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Student Name: Ngure Rhodah Wamaitha

Registration Number: 19/05382

Paper Topic: Modeling for HIV/AID Infection Using Logistic Regression Model

Faculty: School of Business and Public Management

Lecturer Name: Mr. Martin Waweru

Institution: KCA University

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CHAPTER ONE

1.1 Background of the study

This section consists of: HIV/AIDS definition, transmission and the stages of HIV/AIDS

infection, HIV/AIDS as a global pandemic and its consequence, HIV/AIDS in Kenya, and

the impacts of HIV/AIDS on various sectors.

1.1.1 HIV/AIDS Definition, Transmission and the Stages of HIV/AIDS

Acquired immunodeficiency Syndrome (AIDS) is a potentially life threatening and

chronic condition that is caused by the human immunodeficiency virus (HIV) (Odeny,

2015). HIV damages the body immune system that is; it interferes with the body’s ability

to fight diseases and infections. So far there are only two types of HIV variants namely

HIV-1 and HIV-2 (Gilbert, 2003). HIV-1 and HIV-2 share many similarities such as:

both results to AIDs, they have the same modes of transmission; they have the same basic

gene arrangement and the same intracellular replication pathway. However, HIV-2 is

characterized reduced likelihood of progression to AIDS and lower transmissibility. HIV

is transmitted directly through contact with breast milk, semen, blood and vaginal fluid.

The transmission can involve vertical transmission (child birth), breastfeeding, oral, anal

or vaginal sex, contact with contaminated hypodermic needles and other exposure that

lead to getting into contact with body fluids (Padian, 2008).

HIV/AIDS has no cure, but for some period of time there have been medication that

works to acutely slow down the progression of the disease. These drugs have helped to

reduce the number of deaths caused by HIV/AIDS in developed nation but HIV continues
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to lessen the population in African countries. HIV infection has four stages which are

discussed below

Stage 1: Widow Stage (primary HIV infection) – This is the first stage of the infection

which is also known as the acute HIV infection. It normally last for a few weeks and it

can often go unnoticed. This stage can be accompanied by short flu-like illness and it is a

very highly infectious stage.

Stage 2: The Asymptomatic stage of HIV – In this stage most people do not experience

the symptoms of the disease and the period may rust for even a period of 10 years.

Although the symptoms do not show in this stage the virus is active while infecting new

cell, multiplying and weakening the ability of the immune system to fight diseases.

Stage 3: Symptomatic HIV – The immune system is already weakened in this stage and a

lot of symptoms begin to manifest in this particular stage. In this stage, pulmonary TB

can manifest itself.

Stage 4: (Full brown) Progression from HIV to AIDS- In this stage, the immune system

is completely damaged and an individual may become ill of certain opportunistic cancers

and infections. The AIDS-defining illnesses are pneumonia, tuberculosis (TB) and

cancer.
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1.1.2 HIV/AIDS as a Global Pandemic and its Consequences

HIV, the virus that causes AIDS has become one of the world’s most

serious development and health challenge since the first case of HIV infection was

reported in the year 1981. Since the epidemic started, approximately 84 million people

have become infected with HIV virus. As at today 38 million people are living with HIV

and 10 million of the people have already died of caused related to AIDS since the

begging of the epidemic (Kaiser, 2023). The number of people living with HIV as at

2010 was 30.8 million and it have risen to 38.4 million as at the year 2021 ( Kaiser,

2023). The rise in number of people living with HIV show that there is continuing of new

infection and that people are now living longer with HIV. As at 2021, of the people living

with HIV, 1.7 million of them are children under the age of 15 years and 36.7 are adults.

Only 15% of the people infected with HIV are unaware of their status since the testing

capacity of people have increased over time. At 2021 there were 1.5 million new

infection that is about 4000 HIV infections per day (UNAIDS &WHO, 2021). Data show
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that the spread of HIV has slowed down although unequally in different countries.

However, HIV remains to be the number one cause of death especially to women in their

reproductive age. In 2021, 650,000 died as a result of AIDS which is a decrease of 52%

as compare to the year 2010 when 1.4 million died of AIDS. It is also a decrease by 68%

as compared to the year 2004 when 2 million people died of AIDS (UNAIDS, 2022).

Two-thirds of the people living with HIV/AIDS live in the Sub-Saharan Africa, it is

followed by the pacific and Asia, Latin America, Eastern Europe, and central Asia

(UNAIDS, 2022).

