairobi county approval (NCCG/FHS/REC/364) and respective sub-county administrative approvals were obtained on 19^th May 2024. Administrative approvals from the respective hospitals for recruiting the study participants were obtained as well. All participants aged 18 years of age and above provided written informed consent before participating. For participants below 18 years old, written informed consent from their parents and assent from the participants were obtained. Healthcare workers who participated in the key informant session provided written informed consent before participation. The informed consent process ensured full disclosure of study objectives, voluntary participation, study risks and benefits as well as results dissemination. To ensure privacy, data was stored in a password-protected drive accessible only to the lead author.

Results

The sociodemographic characteristics of the participants

253 participants were interviewed for this study. All questions were filled and answered. This demonstrated 100 % response rate. The Table 1 shows the sociodemographic of the respondents.

Table 1. Sociodemographic characteristics of participants.

Variables	Category	Frequency	Percentage %
Age category	15–19 years	86	33.99
Age category	20–24 years	167	66.01
Sex	Male	79	31.23
Sex	Female	174	68.77
Marital status	Single	206	81.42
	Married	37	14.62
	Separated	10	3.95
Education status attained	Never been to school	28	11.07
	Primary	26	10.28
	Secondary	117	46.25
	Tertiary	75	32.24
Current school status	No	139	54.94
Current school status	Yes	114	45.06
Religion	Catholic	96	37.94
	Muslim	36	14.23
	Protestant	105	41.5
	Traditional	8	3.16
	No religion	8	3.16
Employment status of parents	No	100	39.53
Employment status of parents	Yes	153	60.47
Occupation of parents	Formal employment	35	22.88
	Casual labourer	37	24.18
	Self-employment/business	69	45.1
	Farmer	9	5.88
	Other	3	1.96
Employment Status of Respondents	No	163	64.43
Employment Status of Respondents	Yes	90	35.57
Occupation of respondents	Formal employment	22	24.44
	Casual laborer	36	40
	Self-employment/business	31	34.44
	Farmer	1	1.11

The ages of the participants ranged from 15–24 with a mean of 20 (Standard deviation 2.7). The majority (66.01%) of the participants were in the 20–24 age group. The majority (68%) of the participants were female. Out of 253 participants, 81.4% (206) were single, 14.6% were married and 3.95% were separated.

The sexual behavioural profile of the participants

Table 2 shows the sexual behavioral profile of the participants. The mean sexual debut age of the respondent is 17.51 (Standard deviation 2.25). The majority (91.70%) of the participants have ever had sexual relationship. Out of 232 sexually active participants, 69.40% had one partner in the last 12 months, 18.10% had two partners, 10.34% had more than two partners, and 2.16% of the sexually active had zero partners in the last 12 months.

Table 2. Sexual behavioural profile of the respondents aged 15–24 years old living with HIV, Nairobi Kenya.

Variables	Category	Frequency	Percentage %
Ever had sexual relationship	No	21	8.30
Ever had sexual relationship	Yes	232	91.70
Number of sexual partners in last 12 months	One	166	71.55
	Two	42	18.10
	More than two	24	10.34
Type of current partner	Casual	206	81.42
	Regular	37	14.62
	Married	10	3.95
Disclosure of HIV status	Partner knows	92	39.66
Disclosure of HIV status	Partner doesn’t know	140	60.34
Partner ‘s HIV status	Unknown	139	59.91
	Positive	41	17.67
	Negative	52	22.41
HIV transmission concerns	Yes	52	22.41
HIV transmission concerns	No	180	77.59
Sexually transmitted infections in last 12 months	No	203	87.50
Sexually transmitted infections in last 12 months	Yes	29	12.50
Obtained treatment for above STIs	Yes	19	65.52
Obtained treatment for above STIs	No	10	34.48
Pregnancy history	Previous pregnancy	45	19.40
	No previous pregnancy	139	59.91
	Made someone pregnant	8	3.45
	Never made anyone pregnant	40	17.24

At the time of the interview, the majority (81.42%) stated they had a casual partner, 14.62% had a regular partner, and 3.95% were married to their partners. On disclosure of HIV status, 54.74% of the respondents stated their partners are not aware of their status. 42.24% stated they had disclosed their HIV status to their partners while 7 respondents (3.02%) did not have a partner at the time of the interview.

