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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 3  |  Issue : 3  |  Page : 124-129

Baseline and postintervention assessment of sexual violence and condom use among female sex workers in a semiurban African community


1 Department of Research, African Health Project, Abuja, Nigeria
2 Department of Public Health, Triune Biblical University Global Extension, NY, USA
3 Department of National Integrated Specimen Referral Network, Axios International, Abuja, Nigeria

Date of Submission28-May-2020
Date of Decision30-Jun-2020
Date of Acceptance07-Jul-2020
Date of Web Publication27-Jul-2020

Correspondence Address:
Ali Johnson Onoja
Department of Research, African Health Project, Abuja
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/SHB.SHB_29_20

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  Abstract 


Introduction: Sexual violence, which usually involves forced unprotected sex, is very common among sex workers in West Africa. The incidence of HIV in the rural towns and villages is being propelled by risky behaviors such as unprotected sex more prevalent among key population groups including sex workers. The present study aims at comparing sexual violence and condom use among women in Brothel in Bonny Island to assess the impact of a 3 years community-based intervention. Methods: The present study is a quantitative study involving female sex workers in Bonny Island in two surveys; baseline and postintervention. A structured questionnaire was used to obtain the information such as the demographics, sexual violence, and condom use. The data obtained were analyzed using the IBM-SPSS version 25.0. Results: There were 261 and 186 participants in baseline and the postintervention surveys, respectively. The majority 127 (48.7%) and 55 (29.6%) of the participants in both surveys were adolescents aged 14–24 years. Overall, 140/261 (53.6%) have ever been forced to have sex in the baseline study and 24/261 (12.9%) in postintervention. Those that have ever been forced to have sex without a condom were 68 (26.1%) baseline and 20 (10.8%) postintervention. Overall, 59.9% of baseline participants used condom in the last sexual act as compared to 89.6% in postintervention. Furthermore, 42.4% of baseline participants used condom in all the last 5 sexual acts as compared to 85.2% in the postintervention. In the baseline, 40.2% had problems using a condom in the past 2 months as compared to 3.1% after the intervention. Conclusion: This study found a drastic reduction in sexual violence against sex workers due to the community-based intervention. Furthermore, there was an increase in the use of condom among the study participants. It is advocated that community-based intervention should be encouraged and consistent in the HIV prevention and control programs, especially in the grassroots.

Keywords: Condom, HIV, intervention, sex workers, sexual violence


How to cite this article:
Onoja AJ, Sanni FO, Shaibu J, Onoja S, Oguche D, Adamu I, Abiodun PO. Baseline and postintervention assessment of sexual violence and condom use among female sex workers in a semiurban African community. Soc Health Behav 2020;3:124-9

How to cite this URL:
Onoja AJ, Sanni FO, Shaibu J, Onoja S, Oguche D, Adamu I, Abiodun PO. Baseline and postintervention assessment of sexual violence and condom use among female sex workers in a semiurban African community. Soc Health Behav [serial online] 2020 [cited 2020 Aug 8];3:124-9. Available from: http://www.shbonweb.com/text.asp?2020/3/3/124/290978




  Introduction Top


At the end of 2018, 5 million people were living with HIV in West and Central Africa, with a prevalence of 1.5% among the adults of ages 15–49 years. The new infection at this period was estimated as 280,000 and 160,000 AIDS-related deaths.[1] According to Avert,[2] about 65% of people living with HIV/AIDS in these regions were unaware of their status, meaning that only half of these HIV-positive people were on the treatment. Studies have shown that young women aged 15–24 are more affected with HIV as twice as their male counterparts, and this is mostly driven by heterosexual sex.[3] The key population mostly affected in Africa are the sex workers and their sexual partners which were estimated as 64% of all new infections in 2018; though these groups are a very small proportion of the entire population.[4] HIV among sex workers was more prevalent in nine countries West and Central Africa in 2018, including Nigeria with the prevalent range of 4%–30%.[3],[4],[5]

In Nigeria, it has been documented that the majority (80%) of new HIV cases are from unprotected heterosexual sex and the remaining cases are from the key affected populations, including the sex workers.[6] Female sex workers (FSWs) are included among the key population group (1% of the adult population) contribute a significant portion of new HIV infections in Nigeria.[7] These groups contribute almost 23% of new HIV infections and about 20% of the new infections may be traced to FSWs, their clients and client partners alone. Furthermore, three of every four cases of HIV attributed to sex workers are found among brothel-based FSWs.[7] The 2015 progress report on global AIDS response revealed a decline in the percentage of sex workers reached with HIV prevention programs from 34.4% in 2007 to 18.2% in 2010, whereas the percentage of sex workers reporting the use of condom with their most recent client reduced from 91.97% in 2007 to 88.6% in 2010.[6]

