Assessment of Stigma, Violence and Coping Strategies of HIV-Positive Female Sex Workers in Akwa-Ibom-State, Nigeria

Abstract

Introduction: This study identifies factors and qualitatively explores the stigma, violence, and coping mechanisms among female sex workers (FSWs) in Akwa Ibom State.

Method: A descriptive cross-sectional study was conducted among HIV-positive FSWs receiving care at the Heartland Alliance one-stop shop (OSS). Data were collected from 1,723 FSWs at four OSS sites, with 30% recruited from OSS visitors and 70% from local governments, potentially including those treated at either the OSS site or other health facilities. Quantitative data were collected using a pretested structured questionnaire and an adapted stigma scale, while qualitative data came from focus group discussions. 

Results: The study showed a high prevalence of rape (24.3%) among the FSWs, with clients (37.3%) and unknown people (27.3%) being the major perpetrators. Younger FSWs aged 20 and below had a higher proportion reporting high stigma (40.7%) compared to older age groups. FSWs who take alcohol [OR=2.42(95%CI:1.95-3.01;p<0.001)], disclose their HIV status, [OR=1.51(95% CI;1.22-1.87;p<0.001) and those who knew their HIV status for more than 24 months [OR=3.71(95%CI: 2.09-6.59 p < 0.0001)] showed higher odds of experiencing high stigma than their counterparts. FSWs aged 21-30 had a significantly lower odds ratio (OR = 0.61) compared to age 20 and below. Substance usage increases the likelihood of rape (OR = 2.61). Being a widow, [OR=1.53(95%CI:1.08-2.18;p=0.018) substance use [OR =3.34(95%CI: 2.58-4.33 p<0.0001) and alcohol consumption [OR=1.79(95% CI:1.44-2.30 p < 0.0001)] were significantly associated with experience of physical assault among the FSWs. Coping strategies among the FSWs include abstaining from gatherings, not keeping friends and quitting other jobs.

Conclusion: Stigma, rape, and physical abuse, as well as multiple sexual partners and irregular condom use, hinder HIV control among FSWs. To significantly minimise HIV transmission among FSWs, skill acquisition and pre-exposure prophylaxis are needed.