Sexual risk history and condom use among people living with HIV/AIDS in Ogun State, Nigeria

Article (PDF Available)inJournal of Sexual Medicine 9(4):997-1004 · January 2012with25 Reads
DOI: 10.1111/j.1743-6109.2011.02602.x · Source: PubMed
Abstract
The majority of human immunodeficiency virus (HIV) infections are acquired through unprotected sex between partners; only male or female condoms can reduce the chances of infection with HIV during a sexual act. This study was therefore designed to describe sexual risk history and identify factors associated with condom use among people living with HIV/acquired immunodeficiency syndrome (AIDS) (PLWHAs) in Ogun State, Nigeria. Main outcome measures are sexual and HIV risk history, safe sex practices, and condom use. This study is an analytical cross-sectional study. A total sample of all people living with HIV/AIDS attending secondary health facilities in Ogun State were recruited into the study. A total of 637 were interviewed; median age at first sexual intercourse among the study participants was 19 years (mean age = 18.95, standard deviation [SD] = 4.148) with a median of two lifetime sexual partners (mean = 3.22, SD = 3.57). Majority (71.4%) of the respondents had not been diagnosed with a sexually transmitted infection other than HIV. Precisely 47.7% of men and 52.3% of women had two or more sexual partners in the last 6 months. Men were statistically significantly more likely to have multiple sexual partners when compared with women (P = 0.00). Significantly more women (69.8%) than men (30%) had sexual partners whose HIV status they did not know (P = 0.006). Predictors of condom use were individuals who had multiple sexual partners (odds ratio [OR] = 1.41, confidence interval [CI] = 1.05-1.83) and married (OR = 3.13, CI = 1.15-8.51) with higher level of education (OR = 2.78, CI = 1.39-5.79), with knowledge of partner's serostatus (OR = 2.53, CI = 1.50-4.28), and awareness of reinfection (OR = 1.90, CI = 1.22-2.95). The study indicates that the establishment of effective safe sex practices and condom use behavior among PLWHAs in low-income countries such as the study population requires adequate health education on the transmission of HIV/AIDS and the understanding of the dynamics of family life and gender issues.
ORIGINAL RESEARCH—EPIDEMIOLOGY
Sexual Risk History and Condom Use among People Living with
HIV/AIDS in Ogun State, Nigeria
jsm_2602 997..1004
Olorunfemi Amoran, MBBS, MSc[epid], MMP, FMCPH and Temitope Ladi-Akinyemi, Mb ChB, MPH
Department of Community Medicine and Primary Care, College of Health Sciences, Olabisi Onabanjo University
Teaching Hospital, Sagamu, Nigeria
DOI: 10.1111/j.1743-6109.2011.02602.x
ABSTRACT
Introduction. The majority of human immunodeficiency virus (HIV) infections are acquired through unprotected sex
between partners; only male or female condoms can reduce the chances of infection with HIV during a sexual act.
Aim. This study was therefore designed to describe sexual risk history and identify factors associated with condom use
among people living with HIV/acquired immunodeficiency syndrome (AIDS) (PLWHAs) in Ogun State, Nigeria.
Main Outcome Measures. Main outcome measures are sexual and HIV risk history, safe sex practices, and condom use.
Methods. This study is an analytical cross-sectional study. A total sample of all people living with HIV/AIDS
attending secondary health facilities in Ogun State were recruited into the study.
Result. A total of 637 were interviewed; median age at first sexual intercourse among the study participants was 19
years (mean age = 18.95, standard deviation [SD] = 4.148) with a median of two lifetime sexual partners
(mean = 3.22, SD = 3.57). Majority (71.4%) of the respondents had not been diagnosed with a sexually transmitted
infection other than HIV. Precisely 47.7% of men and 52.3% of women had two or more sexual partners in the last
6 months. Men were statistically significantly more likely to have multiple sexual partners when compared with
women (P = 0.00). Significantly more women (69.8%) than men (30%) had sexual partners whose HIV status they
did not know (P = 0.006). Predictors of condom use were individuals who had multiple sexual partners (odds ratio
[OR] = 1.41, confidence interval [CI] = 1.05–1.83) and married (OR = 3.13, CI = 1.15–8.51) with higher level of
education (OR = 2.78, CI = 1.39–5.79), with knowledge of partner’s serostatus (OR = 2.53, CI = 1.50–4.28), and
awareness of reinfection (OR = 1.90, CI = 1.22–2.95).