Sexual violence, which usually involves forced unprotected sex, is very common among sex workers in West Africa, sexual violence in detention.[1] Even, the WHO reported that the highest reported rates of sexual and physical violence toward women are found in Africa, the Middle East, and Southeast Asia.[8] In a study conducted among sex workers in Abuja Nigeria, sexual violence was found as the most common form (41.9%) of violence experienced by the FSWs interviewed and mainly form main clients (63.8%) and brothel management (18.7%).[9] It has also been documented that older FSWs are more likely to experience sexual violence than younger.[10],[11] More than half of FSWs who had experienced sexual violence had experienced it in many instances and around 70% have had this experience earlier than the age of 20.[1]

The incidence of HIV in rural towns and villages is being propelled by risky behaviors such as casual sex, transactional sex, and sex work.[7] HIV prevalence is high among sex workers due to lack of interventions, legal barriers, stigmatization, and discriminations that prevent most of them from accessing HIV-related services.[12],[13],[14] The study aims at comparing sexual violence and condom use among women in Brothel in Bonny Island to assess the impact of 3 years community-based intervention.


  Methods Top


This is a quantitative study carried out in the Bonny kingdom of Rivers State, Nigeria. The Kingdom is based on the Southernmost edge of West Africa in Nigeria and near the town of Port Harcourt' making it a perfect location for trade ships and vessels from the international and inland waters. The Kingdom is among the most industrialized communities in Nigeria, hosting the country's largest coal and oil industries. Bonny Island occupies a location of around 215 km2, with a network of creeks and waterways to its center. The southern edges have got the most easily available landmass. It also has a mangrove forest plus some of the very most fertile farmlands in West Africa. The influx of industries provides spurred the development of urban fabrics and basic infrastructures. Traders have been arriving at the Bonny Kingdom dating back to the 15th century when it had been the major trading post of the Eastern Delta. Even slave traders plied its shores. It is through trade that Bonny turned out to be the wealthiest and most powerful kingdom in Eastern Niger Delta; trading palm oil, ivory, and timber after the slave trade was abolished.

Because of a high incidence of HIV in Bonny kingdom, a preintervention survey was completed in 2006 by the Society for Family Health that was used as a base document in the initiation of a 3 years (2008–2011) HIV/AIDS prevention intervention programme. This survey of HIV/AIDS-related information was vital to create an efficient HIV/AIDS intervention in the Island, accurate baseline data had been obtained from the various risk and work-related groups. The community-based interventions carried out in the kingdom include enlightenment programs, training, free HIV counseling and testing, free condom distribution, and referral and follow-up services for people tested positive for HIV. Awareness and HIV education were carried out using handbills, posters, community townhall meetings, workplace sensitization, drama, radio, and televisions programs. The radio and television programs include “Jann Kunne film,” AIDS and You,” “Ireti alaafia (Hope for well-being-Radio and Television),” “One thing at a time,” “Gari muna fata” (A radio drama program), “Odejinjin” (Television program), and “Abule oloke merin” (a radio drama program on HIV/AIDS). After 3 years of intervention, the impact of the various kinds of interventions was assessed on important elements on sexual violence, and the use of condom among the sex workers using the data extracted from the postintervention survey.

This quantitative survey was conducted among sex workers in the Bonny Kingdom, utilizing a structured questionnaire among a representative sample of the overall population aged 15–49 years. The goal is to compare the findings of the survey before intervention with the findings of the current survey (after intervention) to measure the impact of the intervention programme. The sample size made up of 261 sex workers in the preintervention survey and 186 in the postintervention survey.

Statistical analysis

Data were inputted with CSPro and analyzed with the IBM®-SPSS® Statistics software version 25.0. Descriptive statistics were used to summarize the variables, and the summaries were presented in tables showing the baseline and postintervention findings. The Chi-square analysis was perfomed to determine the significant differences between baseline and postintervention findings, setting the significant level at P < 0.05.

Ethical consideration

Ethical approval was obtained from the National Health Research Ethics committee, Federal Ministry of Health for the seroprevalence facet of the study. In addition, based on the National Guidelines for mobile Voluntary Counselling and Testing (VCT), the respondents' informed consent was sought and signed before the test was administered. Respondents also had the choice of opting out or up taking the test following the counseling procedure, and confidentiality was strictly preserved with respondents not forced to provide names as their VCT forms were assigned codes. Although the code was connected to the questionnaire number; however, it has no link to the individual and confidentiality was guaranteed.


  Results Top


Sociodemographic characteristics of the sex workers

[Table 1] shows the sociodemographic characteristics of sex workers. There were 261 participants in the baseline survey and 186 in the postintervention survey. The dichotomous age distribution shows that 127 (48.7%) of the baseline respondents were adolescents aged 15–24 years. This group represented 55 (29.6%) of the postintervention survey. Participants aged 15–19 years represented 10% of the baseline and 2.2% of the postintervention survey. Majority of both the participants of both surveys attained secondary school or higher education 69.7% and 67.2% and singles 75.1% and 82.8%, and Christians 98.9% and 87.6% for baseline and postintervention surveys, respectively. The majority of the respondents from both groups also had more than a client per day 72.0% and 68.8% for baseline and postintervention surveys.
Table 1: Sociodemographic characteristics of sex workers in the bonny kingdom

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Sexual violence experience of sex workers

