Human immunodeficiency virus awareness and condom use among female adolescent prostitutes in Lagos, Nigeria

Introduction The cornerstone of HIV prevention among female adolescent prostitutes is awareness promotion complemented with advocacy on consistent and correct use of condom. The study aimed at reviewing HIV awareness and condom use among female adolescent prostitutes in Lagos communities, Nigeria. Methods It was a mixed-method study realized through a questionnaire-based survey and in-depth interviews of adolescent sex workers in Oyingbo and Yaba communities of Lagos State, Nigeria; conducted between 1st of April, 2014 and 30th of September, 2014. SPSS version 17.0 and content analysis were used in analyzing quantitative and qualitative data respectively. Results 97.3% had heard about HIV/AIDS; with 86.9% being tested for HIV in the preceding 6 months. While there was consistent use of male condom in 99.7% of the respondents, 90% had experience with the use of female condom, however, 95.5% would allow non- use of condom for higher financial reward. Conclusion Although the level of awareness of HIV/AIDS was high among the respondents, there is need to improve on the level of awareness and preventive strategies for HIV/AIDS, with more emphasis laid on the consistent and correct use of condom in this highly vulnerable class of people.


Introduction
Female adolescent prostitution is a variant of community-induced sexual violence and oppression against young girls and teenagers in the age group of 10-19 years either for sexual gratification or economic reason [1,2]. It is of both public and reproductive health importance. It is a criminal and antisocial sexual behavior of enormous physical, mental and social burden that cuts across all communities [2,3]. Human immunodeficiency virus (HIV) infection along with other sexually transmitted infections is one of the most dreaded major medical complications associated with prostitution business [4][5][6]. Prostitutes and other sexually active young people with risky health behaviour have been shown to be significant HIV transmitters, with HIV prevalence in them almost eight times the national prevalence [4,5,7]. Therefore, there is a strong association between this afore-stated finding and the fact that the first case of acquired immune deficiency syndrome (AIDS) in Nigeria was identified in a sexually active 13-year-old girl in 1984 [8]. Health and other social risks associated with the pandemic of HIV scourge include opportunistic infections, organ damage, stigmatization, psychological/mental stress, suicidal ideation and death [8]; all culminating in negative effects on nation's growth and development.
Condom use has been shown to be a reliable HIV infection prevention strategy if used consistently and correctly [9]. It is, however, interesting and pathetic to find out that, despite their high risk sexual behavior, there is high level of inconsistent use of condom among commercial sex workers, thus exposing them much higher to the risk of contracting and spreading HIV infection. It is also equally disturbing that an increasing number of adolescent girls are entering the sex trade; these are regarded as sex slaves who are highly vulnerable to HIV infection because they lack sex negotiation skills especially when dealing with older men [10]. Condom use in sex industry has been influenced by factors such as age of clients, age of sex worker, types of clients (casual or regular), location of business, number of clients, charges, involvement of threat or coercion [11].
Most of the available studies on HIV awareness and condom use in sex industry were conducted generally on men and women of reproductive age (15-49) [11,12], there is paucity of specific data on the views and experiences of adolescent girls in the same sex trade.
This type of study becomes essential to be able to appreciate the possible prostitution peculiarities and conditions in a younger age group (adolescents) that findings have shown that clients have preference for in the business [13]. Information obtained from this study will give a better understanding to the control and prevention of the higher health burden of HIV/STIs in these highly vulnerable people.

Methods
A research design was drawn to examine the topic of the study and determine the most appropriate methods employed to gather correct and objective data for the study. It was a mixed-method study realized through a questionnaire-based survey and in-depth interviews. The basis of this method was to generate both quantitative and qualitative pieces of information for the study. The However, in the qualitative research method, a total of four (4) indepth interviews were conducted in the study using unstructured interview with "quick questions"; with the 4 respondents drawn from two sampled local government areas. Each of the respondents (adolescent prostitutes) interviewed were picked from 4 different brothels, two from each of the study communities. This was done to have a more objective and balanced representation of the views of respondents from the two communities of study. This made the data generated from the technique represent a relatively true picture of adolescent prostitution in Lagos metropolis.
A purposive sampling technique was utilized to select respondents in the survey, while in the in-depth interview, respondents were selected using both purposive and accidental sampling techniques (the selected method was based on convenience, chance, availability and relevance of the respondents to the theme of the study). Both descriptive and content analyses were utilized to analyze the data generated. For qualitative analytical method, Statistical Packages for Social Sciences (SPSS/PC+) was used to analyze the collected data.
The qualitative data were analyzed using "content analysis". This technique facilitated compressing inferences, by systematically and objectively identifying specified characteristics of messages. In doing this, the in-depth interviews recorded into the tapes were transcribed from a local language (i.e. Yoruba, Igbo or pidgin) to English language. Responses to each question were summarized and important questions were reported verbatim to complement our findings in the survey. It should be noted that the content analysis was done manually in order to enhance the explanatory clarity of findings.

Deep in-depth interview on the use of condom
The influence of financial gain on the use of condom

Discussion
The level of awareness of HIV/AIDS was high among the sex workers in the study location; as the findings from this study showed that 282 What is known about this topic  HIV awareness is on the increase worldwide;  Prostitution cuts across races and it is of public health importance;  Condom use is a reliable tool for HIV prevention.

Competing interests
The authors declare no competing interests.

Authors' contributions
All the aforementioned authors have individually and critically worked on and evaluated the quality of the manuscript and agreed before sending it for publication. BAO, SAO and OSO designed the study, participated in data collection, analysis and writing of the manuscript.
BOR and ROO participated in data collection and review of the manuscript. OBO and ODO critically reviewed the manuscript and data analysis was done by OOA. All authors have read and agreed to the final manuscript.