Conclusion. The study indicates that the establishment of effective safe sex practices and condom use behavior
among PLWHAs in low-income countries such as the study population requires adequate health education on the
transmission of HIV/AIDS and the understanding of the dynamics of family life and gender issues. Amoran O and
Ladi-Akinyemi T. Sexual risk history and condom use among people living with HIV/AIDS in Ogun State,
Nigeria. J Sex Med 2012;9:997–1004.
Key Words. Sexual Risk; Condom Use; PLWHAs; Nigeria; HIV; Unprotected Sex
Introduction
H
uman immunodeficiency virus (HIV)/
acquired immunodeficiency syndrome
(AIDS) is ravaging in sub-Saharan Africa, with
greater than 60% of all HIV infections in the
world occurring in this region [1,2]. Although
most of the HIV-infected people in Africa have not
been tested for HIV and do not know that they are
HIV positive, uptake of HIV testing is increasing
as antiretroviral (ARV) treatment becomes avail-
able. To date, several studies have examined the
sexual relationships and sexual behaviors of people
living with HIV/AIDS (PLWHAs) in Africa.
However, condom use has increased over the past
2 years among people living with HIV in Africa, so
also unprotected intercourse in a 3-month period
[3–5].
997
© 2011 International Society for Sexual Medicine J Sex Med 2012;9:997–1004
Studies have shown that the sexual behavior of
PLWHAs is not substantially different from that
of HIV-uninfected peers [5–7]. However, manage-
ment of sexual and reproductive health of
PLWHAs is critical to reducing HIV transmission
especially among sexual partners [8]. Furthermore,
an overwhelming evidence shows that HIV infec-
tion among the newborns is associated with
increased maternal mortality and morbidity. Pre-
vention of mother to child transmission of HIV is
still a major challenge in sub-Saharan Africa
because effective combination ARV therapy (ART)
only reaches a minority of HIV-infected women
and the access to skilled attendance at birth is still
suboptimal [9–12].
Researchers have suggested that condom use is
determined by the social context within which the
sexual behavior occurs [13–15]. During a sexual
act, only male or female condoms can reduce the
chances of infection with HIV and other sexually
transmitted diseases (STDs) and the chances of
becoming pregnant [16]. The best evidence to date
indicates that typical condom use reduces the risk
of heterosexual HIV transmission by approxi-
mately 80% over the long term, though the benefit
is likely to be higher if condoms are used correctly
on every occasion. In resource-constrained set-
tings, researchers have found that certain intrinsic
factors act as “barriers” rather than “enablers” to
safer sex practices [15,17–19]. These barriers
include underdevelopment/poverty, gender
inequalities/cultural norms, knowledge/risk per-
ception, negotiation ability/self-efficacy, and other
aspects of the environment [20–23]. Little infor-
mation is available on reproductive practices
among HIV-infected people in Africa that could
inform the design of new and culturally appropri-
ate interventions [22]. This study was therefore
designed to describe sexual risk history and iden-
tify factors associated with condom use among
PLWHAs in Ogun State, Nigeria.
Aim of the Study
General Objective
This study was designed to describe sexual risk
history and identify factors associated with
condom use among PLWHAs in Ogun State,
Nigeria.
Specific Objectives
1. To describe the sexual and HIV risk history of
the PLWHAs.
2. To describe the safe sex practices and sexual
activities among PLWHAs.
3. To define factors associated with condom use
among PLWHAs.
Methods
Study Design
This study is an analytical cross-sectional study.
The information was collected from PLWHAs
attending secondary health facilities in Ogun State
from January 15, 2007 to March 15, 2007.
The Study Area
The study was conducted in Ogun State, which is
one of the 36 states in Nigeria, and was created in
February 1976 out of the old western state. It is
located in the South West zone of Nigeria with a
total land area of 16,409.26 km
2
and a population
of 3,507,735 with growth rate of 2.83% per annum
(2006 National Census). However, the estimated
HIV/AIDS prevalence in Ogun State was 1.7% in
2008 [24]. The state has 20 local government areas
(LGAs), with each LGA headed by an executive
chairman. It is divided into eight geopolitical
zones, three senatorial districts, nine federal, and
26 state constituencies.
This study was conducted in all the four general
hospitals offering voluntary counseling and testing
(VCT), prevention of mother to child transmis-
sion (PMTCT), and ART services in the state
during the study period. Data were collected from
January 15, 2007 to March 15, 2007. The study
was carried out within the medical units of the four
general hospitals in the National HIV/AIDS
Control Programme in Ogun State. All consenting
patients including those referred from all parts of
the states were offered enrollment into the study.