When it came to knowing the HIV status of the partner, 133 (58.85%) of the respondents stated partner’s status was unknown, 23.01% stated partner’s status was negative and 18.14 % knew of positive HIV status of their partners.

Participants were asked if they have HIV transmission concerns; 77.59% of the participants reported they had no transmission concerns while 22.41% had HIV transmission concerns. Regarding sexually transmitted infections in the last 12 months, 12.50% had an infection while 203 (87.50%) did not have an infection.

Utilization of sexual reproductive services

The outcome variable utilization was coded non utilization if one used 0-1 services in the last 6 months and utilization if one used more than 1 in the last 6 months.

52.96 % (134) of the participants did not utilize the services while 119 (47.04%) utilized the services. Table 3 shows the same information below.

Table 3. Level of utilization among participants aged 15–24 living with HIV in Nairobi Kenya.

Variables	Category	Frequency	Percentage
Utilization	non utilization	134	52.96
	utilization	119	47.04

The types of sexual and reproductive services utilized

The utilization of sexual and reproductive services was validated by the type of sexual and reproductive services used. Sexual and reproductive health counselling services (42.5%) and collection of condoms (45.7%) were the most utilized while treatment of sexually transmitted infections (8.2%) was the least utilized. This is represented by Figure 1.

Figure 1. Sexual reproductive services utilized by young people living with HIV, Nairobi.

Factors associated with the Utilization of Sexual Reproductive Health Services

Utilization of sexual and reproductive services has significant association with independent sociodemographic variables; age, sex, marital status and current school status. This was evident in Table 4.

Table 4. Sociodemographic factors associated with the utilization of sexual and reproductive health services among young people living with HIV aged 15–24 years in Nairobi, Kenya (binary logistic regression).

Variables		P value	OR (95% Cl)
Age Category	15–19 years		ref
	20–24 years	0.00*	3.4(1.94-5.97)
Sex	Male		ref
Sex	Female	0.01*	2.5(1.44-4.44)
Marital status	Single		ref
	Married	0.00*	3.16(1.48-6.75)
	Separated	0.65	1.34(0.38-4.77)
Education status attained	Never been to school		(ref)
	Primary	0.74	0.83(0.28-2.47)
	Secondary	0.60	1.25(0.54-2.86)
	Tertiary	0.52	1.30(0.54-3.09)
Current school status	No		ref
Current school status	Yes	0.03*	0.60(0.34-0.94)
Religion	Catholic	0.73	1.29(0.29-5.73)
	Muslim	0.18	2.94(0.60-14.38)
	Protestant	0.69	1.35(0.31-5.94)
	Traditional	0.62	1.67(0.23-12.21)
	No religion		ref
Employment status of parents	No		Ref
Employment status of parents	Yes	0.30	0.77(0.47-1.27)
Occupation of parents	Formal employment	0.06	2.5(0.95-6.44)
	Casual labourer		ref
	Self-employment/business	0.21	1.70(0.74-3.92)
	Farmer	0.21	2.60(0.59-11.48)
	Other	0.97	1.04(0.09-12.65)
Employment Status of Respondents	No		ref
Employment Status of Respondents	Yes	0.80	1.58(0.94-2.67)
Occupation of respondents	Formal employment	0.74	1.2(0.41-3.48)
	Casual labourer	ref
	Self-employment/business	0.36	1.58(0.60-4.19)
	Farmer		1

*Notes: * - statistically significant at 5% level (p<0.05, OR- Odds Ratio

Older youth are more likely compared to younger youth to utilize sexual and reproductive services (Crude odds ratio 3.4, p value = 0.00). Married young people are 3 times more likely to utilize sexual and reproductive health services compared to their single youth peers (Crude odds ratio 3.16, p value = 0.00). Female youth have 2.5 higher odds of utilizing sexual and reproductive services compared to male youth (Crude odds Ratio 2.5, p value = 0.01).

