ACCESS TO HIV TESTING AND PREVENTION SERVICES AMONG FEMALE SEX

WORKERS IN IBESIKPO ASUTAN LOCAL GOVERNMENT AREA OF AKWA IBOM

STATE.

Erimma Fortune1, Okereke Peace1, Comfort Jeremiah1, Michael Akanji1, Comfort

Francis1, Ruth Paulinus1 Uduak Matthew2, Dennis Uju2

ABSTRACT

The Human Immuno Deficiency Virus (HIV) remains one of the most dreaded viruses that have
plagued humanity since its discovery in the mid-80s. According to a recent survey by NAIIS, the
prevalence of HIV in Nigeria is at about 1.4% especially among adults between the ages of 15-
49 years. The NAIIS report also suggested that HIV prevalence in Nigeria is zonal, with the
highest being in the South-South Zone (3.1%). Pride of Womanhood Empowerment Initiative
(POWEI) implemented the Integrated Most at Risk HIV Intervention Prevention Program
(IMHIPP) in Ibesikpo from 2016 to 2019. The interventions carried out include HIV testing and
access to treatment for Female Sex Workers (FSW). Community Facilitators, Outreach
Coordinators and Peer Educators served as the frontline health workers, implementing the HIV
testing and prevention services through community mobilization, HIV testing, condom and
lubricant distribution, and linkages to HIV treatment and prevention services like Pre & Post-
exposure prophylaxis (PrEP & PEP). These frontline workers also provide the primary data for
reporting. These interventions in the enumeration area (EA) were implemented at various
locations including bars, hotels, brothels, salons, hostels/lodges, as well as peer sessions in
mapped and validated locations in Ibesikpo Asutan. The total number of FSWs tested per year in
Ibesikpo was compared with the total positive yield. Out of the 10,879 FSWs tested for HIV
using the National algorithm, 1010 tested positive (9.3%), with 989 (97.9%) of them linked to
treatment within the period. In addition to the FSWs, 144 sexual partners (SP) were also tested
for HIV with an 85% (122) positive yield. Despite falling within the most at-risk groups, access
to HIV testing among FSWs in Ibesikpo Asutan before this intervention was very poor. The use
of lay frontline workers, community facilitators, outreach coordinators and peer educators helped
to bridge this gap.
INTRODUCTION

The increased awareness of the existence of the HIV infection has not in effect impacted on the
lifestyle of individuals which might lead to exposure to the virus in our society. According to a
WHO report, as of the end of 2017, not less than 36.9 million people were living with HIV
(PLWH) worldwide with 1.8 million new infections and 940,000 deaths [1]. The 90-90-90
aspirational goal of the public health sector which aimed at ensuring that 90% of individuals
infected with HIV know their status, 90% of such individuals be commenced on treatment, while
also ensuring that 90% of the clients on ARV were virally suppressed by 2020 [2] have not been
achieved. The Sustainable Development Goal 3, went further to propose that the AIDS epidemic
be ended by 2030. Transmission of HIV through risky behaviours such as multiple sexual
partners has for long been a challenge to the fight against the disease. The prevalence rate of
Female Sex Workers (FSWs) stands at 27.4% for brothel-based [3]. Due to the high-risk
behaviour and sexual practices of female sex workers which may include exposure to a large
number of clients, intravenous and oral drug use, excessive alcohol intake, unprotected sex with
clients and the existence of other non-paying sexual partners; boyfriends and husbands, FSWs
are critical in the HIV response Babatunde et al., (2014) posit that the vulnerabilities faced by
FSWs are not only associated with their risk behaviours but also with broader societal and
community factors which include gender inequalities, gender-based violence, social
marginalization, criminalized work environments [4], limited exposure to social opportunities
and health services. [5] Due to a combination of some vulnerability factors which includes
youthful age and the sex trade, young FSWs are believed to be more vulnerable to HIV. Early
sexual debut exposes an individual to the risk of acquiring STIs [12]. Despite the risks, the
pathway of infection through sex work could be controlled. Among the tools available for this
control may include potent ARV therapy [6], administration of post-exposure prophylaxis (PrEP)
[7, 8], and the use of condoms and lubricants [9, 10].