Sampling Technique
A total sample of all patients diagnosed for HIV/
AIDS and receiving treatment within the medical
units of the four general hospitals in the National
HIV/AIDS Control Programme in Ogun State
between January 15, 2007 to March 15, 2007
including those referred from all parts of the states
who consented were enrolled in the study.
Sampling Size Determination
The sample size was calculated using Epi-Info,
version 6.0, statistical software. The result of a
previous study [4] that showed prevalence of
condom use among PLWHAs was used.
998 Amoran and Ladi-Akinyemi
J Sex Med 2012;9:997–1004
However, a total of 637 participants were
recruited into the study.
Study Instrument
The factors examined in the study include socio-
demographic characteristics (age, sex, income,
education, religion, marital status, occupation, and
place of residence), illness-related factors (stage of
disease, duration of test result, and discussion
about HIV), service-related factors (HIV status of
partner and ART), psychosocial factors (active
substance and alcohol use), and behavioral factors
(number of partner, condom use, and perceived
severity).
Single multiple response choice questions were
asked to determine condom use: “Did you use
condom in the last sexual intercourse that you
had.” The reasons for nonuse of condom were
probed.
The questionnaire was pretested on 20 clients
in Institute of Human Virology, Olabisi Onabanjo
University, Sagamu and necessary adjustments
were made. Trained data collectors explained the
aim of the study, obtained informed consent, and
interviewed each respondent privately. All infor-
mation was obtained under anonymity and the
data were collected by trained personnel on clinic
days.
Ethical Considerations
Ethical clearance was obtained from the Olabisi
Onabanjo Teaching Hospital Ethics Board. Con-
fidentiality on candidate’s information was main-
tained. Permission of the State Ministry of Health,
HIV/AIDS Control Division was obtained before
the commencement of the study.
At each of the study site, the matron and
medical officer in-charge were informed for
consent before the commencement of the study.
The purpose, general content, and nature of the
study were explained to each respondent to obtain
verbal and written consent before inclusion into
the study.
Data Analysis
To describe patient characteristics, we calculated
proportions and medians. For categorical vari-
ables, we compared proportions using chi-square
tests and, when appropriate, Fisher’s exact test.
Chi square was used to determine association
between categorical variables, and a P value of less
than 0.05 was considered significant. Data were
presented in tabular form.
A logistic regression model was produced with
use and nonuse of condom as outcome variable to
identify associated factors. All explanatory vari-
ables that were associated with the outcome vari-
able in bivariate analyses were entered into the
model; all variables with a P value of 0.05 were
included in the logistic models. Predictor variables
were restricted to outcome measures that were
statistically significant. A P value 0.05 or confi-
dence limit that did not embrace unity (1) was
considered as statistical significance.
Main Outcome Measures
Main outcome measures are
1. The sexual and HIV risk history;
2. Safe sex practices (sexual activities);
3. Condom use.
Result
Sociodemographic Characteristics of the Respondents
Almost all (95%, N = 637) of those approach
agreed to participate in the study. Two hundred
four (32%) were males and 433 (68%) were
females. Majority (42.4% and 42.9%) of the par-
ticipants were aged 20–39 and 40–59 years, respec-
tively, with 25 (3.9%) being teenagers, 15–19
years. The most common levels of education
attained by the participants were secondary educa-
tion (41.4%), tertiary education (20.9%), and
primary education (23.5%), and 14.1% were illit-
erates. Four hundred thirty-four (68.1%) were
married and 85 (13.1%) were never married.
Majority (63.0%) were unskilled workers and
14.4% were professional workers, and 429 (67.5%)
were from a monogamous family background. The
sociodemographic characteristics of the partici-
pants are summarized in Table 1.
The Sexual and HIV Risk History
Median age at first sexual intercourse among the
study participants was 19 years (mean age = 18.95,
standard deviation [SD] = 4.148), with a median of
two lifetime sexual partners (mean = 3.22,
SD = 3.57). Participants were relatively recently
diagnosed HIV positive as highly active anti-
retroviral therapy (HAART) was introduced in
these centers about 1 year prior to this research
work. Only 104 (16.3%) were on ART. In terms of
their health status, nearly half (53.4%) of the
sample reported having physical symptoms associ-
ated with HIV infection, with an average of four
Sexual Risk and Condom Use among PLWHAs 999
J Sex Med 2012;9:997–1004
current symptoms experienced. Majority (71.4%)
of the respondents had not been diagnosed with a
sexually transmitted infection (STI) other than
HIV. There was no statistically significant differ-
ence between male and female who reported pre-
vious history of STD (P = 0.272). Only 16.0% of
the study participants use any form of psychoactive
substance such as alcohol, nicotine, cigarette, etc.
