An appraisal of female sex work in Nigeria--implications for designing and scaling up HIV prevention programmes.

BACKGROUND: The HIV epidemic in Nigeria is complex with diverse factors driving the epidemic. Accordingly, Nigeria's National Agency for the Control of AIDS is coordinating a large-scale initiative to conduct HIV epidemic appraisals across all states. These appraisals will help to better characterize the drivers of the epidemic and ensure that the HIV prevention programmes match the local epidemic context, with resources allocated to interventions that have the greatest impact locally. Currently, the mapping and size estimation of Female Sex Workers (FSWs)--a major component of the appraisal has been completed in seven states. These states are using the data generated to plan, prioritize and scale-up sub-national HIV prevention programmes. METHODOLOGY: It involved a two-level process of identifying and validating locations where FSWs solicit and/or meet clients ("hotspots"). In the first level, secondary key informants were interviewed to collect information about the geographic location and description of the hotspots. For the second level, FSWs were interviewed at each hotspot and information on population size estimates, typologies and operational dynamics of the FSWs were collected. RESULTS: Across the seven states, a total of 17,266 secondary key informants and 5,732 FSWs were interviewed. 10,233 hotspots were identified with an estimated 126,489 FSWs ranging from 5,920 in Anambra to 46,691 in Lagos. The most common hotspots were bars/nightclubs (30%), hotels/lodges (29.6%), streets (16.6%), and brothels (14.6%). Furthermore, the population density of FSWs (per thousand adult men) across the states ranged from 2 in Anambra to 17 in the Federal Capital Territory. CONCLUSION: FSW populations in Nigeria are large and diverse, with substantial differences between and within states. Improved understanding of the location, population size, density, organizational typologies and clients of sex work has informed and is central to Nigeria's planning process for scaling up focused HIV prevention programmes.

Changes in sexual risk behavior among adolescents: is the HIV prevention programme in Nigeria yielding results?

This study conducted an analysis of the 2007 and 2012 National HIV and AIDS Reproductive Health Survey data with the aim of identifying the changes in high risk sexual behaviour among adolescents aged 15-19 years. It focused on changes in the history of use of condom with boyfriends/girlfriends, engagement in transactional sex, sex with multiple partners and age of sexual debut. Bivariate analysis was conducted to ascertain differences in the number of adolescents who engaged in these high sexual risk behaviours over the five-year study period. Data was also analysed for association between risk behaviour and possible predisposing factors. Over the five year period, HIV prevalence in the population increased significantly (p = 0.02) especially in female (p = 0.008). The number of female adolescents who became sexually active decreased significantly (p = 0.02), and use of condom at last sexual act with non-marital sexual partners significantly increased (p = 0.01). There was an insignificant increase in the proportion of males and females who engaged in transactional sex and who had multiple sex partners over the study period. More females who engaged in transactional sex were HIV positive (p = 0.01), and more males who were sexually active in the last 12 months were HIV positive (p = 0.01). There may be a need to redress the current HIV prevention intervention strategies. Attention needs to be paid to the national programme for the prevention of mother to child transmission of HIV programme as well as HIV prevention needs of female adolescents.