A prospective cohort study of fertility desire, unprotected sex, and detectable viral load in HIV-positive female sex workers in Mombasa, Kenya

BACKGROUND:Little is known about fertility desire in HIV-positive female sex workers (FSW). Fertility desire could increase HIV transmission risk if it were associated with condomless sex or lower adherence to antiretroviral therapy (ART). METHODS:A prospective cohort study was conducted among 255 HIV-positive FSWs in Mombasa, Kenya. Using generalized estimating equations, fertility desire was evaluated as a risk factor for semen detection in vaginal secretions by prostate specific antigen (PSA) test, a biomarker of condomless sex, detectable plasma viral load (VL), and HIV transmission potential, defined as visits with positive PSA and detectable VL. RESULTS:The effect of fertility desire on PSA detection varied significantly by non-barrier contraception use (p-interaction