Table 2 shows the sexual health and risk history
characteristics of the study participants.
Safe Sex Practices (Sexual Activities)
Majority (76.6%) of the study participants were
aware that they can be reinfected with HIV infec-
tion. However, there was no statistically significant
difference in knowledge between male and female
respondents (P = 0.485). For the entire sample,
47.7% of men and 52.3% of women had two or
more sexual partners in the last 6 months. Men
were statistically significantly more likely to report
having multiple sexual partners when compared
with women (P = 0.00) (Table 2). Majority (44.6%)
of the participants did not know the HIV status of
their partners; 193 (30.3%) had HIV-positive part-
ners with 25.3% of men and 74.4% of women.
However, 25.1% reported having HIV-negative
partners. Significantly more women (69.8%) than
men (30%) reported having sexual partners whose
HIV status they did not know (P = 0.006). Unpro-
tected sexual intercourse (69.5%) with HIV con-
cordant and HIV nonconcordant sexual partners
was reported by both men and women. There was,
however, no statistically significant difference in
the use of condom (P = 0.33) between men and
women. Substance use was also common in the
sample, and 16% of all the participants reporting
recent alcohol use, with 63.7% being men and
36.3% being women (P = 0.00).
Condom Use
The prevalence of condom use in the last sexual act
was 30.5%. Those at the extreme of life, i.e., teen-
agers and the elderly, were statistically significantly
more likely to engage in unprotected sex act when
compared with other age groups (X2 = 16.25,
P = 0.001). Male condom use at last sex was statis-
tically significantly associated with education
(X2 = 10.23, P = 0.017). The higher the level of
education, the more likely the use of condom.
Family life factors influencing condom use are
monogamy (X2 = 15.36, P = 0.00) and marriage
Table 1 Condom use and sociodemographic
characteristics
Total
No (%)
Condom
use No. (%) P value
Age
<20 years 25 (3.9) 0 (0.0)
20–39 years 273 (42.9) 92 (47.4)
40–59 years 270 (42.4) 88 (45.4) 0.001
60 years 69 (10.8) 14 (7.2)
Total 637 (100.0) 194 (100.0)
Sex
Male 204 (32.0) 65 (33.5) 0.33
Female 433 (68.0) 280 (66.5)
Religion
Christianity 416 (65.3) 126 (64.9)
Muslim 186 (29.2) 60 (30.9) 0.53
Traditional religion 35 (5.5) 8 (4.1)
Marital status
Never married 85 (13.3) 148 (76.3)
Married 434 (68.1) 20 (10.3)
Separated 50 (7.8) 10 (5.2) 0.022
Divorced 17 (2.7) 2 (1.0)
Widow/widower 51 (8.0) 14 (7.2)
Family type
Monogamy 429 (67.3) 152 (78.4)
Polygamy 208 (32.7) 42 (21.6) 0.0001
No. of children
Had no child 94 (14.8) 25 (12.9)
Had children 543 (85.3) 169 (71.1) 0.37
Level of education
Nil 90 (14.1) 17 (8.8)
Primary 150 (23.5) 42 (21.6) 0.017
Secondary 264 (41.4) 84 (43.3)
Tertiary 133 (20.9) 51 (26.3)
Occupation
Professional 92 (14.4) 34 (17.5)
Skilled 94 (14.8) 23 (11.9) 0.75
Unskilled 401 (63.0) 128 (66.0)
Students 20 (3.1) 2 (1.0)
Unemployed 30 (4.7) 7 (3.6)
Table 2 HIV-related/sexual indices by gender
Total
No. (%)
Male
No. (%)
Female
No. (%) P value
Serostatus of partner
Positive 193 (30.3) 42 (20.6) 124 (28.6)
Negative 160 (25.1) 78 (38.2) 115 (26.6) 0.006
Don’t know 284 (44.6) 84 (41.2) 194 (44.8)
Knowledge of HIV reinfection
Aware 488 (76.6) 157 (77.0) 331 (76.4) 0.49
Not aware 149 (23.4) 47 (33.0) 102 (23.6)
Substance use
Use 102 (16.0) 65 (31.9) 37 (8.5) 0.0001
Do not use 535 (84.0) 139 (68.1) 396 (91.5)
Previous history of STI
Positive 182 (28.6) 62 (30.4) 120 (27.7) 0.27
Negative 455 (71.4) 142 (69.6) 313 (72.3)
No. of sexual partner
One 461 (72.4) 120 (58.8) 341 (78.8) 0.0001
More than one 176 (27.6) 84 (41.2) 92 (21.2)
Condom use
Use 194 (30.5) 65 (31.9) 129 (29.8) 0.33
Not use 443 (69.5) 139 (68.1) 304 (70.2)
HIV = human immunodeficiency virus; STI = sexually transmitted infection
