{
  "abstract": "Adolescents remain a priority population in HIV prevention efforts in sub-Saharan Africa. Yet, evidence on the relationship between HIV knowledge and sexual decision-making indicators among boys in early adolescence in Kenya is limited. This study examined the association between HIV-related knowledge and intention to have sex before marriage, perceived ability to refuse unwanted sex, and communication with a parent or guardian about sex among Kenyan boys aged 11-14 years who reported knowing what sex was and having heard of HIV.\n\nWe conducted a secondary cross-sectional analysis of data from the Kenya Population-based HIV Impact Assessment 2018-2019 (KENPHIA), a nationally representative household survey. The analysis was restricted to boys aged 11-14 years who participated in the child survey, completed the interview, had a valid survey weight, reported knowing what sex is, and had heard of HIV, resulting in a final analytic sample of 495 participants from 1,024 boys who completed the child questionnaire and had valid survey weights. HIV-related knowledge was assessed using a study-specific index derived from five knowledge items and grouped as 0-2, 3-4, or 5 correct responses. The outcomes were intention to have sex before marriage (n = 408), perceived ability to refuse unwanted sex (n = 479), and communication with a parent or guardian about sex (n = 495). Survey-weighted Poisson regression models with a log link and jackknife variance estimation were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). Models were adjusted for age, education level, and residence. Sensitivity analyses were conducted by modeling the HIV knowledge score as a continuous variable.\n\nAfter adjustment for age, residence, and education, HIV-related knowledge categories were not associated with intention to have sex before marriage. Compared with boys with 0-2 correct responses, those with 3-4 or all five correct responses were more likely to report being able to refuse unwanted sex, although prevalence did not rise further in the five-correct group (aPR = 1.32, 95% CI: 1.11-1.57; aPR = 1.29, 95% CI: 1.06-1.57, respectively). Parent/guardian communication prevalence rose across knowledge categories, but category-specific associations were not statistically significant. In sensitivity analyses, each additional correct response was associated with perceived ability to refuse unwanted sex (aPR = 1.08, 95% CI: 1.02-1.14) and parent/guardian communication (aPR = 1.28, 95% CI: 1.03-1.60), but not with intention to have sex before marriage. However, the association for perceived refusal ability departed from linearity.\n\nAmong Kenyan boys aged 11-14 years who reported knowing what sex is and having heard of HIV, greater HIV-related knowledge was associated with a higher prevalence of perceived ability to refuse unwanted sex but not with intention to have sex before marriage. Findings for parent/guardian communication differed between the categorical and continuous specifications of the knowledge score and should be interpreted cautiously. Age-specific HIV prevention approaches that combine knowledge with communication, life-skills, safeguarding, and social support interventions warrant prospective evaluation.",
  "abstract_shown": true,
  "affiliations": [
    "University of California San Francisco"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "E. Ndenga"
    },
    {
      "name": "C. G. Kagecha"
    },
    {
      "name": "N. Mushani"
    },
    {
      "name": "P. M. Murnane"
    },
    {
      "name": "C. Ouma"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4f2vhy3mjpyy7.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.22.26366194",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.22.26366194v1.full",
  "id": "4f2vhy3mjpyy7",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.22.26366194v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "hiv aids"
    ],
    [
      "openalex",
      "3600|Adolescent Sexual and Reproductive Health"
    ]
  ],
  "openalex": "W7223465677",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.22.26366194v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-22",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/4f2vhy3mjpyy7.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:21:40Z",
      "native_id": "10.64898/2026.10.22.26366194",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.22.26366194v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:hiv aids",
      "subfield": "infectious-disease"
    }
  ],
  "title": "HIV-related knowledge and sexual decision-making indicators among Kenyan boys aged 11-14 years who had heard of HIV: A secondary analysis of the 2018 Kenya Population-based HIV Impact Assessment.",
  "title_text": "HIV-related knowledge and sexual decision-making indicators among Kenyan boys aged 11-14 years who had heard of HIV: A secondary analysis of the 2018 Kenya Population-based HIV Impact Assessment.",
  "type": "preprint",
  "updated_at": "2026-10-30T12:21:40Z",
  "url": "https://research.draconitic.com/paper/4f2vhy3mjpyy7",
  "venue": "medRxiv",
  "versions": []
}