Hiv knowledge and risk behaviour of female sex workers in Oyo State South-West Nigeria: Potential Bridging Groups to the General population

…Creating Change, Enhancing LivesSociety for Family Health, Nigeria …Creating Change, Enhancing LivesSociety for Family Health, Nigeria…Creating Change, Enhancing Lives
HIV knowledge and Risk Behaviour of Female Sex
Workers in Oyo State South-West, Nigeria:
Potential Bridging Groups to the General
Population
Bako J. C, Titus M.O. Tijani A.I, Oni F, Atoyebi O, Omoreigie G,
Oyedeji D.S, Tomori O.T, Okere G.C
Society for Family Health
Body and Soul Builders Initiative
National HIV Prevention Conference
November, 2016
…Creating Change, Enhancing LivesSociety for Family Health, Nigeria

…Creating Change, Enhancing LivesSociety for Family Health, Nigeria …Creating Change, Enhancing LivesSociety for Family Health, NigeriaSociety for Family Health, Nigeria …Creating Change, Enhancing Lives
Contents
Background
Methodology Adopted
Why Are Female Sex Workers More at Risk for HIV
transmission
Further Findings
Recommendations

Background
• Of all people living with HIV world wide, 9% of them live in Nigeria.
• Although HIV prevalence among adults is remarkably small (3.4%)
compared to other sub-Saharan African countries such as South Africa
(19.1%) and Zambia (12.5%), the size of Nigeria's population means
that there were 3.2 million people living with HIV in 2013.
• Nigeria, together with South Africa and Uganda, account for almost
half of all annual new HIV infections in sub-Saharan Africa. This is
despite achieving a 35% reduction in new infections between 2005
and 2013.
• Approximately 210,000 people died from AIDS-related illnesses in
Nigeria in 2013, which is 14% of the global total
• Unprotected sex accounts for about 80% of new HIV infections in
Nigeria, with the majority of remaining HIV infections among key
affected populations.

Background Contd.
• Sex workers, Men who have sex with men and
people who inject drugs makes up only 1% of the
Nigerian population, yet this group account for
around 23% of new HIV infections.
• Half of all HIV infections in Nigeria among key
populations are among sex workers, their partners
and their clients.
• This is not surprising considering only 18% of sex
workers were thought to have received HIV
prevention information in 2010.

Background Contd.
• 19% of male sex workers and 25% of female sex
workers in Nigeria are living with HIV.
• This is eight times higher than the general population.
• The 2012 National HIV/AIDS and Reproductive Health
Survey found HIV prevalence to be even higher among
female brothel-based sex workers, at 27.4%.
• Reasons for this high HIV prevalence includes that;
- Many sex workers underestimated their risk of HIV and so did not use
necessary prevention methods
- Others believed that their faith would protect them from infection
- Many sex workers have been found not to use condoms when they had
sex with their partners, despite 88% using condoms with their most
recent client.

Method Adopted
SFH carried out a study (under the Global Fund HIV New
Funding Model HIV Prevention program for MARPs) within 9
months (October 2015 – June 2016) using qualitative research
methods to investigate HIV knowledge and risk factors among
sex workers in Oyo state
Information/data were collected using;
– Participatory Monitoring and Evaluation
– Key In-Depth Interview
– Focus Group Discussion
– Observations
Society for Family Health, Nigeria

Method Adopted Contd.
331 FSWs in 20 brothels across 10 LGAs out of 33
LGAs (Atiba, Oyo west, Oyo East, Ibadan South-East,
Ibadan North West, Ibadan South west, Ibadan North
East, Iseyin, Afijio (Elekara) and Akinyele) in Oyo state
participated in the study
Questions covered broad range of issues including
socio-demographic background, motivation,
perceptions of the work/risk, knowledge of STIs and
HIV, number of sexual partners, Condom use, HIV
Status and willingness to get tested for HIV