1000 Amoran and Ladi-Akinyemi
J Sex Med 2012;9:997–1004
(X2 = 13.13, P = 0.022). Those married and living
in a monogamous family are more likely to be
involved in unprotected sexual act when compared
with the polygamous and those who were never
married. Reported behavioral indices influencing
condom use are knowledge of serostatus of the
partners (X2 = 22.04, P = 0.00), severity of the
disease (X2 = 4.95, P = 0.016), history of STI
(X2 = 5.61, P = 0.011), and multiple sexual part-
ners (X2 = 6.71, P = 0.007) (Table 3).
In the multiple logistic regression model, five
variables were found to be independently associ-
ated with factors of condom use. Predictors of
condom use were individuals who had multiple
sexual partners (odds ratio [OR] = 1.41, confi-
dence interval [CI] = 1.05–1.83) and married
(OR = 3.13, CI = 1.15–8.51) with higher level of
education (OR = 2.78, CI = 1.39–5.79), with
knowledge of partner’s serostatus (OR = 2.53,
CI = 1.50–4.28), and awareness of reinfection
(OR = 1.90, CI = 1.22–2.95) (Table 4). Higher
education (OR = 7.14, CI = 2.28–13.73) and pre-
vious history of STI (OR = 0.45, CI = 0.20–0.98)
were predictive of condom use among male
respondents, while negative serostatus (OR = 1.98,
CI = 1.16–3.39), knowledge of reinfection (OR =
1.78, CI = 1.09–2.91), and having a monogamous
family (OR = 1.82, CI = 1.15–2.89) were predic-
tive factors among the female respondents.
Discussion
The mean lifetime sexual partner among the study
participant is 3.22, where sexual activities com-
mencing at the age of 19 show that the study
population consist of sexually active people. Sexual
activity among PLWHAs is high with about half of
the study population having multiple sexual part-
ners. Men were statistically significantly more
likely to have multiple sexual partners when com-
pared with women. Studies have shown that the
sexual behavior of PLWHAs is not substantially
different from that of HIV-uninfected peers [5–7].
A vast literature clearly demonstrates that inter-
ventions with attention to specific elements can be
successful in reducing and preventing sexual risk
behaviors [3–5,25–29]. Mobilizing more political
commitment and resources and strengthening
family planning services are critically needed to
improve condom use.
Prevalence of condom use in the last sexual act
measured in this study was found to be similar to
other studies among PLWHAs in African popula-
tion [7,8,24–26,30]. The findings in this study
mirror other studies in Africa and elsewhere
[8,9,31]. Over the last quarter century, substantial
progress has been made in effecting purposeful
behavioral change to reduce HIV/AIDS risk behav-
iors. Support for consistent condom use beginning
at the time of sexual debut is the cornerstone of
adolescent HIV/AIDS prevention [25,31].
The study shows that those married, educated,
and informed about transmission of HIV/AIDS
infection were more likely to use condoms than
those that were never married and less educated.
Several other studies have reported similar find-
ings [32–35]. It was not clear whether this was
because of infrequent sexual activity as suggested
by a study among women from the USA [33] and
inability to plan and control the next sexual
encounter or fear of losing the new partners. This
indicates that the establishment of effective safe
sex practices and condom use behavior requires
adequate understanding of the modern civilization
in family life especially among discordance
couples. Family life education requires HIV/AIDS
knowledge and awareness of the benefits of
condom use, skills regarding the use of condoms,
confidence in these skills, and awareness of the
negative consequences of failure to use condoms in
order to improve safe sex practices and condom
use [13,14,36].