HIV/AIDS have resulted to very harsh consequences globally for it not only leads to the

deaths of so many people but it also made so many children orphans. For instance in the

year 2012 884,000 children in Uganda, 892,000 children in Kenya and 11,035,000

children in the sub-Saharan Africa were orphaned due to AIDS (UNAIDS, 2012). The

children have been immensely affected by the loss of their parents. HIV/AIDs have also

affected the economy of countries especially in the African countries. For instance some

people in the sub-Saharan Africa live below the poverty line. HIV/AIDS is the fourth

leading cause of death globally and the leading cause of death in Africa. It has reduced

the life expectancy from 60 years if HIV/AIDS was not there to 40 years (WHO, 2008).

AIDS is killing the young adults who are economically productive hence living countries

and families at a state of poverty.

1.1.3 HIV/AIDS in Kenya

Kenya has recorded an Increase in HIV/AIDS infection over a decade with an increase

of over 2000 infections, that is from 32,025 infections to 34, 540. In the years 2021

alone, the country reported 34,540 case of HIV infection. The new HIV infections have
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been confirmed to be mostly amongst, younger people, adolescents and children.

Amongst the 34,540 infections, 70% (20,505) have been confirmed to be women and

girls. Out of ten new HIV infections, eight of them occurs in young women and

adolescents aged 15- 24 (Nation media group, 2022). The report shows that women

become infected at an early age before the men and the boys. The report also shows that:

 Children between age 0-14 contribute up to 15% of the overall new infections

 Young adults and adolescents between the ages 15 – 29 year contribute up to 52%

of the overall new infections

 Adult of aged 30-44 years contribute up to 26% of the new infections and;

 Adults aged 45 and above only contribute up to 7% of the new infections.

However the HIV infections amongst adolescents reduce by 171 in the year 2021, that is

from 5,294 infections in the year 2020 up to 5123 in the year 2021. Most people living

with HIV/AIDS are the older adults who were infected most likely at a young age. The

new infection are dominant in young people aged 34 and below. As at 2021, ten counties

Mombasa, Kisumu, Nairobi, Kisii, Uasin Gishu, Migori, Siaya, Homabay, Nakuru and

Kakamega accounted for 57% of the new HIV infections (Nation media group, 2022). In

counties such as Isiolo, Turkana, Samburu, Marsabit, Wajir and Tana River. The number

of HIV infections has increased by 30%, Samburu County being the one with the highest

number of increase. As at 2021, 66% adult below the age of 34 including children living

with HIV were under treatment and 85% of adult above 35 years living with HIV were

under treatment. The number of people living with HIV in Kenya is growing due to

improvement on access to treatment. 622,724 were averted between 2010 and 2021,

attribute to ART uptake. With the use of antiretroviral (ART) for pregnant women, the
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rate of mother to child HIV transmissions has reduced. 54.7% of the mother to child

transmission occurs when the mother drops off ART during the pregnancy period. Other

than HIV/AIDS other sexually transmitted diseases; for instance, syphilis infection rose

from 10,000 in the year 2018 up to 14,873 infections in the year 2021. The country has

made significant step in in expanding the access to HIV prevention by providing pre –

exposure prophylaxis (prEP) so as to reduce the number of infection. As the a result of

easy access to prEP the rate of HIV infection in the key population that is: people who

inject drugs, transgender people, female sex workers and men who have sex with other

men have reduced from 33% in the year 2009 to 13% in 2020. The program seems to

have worked well on these key groups for the past one decade. The government is

working hard to reduce mother to child HIV transmissions to a rate below 5% and to end

adolescent HIV infection by the year 2030 (Nation media group, 2022).

1.1.4 The Impact of HIV/AIDS on Various Sectors in Kenya

1.1.41 Agriculture

Agriculture contributes a major portion of the Gross domestic product (GDP) for it

accounts for 70% of the Kenya export earnings and also it employs 80% of the labor

force. The HIV/AIDS epidemic progressions lead to decrease in adult labor force in the

agricultural section which meant that knowledge about indigenous farming methods

would be lost and productivity would decline. The production of both food crops and

cash crop diminished due to HIV/AIDS. In the year 2000, there was 9.6% labor losses

and they would escalate to 22.7% in the year 2020 (organization for economic Co-

operation, 2000). For commercial farming HIV/AIDS resulted to the loss of experienced
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work force which reduced the rates of productivity and labor shortage in fatal periods of

planting and harvesting. Other costs such as funeral, staff welfare, recruitment and

training were incurred by the employers. People working in the Agricultural sector

experienced lack of experienced personnel’s, reduction in labor supply and lack of

essential output. People were forced to switch into farming crops that do not require

intense labor which lead to decrease in goods for export in the long- run.