The quantitative variables converge with the qualitative findings. It was expressed among the young participants that sexual and reproductive services were for married people and females only.

“Am not married to seek these reproductive services” Participant dh001

“Most services are targeted for females” – Participant dh034

“… girls come in more often than boys... girls even come in for condoms for their boyfriends…” key informant interview 03

Utilization of sexual and reproductive services has significant association with independent sexual behavioral variables; type of current sexual partner, disclosure of HIV status to sexual partner, HIV transmission concerns and use of family planning method. This was evident in Table 5.

Table 5. Analysis of sexual behavioral factors associated with the utilization of sexual and reproductive health services among young people living with HIV aged 15–24 years in Nairobi, Kenya (binary logistic regression).

Variables	Category	P value	OR (95%Cl)
Number of sexual partners in last 12 months	One		ref
	Two	0.73	1.12(0.57-2.21)
	More than two	0.23	1.70(0.70-4.11)
Type of current partner	Casual		ref
	Regular	0.07	1.70(0.96-2.98)
	Married	0.00*	3.42(1.51-7.74)
Disclosure of HIV status	Partner knows	0.00*	2.78(1.61-4.81)
Disclosure of HIV status	Partner doesn’t know		ref
Partner ‘s HIV status	Unknown		ref
Partner ‘s HIV status	Positive Negative	0.03* 0.17	2.20(1.06-4.58) 1.56(0.81-2.98)
HIV transmission concerns	Yes	0.00*	2.78(1.60-4.81)
HIV transmission concerns	No		ref
Family planning method	Condom use	0.00*	3.34(1.85-6.04)
	Non-barrier family planning method	0.01*	2.71(1.18-6.20)
	No family planning method		ref
Pregnancy history	Previous pregnancy	0.19	1.5(0.79-3.13)
	No previous pregnancy		Ref
	Made someone pregnant	0.17	0.31(0.62-1.63)
	Never made anyone pregnant	0.50	0.78(0.38-1.58)

*Notes: * - statistically significant at 5% level (p<0.05), OR- Odds Ratio

Youth with regular partners are 70 % more likely to utilize sexual and reproductive health services compared to their single youth peers (Crude odds ratio 1.70, p-value = 0.07). Youth married to their sexual partners are 3 times more likely to utilize sexual and reproductive health services compared to their single youth peers (Crude odds ratio 3.42, p-value = 0.00). Youth who disclosed their HIV status to their sexual partner have 2.78 higher odds of utilizing sexual and reproductive services compared to the youth who did not disclose their HIV status. (Crude odds Ratio 2.78, p-value = 0.00). Youth who use non-barrier methods like hormonal pills are 2.71 more likely to utilize sexual and reproductive services compared to those who do not use methods. (Crude odds ratio 2.78, p value = 0.00). Youth who use condoms have 3.34 higher odds of utilizing sexual and reproductive services compared to the youth who do not. (Crude odds ratio 3.34, p-value = 0.00).

The health care workers had also stated that failure in disclosure of HIV status to the sexual partner is regarded as barrier to accessing sexual and reproductive health services.

“There is fear of disclosure among the young people and mingling with the opposite sex because they do not wish for their partners to know if they are infected so they wouldn’t come for the services together” – Key informant interview 07

Health care workers noted that there was a lack of safety transmission concerns among the young people living with HIV and the participants too reported that they had no sexual health concerns

“There are no sexual and reproductive concerns” – Participant ML005

“I [do] not [have] any concerns in the last 6 months” – Participant ML019

Utilization of sexual and reproductive services has a significant association with facility-level variables; privacy at the facility, the attitude of the healthcare staff, convenient location of facility and availability of commodities. This was evident in Table 6.

Table 6. Analysis of facility factors associated with the utilization of sexual and reproductive health services among young people living with HIV aged 15–24 years in Nairobi, Kenya (binary logistic regression).