This study showed that it is not only knowing
HIV-positive status that is associated with safe sex
Table 3 Condom use and behavioral indices
Total
No. (%)
Condom
use No. (%) P value
Serostatus of partner
Positive 193 (30.3) 69 (35.6)
Negative 160 (25.1) 65 (33.5)
Don’t know 284 (44.6) 60 (30.9) 0.0001
Knowledge of HIV reinfection
Aware 488 (76.6) 160 (50.0)
Not aware 149 (23.4) 160 (50.0) 0.012
Substance use
Use 102 (16.0) 25 (12.9) 0.09
Do not use 535 (84.0) 169 (77.1)
Previous history of STI
Positive 182 (28.6) 43 (22.2)
Negative 455 (71.4) 151 (77.8) 0.011
No. of sexual partner
One 461 (72.4) 144 (74.2) 0.0001
More than one 176 (27.6) 50 (25.8)
Disclosure
Yes 324 (50.9) 111 (57.2) 0.021
No 313 (49.1) 83 (42.8)
Measure of disease severity
On ARV drugs 73 (11.5) 14 (7.2) 0.016
Not on ARV drugs 564 (88.5) 180 (92.8)
ARV = antiretroviral; HIV = human immunodeficiency virus; STI = sexually
transmitted infection
Sexual Risk and Condom Use among PLWHAs 1001
J Sex Med 2012;9:997–1004
practices and condom use, but knowing negative
status as well. Unprotected sexual intercourse with
HIV concordant and HIV nonconcordant sexual
partners was equally reported by both men and
women. This indicates that what matters is not the
HIV status of the partner but rather knowledge of
his/her status. It can also be implied that individu-
als who know their partner’s HIV status have at
least had a discussion about HIV testing; this
would help them to anticipate their partner’s reac-
tion toward condom use. Campaigns should be
stepped up to increase the uptake of voluntary
counseling and testing; this will help sexual part-
ners to know their status and consequently
improve condom use among PLWHAs.
Condoms remain the single most effective
means to reduce the transmission of STIs and to
protect against HIV [36–39]. Timely diagnosis
and treatment of STIs, as part of a package of
best prevention practices, may be an important
component in controlling the risk of HIV-1
transmission in discordant couples. However,
with most participants in this study being diag-
nosed less than a year before study and are still at
the early stage of the disease, the risk of HIV
transmission within discordant couples is rela-
tively low during the chronic phase, but periods
of elevated viral load and the presence of other
STIs in one or both partners are associated with
significantly increased transmission risk [37,38].
Several studies have shown an association
between increased condom use and declined rates
of STIs, including new HIV infections and rein-
fection [39,40].
Table 4 Predictors of condom use
Adjusted odds ratio Odds ratio for male Odds ratio for females
Age
<20 years 0.60 (0.17–2.10) 0.36 (0.05–2.39) 0.79 (0.18–3.53)
20–39 years 1.18 (0.51–2.73) 1.14 (0.33–3.94) 1.77 (0.76–4.12)
40–59 years 1.24 (0.54–2.83) 1.46 (0.49–4.35) 1.71 (0.76–3.88)
60 years 1.00 1.00 1.00
Marital status
Never married 1.86 (0.91–3.80) 2.13 (0.48–9.40) 1.44 (0.68–3.05)
Married 3.13 (1.15–8.51) 2.54 (0.43–12.84) 1.81 (0.66–4.93)
Separated 0.99 (0.40–2.44) 0.90 (0.15–5.46) 0.87 (0.32–2.38)
Divorced 0.84 (0.24–2.92) 2.15 (0.23–20.14) 0.33 (0.08–1.43)
Widow/widower 1.00 1.00 1.00
Family type
Monogamy 1.42 (0.92–2.20) 1.08 (0.46–2.57) 1.82 (1.15–2.89)
Polygamy 1.00 1.00 1.00
Level of education
Nil 1.00 1.00 1.00
Primary 1.68 (0.78–4.02) 2.14 (1.21–8.47) 1.49 (0.53–2.53)
Secondary 1.55 (0.70–3.43) 2.21 (1.35–9.74) 1.14 (0.45–2.79)
Tertiary 2.78 (1.39–5.79) 7.14 (2.28–13.73) 1.75 (0.61–3.23)
Serostatus of partner
Positive 1.47 (0.91–2.38) 0.87 (0.38–1.95) 1.36 (0.80–2.30)
Negative 2.53 (1.50–4.28) 2.40 (0.86–6.72) 1.98 (1.16–3.39)
Don’t know 1.00 1.00 1.00
Knowledge of HIV reinfection
Aware 1.90 (1.22–2.95) 2.09 (0.94–4.63) 1.78 (1.09–2.91)
Not aware 1.00 1.00 1.00
Disclosure
Yes 0.85 (0.55–1.30) 1.14 (0.54–2.39) 0.73 (0.46–1.18)
No 1.00 1.00 1.00
Previous history of STI
Positive 0.72 (0.46–1.11) 0.45 (0.20–0.98) 0.95 (0.59–1.53)
Negative 1.00 1.00 1.00
No. of sexual partner
One 1.00 1.00 1.00
More than one 1.41, CI = 1.05–1.83 2.04 (0.59–10.48) 1.23 (0.78–4.64)
Measure of disease severity
On ARV drugs 1.07 (0.72–1.58) 1.22 (0.59–2.51) 0.92 (0.60–1.42)
Not on ARV drugs 1.00 1.00 1.00
ARV = antiretroviral; CI = confidence interval; HIV = human immunodeficiency virus; STI = sexually transmitted infection
1002 Amoran and Ladi-Akinyemi
J Sex Med 2012;9:997–1004
The study shows that predictors of safe sex
