ISSN: 2320–7183
Novus International Journal of Medical Science 2013, Vol. 2, No. 1 www.novusscientia.org
Accepted on: April 7, 2013
Demographic and social characteristics of female commercial sex workers receiving anti-retroviral treatment (ART) in north-western Nigeria M.N.Sani1*, E.D. Jatau2, S.O. Olonitola2, M.Y. Gwarzo2 and A.H. Kawo3 1
Department of Microbiology, Federal University, PMB 7156, Dutse, Jigawa State, Nigeria 2 Department of Microbiology, Ahmadu Bello University, PMB 1044 Zaria, Nigeria 2 Department of Chemical Pathology, A. K. Teaching Hospital, Bayero University, PMB 3011, Kano, Nigeria 3 Department of Microbiology, Bayero University, PMB 3011, Kano, Nigeria
ABSTRACT A study was conducted to monitor anti-retroviral treatment (ART) among commercial sex workers attending public health facilities in north-western Nigeria. A total of 218 sex workers were recruited from four States of north-western Nigeria. Detailed questionnaire was used to collect data on demographic and social characteristics of the recruited subjects. The results obtained in the study have shown that mean age of the sex workers was 31.44 ± 6.42 years, condom use was lowest among the respondents with non-formal education that never use condom (P < 0.002) and highest among street based sex workers as compared to brothel based (P < 0.002). Most of the respondents had 3.55±2.95 as mean number of sexual partners per week. Radio was the major source of HIV information among the respondents. There is need to establish basic information on HIV status among CSWs as they are major reservoirs and scavengers of HIV transmission in the community. KEYWORDS: Human immunodeficiency Virus, Commercial Sex Worker, Antiretroviral
treatment, Demography, Prevalence. 1
*Corresponding author: M.N.Sani Department of Microbiology, Federal University, PMB 7156, Dutse, Jigawa State, Nigeria Email:
[email protected]
INTRODUCTION The prevalence rates of HIV/AIDS vary amongst regions of the world. It varies from 0.06% in Hungary to 33.4% in Swaziland and 4.1% in Nigeria. Detailed surveys of the infection rates amongst prostitutes over two decades have provided reservoir of basic information on score of fight against HIV epidemic in many countries of the world. In general, even in the most infected countries, prevalence rates for CSWs appear to be significantly higher than the general populace and seem to be a leading indicator of the future prevalence in the general populace. Historically, sex workers have been blamed for spreading sexually transmitted diseases including HIV. Determining HIV prevalence among this group of highly mobile population has been quite challenging. Like other marginalized populations, sex workers often receive little attention from both public health officials and researchers. The stigma attached to sex work and criminal sanctions made reliable data hard to come by and there is almost no information about male sex workers (Louis Saccabarrozzi, 2007.) An overwhelming majority of new adult HIV infections (especially in sub-Saharan Africa) is attributed to sexual activity. It is estimated that 8 in every 10 infections in this part of the Novus International Journal of Medical Science 2013, 2(1)
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world is due to heterosexual intercourse (UN AIDS, 2002). Unfortunately, because it takes an average of 10 years for infected people to develop symptoms, many of those infected are usually asymptomatic, unaware of their HIV sero-status, and in most cases have a very low perception of their own HIV risk . Consequently, the number of infections due to sexual contacts will continue to rise if unchecked until the level of HIV infection reaches a saturation state. High risk groups such as commercial sex workers (CSWs), men who have sex with men (MSM), injecting drug users (IDUs, youths, transport workers, armed forces etc. could facilitate continuous transmission of HIV in the general population. Sexual activities and STD prevalence are related as it affects mainly individuals between the ages of 20 – 29 years. Evidence had shown that preventing transmission among those with high rates of partner exchange is a cost-effective intervention as it can also help avert the spread to members of the wider population (UNAIDS 2002). HIV prevalence rate among female sex workers in Nigeria has remained high and on the increase, from 17.5% in 1991, through 22.5% (1993) to 35.6% (1995). This group constitutes an important reservoir of HIV infection for transmission to the general population, through sexual networking. Strong associations between HIV–1 seropositivity exist among prostitutes of low economic strata (Dada et al., 2003). CD4 cell count and viral load are routinely measured every 3 - 6 months to monitor the