poverty, sexual practices and vulnerability of female sex workers to hiv/aids in oyo state...

Poverty, Sexual Practices and Vulnerability of Female Sex Workers to HIV/AIDs in Oyo State

South-West Nigeria

Tijani A.I, Bako J.C, Oni F, Ajibola O, Titus O.M, Shakede A.O

Body and Soul Builders InitiativeSociety for Family Health

National HIV Prevention Conference November, 2016

…Creating Change, Enhancing LivesSociety for Family Health, Nigeria

Background• The prevalence of HIV among Female who sell sex

in Nigeria has witnessed a sharp decline between 2007 to 2014.

• The decline was recorded both amidst BBFSWs (30.2% in 2007 to 19.4% in 2014) and NBFSWs (37.4% in 2007 to 8.6 in 2014)

• This decline can be attributed to National programmatic response towards achieving universal access to HIV/AIDS preventions in Nigeria.


…Creating Change, Enhancing LivesSociety for Family Health, Nigeria …Creating Change, Enhancing LivesSociety for Family Health, NigeriaSociety for Family Health, Nigeria …Creating Change, Enhancing Lives

Background Cont’d

• However, FSWs and their clients still contribute significantly to the rate of new HIV infection in Nigeria

• Studies have revealed that FSWs, IDUs and MSMs alone, who constitute about 1% of the adult population, contribute as much as 23% of new HIV infections.

• These Most At Risk Populations and their partners contribute as much as 40% of new infections

• Poverty has been described as a drive of the HIV epidemics especially among FSWs with regards to the use of condoms



Intervention Program with FSWs • SFH through the Global Fund supported BASBI to carry out

HIV prevention program for FSWs in Oyo state with the aim of reducing the prevalence of HIV among FWSS in Oyo state

• The program adopted the nationally approved Minimum Prevention Package Intervention to reach FSWs in Oyo state – using behavioural, biomedical and structural approaches.

• Sex-workers were selected and trained as PEs who in-turn selected and reached their peers with SRH/STI/HIV information and messages 3 times monthly.

• 196 FSWs in more than 5 communities in 13 brothels in Oyo state South-West-Nigeria participated in the 12 months’ programme.

• 175 (98%) FSWs met the National approved Minimum Prevention Package Intervention (MPPI).


…Creating Change, Enhancing LivesSociety for Family Health, Nigeria …Creating Change, Enhancing LivesSociety for Family Health, Nigeria

Intervention Program with FSWs Cont’d

• Outreach workers (current or retired FSWs) were engaged

• 147 (75%) FWSS were provided with HTS during the NFM intervention.

• 43 referrals were made to health facilities out of which 4 (2.7%) are TB, 13 (8.8%) are STI and 26 (17.7%) are HTS.

• PM&E was conducted to get the baseline data for the HIV risk behaviour among the selected FWSS.

• HCW from selected referral Health facilities were trained on providing friendly services to MARPs referred to facilities.


Intervention Program with FSWs Cont’d

• Income generating activities and off sites STI outreach were provided for over 120 sex-workers.

• Peer tracking cards were developed and used to track health services provided to FWSS and data were collected.

• IEC materials, lubricant and condoms were distributed to sex workers on a monthly basis.

• 78,948 Male condoms, 301 Female condoms and 5,418 Lubricants were distributed.


Peer Education StrategiesMPPI MPPI Strategies Strategies

Peer Peer Education Education

Peer Education Peer Education Plus Plus

Specific Population Specific Population Awareness Campaign Awareness Campaign

Activities per strategy (Behavioural/Biomedical/Structural)

1. Peer Education

1.1. Edutainment Edutainment 2.2. Psychosocial Psychosocial

activities activities

1. PM&E2. Peer Sessions3. Small group discussion4. Interpersonal

Communications

Who is reached?

1. BBFWSS(formerly FSW)

1. Peers 2. Peer Educators

1. PEs and peers

creating change….enhancing lives


Lessons Learned • During a heart to heart discussion with some FSWs

participating in the program they acknowledged that;• Most of them became commercial sex workers when there

is no sustainability. Some young girls chose to enter the sex industry to make more money for themselves.

• Some of them were enslaved into the business due to the fact that their parents could no longer provide for their needs.

• Most of the FSWs engaged in unprotected sex with their boyfriends, not knowing they are keeping other relationships outside – this increases their vulnerability to STI/HIV.


Lessons Learned Contd.

• Poverty is the real force that drives young girls to seek opportunities in desperation. It is one of the reasons why FWSS are vulnerable to HIV because customers pay more without using condoms.

• PM&E with FSWs shows 45% increase in knowledge of HIV transmission and prevention and condom use as at last sex rising from 42% to 78%

Conclusions and Recommendations• Poverty is a factor which predisposes women to sex selling and

increases their tendencies to HIV risk behaviours

• To reduce risky sexual practices and vulnerability of Female Sex workers to HIV/AIDs. Interventions must be targeted to FSWs in brothels in urban and semi urban communities in Oyo state.

• FSWs capacities should be built on income generating activities to reduce their dependency on selling sex for survival.

• Condoms and lubricants should be made more available to FSWs and through NTOs

• Engage and train more HCWs on how to provide friendly services to FSWs to reduce stigma and discrimination.

• Develop an effective referral and tracking system for FSWs who are STI or HIV positive




THANK YOU!!!

…Creating Change, Enhancing LivesSociety for Family Health, Nigeria …Creating Change, Enhancing LivesSociety for Family Health, Nigeria…Creating Change, Enhancing LivesSociety for Family Health, Nigeria

…Creating Change, Enhancing Lives

poverty, sexual practices and vulnerability of female sex workers to hiv/aids in oyo state...

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