Why are FSWs more at risk of HIV transmission?
Sex workers share common factors that makes them
vulnerable to HIV transmission.
Multiple partners and inconsistent condom use
- High numbers of sexual partners compared with the general
population
- Inconsistent condom use
- Some were found to have no access to condoms or are not aware of
their importance
- Others are powerless to negotiate safer sex (clients may refuse to
pay for sex if they have to use a condom, and use intimidation or
violence to force unprotected sex)
- Clients offering more money for unprotected sex – is hard to refuse
their proposal

Why are FSWs more at risk of HIV transmission?
Injecting drug use
- Sex workers who inject drugs and share needles are at high risk of
contracting HIV
- A study conducted with FSWs in Afijio, Akinyele and Iseyin found
higher rate of HIV infection among female sex workers who inject
or smoke drugs than in other brothels (with few or Non-IDUs)
Social and legal factors
- Sex workers experience criminalisation, marginalization,
discrimination and stigmatisation by the societies in various ways
- Police use provision of accommodation for armed robbers and
possession of condoms as evidence of sex work to arrest and
intimidate FSWs thereby reducing their efforts to protect themselves
- these factors contribute and expose SWs to HIV by making it hard
for them to access healthcare, legal and social services

Further Findings
 Other studies conducted among FSWs in these brothels in the
state revealed that;
- Majority of the sex workers are young, their engagement in
sex work is long term with the intention of leaving the trade
after making “Enough-Money”.
- Clients-In-Flow is relatively high as they see 15 to 35
clients per week.

Further Findings
 FGDs with FSWs shows that;
- Exposure to HIV risk factors
were reported more by sex
workers with high mobility rate
- Sex workers from intervention
brothels said that the greatest
threat to their health and
human rights is the law that
makes it impossible to find safe
heaven to work

Further Findings Contd.
-There is lack of legislation and policies protecting sex
workers (SWs) who are at risk of violence from both state
and non-state actors such as law enforcement, partners,
family members and their clients
-According to them punitive environments limit the
availability, access and uptake of HIV prevention,
treatment, care and support for them and their clients
-SWs who are aware of their positive HIV status are
unwilling to be tested again or place on treatment
-About 75% tested for HIV - over 8.8% were referred for
STI and over 17.7% for care, treatment and support.
.

…Creating Change, Enhancing LivesSociety for Family Health, Nigeria …Creating Change, Enhancing LivesSociety for Family Health, Nigeria
Further Findings Contd.
- Knowledge on STIs/HIV
transmission, prevention and
safer sex products were very
low among new and young
FSWs compare to older ones
- Almost all the girls
interviewed gave hash
economic state and lack of
support, willingness to make
ends meet as their reasons for
engaging in sex work
- Low condom use with special
clients or boyfriends serves
as a bridge between the high
risk population of FSWs and
the general population.

Recommendations
Innovative and integrated approaches are required
to target FSWs, their special-boy-friends/non‐
paying-partners and clients with BCC messages to
prevent them from becoming drivers of the
epidemic.
Harassment and abuse of SWs by the police is one
issue that requires serious advocacy and attention
from key stakeholders.

Recommendations Contd.
There is need for governments and CSOs to increase
funding for programmes for sex workers, create an
environment where FSWs will be able to protect
themselves against HIV, easily access STI/HIV
prevention, testing and treatment services
Addressing the underlying social and structural
problems that makes FSWs vulnerable to HIV,
giving SWs greater legal protection against
violence, and reducing the discrimination they
experience will help reduce the rate of HIV and
other sexually transmitted Infections.

…Creating Change, Enhancing LivesSociety for Family Health, Nigeria …Creating Change, Enhancing LivesSociety for Family Health, Nigeria…Creating Change, Enhancing Lives
…Creating Change, Enhancing Lives

THANK YOU!!!

Hiv knowledge and risk behaviour of female sex workers in Oyo State South-West Nigeria: Potential Bridging Groups to the General population

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