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Female sex workers FSWs who inject drugs have higher risks of HIV infection Girls want sex Nijar to injection drug use and the array of sexual practices employed. This study, therefore, is deed to determine sexual practices of FSWs who inject drug in Osogbo, Nigeria. This study was a cross-sectional descriptive mixed-methods de. Twenty-seven FSWs who inject drug were selected from 11 brothels by snowball sampling and interviewed with a semistructured questionnaire and in-depth interview guide.

The mean age of respondents was. Many of the respondents were aware of the magnitude of HIV and some were sex workers first before turning to be drug users. Some respondents were willing to have male clients who do not wear a condom in exchange for accepting more money in return. Many of the respondents reported use of condom, regular talking of herbs, and good personal hygiene as ways of protecting themselves from HIV.

Respondents have relatively high s of sexual partners. Involving sex workers directly in HIV prevention campaigns will encourage them to look after their health and to access services that could help them. Higher risk of HIV transmission is determined by frequent partner change or higher of partners; lack of, low level, or inconsistent condom use; unprotected anal intercourse; and presence of certain types of STIs, especially genital ulcerative disease, as cofactors [ 2 ].

HIV prevalence among sex workers in Nigeria has remained high over the past decade [ 3 ]. Thus, while HIV prevalence among the general population in Nigeria has been declining from its peak of 5. In a recent survey among most-at-risk populations in six states in Nigeria, over half of sex workers did not consider themselves at risk of HIV infection [ 3 ]. Despite their high-risk sexual activity, many sex workers perceive their risk of HIV infection to be low [ 6 ].

As in most regions globally, many African individuals support themselves and their dependants through sex work, primarily women [ 7 ].

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The risks of HIV transmission experienced by sex workers who inject drugs are related to their individual exposure to factors such as unprotected sex with multiple partners or sharing injecting equipment while injecting drugs [ 2 ]. There is evidence from many countries that sex work rates are much higher among female than among male injecting drug users and that female injectors are more likely to have less control over sharing of injecting equipment in a group injection or even with a sexual partner and are more likely to inject after male injecting drug users, thereby increasing their risk for acquiring HIV [ 11 ].

Osun state has consistently experienced fluctuating HIV prevalence since The HIV prevalence decreased from 4. Factors driving the epidemic in Osun State include poverty, multiple sex partners, marital infidelity, high unprotected sexual activities among youths, ignorance, low risk assessment, negative cultural activities such as female circumcision, and migration of people from the high prevalence states that share borders with Osun [ 13 ].

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This study therefore investigates sexual practices of female sex workers who inject drugs in Osogbo, Nigeria. Osogbo is a city in Nigeria, the capital of Osun State. Osogbo lies on the railway line from Lagos to Kano and is the trade centre for a farming region. Most of the population are members of the Yoruba ethnic group.

Osogbo is the venue of the annual Osun-Osogbo festival along the River Osun. The population of the state according to the National Population Census figures is 3,, including 1, Osun state consists chiefly of the Yoruba people, but with variations in dialects; approximately half of the residents are Muslim, with several mosques in major towns such as Iwo, Ede, Osogbo, Ikire, and Ejigbo. The recruitment of participants was done using purposive sampling. This implies that the participants were selected because they are sex workers and also injecting drug users.

In-depth interview guide and semistructured questionnaire were developed by the researchers based on the literature reviewed together with input from Health Promotion Specialists at the University of Ibadan, Nigeria. The questionnaire was used to document female sex workers sociodemographic characteristics and sexual behaviour, while in-depth interview questions focused on drug use, awareness of HIV magnitude and HIV counseling and testing HCTcondom use, and STI challenges.

Two of the researchers moderated all the interviews, while note-taking was done by other research members to complement the audio recording by the moderator. Questionnaire was Girls want sex Nijar before the interview and IDIs were conducted in a quiet space within their brothels. Each interview lasted about 30—45 minutesand the discussions were audiotaped with the consent of the participants.

The study instruments were reviewed by health promotion experts at the Faculty of Public Health, University of Ibadan, and were also pretested among FSWs who are also injecting drug users in Ibadan which has the same characteristics with the study area to determine how effective the developed instrument would be in collecting appropriate data relevant to the research objectives. A total of four IDIs and questionnaire each were conducted during the pretest and they were revised based on the issues identified by the team.

The quantitative data collected was collated, screened, and entered into computer. For the qualitative data, the analysis was done by reading through the transcribed interviews and listening to the audio records in order to get all major discussions during the interviews and the data were manually analyzed using content analysis technique. Approval for the study was sought from the Osun State Ministry of Health.

Written consent of all the participants was obtained before the interview by giving them informed consent form to fill according to their ability to read and write after explaining the objectives of the study to them. Participation in the study was voluntary and there was no criticism of participants who refused to participate or wish to withdraw from the study. No identifier like participants' name or address was recorded so as to keep the information given by each participant confidential. The age of respondents ranged from 21 to 38 with mean age of Many Majority of the respondents The respondents have been in the business for an average of 5.