efficacy of antiretroviral therapy (ART) in people living with HIV/AIDS (PLWHA). It is worthy to note that some patterns of behaviour among high risk groups such as commercial sex workers (CSWs), men who have sex with men (MSM), injecting drug users (IDUs, youths, transport workers, armed forces etc. could facilitate continuous transmission of HIV in the general population. Antiretroviral treatment monitoring is therefore a cost effective intervention in mitigating the impact of HIV/AIDS among the teaming populace. MATERIALS AND METHODS Study area/population A total of two Hundred and eighteen (218) female commercial sex workers aged 20 - 50 years from 4 out of the 7 states of North – Western Nigeria were recruited for the study. Structured questionnaire was administered to capture demographic data (age of commencing sex trade, duration in sex trade, number of partners per week, amount of money charged per each round of sex, use of illicit drugs and alcoholism, reasons for engaging in sex trade etc).Blood samples were also collected to re-screen the patients for their HIV status between December, 2009 and July, 2011. Sample collection, processing and analysis Five millilitres (5ml) of whole blood was aseptically collected aseptically from the cephalic vein of the ante- cubital fossa of each donor after signing informed consent at the end of group information session (GIS). Sterile EDTA vacutainer was used and the blood allowed to clot for separation (Cheesbrough, 2005). The clotted blood was spun at 3000 g for 10 minutes, the serum separated into a sterile plain container(s) and stored at -20oC until ready for the assay. The analysis was carried out using enzyme linked immunosorbent assay (ELISA) kits, SD – BIOLINE TM HIV-1/2 3.0 manufactured by standard diagnostics corporation 03FK10 –En - 3, Korea. Test procedure (HIV Serology) The test device (cassette) was removed from the foil and placed on a flat surface (laboratory work top).Ten micro-litter (10µl) of plasma was added into the sample well using Pasteur‟s pipette. Four (4) drops about (120 µl) of assay diluents was added into the sample well and allowed to run for 5-20 minutes. Novus International Journal of Medical Science 2013, 2(1)
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Interpretation of the test (a) A color band appeared in the left section of the result window to show that the test working properly. This band is control line. (b) Color bands appeared in the middle and right section of the result window. These were test line 2 and test line 1 (1, 2). Negative test Result Negative result showed presence of only control line (C) within the result window. Positive Result: Positive result showed presence of two lines as control line (C) and test line 1 within the window. This indicates positive result for HIV-1. The presence of two lines as control line (C) and test line 2 (2) within the result window indicates a positive result to HIV -2.The presence of three lines as control line (C), test line 1 (1) and test line 2 (2) within the result window indicates a positive result for HIV-1 and HIV2.All test s were performed according to manufacturer‟s guide. Statistical analysis The data generated in this study was analysed for statistical significance in the association of HIV infection and demographical social parameters as well as possible risk factors using Pearson Chi–Square, Fisher‟s exact test and One Way ANOVA with the aid of Statistical Package for Social Sciences (SPSS) version 17. RESULTS Demographic information Sex trade is an old business that cuts across continents of the word and commercial sex workers of varying age group have been found to play a pivotal role in the spread of sexually transmitted infections including HIV. The mean age of sex workers was found to be 31.44±6.42 (yrs) as shown on table 1. However, their state of sex activity indicates that 81(37.2%) , 59(27.1%) and 51(23.4%) of sex workers who participated in the study were Kaduna, Kebbi and Kano respectively. Similarly, a total of 27(12.1%) sex workers from Jigawa state were used for the study (National HIV sentinel survey, 2005). Table 1 also shows that 78 (35.8%) of the studied population had received primary education while 68(31.2%) had secondary education. Conversely, only 25(11.5%) of the studied population had tertiary/post-secondary education. The mean duration in sex trade in this study was found to be 7.70±5.60 years. The study has also revealed that, major sources of HIV information for the sex workers were radio 158 (72.5%), television 16 (7.3%) while friends accounts for 20(9.2%). Other sources include hospital 22(10.1%) and infected relative/friends accounted for 2 (0.9%) respectively. Sexual behaviors among commercial sex workers Commercial sex workers are group of