Sexual practices conducive to HIV transmission in Southwest Nigeria

Several studies have shown that the AIDS pandemic in sub-Saharan Africa is associated with prevalent sexual practices that facilitate HIV transmission. The objective of this study was to determine the influence of knowledge of transmission routes for HIV in relation to high-risk sexual behaviour and to find factors significantly associated with condom use among sexually active respondents. High-risk sexual activities were assessed among 208 Nigerians using selfadministered questionnaires, in three cities of Southwest Nigeria: Ado-Ekiti, Ibadan and Lagos. Knowledge of HIV transmission routes, high-risk sexual behaviour and condom use were measured. A majority of the sexually active respondents, significantly more males than females, had two or more sexual partners. The highest proportion of sexually active respondents who perceived themselves at high risk of being HIV-positive were aged 19 or below, had poor knowledge of the modes of transmission for HIV and had never used condoms. Using logistic regression analysis, significant determinants of condom use among sexually active respondents were having sexual relations with a prostitute and being in a stable sexual relationship, and selfperception of testing positive for HIV if tested. In urban Southwest Nigeria, there is quite a high level of knowledge of HIV and AIDS, and self-reported condom use. However the non-use of condoms by the adolescents is disturbing; reproductive health and AIDS education programs need to be especially targeted at this group since they are at greatest risk of contracting or spreading HIV. A reasonable generalization from urban Southwest Nigeria to the rest of this region can be made. With the rapid spread of HIV infection in all sub-Saharan African countries, adequate and representative studies on high-risk behaviour are needed in Nigeria. Of all the modes of transmission for HIV infection, sexual transmission is predominant in subSaharan Africa, accounting for as many as 90 per cent of all HIV infections (De Kock et al. 1994). It is currently estimated that about 14 million people in sub-Saharan Africa are infected with HIV, over 60 per cent of the global total (Weekly Epidemiological Record 1997). Previous studies in sub-Saharan Africa have found the risk factors for HIV to be infections with sexually transmitted diseases (STDs) and genital ulcers, multiple sexual partners, lack of circumcision in men, frequent sex with prostitutes, use of herbs and other substances for enhancement of sexual pleasure and exposure of men to menstrual blood (Malamba et al. 1994; Hunter et al. 1994; Bwayo et al. 1994; Mbugua et al. 1995; Runganga and Kasule 1995). The distribution of self-reported number of sexual partners in Nigeria among sexually active individuals has been shown to be similar to those reported in many East and Southern African countries (Orubuloye, Caldwell and Caldwell 1993), but there are sharp differences in the reported number of HIV infections between Nigeria and most East and Southern African countries. Nigeria reportedly has an estimated 1 million people infected with HIV (WHO 86 A. Osho and B.A. Olayinka The Continuing African HIV/AIDS Epidemic 1995). This estimate represents between one and two per cent of the total sexually active population, while estimates among the sexually active population in some East and Southern African countries are higher than 30 per cent (US Bureau of the Census 1997). Knowledge of AIDS as an incurable disease is widespread in sub-Saharan Africa, but sexual behaviour putting this knowledge into practice is known to be lacking (Orubuloye, Caldwell and Caldwell 1990; Mbizvo et al. 1994; Okojie, Ogbeide and Nwulia 1995). It is essential to carry out regular KAP surveys of high-risk sexual behaviour to facilitate education on health and on HIV prevention strategies. This probably remains the best way of controlling the spread of the infection. This study used self-administered questionnaires to determine the present HIV-transmission related practices among sexually active respondents in Southwest Nigeria.