Ademola J. Ajuwon

Knowledge of AIDS and HIV risk-related sexual behavior among Nigerian naval personnel

BackgroundThe epidemic of HIV continues to grow in Nigeria. Personnel in the military are at increased risk of HIV infection. Although HIV-risk related sexual behavior of Nigerian police officers has been studied, little is known about the sexual behavior of their counterparts in the Navy. This study describes knowledge of AIDS, and HIV-risk sexual behavior of naval personnel in Lagos Nigeria.MethodsFour hundred and eighty personnel of the Nigerian Navy completed a 70-item questionnaire in 2002. Group discussion and in-depth interviews of four key informants were also conducted to gain insights into the context of risky sexual behaviors and suggestions for feasible HIV primary prevention interventions.ResultsThe mean age of the respondents was 34 years. Although the overall mean AIDS knowledge score was 7.1 of 10 points, 52.1% of respondents believed that a cure for AIDS was available in Nigeria and that one can get HIV by sharing personal items with an infected person (25.3%). The majority (88.1%) had had lifetime multiple partners ranging from 1–40 with a mean of 5.1; 32.5% of male respondents had had sexual contact with a female sex worker, 19.9% did so during the six months preceding the survey. Forty-one percent of those with sexual contact with a female sex worker did not use a condom during the most recent sexual encounter with these women. Naval personnel who have been transferred abroad reported significantly more risky sexual behaviors than others. Group discussants and key informants believed that sex with multiple partners is a tradition that has persisted in the navy even in the era of AIDS because of the belief that AIDS affects only foreigners, that use of traditional medicine provides protection against HIV infection, and influence of alcohol.ConclusionMany naval personnel report participating in high-risk sexual behavior which may increase their risk of acquiring and spreading HIV. Naval personnel live and interact freely with civilian population and are potential bridging group for disseminating HIV into the larger population. Interventions including sustained educational program, promotion of condoms, changes in transfer policies are recommended to address this problem.

HIV Risk-Related Behavior, Sexual Coercion, and Implications for Prevention Strategies Among Female Apprentice Tailors, Ibadan, Nigeria

We describe a survey of 300 young female apprentice tailors in a periurban community in Ibadan, Nigeria. The objectives were to assess HIV risk-related behavior in order to plan appropriate prevention interventions. Most apprentice tailors were 18–21 years old (68%), single (95%), and had not completed secondary school (98%). History of sexual intercourse was reported by 53%; 42% had ever experienced unwanted touching of the breast, backside, shoulder, or waist; 4% reported being raped in the last 6 months. Of sexually active women, 57% reported sexual debut with an instructor; 21% had exchanged sex for money or gifts and only 27% had used a condom during their most recent sexual intercourse. Instability of employment and lack of instructor support were primary barriers to implementing a pilot peer-education HIV prevention project. The poor social and economic conditions of apprentice tailors make them vulnerable to sexual exploitation and, in turn, to HIV infection. A peer-education intervention within the context of a microcredit economic development program may reduce risk for HIV among women in Nigerias informal economy.

Experience of sexual coercion among adolescents in Ibadan, Nigeria.

This study surveyed 1,025 adolescent students and apprentices in Ibadan, Nigeria, to document their sexual behaviour and experience of sexual coercion including verbal threats, unwanted touch, unwanted kiss, assault, deception, drugging, attempted rape, and rape. Sixty five per cent of male and 48% of female apprentices were sexually experienced, compared to 32% of male and 24% of female students. More males than females reported sex with multiple partners and contact with a sex worker while females had exchanged sex for money and gifts. Fifty five per cent of all the subjects had been victims of at least one type of sexual coercion, the commonest being unwanted kiss and touch of breasts (47%). Although both males and females were victims of coercion, females were disproportionately affected--68% of female students and 70% of apprentices had experienced one coercive behaviour, compared to 42% of male students and 40% of apprentices. Female apprentices fared worst, with 19% of them raped. The main perpetrators of the coercion were persons well known to the victims including neighbours, peers and boy/girlfriends. We recommend multiple intervention programs including skills training for young persons, sensitisation workshop for training health workers, and media advocacy for the public to challenge stereotypes that favour sexual coercion of adolescents.

