Consistent Condom Use among Sex Workers in Nigeria

Objectives: This study examines factors influencing consistent condom use among sex workers in Nigeria. Such information can help improve the design of intervention campaigns to reduce the spread of HIV among high-risk groups and the general population. Methods: We used a nationally representative sample of 2,578 sex workers collected in 1998. This study uses logistic regression to predict the effect of exposure to advertising for “Gold Circle” and “Cool” brand condoms (two popular social marketed brands), knowledge of HIV transmission, number of regular partners, self-efficacy, risk perception, and demographic variables on consistency of condom use. Results: The findings suggest that most sex workers lived in urban (84%) areas, were below age 30 (74%), and over half had secondary or higher education (55%). Most respondents had been involved in sex work for two or less years (73%) and had a regular partner (72%). Although the majority of sex workers were worried about AIDS (81%), only 55% reported consistent condom use in the last five sex acts. Among sex workers who usually asked clients to use condoms, 76 percent used condoms in the last five sex acts, compared to 8% of those who do not ask all clients to use condoms. After controlling for background variables and other factors, multivariate results suggested that sex workers who had been exposed to two or more sources of advertising for “Gold Circle” and “Cool” condom brands were about two times more likely to consistently use condoms than those who did not see any advertisements (p < 0.001). Sex workers who knew of two or more modes of HIV transmission were 44% more likely to consistently use condoms than those who had no knowledge (p < 0.05). Sex workers who worried about contracting HIV were two times more likely to consistently use condoms than those who were not worried (p < 0.001). The most important predictor of consistent condom use was self-efficacy. Sex workers who asked all their clients to use condoms were 39 times more likely to consistently use condoms than those who did not ask all their clients to use condoms. Conclusions: Program interventions that use multiple communication media to increase condom brand awareness, to provide information about the modes of HIV transmission and its consequences, and to increase self-efficacy can help improve consistency of condom use among Nigerian sex workers. This may reduce the likelihood of HIV transmission to other populations