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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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

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Contents BackgroundMethodology Adopted Why Are Female Sex Workers More at Risk for HIV

transmissionFurther 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

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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

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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.

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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.

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Health & Medicine

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