Variables		OR (95%Cl)	P value
The facilities are conveniently located and available	Strongly agree/ Agree	5.41(2.32-12.60)	0.00*
	Neutral	2.00(0.79-5.08)	0.14
	Strongly disagree / disagree	ref
The sexual reproductive health services are in private	Strongly agree/ Agree	5.87(3.01-11.54)	0.00*
	Disagree/strongly disagree	Ref
	Neutral	1.67(0.78-3.60)	0.19
The staff have a welcoming attitude towards youth seeking sexual reproductive services	Strongly agree/ Agree	3.5(1.45-8.47)	0.00*
	Disagree/strongly disagree	Ref
	Neutral	1.25(0.49-3.20)	0.64
Commodities for sexual reproductive services are available	Strongly agree/ Agree	2.70(1.41-5.20)	0.00*
	Neutral	0.90(0.40-1.94)	0.79
	Strongly disagree / disagree	ref

*Notes: * - statistically significant at 5% level (p<0.05), OR-Odds Ratio

Youth who had positive attitudes (strongly agree/ agree) about the healthcare staff having a welcoming attitude and are more likely to utilize sexual and reproductive health services compared to their peers who had negative attitudes (strongly disagree/ disagree) (Crude Odds= 3.5, p-value = 0.00).

The findings from the key informant interview also support that the attitude of the health care workers affecting the utilization of sexual and reproductive health services.

“Initially, there was a lot of negativities especially for the adolescents to get the services but with continuous mentorship and health education there is much improvement among the health care providers and I can say there is a lot of positivity” - Key informant 05

Youth who positively felt that the facilities are conveniently located and available are 5.4 more likely to utilize the services compared to those who negatively felt about the location (Crude Odds ratio 5.41, p-value = 0.00).

Youth who had positive experiences (strongly agree/ agree) about commodities are available and are more likely to utilize sexual and reproductive health services compared to their peers who had negative attitudes (strongly disagree/disagree) (Crude Odds= 2.71, p-value = 0.00).

The qualitative findings also support the above findings. The key informants stated the presence or absence of commodities did influence the utilization of sexual and reproductive services among young people living with HIV. They also stated this problem is not a persistent problem.

“Of course, there have been stockouts… That’s what hinders services…. for instance, one wants to come for the family planning services… the implants are not available so they go home unattended to. But it happens once in a while… on and off.” - Key informant 03

Youth who positively felt that the facilities offer sexual and reproductive services in private are likely to utilize the services compared to those who negatively felt about the location (Crude Odds ratio 5.87, p-value = 0.00). Statements from the open-ended questions also have consistent findings on the same. Lack of privacy was among the reasons the young people living with HIV did not access the services.

“I do not use it because there is no space designed for youth in the facility to access the services”

- Participant PM024

Female sex (AOR: 3.26 95%Cl: 1.67-6.40), increase in age (AOR: 2.30 95%Cl: 1.11-4.65), HIV status disclosure to a sexual partner (AOR: 2.00 95%Cl: 1.11-3.80) and privacy for sexual reproductive health services at a health facility (AOR: 3.27 95%Cl: 1.42-7.60) were factors significantly associated with utilization in multivariate regression. This is evident in Table 7.

Table 7. Analysis of factors associated with the Utilization of Sexual Reproductive Health Services among young people living with HIV aged 15–24 years in Nairobi, Kenya (Stepwise binary logistic regression, best fit mode.