The age of respondents at first intercourse ranged from 13 to 19 with mean age of More than half of the respondents Reasons adduced by respondents for first sexual intercourse included pressure by partner Girls want sex Nijar Majority of the respondents reported having a daily average of 4 clients and usually spending at least 30 minutes with the client. The majority The mean age of respondents when first abortion was performed was Less than a third Majority of the respondents were aware of the magnitude of HIV in Nigeria and also considered HIV as a serious health problem amongst sex workers.

A respondent in urban brothel specially said. Few of the respondents were also of the opinion that other women who are not sex workers are also at risk of HIV as sex workers. A respondent in semi-urban brothel said. On the issue of HIV counseling and testing, some of the respondents reported that they had ever tested for HIV and only one of these respondents disclosed to be HIV positive. Respondents who had never taken HIV test were also asked for their reasons and their reasons were fear of rejection and discrimination by the community and even among other sex workers if the test is positive.

Other reasons were inadequate understanding of the importance of HCT, fear of high blood pressure, and depression and shock if tested positive. A respondent in urban brothel said. Cocaine, marijuana, tobacco, and alcohol were reported as the drugs mostly used by the respondents. All the respondents reported sharing needles and injecting equipment. Few of the respondents reported that they were involved in sex work as a means of financing their drug use, while majority reported that they were into sex work before becoming drug users with a major reason to escape from intense burden of their work.

Other reasons were to become bold, to be confident to negotiate with clients, and to be strong in bed for clients to enjoy their money. Am actually doing this sex work to raise money to finance the drug am taking. All the respondents reported not using a condom at their first intercourse but all had ever used a condom. Less than a third reported using a condom with their last client and more than half reported that ninety percent of their regular clients do not like using a condom. Nearly all the respondents were willing to have clients not to wear a condom in exchange for accepting more money in return, and the majority of them were aware that using a condom could help prevent HIV transmission.

Major reason adduced by respondents for inconsistent condom use was mental imbalance effects from drug use. Other reasons were as follows: clients objected to use it, it reduces sexual pleasure, and they did not have one at hand. A respondent from urban brothel who disclosed to be HIV positive reported to be inconsistent with condom usage with reason that most of her clients always rejected using a condom and even offer more money for this.

The respondent specifically said. I suffered a lot during this period as I was not getting any client and life became miserable for me and that was why I travelled down to this State so that I can continue this business as I have nothing else to survive with. Questions on sexually transmitted infections STIs were also discussed with the respondents and more than half of the respondents had ever been treated for STI more than once.

Reported STIs among respondents were gonorrhea, syphilis, trichomoniasis, and chlamydia infections. Reported s and symptoms experienced by respondents were pain during sexual act, pus like discharges from vagina, an itch in the vagina region, and pain during urination. The respondents Girls want sex Nijar been in the business for an average of 4.

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This is similar to the findings of [ 15 ] which also revealed that interviewed FSWs have been in the business for an average of 4. Majority of the respondents reported having a daily average of 4 clients. In the Russian city of St. Petersburg, female injecting drug users who exchange Girls want sex Nijar for money had a mean of All the respondents had ever aborted a pregnancy more than once. This is in accord with the findings of [ 17 ] who reported that, in the Netherlands, a large proportion of sex workers, mainly from Latin America and Eastern Europe, do not use contraceptives other than condoms and some have undergone two or three abortions.

This is in accord with the findings of [ 18 ] where all the respondents reported sharing needles and injecting equipment. The riskiest activity for HIV infection during injection is frequent sharing of injecting equipment with strangers [ 18 ]. The highest infection risk lies in the sharing of needles and syringes, where blood is most likely to collect during injection, especially when jacking back injecting into a vein, drawing blood into the syringe, and reinjecting the blood-and-drug mixture.

Even if no blood is visible in either the needle or syringe, HIV may remain trapped in microscopic blood particles. A syringe is a particularly viable atmosphere for HIV within blood, and a contaminated syringe may remain capable of infecting others for up to six weeks [ 19 ]. Cocaine, marijuana, and heroin were reported as the drugs mostly used by the respondents and [ 20 ] also it is also reported that about one third of the IDUs reported having injected cocaine, heroin, or speedball heroin and cocaine.

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All the respondents reported not using a condom at their first intercourse, but all had ever used a condom. Lower levels of condom use have also been shown among those injecting drugs and selling or buying sex in other countries. For example, only 10 percent of injecting drug users from three cities in Indonesia, many of whom had multiple-sex worker and other partners, reported using condom [ 21 ]. Among injecting drug user cohorts in Vancouver, Canada, and in several cities of USA condom use with all types of sexual partners clients and casual and primary partners is rare or low among those exchanging sex for drugs or money [ 2324 ].

More than half of the respondents had ever been treated for STI more than once. This is in accord with the findings of [ 15 ] where more than half of the respondents indicated having sexually transmitted diseases once or more.

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