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.
- 1University of California San Francisco
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.
We 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.
After 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.
Among 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.
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BibTeX
@misc{ndenga2026hivrelated,
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.}},
author = {E. Ndenga and C. G. Kagecha and N. Mushani and P. M. Murnane and C. Ouma},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.22.26366194},
url = {https://www.medrxiv.org/content/10.64898/2026.10.22.26366194v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - 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.
AU - E. Ndenga
AU - C. G. Kagecha
AU - N. Mushani
AU - P. M. Murnane
AU - C. Ouma
PY - 2026
DA - 2026/10/22
PB - medRxiv
DO - 10.64898/2026.10.22.26366194
UR - https://www.medrxiv.org/content/10.64898/2026.10.22.26366194v1
AB - 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. We 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. After 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. Among 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.
ER -