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Afr J Med Med Sci. Author manuscript; available in PMC 2015 December 17. Published in final edited form as: Afr J Med Med Sci. 2014 September ; 43(Suppl 1): 5–13.
DECLINING PREVALENCE OF HIV AND OTHER SEXUALLY TRANSMITTED INFECTIONS AMONG FEMALE SEX WORKERS IN JOS, NORTH-CENTRAL NIGERIA AE Ogbea, AS Sagaya,*, GE Imadea, J Musaa, VC Pama, D Egahb, V Onwuliric, and R Shortd aDepartments
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of Obstetrics and Gynaecology, University of Jos /Jos University Teaching Hospital, Jos, Plateau State, Nigeria.
bMedical
Microbiology, University of Jos, Jos, Plateau State, Nigeria.
cBiochemistry,
Faculty of Medical Sciences, University of Jos, Jos, Plateau State, Nigeria.
dFaculty
of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
Abstract
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BACKGROUND—Female Sex Workers (FSWs) are key reservoirs of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) from which transmission to the general population fuels epidemics. STIs amplify HIV infectiousness and susceptibility. We determined the status of HIV and STIs among brothel-based FSWs in Jos as part of an ongoing prevention intervention. METHOD—Between January and May 2012, consenting consecutive brothel-based FSWs were recruited from previously designated brothels across Jos. HIV counseling and testing as well as screening for gonorrhoea, syphilis, trichomonasis, candidasis and Bacteria vaginosis (BV) were performed. Positive cases were provided free treatment and follow-up at Solat Women Hospital, Jos. Ethical clearance was obtained from Jos University Teaching Hospital (JUTH) ethical committee.
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RESULT—Two hundred FSWs aged 27.6 ± 4.6 years (range 15–55 years) were recruited and of these, 47 (23.5%) were HIV Positive, 20 (10.0%) had syphilis, 9 (4.5%) had Neisseria gonorrhea, 3 (1.5%) had Trichomonas vaginalis and 86 (43.0%) had BV. The association between HIV and bacterial vaginosis was statistically significant (OR of 2.2, 95% CI of 1.1–4.2, P-value=0.02). In comparison to similar prevalence in 2006, the current findings represent 51.5% decline in HIV prevalence, 40.8% decline for syphilis and over 83.3% decline in prevalence for Trichomonas vaginalis. There was no significant change in the prevalence of Neisseria gonorrhoea and BV.
*
Correspondence: Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Jos, PMB 2084, Jos Phone number: +2348034519740 [email protected]. Conflict of Interest: None declared.
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CONCLUSION—The prevalence of HIV and STIs among brothel-based FSWs in Jos remain unacceptably high, although, there is a declining trend. A comprehensive HIV prevention program targeting these women is required to block transmission to the general population. Keywords Prevalence; STI; HIV; Female Sex Workers; Nigeria
INTRODUCTION
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Since the first case of acquired immune deficiency syndrome (AIDS) was reported in a 13 year old girl in Nigeria in 1986, the human immunodeficiency virus (HIV) / AIDS epidemic has continued to evolve.1 The prevalence of HIV among pregnant women in Nigeria rose from 1.8% in 1991, to reach a peak of 5.8% in 2001, before witnessing a slow decline to 4.4% in 2005 and 4.1% in 2010.1 Other sexually transmitted infections (STIs) such as gonorrhoea, syphilis, trichomonasis, candidasis and Bacterial Vaginosis (BV) have been shown to enhance the transmission and acquisition of HIV.2 These STIs boost HIV shedding in the genital tract and amplify HIV infectiousness. The presence of STI also increases the susceptibility to HIV by recruiting HIV susceptible inflammatory cells to the genital tract as well as by disrupting mucosal barriers to infection. 2
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Among the high risk groups, female sex workers (FSWs) constitute an important reservoir of HIV and STIs for continuous transmission to the general population.1 In Nigeria, the prevalence of HIV among brothel-based female sex workers (BBFSWs) rose from 17.5% in 1991 through 22.5% in 1993 to 37.4% in 2007, followed by a decline to 27.4% in 2010. 1, 3, 4 The high risk of infection among sex workers is not only due to the fact that they have multiple partners but also due to a contribution of other factors that compound this risk. These factors include poverty, low educational level, low levels of knowledge about STI and HIV/AIDS prevention, gender inequalities and limited ability to negotiate condom use. 5, 6 These factors make them prone to having unprotected sex. Their clients and partners therefore serve as a bridging population for spreading STI and HIV to the general population. 7, 8 Treatment of HIV and STI is now recognised as a critical prevention tool in the control of the HIV epidemic.9, 10
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In an earlier study of STI and HIV among brothel-based FSW in Jos in 2006, we found a 48.5% prevalence of HIV.11 Since then, HIV counseling and testing services with referrals for free treatment and care of positive clients of the same brothels has continued. This follow-up study was conducted to determine the status of HIV and STI among BBFSWs in the target brothels as a way of elucidating the impact, if any, of access to free reproductive health services and HIV treatment/care on the trend of HIV prevalence.
METHODS Study Area and Mobilisation This study was carried out between January and May, 2012 in collaboration with the Mary Magdalene Reproductive Health Initiative (MMRHI); a non-governmental organization that
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provides free reproductive health services to BBFSWs in Jos. Jos is the capital city of Plateau State in north-central Nigeria with a population of about 900,000 people 12. The city comprises Jos-North and Jos-South local government areas (LGA) with Jos-North being the state capital where most commercial activities take place 10. All 6 brothels involved in this study were in Jos-North LGA.