1.1.42 Education Sector

HIV/AIDS lead to the decline of school enrollment when children got infected and they

could no longer join school or continue with school. Many children became orphans and

some were forced to be the bread winners at such a young age which forced them to drop

out of school. The teacher and the other education staff got infected and it increased

teachers’ absenteeism hence lowering the output. The country lost productive head-

teachers, teachers and productive education officials which greatly affected the education

sector.

1.143 The Economy

HIV/AIDS have a negative impact on the economy by reducing the availability of

human capital. In developing countries, large of population are developing AIDS due to

lack of quality health care, proper preventing and the proper nutrition. People with

HIV/AIDS require significant health care and also most of them are unable to work. The

most people who are infected by HIV/AIDS are the active adult who contribute a lot to

the economy and when their deaths occur so many orphans are left behind being taken

care of by the elderly grandparents. The increased mortality due to HIV/AIDS results to:

reduced number of labor force, and reduced population with skills hence resulting to
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reduced productivity. Having HIV/AIDS patient also affects their family member where

by the family members have to take time off to take care of their infected family member.

By taking time off, the productivity is lowered hence significantly impacting the

economy negatively.

1.2 Statement of the problem

HIV/AIDS still remain a main problem in Kenya and most African countries. There still a

high number of people being infected with HIV/AIDS everyday especially the adolescent and

the young adults. Most money that could be used for other things is being used is being used

to take care of the health bills of the people infected by HIV/AIDS. HIV/AIDS infection

among adolescent, University students and young adult is alarming. The problem that your

study aims to address is the need to identify risk factors for HIV infection in Kenya using a

logistic regression model. Identifying risk factors can help inform prevention and treatment

strategies to reduce the spread of HIV. Some of those factors that will be covered in the

study are: Age, gender, marital status and maternal health care.

The Health Belief Model (HBM) and Social Cognitive Theory (SCT) provide relevant

theoretical frameworks for understanding individual behavior related to HIV prevention and

treatment. The HBM posits that individuals are more likely to engage in behavior that

prevents or treats a disease if they perceive themselves to be susceptible to the disease,

believe that the consequences of the disease are severe, and believe that the benefits of taking

action outweigh the costs (Rosenstock, 1974). SCT posits that behavior is influenced by

personal factors, such as knowledge and beliefs, as well as environmental factors, such as

social norms and support (Bandura, 1986). Despite the relevance of these theories, previous

studies in Kenya have not utilized logistic regression models to identify the risk factors
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associated with HIV infection. Instead, these studies have relied on descriptive statistics and

bivariate analyses to examine the relationships between individual and environmental factors

and HIV infection. Consequently, there is a gap in the literature regarding the use of logistic

regression models to identify the most significant risk factors associated with HIV infection

in Kenya.

Therefore, this study aims to fill this gap by applying logistic regression models to

investigate the relationships between individual and environmental factors and HIV

infection. By doing so, this study will contribute to the development of more effective

prevention and treatment strategies for HIV in Kenya.

1.3 Objectives of the study

1.3.1 General objectives

To model for HIV infections in Kenya using Logistic regression model.

1.3.2 Specific objectives

1. To determine the factors affecting the spread of HIV/AIDS

2. To estimate the logistic regression model

3. To evaluate the estimated logistic regression model.

4. To establish recommendations that can be drawn from the study

1.4 Research questions

1. What are the factors affecting the spread of HIV/AIDS in Kenya?

2. What is the estimated logistic regression model?

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3. What are the possible recommendations that can be drawn from the study?

1.5 HYPOTHESIS OF THE STUDY

1. H0 HIV/AIDS prevalence is the same for all age groups.

H1 HIV/AIDS prevalence is not the same for all age groups.

2. H0 Maternal health care is associated with HIV/AIDS prevalence.

H1 Maternal health care is not associated with HIV/AIDS prevalence.

3. H0 HIV/AIDS prevalence is the same in both genders.

H1 HIV/AIDS prevalence is not the same in both genders.

4. H0 Marital status is associated with HIV/AIDS prevalence.

H1 Marital status is not associated with HIV/AIDS prevalence.

1.6 Significance of the study

The finding will significantly inform the Ministry of health and the interested Non-

governmental Organizations (NGOs) intervention toward successful management of

HIV/AIDS prevalence in key population and in the most vulnerable regions. This study will

help to determine the factors that have resulted to slow decline of the epidemic prevalence

and the people and the government can work towards formulating effective preventative

strategies. With the finding from this study, the Ministry of health in Kenya can track the

countries progress against HIV/AIDS; it can target prevention effort, and assist people who

have been already infected to get treatment and care so as to remain healthy and also to

prevent new infections.

