Risk of HIV Infection among Men Aged 50 to 75 Years Using Erectile Dysfunction Drugs Attending Kenyatta National Hospital

Abstract

Erectile dysfunction drug (EDD) use has gained popularity among older men for enhancement and treatment of erectile dysfunction in recent years. Increased number of sexual partners and sexual activity due to EDD use concerns about the rising rate of HIV infection among older men. Men who use EDD for erectile dysfunction are found to be two to three times more likely to have sexually transmitted diseases, particularly HIV than non-users. In Kenya, the prevalence of HIV among men of age 50 to 54 years has increased from 5.7% in 2003 to 9.1% in 2008/09. This study aimed at determining the association between EDD use and risk of HIV infection among men aged 50 to 75 years. Unmatched case-control study was conducted among men of 137 HIV positive (cases) and 137 HIV negative (controls). A pre-tested semi-structured questionnaire was administered where information regarding socio-demographic characteristics, EDD use, sexual behavior, and confounding factors in EDD use and HIV infection were collected. Pearson’s chi-square test (P-value <0.05) and odds ratio with corresponding 95% confidence interval were computed to establish the association between the dependent variable (HIV status) and independent variables (Key independent variable being EDD use). Binary logistic regression analysis was performed to adjust for confounding factors in the relationship between HIV status and EDD use. Out of 137 cases, 18(13.1%) used EDD before they tested HIV +ve compared to 8(5.8%) of the controls. Even though the use of erectile dysfunction drugs was found to be significantly associated with serum HIV positivity in bivariate analysis (OR= 2.44; 95%CI: 1.04-5.93; P=0.039), it was not significant after adjustment for other factors at the multivariate analysis (AOR=1.52; 95%CI: 0.43-5.34; P=0.519). Multiple logistic regression revealed the following factors as independent predictors of HIV: presence of sexually transmitted diseases (AOR=5.96; 95%CI: 2.43–14.63; P<0.001), taking alcohol (AOR=6.85; 95%CI: 3.22–14.56; P<0.001) and having multiple sexual partners (AOR=21.69; 95%CI: 8.82–53.33; P<0.001). Although this study shows that there is an increased risk of HIV infection among older men using EDD in bivariate analysis, it was not sustained at multivariate analysis. The study however highlights the need for the Ministry of Health and other concerned stakeholders to prompt screening and treatment of STDs, increase awareness of using condoms and educate about the effects of taking alcohol on HIV infection. xiv