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Meetings were held between representatives of the MMRHI, the brothel managers and representatives of the BBFSWs intimating them of the purpose of the study and seeking their cooperation. The field officers (a nurse/midwife and a research assistant) of MMRHI have a long standing relationship with the brothels’ managements because of their on-going provision of HIV and STI prevention services which dated back to 2006. Clients found to be infected with HIV and other STIs were referred to Solat Women Hospital (Private hospital) Jos, which is a PEPFAR supported national HIV treatment and care facility where free services are accessed. The private facility is popular among BBFSWs because of the privacy, confidentiality and timeliness it offers in accessing care. Free services available at Solat Women Hospital (SWH) include; Adult and Paediatric HIV treatment and care, full range of prevention of mother-to-child transmission (PMTCT) of HIV services, laboratory monitoring with CD4, haematology, chemistry, viral load (through linkage), tuberculosis and hepatitis B screening. Study Population and Study Design
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Female Sex Worker was defined as any biological female aged 15 years and older who receives money or other gifts/incentives in exchange for sex in areas such as brothels, bars, restaurants, nightclubs, hotels, or on the street.4 There are therefore those who are brothelbased (BBFSWs) and non brothel-based (NBBFSWs). The study participants comprised BBFSWs in Jos, Plateau State, Nigeria. This was a cross-sectional survey. The pre-existing knowledge of HIV status by any of the BBFSWs did not affect study eligibility. The participants were recruited for the study between January and May 2012. A structured questionnaire was administered by a trained nurse counsellor. Pre-HIV test counselling and HIV test as well as screening for syphilis, gonorrhoea, trichomoniasis, candidiasis and BV were done for all participants recruited. Ethical Consideration The present study was approved by the Ethical Committee at the Jos University Teaching Hospital, Jos, Nigeria. All study subjects gave informed consent to participate in the study. Study Procedure (Protocol)
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The representatives of the MMRHI recruited the BBFSWs from their respective brothels to the private hospital. On arrival at SWH, a gynaecologist with a nurse counsellor in attendance explained the purpose of the study to the BB FSWs as a group. Those who consented to participate were then recruited. The nurse counsellor then performed pre-test counselling one on one with each BBFSW before a laboratory scientist collected blood samples for HIV and syphilis tests. Each BBFSW thereafter met the investigating gynaecologist who administered the questionnaire, performed a gynaecological examination
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and collected high vaginal (HVS) and endocervical swabs (ECS) for the diagnosis of trichomoniasis, candidiasis, BV, and gonorrhoea. The venous blood sample was tested for HIV and syphilis. The serum was screened for HIV-1 and HIV-2 using the WHO parallel test algorithm 13. The rapid test kits used were Abbott Determine (Abbott laboratories, Abbott park, IL USA) and Unigold (Trinity Biotech, Bray, Ireland). Discordant results were confirmed using Stat-pak kit as a tie-breaker (Chembio diagnostic system, Medford, NY, USA). Syphilis was diagnosed if the patient’s serum was reactive with both the Rapid Plasma Reagin Syfacard-R (Murex Biotech, Kent, UK) and the Determine Syphilis Treponema Pallidum Antibody Assay (Abbott, Wiesbaden, Germany).
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A wet mount of the vaginal swab was prepared in saline immediately after collection and examined microscopically for the presence of clue cells and motile trichomonas vaginalis. Direct microscopy of Gram-stained genital swabs was carried out for the detection of leukocytes and Gram-negative diplococci. Isolation of Neisseria gonorrhoea was done by inoculation of the endocervical swab on modified Thayer Martin media followed by incubation in a candle-extinctive jar at 36°C for 24–48 hours. Isolates were identified on the basis of colony morphology, visualization of Gram-negative diplococcic, positive oxidase reaction and sugar fermentation tests. Antibiotic sensitivity was assessed on all N. gonorrhoea isolates to determine the appropriate drug of choice for treatment. Bacterial vaginosis was diagnosed according to the Amsel criteria 14, 15.
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Post-test counselling was offered by the nurse counsellor on the first day at the clinic and those found to be HIV positive were referred to the PEPFAR supported HIV/AIDS treatment and care unit in the same facility (SWH). Each subject participating in the study was educated on HIV and other STI prevention strategies, given condoms and an appointment for a follow-up visit after retrieving the remaining results. During the follow-up visit, appropriate treatment was offered free of charge for any detected STI. Data Analysis Data entry and analysis were done using Epi info version 3.5.3 (CDC, Atlanta, GA, USA). The test of significance for continuous variables was done using the student t-test and X2 was used for categorical variables. In estimating the differences in prevalence of the various STIs between the 2006 and the current data, we used the two-sample for proportion test calculator on STATA version 11.0, College Station, Texas, USA. Estimates of 95% confidence intervals were calculated and a P-value of less than 0.05 was considered statistically significant.
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Results A total of 200 BBFSWs were recruited and of these, 47 (23.5%) were HIV Positive, 20 (10.0%) had syphilis, 9 (4.5%) had Neisseria gonorrhea, 3 (1.5%) had Trichomonas vaginalis and 86 (43.0%) had BV (Table 1). The characteristics of the 200 FSWs showed a mean age ± SD of 27.6 ± 4.6 years (range 15–55 years) and there was no statistically
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significant difference by HIV status (P=0.35). The mean parity ± SD was 2.0 ± 1.3 and there was no statistically significant difference by HIV status (P=0.91) (Table 2). The majority of participants in this study were never married (114/200=57%) and 90% (180/200) had some form of formal education. Comparison by HIV status showed no significant difference with respect to educational level (P=0.56) (Table 2).
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The mean duration of sex work ± standard deviation (SD) for the HIV positive FSWs was 4.7 ± 2.5 years while that of the HIV negative FSWs was 3.7 ± 1.9 years. The difference in duration of sex work was statistically significance between these two groups (P=0.01). All BBFSWs in the study reported using condom with their customers, the vast majority use it most times or all the time (198/200 or 99%). Overall, more BBFSWs used condom for every coitus when having sex with paying (customers) 143 (71.5%) compared with 21 (10.5%) that used it for every coitus when having sex with steady partners or boyfriends (Table 2). With regard to association between HIV and specific STIs, only BV and HIV demonstrated statistically significant association. Those with HIV and BV were 27 (31.4%) compared with those with HIV and no BV 20 (17.5%). The association is statistically significant (OR of 2.2, 95% CI of 1.1–4.2, P-value=0.02) (Table 3). When we compared the prevalence of HIV and other STIs in this study with the findings reported by our group in the same settings 6 years earlier, there were statistically significant declines in HIV (48.5% vs 23.5%, P=0.001), syphilis (16.9% vs 10.0%, P=0.024) and Trichomonas vaginalis (9.0% vs 1.5%, P=0.001) while Neisseria gonorrhoea (3.4% vs 4.5%, P=0.505) and Bacterial vaginosis (46.7% vs 43.0%, P=0.391) remained essentially unchanged (Table 4).