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CHAPTER TWO

2.1 Literature Review

According to UNICEF data approximately 38.4 million people were living with HIV. Most
of the infected people are in the most productive phase of their lives which results to
physiological problem resulting from stigma and discrimination, high medical costs, which
results to increase of cost to the local and nation economy at large. Sub-Sahara Africa
continues to be severely affected with 69% of the overall global infections

The global pandemic HIV continues to be a major public health issue in Kenya, with an
estimated 1.6 million people living with the virus in 2019 (NACC, 2020). Understanding the
risk factors associated with HIV infection is crucial for the development of effective
prevention and treatment strategies. Several studies have investigated the factors that
contribute to HIV infection in Kenya.
One study by Maingi et al. (2018) found that being unmarried, having multiple sexual
partners, and not using condoms were significant risk factors for HIV infection among young
adults in Kenya. Another study by Mwamburi et al. (2017) found that being female; having
low levels of education, and engaging in transactional sex were associated with increased risk
of HIV infection in coastal Kenya.
The Health Belief Model (HBM) provides a theoretical framework for understanding
individual behaviors related to HIV prevention and treatment. The HBM posits that
individuals are more likely to take action to prevent or treat a disease if they perceive
themselves to be susceptible to the disease, if they believe that the consequences of the
disease are severe, and if they believe that the benefits of taking action outweigh the costs
(Rosenstock, 1974).
Social cognitive theory (SCT) is another relevant theory for understanding health behavior
related to HIV prevention and treatment. SCT posits that behavior is influenced by personal
factors, such as knowledge and beliefs, as well as environmental factors, such as social
norms and support (Bandura, 1986).
In the context of HIV infection in Kenya, understanding the social and cultural factors that
influence health behavior is also important. For example, a study by Wamoyi et al. (2011)
found that gender norms and power dynamics within sexual relationships played a significant
role in HIV risk among young women in Tanzania.
HIV infection is estimated to be highest in some counties. Nairobi county, Homabay. Siaya,
Migori. Nakuru, Mombasa, Kakamega, Kisii and Uasin accounts upto 57% of the country’s
overall infections as at 2021. Other counties such as Wajir account to even less than 0.2% of
the total infections. This shows that specific programs should be designed in order to deal
with our problem effectively.

Overall, these studies highlight the importance of addressing both individual and societal
factors in developing effective strategies for HIV prevention and treatment in Kenya.
2.2 Theoretical framework
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2.2.1 Marital status

Being married does not necessary protect someone from HIV infection since most of the people
become sexually active at a very tender aged. Several studies have shown that marital status is a
significant factor in HIV transmission in Kenya. Married individuals have a higher risk of HIV
infection compared to unmarried individuals, primarily due to the high prevalence of
extramarital sexual relationships (Blessing et al., 2018; Kwena et al., 2013). For instance, a study
conducted in Nairobi, Kenya, found that HIV prevalence was higher among married individuals
(8.6%) compared to unmarried individuals (4.3%) (Kwena et al., 2013). Similarly, a national
survey in Kenya found that the prevalence of HIV was higher among married individuals (6.2%)
compared to unmarried individuals (4.0%) (National AIDS and STI Control Programme, 2018).