Variables	Category	COR (95%Cl)	AOR	P value
Sex	Male	ref	ref
Sex	Female	2.50 (1.45-4.44)	3.26(1.67-6.40)	0.00*
Age groups	20–24 years	3.40(1.94-5.97)	2.27(1.11-4.65)	0.03*
Age groups	15–19 years	ref
Currently in school	No	ref
Currently in school	Yes	1.10(.60-2.024)
Marriage status	Married	3.16(1.48-6.75)
	Single	Ref
	Separated	1.34(0.38-4.77)
Disclosure of HIV status	Partner knows	2.78(1.61-4.81)	2.00(1.11-3.80)	0.04*
Disclosure of HIV status	Partner doesn’t know	ref	ref
HIV transmission concerns	Yes	2.78(1.60-4.81)
HIV transmission concerns	No	ref
The facilities are conveniently located and available	Strongly agree/ Agree	5.41(2.32-12.60)	1.16(0.65-5.22)	0.80
	Neutral	2.00(0.79-5.08)	1.20(0.36-3.83)	0.80
	Strongly disagree / disagree	ref
The sexual reproductive health services are in private	Strongly agree Agree	5.87(3.12-11.54)	3.27(1.42-7.60)	0.01*
	Disagree/strongly Disagree	Ref
	Neutral	1.67(0.78-3.60)	1.40(0.98-5.60)	0.48
The staff have a welcoming attitude towards youth seeking sexual reproductive services	Strongly agree/ Agree	3.5(1.45-8.47)	2.35(0.83-6.60)	0.11
	Disagree/strongly disagree	Ref
	Neutral	1.25(0.49-3.20)	1.40(0.44-4.41)	0.57
Commodities for sexual reproductive services are Available	Strongly agree/ Agree	2.70(1.41-5.20)	2.20(0.76-6.38)	0.05
	Neutral	0.90(0.40-1.94)	2.34(0.98-5.60)	0.14
	Strongly disagree / disagree	ref

*Notes: * - statistically significant at 5% level (p<0.05) , COR -Crude Odds Ratio, ADR- Adjusted Odds Ratio

Discussion

This study aimed at determining factors associated with sexual and reproductive service utilization among young people living with HIV. This is an essential component in the health agenda for combating HIV transmission. Only 47.04% of young people living with HIV had utilization where they used one or more services in the last 12 months. This is below the expected standard given that these young people are in frequent contact with the health care system. A study in Ethiopia done by Motuma et al. (2016) had higher rates of utilization (64%). Studies in western Kenya by Embleton et al. (2023) and Abdurahman et al. (2022) had lower rates (36%) and 23% compared to our findings. This variation could be attributed to different settings of the study area as the health system. Other reasons could be differences in baseline respondents' backgrounds and time references used in the definition of SRH service utilization.

A variety of studies used different types or mixes of services to define youth-friendly sexual and reproductive services. The World Health Organization's definition of youth-friendly services includes family planning, voluntary counselling and treatment of sexually transmitted infections. This study did not examine voluntary testing as the study population was young people living with HIV. A cross-sectional study done by Amaje et al. (2022) had more components of sexual and reproductive services than this study; they used 8 components. The study however had similar ratings of the first three services compared to our study findings; sexual and reproductive health counselling (59.40%), condom collection (55.70%) and family planning (51.40%).

Sociodemographic variables that were found to have significant association after controlling for confounders were age and sex. Age was found a significant sociodemographic factor associated with utilization among young people living with HIV as evidenced by tables from the results section. Older youth (age category) are more likely to utilize the services compared to their younger peers. This finding is similar to findings to a mixed-method cross-sectional done in India by Banerjee et al. (2023). Females are more likely to have higher utilization rates compared to males (AOR: 3.30 95% Cl: 1.67-6.40). This is due to the perceived consequences females face such as unplanned pregnancy. These findings are similar to the results of the previous cross-sectional studies done in Ethiopia and a mixed method study in Nigeria (Odo et al., 2021; Zepro et al., 2023). This emphasizes the need for addressing sex specific needs according to different settings.

Though not in the final model, marital status is a sociodemographic variable worth noting. Married youth were more likely to utilize the services compared to those who were not married (COR:3.16 95% CL 1.48-6.75). Qualitative data from the opened questions also converged with these findings. Qualitative data from a study in Nigeria had consistent findings as well: it was a cultural belief that these services are taboo for unmarried people (Odo et al., 2021). Designing the services in a way that appreciates the unique characteristics of unmarried people is essential.