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DISCUSSION The main findings of this study show that the prevalence of HIV and other STIs among BBFSWs in the Jos metropolis remain unacceptably high. Secondly, BBFSWs have a very low rate of condom use (10.5%) with their steady partners or boyfriends, making this group an important bridge population for transmission of HIV and STIs to the general population. Thirdly, although these prevalence rates are high, in comparison to similar figures in 2006, they represent a 51.5% decline in HIV prevalence, 40.8% decline for syphilis and over 83.3% decline in prevalence for Trichomonas vaginalis. There was no significant change in the prevalence of Neisseria gonorrhoea and BV (Table 4 and Figure1). HIV Prevalence and Condom use
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The HIV prevalence of 23.5% among BBFSWs in the current study is in tandem with the findings of the integrated biological and behavioral surveillance surveys (IBBSS 2010) which reported HIV prevalence of 27.4% among BBFSWs in Nigeria.4 When the same 6 states with data in 2007 were compared with data obtained in 2010, HIV prevalence among BBFSWs declined by more than one-third between 2007 and 2010 (37% vs. 23%; P< 0.001). 16 Our study indicated that a steeper decline in HIV prevalence occurred in the targeted brothels in Jos. A recent study from Kano17 also reported a 29.6% prevalence rate
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of HIV among BBFSWs but more worryingly, despite their knowledge that unprotected sexual intercourse is the commonest risk factor associated with STI and HIV acquisition, all these HIV-infected women reported ongoing unprotected sexual intercourse with clients. Similarly, 60.7% of the study participants who reported having symptoms of STI continued to have unprotected sex. IBBSS 20104 with data from 12 States in Nigeria, also reported a low rate of condom use (20% –30%) with boyfriends or steady partners by BBFSWs. The present study found that only 10.5% of BBFSW used condom for sex with their boyfriends/ steady partners. These findings indicate that substantial amount of unprotected sexual exposure, even in the presence of STI, continue to occur in brothel settings in Nigeria. This portends danger if available HIV prevention knowledge are not utilised to stop transmission in this high risk setting. Decline in HIV and STI prevalence
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The significant declines in the prevalence of HIV (50.5%), syphilis (40.8%) and Trichomonas vaginalis (83.3%) deserve careful scrutiny. First, BBFSW are a fairly mobile population. Indeed, our study found that 115 (57.5%) of these women had moved into Jos within the last 4 years so, we were not entirely dealing with the same cohort of 2006. In three serial cross-sectional surveys conducted between 1993 and 1999 in Cotonou, Benin, the authors reported a decline in the prevalence of HIV and STIs among FSWs and attributed the decline partly to the changing sex work Milieu as the country of origin of the FSWs changed dramatically within the period. 18 The authors also attributed the decline in the HIV prevalence partly to the intervention instituted among these women after the first cross-sectional survey 18. A similar decline was observed in the prevalence of HIV in Southern India from 19.6% to 16.4% among sex workers in the three years following the initiation of a large scale HIV prevention program19. Several other programmes in India have implemented condom promotion and syndromic STI treatment among FSWs and their clients and demonstrated subsequent decline in the prevalence of STIs (syphilis, gonorrhoea and Chlamydia) among FSWs and reduced HIV risk in the general population. 20–22 We believe that the decline observed in this study can be attributed to a variety of factors. It may reflect lower HIV prevalence in the general population and a changing sex work milieu. Indeed, the decline in HIV prevalence might partly be due to the impact of the sexual health education, condom supplies, ongoing HIV counselling and testing with linkage to free treatment and care and other reproductive health services offered by the Mary Magdalene reproductive health initiative (MMRHI) to these female sex workers.
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The decline in prevalence of syphilis and trichomonas vaginalis along with HIV may reflect dividends from more consistent condom use with commercial clients as was reported in this study. There was no significant change in prevalence for gonorrhoea in the current study although a recent work among FSWs in India reported a significant decline in gonorrhoea as well. 22 The persistently high prevalence of gonorrhoea in this study could be reflective of the prevalence of gonorrhoea in the general population. This study was however not designed to evaluate the general population.
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Association between HIV and specific STI entities
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When the association between HIV and specific STI entities were evaluated, it was found that the prevalence of HIV was higher when there was an associated STI compared to when there was no associated STI. This association was only found to be statistically significant with BV (OR=2.2, 95% CI=1.1–4.2, P=0.02). In a study to review the scientific data on the role of sexually transmitted infections in sexual transmission of HIV infections, the authors concluded that both the ulcerative and non-ulcerative STIs promote HIV infectiousness and susceptibility 23. The association between HIV and BV has been well studied in a variety of settings with the suggestion that bacterial vaginosis may increase susceptibility to HIV acquisition. 24, 25
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The association between HIV and syphilis showed a higher proportion of FSWs with HIV and syphilis (35.0%) compared to those with HIV and no syphilis (22.2%). However, the association was not statistically significant (OR= 1.9, 95% CI=0.7–5.0, P-value=0.16). The association between HIV and Neisseria gonorrhoea was not found to be statistically significant in this study (OR= 2.8, 95% CI= 0.7–10.7, P-value =0.13). In a study conducted in Nairobi, Kenya among 92 HIV positive FSWs, there was no statistically significant association between HIV and gonorrhoea 26. However, another study from Kinshasa, Zaire among 431 FSWs showed significant association when these women were followed up prospectively for a mean duration of 2years 27. The difference in this study could be attributed to the study design. The association between HIV and Trichomonas vaginalis from this study was not statistically significant. A number of other studies have also found no significant association. 24, 27, 28
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LIMITATIONS OF THE STUDY We were unable to study Chlamydia. The findings from the study only demonstrated a significant association between HIV and BV, but by its design cannot show a causal relationship. Part of the study relied on self reported behaviour (eg condom use), hence, social desirability and stigma may have biased respondents’ answers, however, the good rapport established over time, between the field nurses of MMRHI and the brothel management and head-girls significantly facilitated the work.
Conclusions and Recommendations
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This study showed that although the prevalence of HIV and STIs among the BBFSWs in Jos remain unacceptably high, there is a declining trend. The potential for HIV and STI transmission to the general population remains high. To maintain this declining trend of HIV and STI prevalence among FSWs, HIV prevention programs targeting brothel-based FSWs should be prioritized and consideration should be given to site-based intervention strategies that promote safer sex, diagnosis and treatment of STIs and access to HIV treatment, care and support. The integration of rapid diagnostic technologies into STI surveillance in highrisk groups may improve the effectiveness of such programmes and should be pursued. The
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policy environment should consider recommending life-long antiretroviral therapy for all HIV infected FSWs and pre-exposure prophylaxis medication for HIV negative FSWs.
Acknowledgements We are grateful to the women who participated in this study, and the research staff involved in the fieldwork, counselling and testing of biological samples. We are thankful to the staff of Solat Women Hospital, Jos for their cooperation. The study was funded through private donations to the Mary Magdalene Reproductive Health Initiative (MMRHI). Data analysis and writing of this paper was supported by the Medical Education Partnership Initiative in Nigeria (MEPIN) project funded by Fogarty International Center, the Office of AIDS Research, and the National Human Genome Research Institute of the National Institute of Health, the Health Resources and Services Administration (HRSA) and the Office of the U.S. Global AIDS Coordinator under Award Number R24TW008878. HIV/AIDS services in Solat Women Hospital, Jos was supported by AIDS Prevention Initiative in Nigeria (APIN) with HRSA funding through award number U51HA02522-01-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding organizations.
