Mbili Pamoja Dissemination Report held on 12^th August 2025

Facilitator-Felix Ochieng

Note taker-Patriciah Wambua

Venue-Anza Mapema

Date-12^th August 2025

Composition of the attendees.

A total of 15 staff members participated in the dissemination. The team comprised: one receptionist/records officer, two HTS counsellors, a hygiene officer, a field officer, a recruitment and retention officer, an activities coordinator, the programs manager, two clinicians, one attaché, two laboratory representatives, one transport officer, and one data officer.

Staff Dissemination Report

The dissemination session began with an overview of the study design, objectives, and progress. The three goals of the study were outlined, together with the eligibility criteria for participants, the study timeline beginning with baseline enrolment in 2024 up to the 12-month mark, and the number of participants enrolled in both Nairobi and Kisumu. The study procedures were also explained, including registration, ACASI/ACAPI interviews, medical history and examination, sample collection, HIV testing, and participant reimbursement.

Baseline findings showed that the prevalence of urethral and rectal chlamydia and gonorrhoea (CT/NG) was higher in Nairobi than in Kisumu. Staff were invited to give reasons for this difference, which generated active discussion. It was suggested that Nairobi’s larger population contributed to higher case numbers, and that people in Nairobi often had multiple partners. Others noted that Nairobi had many students who sought high-end clients, where clients often controlled sexual negotiations and resisted condom use. Age was also cited as an important factor, with participants in their mid-twenties described as being at the peak of sexual experimentation and activity.

Several explanations emerged. One participant noted, “The high population in Nairobi compared to Kisumu would automatically register higher numbers. Another possible reason linked to this is that due to the high demography in Nairobi, people tend to have many sexual partners, which leads to the high numbers in rectal and urethral CT/NG.” Another added, “Nairobi has many students who look for high-end clients who are not concerned about safe sex because they hold the higher power in sex negotiation.”

Staff reflections revealed important contextual insights. One participant explained that “Nairobi life is expensive; one must have money in order to survive. Regarding the STI issue, perhaps the study in Nairobi was conducted broadly; if, for example, most of the participants were already infected, that could affect the results. Nairobi itself is generally cold, and participants are afraid of being rained on. As a result, they might prefer to have sex indoors, which could be a reason for the rising rates of STIs compared to Kisumu.” Another participant shared that “STI infection whether in Nairobi or Kisumu is not equivalent to the number of sexual acts. What promotes STI infection is the number of infected individuals in that region regardless of how often they have sex.” Others observed that MSM in Nairobi appeared more informed and open about their status, encouraging each other to adhere to treatment and practice safe sex, while the opposite was more common in Kisumu.

In terms of age differences, one participant explained that “The 25–29 group is where participants are more financially stable and can negotiate for sex. This explains why urethral infections are significant in this age group.” Another participant stated that, “The age group that participated in this study are at the peak of experimenting sexually and are the most sexually active age group.” The following results showed a significant association between urethral STIs and the 25–29 age group. Participants reasoned, “This age group has high sexual excitement, tends to experiment with things like group sex, and may have sex while not sober.”

Across sites, patterns of behaviour and identity appeared to differ. Nairobi participants were described as more likely to be open about their sexual identity and willing to enrol in studies, with several prevention programs and social activities available to them throughout the week. Kisumu participants, by contrast, were described as more hesitant about procedures such as proctoscopy and included more bisexual men. Staff debated whether bisexuality increased or lowered the risk of HIV and STIs.

Methodological reflections also emerged, especially concerning the use of ACASI compared to CAPI. It was agreed that ACASI elicited more sensitive responses, particularly on sexual behaviour, though limitations such as social desirability bias and participants skipping questions were noted. One staff member reflected that “The ACASI time needs to be really considered. In the previous study ACASI was long, and people were even sleeping. Since no refreshments were given, participants learned skipping patterns to finish quickly.”

Discussions also touched on condom use and its limitations. Despite reports of condom use, staff questioned why participants still contracted STIs. The group agreed that factors such as not using condoms consistently throughout all rounds of sex, having multiple partners, and the possibility of oropharyngeal transmission from oral sex played a role.

The dissemination highlighted that while chlamydia decreased over time at both sites, gonorrhoea remained consistently higher in Nairobi. Antibiotic use was also more common in Nairobi, reflecting higher STI prevalence. Staff emphasized that sexual negotiation power, economic dynamics, and age strongly influence transmission patterns.

Other participants emphasized regional differences in interventions. One participant remarked, “Kisumu has better interventions to combat STI because it is the Nyanza region where there is a high prevalence of HIV. People here know they are at high risk and take extra caution, and many interventions are brought here.” This was contested by another who argued, “If that was so, then the cases of HIV would be significantly more in Nairobi than in Kisumu. We cannot always just assume that people in Nairobi are more sexually active compared to people in Kisumu.”

Sexual identity was also discussed, with one participant asking, “Could it be possible that Nairobi enrolled more gay men and less bisexual men, while Kisumu enrolled more bisexual men than gay men? People in Nairobi have embraced being gay openly and are not afraid to enroll in such studies, while in Kisumu people are still afraid to come out.” This question sparked debate about whether gay men are at greater risk of HIV/CT/NG than bisexual men. Opinions were divided, and the discussion expanded to sexual roles, asking whether men in Nairobi were more likely to identify as versatile, top, or bottom. No conclusive agreement was reached, as these factors were not part of the study eligibility criteria.

Other speculative explanations included environmental influences, with one participant suggesting, “The weather in Nairobi could be promoting more sexual acts that lead to the high numbers in urethral and anal CT/NG.” This triggered a long debate without a definitive conclusion.

In closing this section, a participant pointed out, “There is a high percentage in the use of antibiotics in Nairobi compared to Kisumu.” It was agreed that this reflected the higher STI burden in Nairobi, coupled with challenges in negotiating protected sex with high-end clients.

The dissemination highlighted critical differences between the two sites. Staff emphasized that sexual negotiation power, economic circumstances, and age were major drivers of STIs transmission patterns.