[Table 2] shows the proportion of sex workers that experienced sexual violence and sexual violence without condom in both surveys. Overall, 140/261 (53.6%) have ever been forced to have sex in the baseline study and 68 (26.1%) have been forced to have sex without a condom. This implies that 48.9% of those who have ever been forced into sexual intercourse in the baseline experienced it without a condom. In the postintervention arm, 24/261 (12.9%) have been forced to have sex and 20 (10.8%) were forced to have sex without using condoms. This implies that 83.3% of those who have ever experienced sexual violence in the postintervention survey was forced without a condom. All the participants who were forced to have sex among the uneducated or had primary education and full-time sex workers in the baseline survey were forced without condom (100.0%). However, the proportion of sex workers who were forced to have sex was very minimal at the postintervention survey though the majority of them reported them were still forced to have sex without a condom. There were significant differences between postintervention and baseline survey, considering sexual violence and sex without condom experience among the FSWs (P < 0.001).
Table 2: Sexual violence by sociodemographic

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Condom use among sex workers in the bonny kingdom

Self-reported of use of condoms among Bonny FSWs is shown in [Table 3]. Overall, the baseline survey revealed that 59.9% of the FSWs used condom in the last sexual act as compared to 89.6% in the postintervention arm. Those who reported using condoms in all the last 5 sexual acts was 42.4% in the baseline survey as compared to 85.2% in the postintervention. In the baseline, 40.2% had problems (such as dislike, burst, incorrect use, and unavailability of condoms) in the last 2 months as compared to 3.1% after the intervention. Those that had secondary education or more used condom in the last/5-last sexual acts more than those who had primary education or less. Furthermore, more of those who attained primary education or less had issues with using condoms than those who attained secondary education or higher as shown in both survey results. The use of condom and difficulties using condoms was also higher among sex workers aged 14–24 years than those above 25 years.
Table 3: Percentages of respondents who have ever used condoms by sociodemographic characteristics

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  Discussion Top


Although sex work is illegal in Nigeria, the work has been growing, due to the deteriorating economy and the inability of young women to find the other forms of employment. This study reports the experience of sexual violence and the use of condom among FSWs in a rural setting in a bid to assess the impact of community-based intervention.

Sexual violence against sex workers usually involves forced unprotected sex against sex workers and has a negative physical and psychosocial impact on the health of the victims. This study discovered a very high rate of sexual violence against FSWs in the Bonny kingdom before the community-based interventions as compared to postintervention experience (P < 0.001). More than half of sex workers have been forced into sexual acts with the majority being unprotected sex. Several studies have reported sexual violence against sex workers.[6],[15],[16],[17]

A similar study but without intervention conducted in Abuja, Nigeria, found that the level of sexual violence among sex workers was 41.9%. This value is lower than 53.6% seen in this before the interventions.

Due to the community intervention, the rate of sexual violence declined drastically from above 50%–12.9%, although the few that were forced to have sex still reported a high rate of unprotected sex. This reduction was not only due to the intervention (awareness, HIV education, comprehensive, etc.,) programme executed among the sex workers but also due to the intervention programme that involved the entire community where those that are involved in the violent acts reside. Several studies have reported behavioral changes due to community-based intervention, even among sex workers.[18],[19],[20],[21]

This study found an improved use of condom among the interviewed FSWs in the postintervention survey. The condom use increased 50% from 60% in the baseline to 90% in the postintervention arm. Similarly, those who used condom in the last 5 sexual acts in the postintervention survey was 101% of the baseline percentage. Similarly, only 3.1% reportedly had problems using condoms as compared to 40.2% in the baseline survey. This shows a very high impact of the intervention programs toward the prevention of HIV in rural communities, especially the key population such as sex workers. The low use of condom seen in this case at a baseline report is similar to the low levels of condom use reported among FSWs in situ ations without intervention. A study conducted in Iran reported that only 33.6% FSWs reported using condoms with their paying clients,[22] just 16.1% in Tanzania,[23] 23.5% in Swaziland study reported 23.5%,[24] 40.0% in the Democratic Republic of the Congo,[25] and 17.0% in a study involving sex workers in three countries (Swaziland, Togo, and Burkina Faso).[26]

Similar to this study, improved rates of condom use have been reported among sex workers included in HIV prevention intervention programmes. Condom use was reported as 56% in Kibera, Kenya at baseline but increased to 68% after 6 months of intervention.[27] Furthermore, the positive impact of interventions was seen among sex workers in India where condom use increased from 63.6% to 83.4% after the intervention.[18] Several other studies have also reported the positive influence of community-based intervention in promoting the use of condom during the sexual activities.[20],[21],[22],[25],[28],[29],[30]

Conclusion

This study found a drastic reduction in sexual violence against sex workers due to community-based intervention. Furthermore, there was an increase in the use of condom among the study participants, which can be attributed to the HIV prevention programmes extended to them in the community. Since these positive impacts have also been reported in some other parts of the world, it is advocated that community-based intervention should be promoted in developing countries. This will significantly contribute to the success of HIV prevention and control programs, especially in the grassroots.

Financial support

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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