Abstract
Support by brothel leaders and the promotion of a conducive environment for HIV prevention programs within brothel establishments are important to promote a safe working environment for Brothel-Based Female Sex Workers (BB FSWs). This study assesses the effects of a cluster randomized pilot trial examining the use of brothel leaders to improve consistent condom use by FSWs residing in brothels and also assessed the feasibility of implementing a similar intervention on a broader scale. Ten brothels in Abuja, Nigeria were randomized and exposed to the experimental (n=5) and control (n=5) arms of the intervention. 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 and condom negotiation self-efficacy outcomes were analysed using multi-level mixed regression models. A total of 243 FSWs were recruited into the study (control n=66 and experimental n=177) and 107 of them (44%) were available at 16 weeks follow-up. The intervention demonstrated feasibility and positive outcomes for consistent condom use with boyfriends, casual partners and clients of FSWs were obtained. The interaction effect between condition and time indicated increased consistent condom use with boyfriends in the experimental condition (p=0.02). Adherence to the intervention by the FSWs was moderate with the mean sessions attended at 4.4(SD=2.0). The attrition rate during the intervention was high due to mobility of the FSWs. The intervention showed feasibility and effect outcomes indicate promise in enhancing condom use with steady partners of BB FSWs. The design of HIV prevention interventions may benefit from the inclusion of gatekeepers in the promotion of condom use within the brothel, but an adequately powered phase III trial is needed to inform large-scale implementation of this approach.
Highlights
In Nigeria, brothel based female sex workers (BB FSWs) have the second highest prevalence of HIV compared to other sub-populations within the country
Our findings indicate that the study had a positive effect in increasing consistent condom use outcomes with boyfriends, casual partners and clients
Our findings indicate the feasibility of engaging brothel leaders in condom promotion interventions within brothels and the possible benefits of this for HIV prevention efforts among Based Female Sex Workers (BB FSWs) in Nigeria
Summary
In Nigeria, brothel based female sex workers (BB FSWs) have the second highest prevalence of HIV compared to other sub-populations within the country. The HIV prevalence for BB FSWs is twice that of their non-brothel based counterparts with prevalence rates of 19.4% and 8.6% respectively (FMOH, 2014). The HIV prevalence rate for BB FSWs has shown a decrease from 2010 to 2014, (FMOH, 2010, 2014) the prevalence is still much higher than the general population prevalence of 3.4% (FMOH, 2013). BB FSWs are reported to have higher number of clients and less correct knowledge about HIV transmission than the non-brothel based FSWs in Nigeria (FMOH, 2014; Ikpeazu, Momah-Haruna, Mari, Thompson, & Ogungbemi, 2014; Okafor, Crutzen, Okekearu, Adebajo, & Van Den Borne, 2017). Support by gatekeepers and the promotion of a conducive environment for HIV prevention programs within sex work establishments are key community and gjhs.ccsenet.org
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