Furthermore, some studies suggest that the effect of marital status on HIV transmission is
dependent on gender. For example, a study conducted in rural Kenya found that married women
had a higher risk of HIV infection compared to married men due to the higher prevalence of
extramarital relationships among men (Mensch et al., 2003). On the other hand, a study
conducted in Nairobi found that married men had a higher risk of HIV infection compared to
married women due to the higher prevalence of transactional sex among men (Blessing et al.,
2018).
Overall, these studies highlight the importance of considering marital status as a factor affecting
HIV transmission in Kenya. By doing so, prevention and treatment programs can be tailored to
address the specific needs of married individuals, such as increasing awareness about the risks
associated with extramarital relationships and encouraging mutual HIV testing and counseling.
2.2.2 Age
Age is another important factor affecting HIV transmission in Kenya. Studies have shown that
HIV prevalence varies by age group, with the highest prevalence observed among young people
aged 15-24 years (National AIDS and STI Control Programme, 2018; UNAIDS, 2018). For
instance, the Kenya AIDS Indicator Survey 2018 found that HIV prevalence among young
people aged 15-19 years was 2.6%, while prevalence among those aged 20-24 years was 6.6%
(National AIDS and STI Control Programme, 2018). This is concerning as young people are a
key population that drives the HIV epidemic in Kenya, accounting for approximately 40% of all
new HIV infections (UNAIDS, 2018).
Several factors contribute to the higher prevalence of HIV among young people in Kenya,
including a lack of comprehensive sex education, low condom use, and limited access to HIV
prevention and treatment services (UNAIDS, 2018). Moreover, some studies suggest that age-
disparate relationships, where one partner is significantly older than the other, increase the risk of
HIV transmission, particularly among young women (Chirawu et al., 2011; Camlin et al., 2018).
Therefore, addressing the unique needs and challenges of young people, such as providing
comprehensive sex education, promoting condom use, and expanding access to HIV prevention
and treatment services, is crucial in reducing the burden of HIV among this population.
2.2.3 Maternal health care
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Maternal healthcare is an important factor affecting HIV transmission in Kenya. Studies have
shown that mother-to-child transmission (MTCT) is a major mode of HIV transmission in the
country, accounting for approximately 10% of all new HIV infections (National AIDS and STI
Control Programme, 2018). This highlights the importance of maternal healthcare in preventing
HIV transmission to newborns.
Antenatal care (ANC) is an essential component of maternal healthcare and plays a critical role
in preventing MTCT of HIV. ANC visits provide an opportunity for HIV testing and counseling,
provision of antiretroviral therapy (ART), and adherence counseling, which can significantly
reduce the risk of MTCT (National AIDS and STI Control Programme, 2018). However, despite
the availability of free ANC services in Kenya, many pregnant women still do not receive
adequate care, particularly in rural areas (Kenya National Bureau of Statistics, 2015).
Several factors contribute to the low uptake of ANC services in Kenya, including distance to
health facilities, cost, lack of awareness, cultural and religious beliefs, and stigma (see Figure 2)
(Kenya National Bureau of Statistics, 2015). Therefore, improving access to ANC services,
addressing cultural and social barriers, and promoting awareness about the importance of ANC
in preventing MTCT of HIV are crucial in reducing the burden of HIV among newborns in
Kenya.
2.2.4 Gender
Gender is an important factor affecting HIV infection in Kenya. According to the Kenya HIV
Estimates Report of 2020, women account for a higher proportion of new HIV infections
compared to men, with an HIV prevalence of 6.6% among women compared to 4.4% among
men (National AIDS Control Council, 2020).
Several studies have investigated the association between gender and HIV infection in Kenya. A
study by Mwangi et al. (2021) found that women who had experienced intimate partner violence
were more likely to have HIV infection compared to those who had not experienced violence.
Another study by Karau et al. (2018) found that gender norms, including traditional beliefs about
masculinity and femininity, influenced HIV risk among young people in Kenya.
Gender-based factors such as poverty, gender-based violence, and limited access to education
and healthcare, also contribute to the higher HIV prevalence among women in Kenya
(Nyambedha et al., 2013). Women may also face social and economic barriers to accessing HIV
prevention and treatment services, such as stigma and discrimination, lack of decision-making
power, and financial constraints (Kabami et al., 2021).
Overall, these findings highlight the need for gender-sensitive HIV prevention and intervention
strategies in Kenya that take into account the unique social, economic, and cultural factors that
contribute to HIV risk among women.
2.3 Empirical frame work
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References

Fox, M. P., Rosen, S., MacLeod, W. B., Wasunna, M., Bii, M., Foglia, G., & Simon, J. L.

(2004). The impact of HIV/AIDS on labour productivity in Kenya. Tropical

Medicine & International Health, 9(3), 318-324.

Gilbert, P. B., McKeague, I. W., Eisen, G., Mullins, C., Guéye‐NDiaye, A., Mboup, S., &

Kanki, P. J. (2003). Comparison of HIV‐1 and HIV‐2 infectivity from a

prospective cohort study in Senegal. Statistics in medicine, 22(4), 573-593.

https://images.app.goo.gl/nSxzNnGepjzVMQZf9

Nation Media group. (2022). Kenya records rise in new HIV infections in over a decade.

Nation Africa. https://nation.africa/kenya/health/kenya-records-rise-in-new-hiv-

infections-in-over-a-decade-4038518

Odeny, T. A., Padian, N., Doherty, M. C., Baral, S., Beyrer, C., Ford, N., & Geng, E. H.

(2015). Definitions of implementation science in HIV/AIDS. The Lancet

HIV, 2(5), e178-e180.

Padian, N. S., Buvé, A., Balkus, J., Serwadda, D., & Cates, W. (2008). Biomedical

interventions to prevent HIV infection: evidence, challenges, and way

forward. The Lancet, 372(9638), 585-599.

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Were, M., & Nafula, N. N. (2003). An assessment of the impact of HIV/AIDS on

Economic Growth: The case of Kenya. Aids on Economic Growth: The Case of

Kenya (September 2003).