Among the sexual behavioral factors, HIV status disclosure to a sexual partner was a statically significant factor in the final model (AOR: 2.00 95% Cl: 1.11-3.80). Those who disclosed their status to their sexual partner have higher odds of utilizing the services. A study in South Africa conducted by Mengwai et al. (2020) reported disclosure to sexual partners as a predictor of sexual services utilization. Studies in Ethiopia and Kenya have similar findings with this (Mulongo et al., 2017; Tewabe et al., 2020). This highlights that open disclosure of HIV status facilitates open communication about sexual and reproductive health and the use of its services. However, this is in contrast to a previous study done in Ethiopia (Berhane et al., 2013). More than 50% of YPLWH reported low levels of HIV status disclosure to their sexual partners. Furthermore, many of them are not aware of their partner’s HIV status either (Ndongmo et al., 2017).

There is an association between facility-level factors and the utilization of sexual and reproductive health services. Health facility-level factors such as the attitude of the health care providers, privacy and availability of commodities were found to be predictors of the use of the services in both qualitative and quantitative findings. This is in convergence with information from a previous study from Nigeria where the qualitative data stated major barriers to utilization include the attitude of the health care providers and lack of privacy (Odo et al., 2021).

The attitude of healthcare workers is an important determinant that influences the utilization of youth-friendly sexual and reproductive services (Pettitt et al., 2013). This supports our findings in quantitative and qualitative arms. A mixed-method study in Kenya by Mulongo et al. (2017) stated negative attitudes of the health workers toward young people living with HIV limiting access to services. This could be due to intrapersonal beliefs and poor professional skills in handling the sensitivity of sexual health topics among young vulnerable populations.

Privacy concern is a key barrier to the utilization of sexual services. This was found in quantitative results that those who had positive attitudes that privacy was meant were more likely to utilize the services compared to those who had neutral and negative attitudes. Poor privacy setting and practices is a maker of poor-quality services (Robert et al., 2020). Previous studies in Uganda had similar findings to this study and reported service features that threaten privacy such as poor infrastructure of the health facility (Akatukwasa et al., 2019; Nalwadda et al., 2016).

Study limitations

The study encountered some limitations. Firstly, the data collection was based on primary data therefore utilization of sexual and reproductive services was based on self-reporting information. This can lead to underreporting and over reporting.

The school season also affected the distribution of the participants as many youths were in boarding school at the time the data collection was being conducted. The target population was from Nairobi County therefore generalization to the other counties of Kenya may not be possible.

Conclusion

53% of the participants had utilized services in the last 12 months at the time of the data collection. Those who were female, mature in age and had disclosed their HIV status to their sexual partners were more likely to utilize the services compared to their peers. Facility factors like commodity availability, privacy and attitude of the health care workers are important determinants as well. Though this vulnerable subpopulation has more frequent contact with health care service providers, the utilization of sexual and reproductive services is suboptimal and it can be improved.

Policymakers and practitioners should work towards developing interventions that are sensitive to gender differences to improve the utilization of sexual and reproductive services including health promotion of male involvement in sexual and reproductive health.

Sexual and reproductive programs should be implemented to have an age-appropriate and holistic approach that includes broader sexual and reproductive health and rights (SRHR) of young people living with HIV by engagement of youth champions.

Stakeholders also need to reconsider the reorganization of health facilities to promote privacy by extending operating hours, improving waiting and consultation areas.

List of abbreviations

HIV	Human immuno-deficiency virus
ARV	Antiretroviral therapy
STI	Sexually transmitted infections
SRH	Sexual and reproductive health
YPLWH	Young people living with HIV
WHO	World Health Organization

Data availability

Underlying data

Figshare: Utilization of Sexual Reproductive Health Services Among Young People Living with HIV attending Selected HIV clinics in selected sub counties of Nairobi, Kenya. https://doi.org/10.6084/m9.figshare.25880419 (Phiri, 2024)

The underlying data contains

anonymized raw data file (in both DTA and excel formats)
log file that contains codebook and regression multivariate model (DTA and PDF formats)

Extended data

The project contains the following extended data:

Questionnaire
Key informant interview guide

Data is available under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0).