Prevalence and nature of violence among young female hawkers in motor‐parks in south‐western Nigeria

A total of 345 young female hawkers (YFH) from six motor‐parks in south‐western Nigeria were interviewed to determine the nature and extent of violent acts against them – particularly sexual harassment, economic violence, forced marriage and involuntary withdrawal from school. Beatings or batterings and being sexually abused in childhood were reported. The most common perpetrators of the abuse were drivers or bus conductors and neighbours and these acts mostly occurred in the motor‐parks and at home. About a quarter had experienced attempted rape, while about one in 20 had actually been raped. The rapists were spouses and boyfriends. Most of the victims did not seek care or redress. Concludes that violence is a major problem affecting YFH and recommends education programmes for men on both physical and sexual violence, and on culturally‐promoted, psychological and economic violence. YFH need to be empowered educationally and economically to enable them to resist violence.

Sexual Behavior and Knowledge of AIDS among Female Trade Apprentices in a Yoruba Town in South-Western Nigeria

This exploratory study was carried out among unmarried female trade apprentices in Ikorodu, a Yoruba town in south-western Nigeria, to identify sexual risk behaviors, assess knowledge on HIV/AIDS, and recommend an appropriate AIDS education program. Four focus groups were conducted to gain insight into the social-cultural and economic factors influencing sexual risk behaviors, followed by a survey involving 280 randomly selected respondents. Findings showed that many group discussants approved of premarital sex and believed that sex with multiple partners occurred mainly because of the economic difficulties encountered by female apprentices. Most of the survey respondents (70.9%) were sexually experienced, with age of first sexual intercourse ranging from eleven to twenty-two years. One hundred and fifty-five (78.2%) were sexually active; of these, 37.4 percent said that their last sexual encounter occurred because they could not resist the pressure put on them by their male partners, were under the influence of alcohol, were in need of money, and raped. Sixty percent of the sexually active respondents did not take any action to prevent STD or pregnancy during their last sexual encounter. Of the fifty-eight who did, 37.9 percent used the condom. Of those sexually experienced (45.3%) have had at least one STD symptom in the year before, half of them did not do anything about their condition; 37 percent practiced self-medication or received injections from quacks. Although 70.9 percent had heard about AIDS, many had limited knowledge about the nonsexual routes of HIV transmission. Appropriate intervention strategies were recommended to educate the apprentices.

Women and the Risk of HIV Infection in Nigeria: Implications for Control Programs

AIDS is a growing public health problem in Nigeria. Since 1984 when AIDS was officially reported in the country, the number of persons infected with HIV and those with AIDS continue to increase rapidly. This trend is likely to persist in the coming years because, in spite of a high level of public awareness about AIDS, many Nigerians continue to engage in behaviors, such as unprotected sexual networking, which would raise their risk of exposure to HIV. Women in Nigeria are particularly susceptible to HIV infection and its consequences because existing sexual norms place them at a disadvantage in that they are unable to control the sexually risky behaviors of their spouses or take action that would limit their risk of exposure. The current economic crisis in Nigeria has also caused many women to go into full-time commercial sex work or enter other occupations in which they are predisposed to being lured or forced to having sexually risky relationships with men. Unfortunately, the current AIDS control intervention in Nigeria do not address these issues. This article draws attention to the biological, cultural, and economic conditions which make women in Nigeria susceptible to HIV infection and recommends how to overcome them.

Evaluation of interventions to prevent gender-based violence among young female apprentices in Ibadan Nigeria.

