Changes in HIV-related behaviours, knowledge and testing among refugees and surrounding national populations: a multicountry study.

To our knowledge, there is currently no published data on the prevalence of risky sex over time as displaced populations settle into long-term post-emergency refugee camps. To measure trends in HIV-related behaviours, we conducted a series of cross-sectional HIV behavioural surveillance surveys among refugees and surrounding community residents living in Kenya, Tanzania and Uganda, at baseline in 2004/2005 and at follow-up in 2010/2011. We selected participants using two-stage cluster sampling, except in the Tanzanian refugee camp where systematic random sampling was employed. Participants had to reside in a selected household for more than weeks and aged between 15 and 49 years. We interviewed 11,582 participants (6448 at baseline and 5134 at follow-up) in three camps and their surrounding communities. The prevalence of multiple sexual partnerships ranged between 10.1 and 32.6% at baseline and 4.2 and 20.1% at follow-up, casual partnerships ranged between 8.0 and 33.2% at baseline and 3.5 and 17.4% at follow-up, and transactional partnerships between 1.1 and 14.0% at baseline and 0.8 and 12.0% at follow-up. The prevalence of multiple partnerships and casual sex in the Kenyan and Ugandan camps was not higher than among nationals. To our knowledge these data are the first to describe and compare trends in the prevalence of risky sex among conflict-affected populations and nationals living nearby. The large reductions in risky sexual partnerships are promising and possibly indicative of the success of HIV prevention programs. However, evaluation of specific prevention programmes remains necessary to assess which, and to what extent, specific activities contributed to behavioural change. Notably, refugees had lower levels of multiple and casual sexual partnerships than nationals in Kenya and Uganda and thus should not automatically be assumed to have higher levels of risky sexual behaviours than neighbouring nationals elsewhere.