Effect of brothel leaders on condom use promotion for young female sex workers residing brothels in Abuja, Nigeria
Okafor U, Cruzen R and Van den Borne H W
Maastricht University, Netherlands
: J Immunol Tech Infect Dis
Abstract
Background: Brothel leaders support and the enabling of a conducive environment for HIV prevention programs to promote consistent condom use within sex work establishments are key community and institutional factors that promote a safe working environment for young brothel based FSWs. Their vulnerability to sexually transmitted infections including HIV/AIDs and the social factors within their high-risk environment are important aspects to be addressed if positive strides will be taken towards curbing the HIV epidemic. This study assesses the effectiveness and condom use outcomes of a cluster randomized pilot trial using brothel leaders and peer education to improve consistent condom use by FSWs residing in brothels. Methods: Twelve brothels in Abuja, Nigeria were randomized into either an experimental (n=5) or a control (n=5) condition. The feasibility of the intervention and consistent condom use outcomes by FSWs with different partner types as well as condom negotiation self-efficacy were measured. Condom use outcomes were assessed using multi-level logistic regression and linear regression mixed model’s analysis was carried out for condom negotiation self-efficacy outcomes. Results: A total of 243 FSWs were recruited for the study (control n=66 and experiment n=177) and at follow-up, 107 participants (44%) were available. The intervention demonstrated feasibility and positive outcomes for consistent condom use with different FSW partner types was obtained. The interaction effect between condition and time increased significantly for consistent condom use with boyfriends (p=0.022) while for casual partners and clients, the increase was insignificant (p=0.454 and 0.681 respectively). Adherence to the intervention by the FSWs was moderate with the attrition rate at 55.6%. Conclusions: The intervention showed effectiveness and demonstrated promise in enhancing condom use with non-paying partners of BB FSWs i.e. their boyfriends and steady partners on a larger scale. Future HIV Prevention interventions in Nigeria should incorporate gatekeepers of FSWs as key change agents in the mix of strategies adopted for HIV prevention programs and adapt this approach to the various contexts prevalent within sex work settings.
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