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17. Lawan UM, Abubakar S, Ahmed A. Risk Perceptions, Prevention and Treatment Seeking for Sexually Transmitted Infections and HIV/AIDS among Female Sex Workers in Kano, Nigeria. Afr J Reprod Health. 2012; 16:61–67. [PubMed: 22783669] 18. Alary M, Mukenge-Tshibaka L, Bernier F, et al. Decline in the prevalence of HIV and sexually transmitted diseases among female sex workers in Cotonou, Benin, 1993–1999. AIDS. 2002; 16:463–470. [PubMed: 11834959] 19. Ramesh BM, Beattie TSH, Shajy I, et al. Changes in risk behaviour and prevalence of sexually transmitted infections following HIV prevention interventions among female sex workers in five districts in Karnataka state, south India. Sex Transm Infect. 2010; 86:17–24. 20. Mainkar MM, Pardeshi DB, Dale J, et al. Targeted interventions of the Avahan program and their association with intermediate outcomes among female sex workers in Maharashtra, India. BMC Public Health. 2011; 11:S2. [PubMed: 22375562] 21. Rachakulla HK, Kodavalla V, Rajkumar H, et al. Condom use and prevalence of syphilis and HIV among female sex workers in Andhra Pradesh, India—following a large-scale HIV prevention intervention. BMC Public Health. 2011; 11:S1. [PubMed: 22376071] 22. Arora P, Nagelkerke NJD, Moineddin R, Bhattacharya M, Jha P. Female sex work interventions and changes in HIV and syphilis infection risks from 2003 to 2008 in India: a repeated crosssectional study. BMJ Open. 2013; 3:e002724. 23. Fleming DT, Wasserheit JN. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV. Sex Transm Infect. 1999; 75:3–17. [PubMed: 10448335] 24. Sewankambo N, Gray RH, Wawer MJ, et al. HIV-1infection associated with abnormal vaginal flora morphology and bacterial vaginosis. Lancet. 1997; 350:546–550. [PubMed: 9284776] 25. Taha TE, Hoover DR, Dallabetta GA, et al. Bacterial vaginosis and disturbances of vaginal flora: association with increased acquisition of HIV. AIDS. 1998; 12:1699–1706. [PubMed: 9764791] 26. Kreiss J, Willerford DM, Hensel M, et al. association between cervical inflammation and cervical shedding of human immunodeficiency virus DNA. J. Infect Dis. 1994; 170:1597–1601. [PubMed: 7996003] 27. Laga M, Manoka A, Kivuvu M, et al. Non-ulcerative sexually transmitted infections as risk factors for HIV-1 transmission in women: results from a cohort study. AIDS. 1993; 7:95–102. [PubMed: 8442924] 28. Kassler WJ, Zenilman JM, Erickson B, et al. Seroconversion in patients attending sexually transmitted disease clinics. AIDS. 1994; 8:351–355. [PubMed: 8031513]
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Figure 1.
Comparison of the prevalence of HIV and others STIs among Brothel-based FSWs between 2006 and 2012 in Jos, Nigeria
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Table 1
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Prevalence of HIV and other STIs among Brothel-based FSWs in Jos, Nigeria Variable
Frequency (n=200)
Prevalence (%)
HIV
47/200
23.5%
Syphilis
20/200
10.0%
Neisseria gonorrhoea
9/200
4.5%
Trichomonas vaginalis
3/200
1.5%
Bacterial vaginosis
86/200
43.0%
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Table 2
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Characteristic of the study group by HIV status
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Variables
HIV Positive
HIV Negative
p-Value
Mean age ±SD (years)
27.9 ± 4.1
27.2 ±5.0
0.35
Mean Parity ± SD
2.0 ±1.1
2.0 ±1.4
0.91
Married
-
1 (100%)
Never married
27 (23.7%)
87 (76.3%)
Separated
9 (17.3%)
43 (82.7%)
Divorced
8 (29.6%)
19 (70.4%)
Widowed
3 (50.0%)
3 (50.0%)
No formal education
5 (25.0%)
15 (75.0%)
Some primary education
9 (30.0%)
21 (70.0%)
Completed primary
7 (30.4%)
16 (69.6%)
Some secondary
16 (25.0%)
48 (75.0%)
Completed secondary
9 (17.6%)
42 (82.4%)
Tertiary
1 (8.3%)
11 (91.7%)
Christian
46 (23.1%)
153 (76.9%)
Muslim
1 (100%)
-
Mean duration of sex work ± SD (years)
4.7 ± 2.5
3.7 ± 1.9
Non-use
-
-
Rarely
-
-
Sometimes
1 (50.0%)
1 (50.0%)
Most coitus
13 (23.6%)
42 (76.4%)
Every coitus
33 (23.1%)
110 (76.9%)
Non-use
8 (28.6%)
20 (71.4%)
Rarely
2 (33.3%)
4 (66.7%)
Sometimes
18 (30.5%)
41 (69.5%)
Most coitus
4 (10.8%)
33 (89.2%)
Marital status
-
Educational status
0.56
Religion -
0.01
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Use of condom with customers
-
Use of condom with steady partners
-
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Author Manuscript 43 (22.5%)
46 (23.4%)
No
27 (31.4%) 20 (17.5%)
Yes
No
Bacterial vaginosis
1 (33.3%)
Yes
Trichomonas vaginalis
4 (44.4%)
No
40 (22.2%)
7 (35.0%)
HIV Positive
Yes
Neisseria gonorrhea
No
Yes
Syphilis
Variable
94 (82.5%)
59 (68.6%)
151 (76.6%)
2 (66.7%)
148 (77.5%)
5 (55.6%)
140 (77.8%)
13 (65.0%)
HIV Negative
2.2
1.6
2.8
1.9
Odds ratio
1.1 – 4.2
0.15 – 18.5
0.7 – 10.7
0.7 – 5.0
95% confidence interval
0.02
0.6
0.13
0.16
P- Value
Association between HIV and Other Sexually Transmitted Infections in Jos, Nigeria
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Table 3 Ogbe et al. Page 13
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Table 4
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Prevalence of HIV and Other STIs among FSWs in Jos, Nigeria 2006 and 2012 Sexually Transmitted Infections HIV
Syphilis
Neisseria gonorrhoea
Trichomonas vaginalis
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Bacterial vaginosis
*Prevalence in 2006 (n=398)
P-Value
47/200
193/398
0.001
[23.5%(95%CI:17.6–29.4)]
[48.5%(95%CI:43.6–53.4)]
Prevalence in present study 2012 (n=200)
20/200
67/397
[10.0%(95%CI:5.8–14.2)]
[16.9%(95%CI:13.2–20.6)]
9/200
13/378
[4.5%(95%CI:1.62–7.40)]
[3.4%(95%CI:1.61–5.20)]
3/200
34/378
[1.5%(95%CI:0.2–3.2)]
[9.0%(95%CI:6.2–11.8)]
86/200
186/398
[43.0%(95%CI:36.1–49.9)]
[46.7%(95%CI:41.8–51.6)]
0.024
0.505
0.001
0.391
*
Imade G, Sagay A, Egah D et al 200811
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Afr J Med Med Sci. Author manuscript; available in PMC 2015 December 17. Published in final edited form as: Afr J Med Med Sci. 2014 September ; 43(Suppl 1): 5–13.