IBESIKPO ASUTAN
Ibesikpo Asutan is a Local government Area in Akwa Ibom State with its headquarters at Nung
Udoe [11].

HIV PREVALENCE SOUTH SOUTH

AKS AKWA IBOM

RIVERS
CROSS RIVER
BAYELSA
DELTA
EDO

FIGURE 2: PREVALENCE OF HIV IN SOUTHERN NIGERIA (NAIIS, 2019)

OUTREACHES BY POWEI FRONTLINE

Outreaches could be described as the services or activities carried out at the community level
among female sex workers by frontline health workers. In the course of this implementation
research, POWEI recruited 105 frontline health workers in Ibesikpo (15 outreach coordinators,
30 peer educators and 50 community facilitators). These individuals were trained by the
organization and given the mandate to provide sex education and HIV testing services to FSWs
in their various communities. The selection of frontline workers was based on a few criteria
which include being resident in such a community, being or having been a community member
(FSWs) and the ability to communicate in the local dialect. Targeted HIV testing through the
use of vulnerability risk assessment, Inter-Personal Communication (IPC), community
outreaches were some of the major strategies deployed by the team where the female sex
workers were approached for counselling and testing during peak working hours, usually at night
in brothels and bars. Outreach Coordinators organized outreaches and provided supervision for
the counsellor testers. On the other hand, peer educators mobilized peers within their age range
and provided sex education during their sessions

SUPPORT & CARE

Adequate measures were put in place, through the care and support unit of the organization
during the implementation to ensure that clients who tested positive were linked to treatment and
those on treatment were retained in care. Moreover, clients who stopped treatment were brought
back to care through phone calls, text messages, visits and other follow up strategies as deployed
by the frontline health workers.
RESULTS & FINDINGS

1886

1306 1320

243
243 128 131
134 141
27 9 9
2016 2017 2018 2019

HTS POS LINKED

FIGURE 4: NUMBER OF CLIENTS TESTED PER YEAR AND OUTCOME.

DISCUSSION

The graph above shows the relationship between the number of clients tested per year, the
number reactive and linkage to treatment. In the first year of 2016, a total of 27 clients were
tested for HIV using the national algorithm. 9 clients tested positive and were all linked to
treatment. In 2017, a total of 1886 clients were tested, 243 clients were reactive to the kits, and
all were linked to treatment. In 2018, a total of 1306 clients were tested with a positive of 134.
Those linked to treatment were 128. In the final year of the research in 2019, 1320 clients were
tested. This yielded 141 positive cases, with only 10 of them not linked to treatment.

LESSONS LEARNT AND CHALLENGES

1. Sexual partners of sex workers remain a dominant area for increased interventions as part
of the priority population.
2. Young female sex workers continued to be more vulnerable and hard to reach due to their
base of operation, mostly from virtual spaces.
3. Linkages to treatment for some of Female sex workers is still an issue due to some
religious and cultural beliefs.
 RECOMMENDATIONS

Due to the various challenges met during the implementation period, it is recommended that

1. Implementation Researches of this sort are carried out in all the LGAs in the state to be
able to ascertain the trend of events with key population.
2. Care and support be provided to FSWs to improve prevention and control spread of the
HIV infection.
3. Peer Educators, Community Facilitators and Outreach Coordinators be engaged by the
state government to help reduce the spread of the virus.
4. Acts protecting FSWs be enacted into law as they occupy a very important ecological
niche in our communities.
5. More emphasis should be placed on prevention services through rapid testing, sex
education and provision of condoms to female sex workers.
6. Virtual interventions need to be increased for hard to reach young female sex workers.

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