practices and condom use among both genders
defer. Education and previous history of STI were
predictive of condom use among male respon-
dents, while negative serostatus, knowledge of
reinfection, and having a monogamous family
were predictive factors among the female respon-
dents. This implies that the major drive for
condom use among male PLWHAs among the
study population was level of education and previ-
ous experience, and for females it was status. This
may have implication in the design of effective
health education programs among the study par-
ticipants in low-income areas such as Nigeria.
The results of this study should be interpreted
cautiously. First, the study was conducted among
service users in selected secondary health facilities.
This setting may overestimate safe sex practices
and condom use. The study was also limited in that
it relied on self-report and is therefore subject to
reporting bias. The effect of social desirability bias
and telescoping bias may be other potential limi-
tations in this study. It would have been preferable
to interview HIV-positive individuals who do not
seek services, but considering ethical and practical
issues, it was not possible in this study. Our find-
ings have implications for interventions with
PLWHA on barriers to accepting and using
condoms and sexual decision-making that
heighten HIV infection.
Corresponding Author: Olorunfemi Amoran, MBBS,
MSc [epid], MMP, FMCPH, Department of Commu-
nity Medicine and Primary Care, College of Health
Sciences, Olabisi Onabanjo University Teaching Hos-
pital, Sagamu 234, Nigeria. Tel: +2348034129441; Fax:
+2348034129441234; E-mail: drfamoran@yahoo.com
Conflict of Interest: None.
Statement of Authorship
Category 1
(a) Conception and Design
Olorunfemi Amoran; Temitope Ladi-Akinyemi
(b) Acquisition of Data
Temitope Ladi-Akinyemi
(c) Analysis and Interpretation of Data
Olorunfemi Amoran
Category 2
(a) Drafting the Article
Olorunfemi Amoran; Temitope Ladi-Akinyemi
(b) Revising It for Intellectual Content
Olorunfemi Amoran
Category 3
(a) Final Approval of the Completed Article
Olorunfemi Amoran; Temitope Ladi-Akinyemi
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J Sex Med 2012;9:997–1004
    • "Sex without condoms may be more highly remunerated than protected sex [27], and other types of work may pay less [12]. On the other hand, sex workers in Kenya and other locations in sub-Saharan Africa have also been found to use condoms more frequently with clients than they do with boyfriends or primary partners, but they may use condoms less frequently with regular clients due to a perception that HIV risk is low with regular partners in general [12,282930. Another factor contributing to sex workers' vulnerability to HIV is the illegal status and clandestine nature of sex work in Kenya. "
    [Show abstract] [Hide abstract] ABSTRACT: Background As pre-exposure prophylaxis (PrEP) moves closer to availability in developing countries, practical considerations for implementation become important. We conducted a consultation with district-level community stakeholders experienced in HIV-prevention interventions with at-risk populations in Bondo and Rarieda, Kenya to generate locally grounded approaches to the future rollout of oral PrEP to four populations: fishermen, widows, female sex workers, and serodiscordant couples. Methods The 20 consultation participants represented the Ministry of Health, faith- and community-based organizations, health facilities, community groups, and nongovernmental organizations. Participants divided into breakout groups and followed a structured discussion guide asking them to identify barriers to implementing HIV-prevention interventions (including PrEP) with each population. Questions also solicited solutions for addressing these barriers, as well as other facilitators for PrEP implementation. In particular, questions focused on how to encourage people to screen for PrEP eligibility by having HIV and other blood tests and how to encourage compliance with ongoing HIV testing. Results The barriers and facilitators/solutions discussants provided were frequently population-specific, but there were also broad-level similarities across populations. Service delivery barriers to HIV-prevention interventions concerned the need for staff trained to address the needs of particular populations. Service delivery facilitators to provision