Acknowledgements

The authors acknowledge the support from young people attending the selected HIV clinics as well as the support of the clinic staff in those selected facilities in Nairobi County.

Faculty Opinions recommended

References

Abdurahman C, Oljira L, Hailu S, et al.: Sexual and reproductive health services utilization and associated factors among adolescents attending secondary schools. Reprod Health. 2022; 19(1): 161. PubMed Abstract | Publisher Full Text | Free Full Text
Akatukwasa C, Bajunirwe F, Nuwamanya S, et al.: Integration of HIV-sexual reproductive health services for young people and the barriers at public health facilities in Mbarara Municipality, Southwestern Uganda: a qualitative assessment. Int J Reprod Med. 2019; 2019: 6725432. PubMed Abstract | Publisher Full Text | Free Full Text
Åkerman E, Östergren PO, Essén B, et al.: Knowledge and utilization of sexual and reproductive healthcare services among thai immigrant women in Sweden. BMC Int Health Hum Rights. 2016; 16(1): 25. PubMed Abstract | Publisher Full Text | Free Full Text
Amaje E, Daniel E, Tefera K, et al.: Utilization of youth-friendly reproductive health service and associated factors among youth in Aleta Wondo town, southern Ethiopia, 2020. SAGE Open Med. 2022; 10: 20503121221088089. PubMed Abstract | Publisher Full Text | Free Full Text
Banerjee A, Paul B, Das R, et al.: Utilization of adolescent reproductive and sexual health services in a rural area of West Bengal: a mixed-method study. Malays Fam Physician. 2023; 18: 26. PubMed Abstract | Publisher Full Text | Free Full Text
Berhane Y, Berhe H, Abera GB, et al.: Utilization of modern contraceptives among HIV positive reproductive age women in Tigray, Ethiopia: a cross-sectional study. ISRN AIDS. 2013; 2013: 319724. PubMed Abstract | Publisher Full Text | Free Full Text
Embleton L, Braitstein P, Di Ruggiero E, et al.: Sexual and reproductive health service utilization among adolescent girls in Kenya: a cross-sectional analysis. PLOS Glob Public Health. 2023; 3(2): e0001508. PubMed Abstract | Publisher Full Text | Free Full Text
Erhabor O, Adias T, Akani C: Reproductive health challenges of living with HIV-infection in Sub Saharan Africa. Curr Perspex HIV Infect. 2013; 325–348. Publisher Full Text
Mengwai K, Madiba S, Modjadji P: Low disclosure rates to sexual partners and unsafe sexual practices of youth recently diagnosed with HIV; implications for HIV prevention interventions in South Africa. Healthcare (Basel). 2020; 8(3): 253. PubMed Abstract | Publisher Full Text | Free Full Text
Mkumba LS, Nassali M, Benner J, et al.: Sexual and reproductive health needs of young people living with HIV in low-and middle-income countries: a scoping review. Reprod Health. 2021; 18(1): 219. PubMed Abstract | Publisher Full Text | Free Full Text
Motuma A, Syre T, Egata G, et al.: Utilization of youth friendly services and associated factors among youth in Harar town, east Ethiopia: a mixed method study. BMC Health Serv Res. 2016; 16: 272. PubMed Abstract | Publisher Full Text | Free Full Text
Mulongo AM, Lihana RW, Githuku J, et al.: Factors associated with uptake of dual contraception among HIV-infected women in Bungoma County, Kenya: a cross-sectional study. Pan Afr Med J. 2017; 28(Suppl 1): 2. PubMed Abstract | Publisher Full Text | Free Full Text
Nalwadda G, Mirembe F, Byamugisha J, et al.: Young peoples’ interface with providers of contraceptive care: a simulated client study in two Ugandan districts. Contracept Reprod Med. 2016; 1: 15. PubMed Abstract | Publisher Full Text | Free Full Text
Ndongmo TN, Ndongmo CB, Michelo C: Sexual and reproductive health knowledge and behavior among adolescents living with HIV in Zambia: a case study. Pan Afr Med J. 2017; 26: 71. PubMed Abstract | Publisher Full Text | Free Full Text
Odo AN, Samuel ES, Nwogu EN, et al.: Sexual and Reproductive Health Services (SRHS) for adolescents in Enugu state, Nigeria: a mixed methods approach. BMC Health Serv Res. 2018; 18(1): 92. PubMed Abstract | Publisher Full Text | Free Full Text
