Predictors of Condom Use Among Female Sex Workers with Their Clients in Nigeria

Background:  Clients of female sex workers (FSW) are important in HIV transmission dynamics in Nigeria. Understanding sexual behavior of clients of FSW is important in designing effective HIV prevention programs. Little is known about clients of FSW and their HIV prevalence in Nigeria. Unfortunately, they are possible bridge population between FSW and the general population. This study examined the predictors of condom use among FSW with their clients in Nigeria.

Methods:  Secondary data analysis was done using the 2010 Integrated Biological and Behavioral Surveillance Survey (IBBSS). Behavioral and biological information from 4459 brothel and non-brothel FSWs was collected in nine states. Multiple logistic regression models were used to assess the predictors of condom use with their clients.

Results:  Average age of FSW was 26.5±5.8years; overall HIV prevalence was 21.2%; brothel-based FSW was 25.6% and non-brothel based was 16.5%. The mean age at first sex was 17±2.7years; average clients/day was 4; 29.3% of married FSWs were HIV+, 21.7% of HIV+ FSW used condom with their last client while 21.9% of HIV+ FSW used condom consistently.  About 10.6% had been forced for sex by their clients and 60.2% tested and received HIV result within the last one year. Significant predictors of clients’ condom use were FSW knowing their HIV test result in the last 12monts OR=2.5 and 95%CI 1.4 -4.5; not being currently married OR =2.5 and 95%CI 1.1 - 5.4 and consistent condom in other sexual relationships OR=8.0 and 95%CI 6.3 and 11.0.

Conclusions:  Condom use with clients depends on sex worker knowing their HIV status and currently unmarried. There is a need to increase awareness and uptake of HIV testing among FSW even if it is difficult to reach their clients. Additionally, targeted health education and motivational programs are needed to increase their uptake of condom and HIV testing.