DECLINING PREVALENCE OF HIV AND OTHER SEXUALLY TRANSMITTED INFECTIONS AMONG FEMALE SEX WORKERS IN JOS, NORTH-CENTRAL NIGERIA AE Ogbea, AS Sagaya,*, GE Imadea, J Musaa, VC Pama, D Egahb, V Onwuliric, and R Shortd aDepartments
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of Obstetrics and Gynaecology, University of Jos /Jos University Teaching Hospital, Jos, Plateau State, Nigeria.
bMedical
Microbiology, University of Jos, Jos, Plateau State, Nigeria.
cBiochemistry,
Faculty of Medical Sciences, University of Jos, Jos, Plateau State, Nigeria.
dFaculty
of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
Abstract
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BACKGROUND—Female Sex Workers (FSWs) are key reservoirs of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) from which transmission to the general population fuels epidemics. STIs amplify HIV infectiousness and susceptibility. We determined the status of HIV and STIs among brothel-based FSWs in Jos as part of an ongoing prevention intervention. METHOD—Between January and May 2012, consenting consecutive brothel-based FSWs were recruited from previously designated brothels across Jos. HIV counseling and testing as well as screening for gonorrhoea, syphilis, trichomonasis, candidasis and Bacteria vaginosis (BV) were performed. Positive cases were provided free treatment and follow-up at Solat Women Hospital, Jos. Ethical clearance was obtained from Jos University Teaching Hospital (JUTH) ethical committee.
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RESULT—Two hundred FSWs aged 27.6 ± 4.6 years (range 15–55 years) were recruited and of these, 47 (23.5%) were HIV Positive, 20 (10.0%) had syphilis, 9 (4.5%) had Neisseria gonorrhea, 3 (1.5%) had Trichomonas vaginalis and 86 (43.0%) had BV. The association between HIV and bacterial vaginosis was statistically significant (OR of 2.2, 95% CI of 1.1–4.2, P-value=0.02). In comparison to similar prevalence in 2006, the current findings represent 51.5% decline in HIV prevalence, 40.8% decline for syphilis and over 83.3% decline in prevalence for Trichomonas vaginalis. There was no significant change in the prevalence of Neisseria gonorrhoea and BV.
*
Correspondence: Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Jos, PMB 2084, Jos Phone number: +2348034519740 [email protected]. Conflict of Interest: None declared.
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CONCLUSION—The prevalence of HIV and STIs among brothel-based FSWs in Jos remain unacceptably high, although, there is a declining trend. A comprehensive HIV prevention program targeting these women is required to block transmission to the general population. Keywords Prevalence; STI; HIV; Female Sex Workers; Nigeria
INTRODUCTION
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Since the first case of acquired immune deficiency syndrome (AIDS) was reported in a 13 year old girl in Nigeria in 1986, the human immunodeficiency virus (HIV) / AIDS epidemic has continued to evolve.1 The prevalence of HIV among pregnant women in Nigeria rose from 1.8% in 1991, to reach a peak of 5.8% in 2001, before witnessing a slow decline to 4.4% in 2005 and 4.1% in 2010.1 Other sexually transmitted infections (STIs) such as gonorrhoea, syphilis, trichomonasis, candidasis and Bacterial Vaginosis (BV) have been shown to enhance the transmission and acquisition of HIV.2 These STIs boost HIV shedding in the genital tract and amplify HIV infectiousness. The presence of STI also increases the susceptibility to HIV by recruiting HIV susceptible inflammatory cells to the genital tract as well as by disrupting mucosal barriers to infection. 2
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Among the high risk groups, female sex workers (FSWs) constitute an important reservoir of HIV and STIs for continuous transmission to the general population.1 In Nigeria, the prevalence of HIV among brothel-based female sex workers (BBFSWs) rose from 17.5% in 1991 through 22.5% in 1993 to 37.4% in 2007, followed by a decline to 27.4% in 2010. 1, 3, 4 The high risk of infection among sex workers is not only due to the fact that they have multiple partners but also due to a contribution of other factors that compound this risk. These factors include poverty, low educational level, low levels of knowledge about STI and HIV/AIDS prevention, gender inequalities and limited ability to negotiate condom use. 5, 6 These factors make them prone to having unprotected sex. Their clients and partners therefore serve as a bridging population for spreading STI and HIV to the general population. 7, 8 Treatment of HIV and STI is now recognised as a critical prevention tool in the control of the HIV epidemic.9, 10
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In an earlier study of STI and HIV among brothel-based FSW in Jos in 2006, we found a 48.5% prevalence of HIV.11 Since then, HIV counseling and testing services with referrals for free treatment and care of positive clients of the same brothels has continued. This follow-up study was conducted to determine the status of HIV and STI among BBFSWs in the target brothels as a way of elucidating the impact, if any, of access to free reproductive health services and HIV treatment/care on the trend of HIV prevalence.
METHODS Study Area and Mobilisation This study was carried out between January and May, 2012 in collaboration with the Mary Magdalene Reproductive Health Initiative (MMRHI); a non-governmental organization that
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provides free reproductive health services to BBFSWs in Jos. Jos is the capital city of Plateau State in north-central Nigeria with a population of about 900,000 people 12. The city comprises Jos-North and Jos-South local government areas (LGA) with Jos-North being the state capital where most commercial activities take place 10. All 6 brothels involved in this study were in Jos-North LGA.