highly mobile population. Some are hostile as a result of drug influence, stigmatization, and rejection and to some extent oppression by customers and security agents. Forced marriage, economic problems, etc were found to be among factors that drag these women into sex trade. The results shown in Table 2 indicated that 123 (56.4%) ever used condom before sex while 95 (43.6%) did not. It can also be deduced from the study that 52(42.3%) always used condom before sex while 65 (52.8%) occasionally used condom before sex. The study shows that 6 (2.8%) of the study population rarely use condom during sexual intercourse with their clients. Findings from this study have also revealed 68 (31.2%) of the studied population were Brothel based while 150 (68.8) were street based commercial sex workers respectively. The table also indicated that 202 (92.7%) of the studied population went into commercial sex activity for economic reasons while 15(6.9%) were Novus International Journal of Medical Science 2013, 2(1)
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found to be in sex trade for social reasons. However, 1 (0.5%) were in the trade for other reasons. Table: 1 Demographic Characteristics of Commercial Sex Workers (N = 218) Characteristic Mean Age at Time of Enrolment (years)
Value* 31.44 ± 6.42
State of Sex Activity, no. (%) Kaduna
81 (37.2)
Kebbi
59 (27.1)
Kano
51 (23.4)
Jigawa
27 (12.1)
Educational Level, no. (%) Non-formal
47 (21.6)
Primary
78 (35.8)
Secondary Tertiary
68 (31.2) 25 (11.5)
Mean Duration in Sex Trade (years)
7.70 ± 5.60
Source of HIV Information, no. (%) Radio
158 (72.5)
Television
16 (7.3)
Friends
20 (9.2)
Hospital
22 (10.1)
Infected Relative/Friends
2 (0.9)
*
Plus-minus values are means ± SD Table: 2 Use of illicit drugs among Commercial Sex Workers (N = 218)
Characteristic Use of Illicit Drugs Before Sex Yes No Types of Illicit Drugs Used Morphine Indian Hemp Alcohol Use Before Sex Yes No
Value, no. (%) 16 (7.3) 202 (92.7) 2 (12.5) 14 (87.5) 7 (3.2) 211 (96.8)
Plus-minus values are means ± SD; †Median (IQR)
*
The mean age of commencing sex activity by the studied population was found to be 23.85 ± 6.3 years, while the median number of sexual partners per week per sex worker was found to be 3(2). Similarly, the study has revealed that amount of money charged to clients per sex round per client was ₦1,500 (1000).Table 2 has also shown that only 16 (7.3%) of the sex workers use illicit drugs while 202(92.7%) do not use illicit drugs before sexual intercourse. Social orientation of the study group has exposed them to use of illicit drugs. Consequently, 2 (12.5%) use morphine while 14 (87.5%) of the studied population use Indian Hemp. Similarly, 7 (3.3%) of the sex workers take alcohol before sex while 211(96.8%) do not. The Novus International Journal of Medical Science 2013, 2(1)
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study also revealed that out of the 218 respondents,7 (3.2%) use alcohol before sex.One of the clients was drunk at the time of questionnaire and phlebotomy sessions respectively. HIV Prevalence Table 3 shows prevalence of HIV among Commercial sex workers in relation to state of activity, condom use, and type of sex worker and duration in sex trade, condom use and frequency and amount of money charged. The table indicates that HIV - 1 is more prevalent in Kaduna state with 53 (65.4%) followed by Kebbi state with 33 (55.9%).Kano, the most populous state in the region had HIV – 1 prevalence of 32 (62.7%).However, Jigawa state had the least prevalence of 16 (59.3%). On the other hand, HIV – 2 was only found in Kaduna state with 4 (4.9%) patients infected accordingly (P = 0.269). The prevalence of mixed infection (HIV 1 &2) in the four states was equally recorded and incidentally, Kebbi state had the highest prevalence of 26 (44.1%) followed by Kaduna state with 24 (29.6%) respectively. The prevalence of HIV- 1 and 2 in Kano state was 19 (37.3%) while Jigawa state recorded the lowest prevalence of 11 (40.7%) with P= 0.269. Table 3 also indicated that HIV – 1 was more prevalent among street based sex workers 92 (61.3%) while brothel based sex workers recorded HIV – 1 prevalence of 42 (61.8%) respectively. HIV – 2 with prevalence of 4(92.7%) was only found among street based commercial sex workers in Kaduna state. The rate of mixed infection (HIV – 1 and 2) recorded among street based sex workers 54 (36.0%) was slightly twice what was recorded among brothel based sex workers 26 (38.2%) respectively (P =0.554). In this study, patient‟s knowledge on condom use was shown to impact positively on both clinical and demographic characteristics of the studied population. Table 4 shows that sex workers in Kaduna State tend to use condom 45 (55.6%) more than those from Kebbi state 41 (69.5%) P