Odo AN, Ofuebe JI, Anike AI, et al.: Predictors of young people’s use of sexual and reproductive health services in Nigeria: a mixed-method approach. BMC Public Health. 2021; 21(1): 37. PubMed Abstract | Publisher Full Text | Free Full Text
Pettitt ED, Greifinger RC, Phelps BR, et al.: Improving health services for adolescents living with HIV in sub-Saharan Africa: a multi-country assessment. Afr J Reprod Health. 2013; 17(4 Spec No): 17–31. PubMed Abstract
Phiri N: Utilization of Sexual Reproductive Health Services among young people living with HIV attending selected HIV clinics in selected sub counties of Nairobi, Kenya. figshare. [Dataset] 2024. http://www.doi.org/10.6084/m9.figshare.25880419
Robert K, Maryline M, Jordan K, et al.: Factors influencing access of HIV and sexual and reproductive health services among adolescent key populations in Kenya. Int J Public Health. 2020; 65(4): 425–432. PubMed Abstract | Publisher Full Text | Free Full Text
Stackpool-Moore L, Bajpai D, Caswell G, et al.: Linking sexual and reproductive health and rights and HIV services for young people: the link up project. J Adolesc Health. 2017; 60(2S2): S3–S6. PubMed Abstract | Publisher Full Text
Tewabe T, Ayalew T, Abdanur A, et al.: Contraceptive use and associated factors among sexually active reproductive age HIV positive women attending ART clinic at Felege Hiwot Referral Hospital, Northwest Ethiopia: a cross-sectional study. Heliyon. 2020; 6(12): e05653. PubMed Abstract | Publisher Full Text | Free Full Text
Thongmixay S, Essink DR, Greeuw TD, et al.: Perceived barriers in accessing sexual and reproductive health services for youth in Lao people’s democratic republic. PLoS One. 2019; 14(10): e0218296. PubMed Abstract | Publisher Full Text | Free Full Text
Zepro NB, Ali NT, Tarr N, et al.: Sexual and reproductive health services use among adolescents in pastoralist settings, northeastern Ethiopia. BMC Health Serv Res. 2023; 23(1): 677. PubMed Abstract | Publisher Full Text | Free Full Text

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Research Article

Published

July 3, 2024

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https://doi.org/10.12688/openreseurope.17611.1

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July 25, 2025 (Version of Record 1.0)
July 3, 2024 (Published Manuscript Under Review 1.0)

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European & Developing Countries Clinical Trials Partnership

Grant ID(s): CSA2020E-3129

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HIV, sexual reproductive health, youth, adolescent, health services

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Nomsa Phiri

Department of Environmental Health and Disease Control, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Nairobi County, Kenya

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Corresponding Author, Co-Author, Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

0009-0006-7362-289X

nphirimd@gmail.com

Susan Mambo

Department of Environmental Health and Disease Control, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Nairobi County, Kenya

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Co-Author, Conceptualization, Funding Acquisition, Resources, Supervision, Validation, Writing – Review & Editing

susan.mambo@jkuat.ac.ke

Careena Otieno Odawa

Department of Community Health, Great Lakes University of Kisumu, Kisumu, Kisumu County, Kenya

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Co-Author, Conceptualization, Data Curation, Resources, Supervision, Validation, Writing – Review & Editing

0000-0002-4124-8411

otienocareena@gmail.com

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Utilization of sexual and reproductive health services among young people living with HIV and attending selected HIV clinics in selected sub-counties of Nairobi, Kenya

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