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Meetings were held between representatives of the MMRHI, the brothel managers and representatives of the BBFSWs intimating them of the purpose of the study and seeking their cooperation. The field officers (a nurse/midwife and a research assistant) of MMRHI have a long standing relationship with the brothels’ managements because of their on-going provision of HIV and STI prevention services which dated back to 2006. Clients found to be infected with HIV and other STIs were referred to Solat Women Hospital (Private hospital) Jos, which is a PEPFAR supported national HIV treatment and care facility where free services are accessed. The private facility is popular among BBFSWs because of the privacy, confidentiality and timeliness it offers in accessing care. Free services available at Solat Women Hospital (SWH) include; Adult and Paediatric HIV treatment and care, full range of prevention of mother-to-child transmission (PMTCT) of HIV services, laboratory monitoring with CD4, haematology, chemistry, viral load (through linkage), tuberculosis and hepatitis B screening. Study Population and Study Design
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Female Sex Worker was defined as any biological female aged 15 years and older who receives money or other gifts/incentives in exchange for sex in areas such as brothels, bars, restaurants, nightclubs, hotels, or on the street.4 There are therefore those who are brothelbased (BBFSWs) and non brothel-based (NBBFSWs). The study participants comprised BBFSWs in Jos, Plateau State, Nigeria. This was a cross-sectional survey. The pre-existing knowledge of HIV status by any of the BBFSWs did not affect study eligibility. The participants were recruited for the study between January and May 2012. A structured questionnaire was administered by a trained nurse counsellor. Pre-HIV test counselling and HIV test as well as screening for syphilis, gonorrhoea, trichomoniasis, candidiasis and BV were done for all participants recruited. Ethical Consideration The present study was approved by the Ethical Committee at the Jos University Teaching Hospital, Jos, Nigeria. All study subjects gave informed consent to participate in the study. Study Procedure (Protocol)
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The representatives of the MMRHI recruited the BBFSWs from their respective brothels to the private hospital. On arrival at SWH, a gynaecologist with a nurse counsellor in attendance explained the purpose of the study to the BB FSWs as a group. Those who consented to participate were then recruited. The nurse counsellor then performed pre-test counselling one on one with each BBFSW before a laboratory scientist collected blood samples for HIV and syphilis tests. Each BBFSW thereafter met the investigating gynaecologist who administered the questionnaire, performed a gynaecological examination
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and collected high vaginal (HVS) and endocervical swabs (ECS) for the diagnosis of trichomoniasis, candidiasis, BV, and gonorrhoea. The venous blood sample was tested for HIV and syphilis. The serum was screened for HIV-1 and HIV-2 using the WHO parallel test algorithm 13. The rapid test kits used were Abbott Determine (Abbott laboratories, Abbott park, IL USA) and Unigold (Trinity Biotech, Bray, Ireland). Discordant results were confirmed using Stat-pak kit as a tie-breaker (Chembio diagnostic system, Medford, NY, USA). Syphilis was diagnosed if the patient’s serum was reactive with both the Rapid Plasma Reagin Syfacard-R (Murex Biotech, Kent, UK) and the Determine Syphilis Treponema Pallidum Antibody Assay (Abbott, Wiesbaden, Germany).
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A wet mount of the vaginal swab was prepared in saline immediately after collection and examined microscopically for the presence of clue cells and motile trichomonas vaginalis. Direct microscopy of Gram-stained genital swabs was carried out for the detection of leukocytes and Gram-negative diplococci. Isolation of Neisseria gonorrhoea was done by inoculation of the endocervical swab on modified Thayer Martin media followed by incubation in a candle-extinctive jar at 36°C for 24–48 hours. Isolates were identified on the basis of colony morphology, visualization of Gram-negative diplococcic, positive oxidase reaction and sugar fermentation tests. Antibiotic sensitivity was assessed on all N. gonorrhoea isolates to determine the appropriate drug of choice for treatment. Bacterial vaginosis was diagnosed according to the Amsel criteria 14, 15.
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Post-test counselling was offered by the nurse counsellor on the first day at the clinic and those found to be HIV positive were referred to the PEPFAR supported HIV/AIDS treatment and care unit in the same facility (SWH). Each subject participating in the study was educated on HIV and other STI prevention strategies, given condoms and an appointment for a follow-up visit after retrieving the remaining results. During the follow-up visit, appropriate treatment was offered free of charge for any detected STI. Data Analysis Data entry and analysis were done using Epi info version 3.5.3 (CDC, Atlanta, GA, USA). The test of significance for continuous variables was done using the student t-test and X2 was used for categorical variables. In estimating the differences in prevalence of the various STIs between the 2006 and the current data, we used the two-sample for proportion test calculator on STATA version 11.0, College Station, Texas, USA. Estimates of 95% confidence intervals were calculated and a P-value of less than 0.05 was considered statistically significant.
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Results A total of 200 BBFSWs were recruited and of these, 47 (23.5%) were HIV Positive, 20 (10.0%) had syphilis, 9 (4.5%) had Neisseria gonorrhea, 3 (1.5%) had Trichomonas vaginalis and 86 (43.0%) had BV (Table 1). The characteristics of the 200 FSWs showed a mean age ± SD of 27.6 ± 4.6 years (range 15–55 years) and there was no statistically
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significant difference by HIV status (P=0.35). The mean parity ± SD was 2.0 ± 1.3 and there was no statistically significant difference by HIV status (P=0.91) (Table 2). The majority of participants in this study were never married (114/200=57%) and 90% (180/200) had some form of formal education. Comparison by HIV status showed no significant difference with respect to educational level (P=0.56) (Table 2).
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The mean duration of sex work ± standard deviation (SD) for the HIV positive FSWs was 4.7 ± 2.5 years while that of the HIV negative FSWs was 3.7 ± 1.9 years. The difference in duration of sex work was statistically significance between these two groups (P=0.01). All BBFSWs in the study reported using condom with their customers, the vast majority use it most times or all the time (198/200 or 99%). Overall, more BBFSWs used condom for every coitus when having sex with paying (customers) 143 (71.5%) compared with 21 (10.5%) that used it for every coitus when having sex with steady partners or boyfriends (Table 2). With regard to association between HIV and specific STIs, only BV and HIV demonstrated statistically significant association. Those with HIV and BV were 27 (31.4%) compared with those with HIV and no BV 20 (17.5%). The association is statistically significant (OR of 2.2, 95% CI of 1.1–4.2, P-value=0.02) (Table 3). When we compared the prevalence of HIV and other STIs in this study with the findings reported by our group in the same settings 6 years earlier, there were statistically significant declines in HIV (48.5% vs 23.5%, P=0.001), syphilis (16.9% vs 10.0%, P=0.024) and Trichomonas vaginalis (9.0% vs 1.5%, P=0.001) while Neisseria gonorrhoea (3.4% vs 4.5%, P=0.505) and Bacterial vaginosis (46.7% vs 43.0%, P=0.391) remained essentially unchanged (Table 4).
