The HIV prevalence reported in this study is similar to earlier reports in Kitale district hospital and other health facilities used as sentinel surveillance sites for HIV and STDs prevalence in Kenya [2, 3]. In the current study, the overall HIV prevalence was 6.7% with Kitale district hospital having the highest (15.3%) followed by Kapsabet and South Nandi Hills district hospitals (3.4% and 2% respectively). In 2001, 2002, 2003 and 2004, the HIV prevalence in Kitale district hospital was 13%, 16%, 11% and 7% respectively among antenatal attendees . The disparities in HIV prevalence in the hospitals may be due to differences in urbanization, ethnic groups and economic activities in the specific areas but further studies are required to elucidate the reasons in details.
The highest proportion of HIV infected women was in the age group 21–25 years (35.5%). This peak age group differed from the report of a demographic health survey carried out in 2003 where the peak was in 25–29 years (13%) among women .
In this study, it was found that women in a polygamous marriage had a higher HIV positivity than those in monogamous union (p = 0.000). This suggests that polygamy is a risk factor for HIV-1 infection. However, it should be noted that marital status was self-reported and the study did not specifically request for information on multiple partners. Despite this limitation in our study, it has clearly shown that there is a relationship between HIV status and marital status. This finding is in agreement with previous reports where susceptibility and vulnerability to HIV/AIDS was attributed to marital and family status [4, 5].
In the current study, there was no statistical significance between the level of education and HIV infection (p = 0.653 and p = 0.469 for secondary and tertiary education respectively). This differed from previous reports where higher levels of education were associated with a higher HIV seroprevalence . However, some serial cross-sectional studies have found greater reductions in HIV prevalence among the more educated groups, especially in cohorts of young adults [7, 8]. These findings suggest that there is a shift in the association between education level and HIV infection.
Among the pregnant women whose CD4 count was determined, 39 (14%) had less than 200 cells per cubic millilitre. As per the current Ministry of Health guidelines on ARV therapy, all these women (39) should be on antiretroviral treatment . However, this study has established that nine of these women are on ARVs, suggesting that there are still major challenges in access of ARVs for those who need them. Such a population would therefore be missing the benefits of timely introduction of HAART, such as the reported threefold reduction of AIDS incidence when HAART is administered to patients with CD4 cell counts below 200 cells/mm3 .
It is important to critically evaluate the results and the whole study. The present study has certain limitations that need to be taken into account. The first major limitation is that it was part of a larger study looking into drug resistant HIV genotypes and their effect on prophylaxis against HIV vertical transmission. In this regard, there are other socioeconomic factors such as acres of land owned, number of animals and cultivated farmlands that were not include in the current study. The intricate relationship between poverty and HIV has been shown to be a vicious cycle in response to HIV pandemic. While increasing poverty levels fuel the spread of HIV, the pandemic itself exacerbates those levels in households and families with people living with HIV/AIDS . The limitations of this study bring forth some fruitful and interesting possible avenues for future research that might be needed in relation to the theme of the study.