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Sexual Risk Behaviors and HIV Among Female Sex Workers in Nigeria

Eluwa, George I. MBBS, MS*; Strathdee, Steffanie A. PhD; Adebajo, Sylvia B. MBBS, MPH, MS*; Ahonsi, Babatunde PhD*; Azeez, Aderemi MBBS, MPH; Anyanti, Jennifer MBBS, MPH§

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 1st, 2012 - Volume 61 - Issue 4 - p 507–514
doi: 10.1097/QAI.0b013e31826dfb41
Epidemiology and Prevention

Background: Female sex workers (FSWs) account for about 20% of new HIV infections in Nigeria. We estimated the change in HIV prevalence and sexual risk behaviors between 2 consecutive rounds of integrated biological and behavioral surveillance surveys (IBBSSs) and determined correlates of HIV transmission among FSWs.

Methods: In 2007 and 2010, HIV prevalence and risk behavior data on brothel-based (BB) and non–brothel-based (NBB) FSWs from the integrated biological and behavioral surveillance survey were evaluated in 6 Nigerian states. Logistic regression was used to identify correlates of HIV infection.

Results: A total of 2897 and 2963 FSWs were surveyed in 2007 and 2010, respectively. Overall HIV prevalence decreased in 2010 compared to 2007 (20% vs. 33%; P < 0.001), with similar magnitude of declines among BB-FSW (23% vs. 37%; P < 0.0001) and NBB-FSW (16% vs. 28%; P < 0.0001). Consistent condom use with boyfriends in the last 12 months was lower in 2010 compared to 2007 overall (23% vs. 25%; P = 0.02) and among BB-FSWs (17% vs. 23%; P < 0.01] while NBB-FSWs showed a marginal increase (30% vs. 27%; P = 0.08). FSWs residing in the Federal Capital Territory [adjusted odds ratio (AOR): 1.74 (1.34 − 2.27)] and Kano state [AOR: 2.07 (1.59 − 2.70)] were more likely to be HIV-positive while FSWs recruited in 2010 [AOR: 0.81 (0.77–0.85)] and those who had completed secondary education [AOR: 0.70 (0.60–0.80)] were less likely to be HIV-positive.

Conclusions: Results suggest significant progress in reducing the burden of HIV among FSWs in Nigeria, although low condom use with boyfriends continued to be a potential bridge between FSWs and the general population. Venue-based prevention programs are needed to improve safer sex practices among BB-FSWs.

*Department of HIV/AIDS, Population Council Nigeria, Abuja, Nigeria

Division of Global Public Health, Department of Medicine, University of California, San Diego, CA

Department of HIV/AIDS, HIV and AIDS Division, Federal Ministry of Health, Abuja, Nigeria

§Department of HIV/AIDS, Society for Family Health, Abuja, Nigeria.

Correspondence to: George I. Eluwa, MBBS, MS, Operations Research Division, Department of HIV/AIDS, Population Council Nigeria, 3rd Floor, Bassan Plaza, Plot 759 Cadastral Zone AO, Central Business District, Abuja, Nigeria (e-mail:

Supported by Department for International Development, United States Agency for International Development.

Funds for data collection and technical support for the survey were provided by British Government's Department for International Development (Department for International Development/United Kingdom Agency for International Development)., through the Enhancing Nigeria's Response to HIV and AIDS Program, led by Society for Family Health, Nigeria and US President's Emergency Plan for AIDS Relief through US Agency for International Development Cooperative Agreement No. 620-A-00-04-00122-00, through FHI360s Global HIV/AIDS Initiative in Nigeria.

Author contributions: G.I. Eluwa and S.B. Adebajo conceived the study. G.I. Eluwa and S.A. Strathdee performed the statistical analysis. G.I. Eluwa, B. Ahonsi, and S.B. Adebajo participated in the study design. A. Azeez, S.B. Adebajo, and J. Anyanti participated in the integrated biological and behavioral surveillance survey design and coordinated data collection. G.I. Eluwa, S.A. Strathdee, and S.B. Adebajo drafted the article. S.A. Strathdee, S.B. Adebajo, J. Anyanti, and B. Ahonsi interpreted the data and provided critical review of the article. All authors contributed to and have approved the final manuscript.

The authors have no conflicts of interest to disclose.

Received March 30, 2012

Accepted August 2, 2012

© 2012 Lippincott Williams & Wilkins, Inc.