It has been shown that PLWHA are living longer due to increasing availability and
uptake of antiretroviral therapy (ART). There has been limited research on whether
PLWHA adopt safer sexual and reproductive practices as focus has been primarily on
HIV negative persons. The purpose of this study was to determine predictors of selfefficacy
in HIV prevention among PLWHA in Thika district, Kiambu County; „a case
of prevention with positives‟. Specific objectives included: to assess sociodemographic
characteristics of PLWHA, determine attitude towards sexual and
reproductive behaviour, establish sexual and reproductive practices, identify barriers
to safe sexual and reproductive behaviour and to analyze the decision making patterns
on sexual and reproductive behaviour and determine the predictors of self-efficacy in
HIV prevention. The study was guided by Health Belief Model and General Systems
Theory. The study employed a cross-sectional survey research design. Three divisions
of Thika district were chosen purposively namely: Ruiru, Thika Municipality and
Kamwangi. The sample size comprised 239 PLWHA. The data were collected using
interview guides, focus group discussions and key informant interviews. Both
qualitative and quantitative data analyses were used. Chi-square results yielded
significant relationship between self-efficacy in HIV prevention and gender
(p=0.000), marital status (p=0. 001), monthly income (p=0. 043), employment status
(p=0. 037), attitude towards HIV-negative people (p=0.002), attitude towards
reproductive behaviour (p=0. 049), number of sexual partners (p=0.000), type of
sexual partner (p=0.000), awareness of HIV-status of sexual partner (p=0.025), HIV
disclosure (p=0.003), number of children born after testing HIV positive (p=0.034),
partner‟s condom refusal (p=0.028), alcohol and drug abuse (p=0.000), financial
constraints (p=0.000), condom fatigue (p=0.002), decision on whether to use condoms
(p=0.050), and which type of condoms used (p=0.010). Further analysis by use of
Binary Logistic Regression showed positive predictors of self-efficacy in HIV
prevention namely: gender (p=0.050), monthly income (p=0.002), attitude towards
reproductive behaviour (p=0.007), number of children born after testing sero-positive
(p=0.0.029), financial constraints and condom fatigue (p=0.046). Negative predictors
were number of sexual partners (p=0.001) and alcohol and drug abuse (p=0.021). It
was concluded that females, middle income earners, positive attitude towards
reproductive behaviour, having more than one child after testing sero-positive and
those not facing challenges condom fatigue and financial constraints predicted high
self-efficacy in HIV prevention. On the contrary, having multiple partners and
indulging in alcohol and drug abuse predicted low self-efficacy in HIV prevention. It
was recommended that there was need to promote inclusion of both men and women
in HIV and AIDS programs, ensure sustainable income generating activities, promote
sexual behaviour change programmes within the community targeting PLWHA,
ensure effective provision of alcohol and drug abuse counselling sessions among
PLWHA and strengthen consistent use of condoms. These might increase selfefficacy
in HIV prevention among PLWHA thus reducing the number of new HIV
cases.