of ongoing HIV testing consisted of offering testing options besides facility-based testing. Stigma was the main community-level barrier for all groups, whereas barriers at the level of target populations included mobility; lifestyle and life circumstances, especially cultural norms among fishermen and widows; and fears, lack of awareness, and misinformation. Proposed facilitators and strategies for addressing community- and population-level barriers included topic-specific education within the populations and community, involvement of partners and family members, mass HIV testing, and peer educators. Barriers to PrEP uptake included non-adherence to pill taking and missing clinic visits. For drug adherence, facilitators were counselling and involving family members. Discussants suggested that client reminders, e.g., home visits, were needed to encourage clients to keep their clinic appointments. Conclusions Strategies for encouraging eligibility screening and ongoing HIV testing will have local and population-specific aspects. Our results nonetheless apply to similar populations throughout sub-Saharan Africa and reach beyond oral PrEP to other ARV-based PrEP formulations.
    Full-text · Article · May 2014
  • [Show abstract] [Hide abstract] ABSTRACT: Introduction: The HIV/AIDS prevalence rate in Gabon in 2011 was 5% among subjects aged 15 to 49 years. The objective of this study was to describe sexuality and condom use among people living with HIV/AIDS (PLWH) by comparing those living in the capital with those living in two provinces of Gabon: Ogowe-Maritime (Port-Gentil) and Ogowe-Moyen (Lambarene). Methods: A 5-month, cumulative, cross-sectional descriptive survey was conducted between May 2009 and September 2010 among PLWH over the age of 18 years, attending Gabon treatment centres and treated with ARVs for at least six months. A simple random sampling method was used to construct this sample. This survey was conducted in seven different centres for PLWH. Results: The survey was conducted among 422 PLWH treated with ARV for at least six months: 284 (67.3%) subjects in Libreville and 138 (32.7%) in the provinces. The F/M sex ratio was 0.71. In this sample, 68% of PLWH reported sexual intercourse at least once during the previous 6 months. 49.5% of PLWH declared that they always used a condom with their main partner (p = 0.0096) and 52.4% declared that they always used a condom with other partners (p < 0.0001). 50.1% of PLWH also reported that their last sexual intercourse during the previous 6 months was with their main partner (p < 0.0001). Conclusion: The majority of patients on ARV therapy use condoms with their main partner and with occasional partners. Management and condom use are more effective in Libreville.
    Article · Nov 2013
  • [Show abstract] [Hide abstract] ABSTRACT: Introduction: The HIV/AIDS prevalence rate in Gabon in 2011 was 5% among subjects aged 15 to 49 years. The objective of this study was to describe sexuality and condom use among people living with HIV/AIDS (PLWH) by comparing those living in the capital with those living in two provinces of Gabon: Ogowe-Maritime (Port-Gentil) and Ogowe-Moyen (Lambaréné). Methods: A 5-month, cumulative, cross-sectional descriptive survey was conducted between May 2009 and September 2010 among PLWH over the age of 18 years, attending Gabon treatment centres and treated with ARVs for at least six months. A simple random sampling method was used to construct this sample. This survey was conducted in seven different centres for PLWH. Results: The survey was conducted among 422 PLWH treated with ARV for at least six months: 284 (67.3%) subjects in Libreville and 138 (32.7%) in the provinces. The F/M sex ratio was 0.71. In this sample, 68% of PLWH reported sexual intercourse at least once during the previous 6 months. 49.5% of PLWH declared that they always used a condom with their main partner (p = 0.0096) and 52.4% declared that they always used a condom with other partners (p < 0.0001). 50.1% of PLWH also reported that their last sexual intercourse during the previous 6 months was with their main partner (p < 0.0001). Conclusion: The majority of patients on ARV therapy use condoms with their main partner and with occasional partners. Management and condom use are more effective in Libreville.
    Article · Jan 2014
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