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DISCUSSION The main findings of this study show that the prevalence of HIV and other STIs among BBFSWs in the Jos metropolis remain unacceptably high. Secondly, BBFSWs have a very low rate of condom use (10.5%) with their steady partners or boyfriends, making this group an important bridge population for transmission of HIV and STIs to the general population. Thirdly, although these prevalence rates are high, in comparison to similar figures in 2006, they represent a 51.5% decline in HIV prevalence, 40.8% decline for syphilis and over 83.3% decline in prevalence for Trichomonas vaginalis. There was no significant change in the prevalence of Neisseria gonorrhoea and BV (Table 4 and Figure1). HIV Prevalence and Condom use
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The HIV prevalence of 23.5% among BBFSWs in the current study is in tandem with the findings of the integrated biological and behavioral surveillance surveys (IBBSS 2010) which reported HIV prevalence of 27.4% among BBFSWs in Nigeria.4 When the same 6 states with data in 2007 were compared with data obtained in 2010, HIV prevalence among BBFSWs declined by more than one-third between 2007 and 2010 (37% vs. 23%; P< 0.001). 16 Our study indicated that a steeper decline in HIV prevalence occurred in the targeted brothels in Jos. A recent study from Kano17 also reported a 29.6% prevalence rate
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of HIV among BBFSWs but more worryingly, despite their knowledge that unprotected sexual intercourse is the commonest risk factor associated with STI and HIV acquisition, all these HIV-infected women reported ongoing unprotected sexual intercourse with clients. Similarly, 60.7% of the study participants who reported having symptoms of STI continued to have unprotected sex. IBBSS 20104 with data from 12 States in Nigeria, also reported a low rate of condom use (20% –30%) with boyfriends or steady partners by BBFSWs. The present study found that only 10.5% of BBFSW used condom for sex with their boyfriends/ steady partners. These findings indicate that substantial amount of unprotected sexual exposure, even in the presence of STI, continue to occur in brothel settings in Nigeria. This portends danger if available HIV prevention knowledge are not utilised to stop transmission in this high risk setting. Decline in HIV and STI prevalence
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The significant declines in the prevalence of HIV (50.5%), syphilis (40.8%) and Trichomonas vaginalis (83.3%) deserve careful scrutiny. First, BBFSW are a fairly mobile population. Indeed, our study found that 115 (57.5%) of these women had moved into Jos within the last 4 years so, we were not entirely dealing with the same cohort of 2006. In three serial cross-sectional surveys conducted between 1993 and 1999 in Cotonou, Benin, the authors reported a decline in the prevalence of HIV and STIs among FSWs and attributed the decline partly to the changing sex work Milieu as the country of origin of the FSWs changed dramatically within the period. 18 The authors also attributed the decline in the HIV prevalence partly to the intervention instituted among these women after the first cross-sectional survey 18. A similar decline was observed in the prevalence of HIV in Southern India from 19.6% to 16.4% among sex workers in the three years following the initiation of a large scale HIV prevention program19. Several other programmes in India have implemented condom promotion and syndromic STI treatment among FSWs and their clients and demonstrated subsequent decline in the prevalence of STIs (syphilis, gonorrhoea and Chlamydia) among FSWs and reduced HIV risk in the general population. 20–22 We believe that the decline observed in this study can be attributed to a variety of factors. It may reflect lower HIV prevalence in the general population and a changing sex work milieu. Indeed, the decline in HIV prevalence might partly be due to the impact of the sexual health education, condom supplies, ongoing HIV counselling and testing with linkage to free treatment and care and other reproductive health services offered by the Mary Magdalene reproductive health initiative (MMRHI) to these female sex workers.
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The decline in prevalence of syphilis and trichomonas vaginalis along with HIV may reflect dividends from more consistent condom use with commercial clients as was reported in this study. There was no significant change in prevalence for gonorrhoea in the current study although a recent work among FSWs in India reported a significant decline in gonorrhoea as well. 22 The persistently high prevalence of gonorrhoea in this study could be reflective of the prevalence of gonorrhoea in the general population. This study was however not designed to evaluate the general population.
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Association between HIV and specific STI entities
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When the association between HIV and specific STI entities were evaluated, it was found that the prevalence of HIV was higher when there was an associated STI compared to when there was no associated STI. This association was only found to be statistically significant with BV (OR=2.2, 95% CI=1.1–4.2, P=0.02). In a study to review the scientific data on the role of sexually transmitted infections in sexual transmission of HIV infections, the authors concluded that both the ulcerative and non-ulcerative STIs promote HIV infectiousness and susceptibility 23. The association between HIV and BV has been well studied in a variety of settings with the suggestion that bacterial vaginosis may increase susceptibility to HIV acquisition. 24, 25
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The association between HIV and syphilis showed a higher proportion of FSWs with HIV and syphilis (35.0%) compared to those with HIV and no syphilis (22.2%). However, the association was not statistically significant (OR= 1.9, 95% CI=0.7–5.0, P-value=0.16). The association between HIV and Neisseria gonorrhoea was not found to be statistically significant in this study (OR= 2.8, 95% CI= 0.7–10.7, P-value =0.13). In a study conducted in Nairobi, Kenya among 92 HIV positive FSWs, there was no statistically significant association between HIV and gonorrhoea 26. However, another study from Kinshasa, Zaire among 431 FSWs showed significant association when these women were followed up prospectively for a mean duration of 2years 27. The difference in this study could be attributed to the study design. The association between HIV and Trichomonas vaginalis from this study was not statistically significant. A number of other studies have also found no significant association. 24, 27, 28
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LIMITATIONS OF THE STUDY We were unable to study Chlamydia. The findings from the study only demonstrated a significant association between HIV and BV, but by its design cannot show a causal relationship. Part of the study relied on self reported behaviour (eg condom use), hence, social desirability and stigma may have biased respondents’ answers, however, the good rapport established over time, between the field nurses of MMRHI and the brothel management and head-girls significantly facilitated the work.
Conclusions and Recommendations
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This study showed that although the prevalence of HIV and STIs among the BBFSWs in Jos remain unacceptably high, there is a declining trend. The potential for HIV and STI transmission to the general population remains high. To maintain this declining trend of HIV and STI prevalence among FSWs, HIV prevention programs targeting brothel-based FSWs should be prioritized and consideration should be given to site-based intervention strategies that promote safer sex, diagnosis and treatment of STIs and access to HIV treatment, care and support. The integration of rapid diagnostic technologies into STI surveillance in highrisk groups may improve the effectiveness of such programmes and should be pursued. The
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policy environment should consider recommending life-long antiretroviral therapy for all HIV infected FSWs and pre-exposure prophylaxis medication for HIV negative FSWs.
Acknowledgements We are grateful to the women who participated in this study, and the research staff involved in the fieldwork, counselling and testing of biological samples. We are thankful to the staff of Solat Women Hospital, Jos for their cooperation. The study was funded through private donations to the Mary Magdalene Reproductive Health Initiative (MMRHI). Data analysis and writing of this paper was supported by the Medical Education Partnership Initiative in Nigeria (MEPIN) project funded by Fogarty International Center, the Office of AIDS Research, and the National Human Genome Research Institute of the National Institute of Health, the Health Resources and Services Administration (HRSA) and the Office of the U.S. Global AIDS Coordinator under Award Number R24TW008878. HIV/AIDS services in Solat Women Hospital, Jos was supported by AIDS Prevention Initiative in Nigeria (APIN) with HRSA funding through award number U51HA02522-01-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding organizations.