Purpose – This intervention project targeted one vulnerable group, female apprentices in Ibadan, Nigeria, to evaluate the effectiveness of multiple interventions aimed at preventing voilence against women (VAW).Design/methodology/approach – A baseline survey was conducted through face‐to‐face interviews with 350 young women recruited from apprenticeship workshops in Ibadan. The interventions consisted of skills training workshops for apprentices (323), sensitization training for the instructors of apprentices (54), police (30) and judicial officers (25) and the development/distribution of educational materials to reduce the incidence of violence. A follow‐up survey was conducted with 203 apprentices after five months of interventions.Findings – Improvements were found at follow‐up with respect to knowledge of types of violence and sexual forms of violence (up from 89.4 to 97 percent) (p<0.05), and appreciation of vulnerability to VAW increased (from 77 to 95 percent) (p<0.05). The prevalence of beating dr...

Effects of training programme on HIV/AIDS prevention among primary health care workers in Oyo State, Nigeria

Purpose – The purpose of this paper is to train primary health care workers to be trainers and implementers of community‐based AIDS prevention activities in Oyo State, Nigeria, by describing an evaluation of the project.Design/methodology/approach – A total of 148 primary health care workers recruited from the 33 local government areas (LGA) of the state were trained as trainers. They were provided seed grants to replicate similar training for health workers, implement and evaluate community‐based AIDS prevention activities. Questionnaires were used before and after the training and the community based projects to evaluate its impact on knowledge of cause of AIDS, routes of HIV transmission, signs and symptoms of AIDS, and precautions to prevent.Findings – At pre‐test, only 30.8 per cent of trainers could list at least four signs and symptoms of AIDS compared with 70.9 per cent who could do so after the training. The trainers trained 973 health workers; the number trained ranged from 20‐80 with a mean of ...

Outcome of two patient education methods on recruitment and compliance with ivermectin in the treatment of onchocerciasis.

Two patient education methods, Information Media (IM) and Social Network (SN), were compared to determine their relative effectiveness on recruitment and subsequent compliance behavior of people infected with onchocerciasis in respect of appointment keeping and ivermectin consumption in existing primary health care facilities in six communities in southwestern Nigeria. Two communities each were randomly assigned to the IM intervention group, two of the SN group, and two served as controls. A total of 1265 persons out of an estimated target population of 5033 infected individuals were enrolled in the study. Coverage rates were higher in the intervention communities (30.3% for SN and 29.9% for IM) than control (7.3%), but the differences between intervention groups was not significant. A drop-off was seen in attendance at the second round of ivermectin distribution. Nearly equal proportions of the intervention groups returned (43.3% for SN and 47.4% for IM), while few control patients came back for their second dose (12.3%). Factors responsible for the low turnout were thought to include the content of educational messages, mobility of community members and limited time available to collect the drugs. Cost considerations led to recommendations to maintain facility based distribution and the SN approach, with greater emphasis on mobilization to increase coverage and compliance.

Ethical and Methodological Challenges Involved in Research on Sexual Violence in Nigeria

Research on sexual violence is fraught with ethical and methodological challenges due to its sensitive nature. This paper describes the ethical and methodological challenges encountered in planning and conducting two exploratory studies on sexual violence that included in-depth interviews of eight female adolescent rape survivors in Ibadan and four married women in Lagos Nigeria who were raped, forced to perform sexual acts and sexually deprived. The first challenge encountered was an Institutional Review Board (IRB) requirement to obtain parental permission from adolescents, when such a requirement may place the adolescent at risk if a parent was a perpetrator of sexual violence. Using arguments emphasizing the Council for International Organization for Medical Sciences guidelines helped convince the IRB to provide a waiver of parental consent. Second, the privacy required to conduct in-depth interviews for rape survivors was difficult to achieve because five of the rape survivors were apprentices who work in public settings which are typically used to conduct business in the informal sector. To overcome this challenge, interviews were conducted in safe locations, investigators offices and homes of survivors. The culture of silence associated with sexual violence posed a challenge because it encourages perpetration of violence with impunity causing rape survivors to suffer in silence. None of the affected adolescents had sought judicial redress for rape despite availability of stringent punishment for this behaviour. Referral information was provided on where survivors could seek care. Interviews with the women could not be recorded on audio-tapes because of concerns that their partners might identify their voices from the tapes and punish them for this. Although research on sexual violence poses ethical and methodological challenges, it is not only desirable but also feasible to conduct such research in ways that ensure safety of participants.