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17. Lawan UM, Abubakar S, Ahmed A. Risk Perceptions, Prevention and Treatment Seeking for Sexually Transmitted Infections and HIV/AIDS among Female Sex Workers in Kano, Nigeria. Afr J Reprod Health. 2012; 16:61–67. [PubMed: 22783669] 18. Alary M, Mukenge-Tshibaka L, Bernier F, et al. Decline in the prevalence of HIV and sexually transmitted diseases among female sex workers in Cotonou, Benin, 1993–1999. AIDS. 2002; 16:463–470. [PubMed: 11834959] 19. Ramesh BM, Beattie TSH, Shajy I, et al. Changes in risk behaviour and prevalence of sexually transmitted infections following HIV prevention interventions among female sex workers in five districts in Karnataka state, south India. Sex Transm Infect. 2010; 86:17–24. 20. Mainkar MM, Pardeshi DB, Dale J, et al. Targeted interventions of the Avahan program and their association with intermediate outcomes among female sex workers in Maharashtra, India. BMC Public Health. 2011; 11:S2. [PubMed: 22375562] 21. Rachakulla HK, Kodavalla V, Rajkumar H, et al. Condom use and prevalence of syphilis and HIV among female sex workers in Andhra Pradesh, India—following a large-scale HIV prevention intervention. BMC Public Health. 2011; 11:S1. [PubMed: 22376071] 22. Arora P, Nagelkerke NJD, Moineddin R, Bhattacharya M, Jha P. Female sex work interventions and changes in HIV and syphilis infection risks from 2003 to 2008 in India: a repeated crosssectional study. BMJ Open. 2013; 3:e002724. 23. Fleming DT, Wasserheit JN. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV. Sex Transm Infect. 1999; 75:3–17. [PubMed: 10448335] 24. Sewankambo N, Gray RH, Wawer MJ, et al. HIV-1infection associated with abnormal vaginal flora morphology and bacterial vaginosis. Lancet. 1997; 350:546–550. [PubMed: 9284776] 25. Taha TE, Hoover DR, Dallabetta GA, et al. Bacterial vaginosis and disturbances of vaginal flora: association with increased acquisition of HIV. AIDS. 1998; 12:1699–1706. [PubMed: 9764791] 26. Kreiss J, Willerford DM, Hensel M, et al. association between cervical inflammation and cervical shedding of human immunodeficiency virus DNA. J. Infect Dis. 1994; 170:1597–1601. [PubMed: 7996003] 27. Laga M, Manoka A, Kivuvu M, et al. Non-ulcerative sexually transmitted infections as risk factors for HIV-1 transmission in women: results from a cohort study. AIDS. 1993; 7:95–102. [PubMed: 8442924] 28. Kassler WJ, Zenilman JM, Erickson B, et al. Seroconversion in patients attending sexually transmitted disease clinics. AIDS. 1994; 8:351–355. [PubMed: 8031513]
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Figure 1.
Comparison of the prevalence of HIV and others STIs among Brothel-based FSWs between 2006 and 2012 in Jos, Nigeria
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Table 1
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Prevalence of HIV and other STIs among Brothel-based FSWs in Jos, Nigeria Variable
Frequency (n=200)
Prevalence (%)
HIV
47/200
23.5%
Syphilis
20/200
10.0%
Neisseria gonorrhoea
9/200
4.5%
Trichomonas vaginalis
3/200
1.5%
Bacterial vaginosis
86/200
43.0%
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Table 2
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Characteristic of the study group by HIV status
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Variables
HIV Positive
HIV Negative
p-Value
Mean age ±SD (years)
27.9 ± 4.1
27.2 ±5.0
0.35
Mean Parity ± SD
2.0 ±1.1
2.0 ±1.4
0.91
Married
-
1 (100%)
Never married
27 (23.7%)
87 (76.3%)
Separated
9 (17.3%)
43 (82.7%)
Divorced
8 (29.6%)
19 (70.4%)
Widowed
3 (50.0%)
3 (50.0%)
No formal education
5 (25.0%)
15 (75.0%)
Some primary education
9 (30.0%)
21 (70.0%)
Completed primary
7 (30.4%)
16 (69.6%)
Some secondary
16 (25.0%)
48 (75.0%)
Completed secondary
9 (17.6%)
42 (82.4%)
Tertiary
1 (8.3%)
11 (91.7%)
Christian
46 (23.1%)
153 (76.9%)
Muslim
1 (100%)
-
Mean duration of sex work ± SD (years)
4.7 ± 2.5
3.7 ± 1.9
Non-use
-
-
Rarely
-
-
Sometimes
1 (50.0%)
1 (50.0%)
Most coitus
13 (23.6%)
42 (76.4%)
Every coitus
33 (23.1%)
110 (76.9%)
Non-use
8 (28.6%)
20 (71.4%)
Rarely
2 (33.3%)
4 (66.7%)
Sometimes
18 (30.5%)
41 (69.5%)
Most coitus
4 (10.8%)
33 (89.2%)
Marital status
-
Educational status
0.56
Religion -
0.01
Author Manuscript
Use of condom with customers
-
Use of condom with steady partners
-
Author Manuscript Afr J Med Med Sci. Author manuscript; available in PMC 2015 December 17.
Author Manuscript
Author Manuscript
Author Manuscript 43 (22.5%)
46 (23.4%)
No
27 (31.4%) 20 (17.5%)
Yes
No
Bacterial vaginosis
1 (33.3%)
Yes
Trichomonas vaginalis
4 (44.4%)
No
40 (22.2%)
7 (35.0%)
HIV Positive
Yes
Neisseria gonorrhea
No
Yes
Syphilis
Variable
94 (82.5%)
59 (68.6%)
151 (76.6%)
2 (66.7%)
148 (77.5%)
5 (55.6%)
140 (77.8%)
13 (65.0%)
HIV Negative
2.2
1.6
2.8
1.9
Odds ratio
1.1 – 4.2
0.15 – 18.5
0.7 – 10.7
0.7 – 5.0
95% confidence interval
0.02
0.6
0.13
0.16
P- Value
Association between HIV and Other Sexually Transmitted Infections in Jos, Nigeria
Author Manuscript
Table 3 Ogbe et al. Page 13
Afr J Med Med Sci. Author manuscript; available in PMC 2015 December 17.
Ogbe et al.
Page 14
Table 4
Author Manuscript
Prevalence of HIV and Other STIs among FSWs in Jos, Nigeria 2006 and 2012 Sexually Transmitted Infections HIV
Syphilis
Neisseria gonorrhoea
Trichomonas vaginalis
Author Manuscript
Bacterial vaginosis
*Prevalence in 2006 (n=398)
P-Value
47/200
193/398
0.001
[23.5%(95%CI:17.6–29.4)]
[48.5%(95%CI:43.6–53.4)]
Prevalence in present study 2012 (n=200)
20/200
67/397
[10.0%(95%CI:5.8–14.2)]
[16.9%(95%CI:13.2–20.6)]
9/200
13/378
[4.5%(95%CI:1.62–7.40)]
[3.4%(95%CI:1.61–5.20)]
3/200
34/378
[1.5%(95%CI:0.2–3.2)]
[9.0%(95%CI:6.2–11.8)]
86/200
186/398
[43.0%(95%CI:36.1–49.9)]
[46.7%(95%CI:41.8–51.6)]
0.024
0.505
0.001
0.391
*
Imade G, Sagay A, Egah D et al 200811
Author Manuscript Author Manuscript Afr J Med Med Sci. Author manuscript; available in PMC 2015 December 17.
