Sexual Practices and HIV Prevention Strategies Used by Female Sex Workers in Lagos, Nigeria: An Assessment of the Willingness to Use a Microbicide.

Abstract

Background: Female sex workers have a 13-fold higher risk of acquiring HIV than women who do not engage in sex work. The willingness and acceptability of a product is crucial for the development of microbicides. This research aimed to evaluate the sexual practices, existing HIV prevention methods, and willingness to use a microbicide for HIV prevention among female sex workers in Nigeria. We also explored factors that might influence their willingness to use a new microbicide product.

Methods: A cross-sectional study was conducted among female sex workers recruited from brothels within Lagos-Nigeria, in which participants were selected via purposive sampling over a period of five-months. An interviewer-administered, semi-structured questionnaire was used to obtain information. Descriptive statistics were used to present the results, and a multiple logistic regression model was used to determine the factors associated with willingness to use a microbicide.

Results: A total of 461 female participants with a mean-age of 29.63 ± 8.8 years were included in the analysis of which 34.3% had >4 sexual partners, 91.8% used condoms, 53.6% engaged in anal sex, 69.6% had experienced condom rupture, and 31% would "accept unprotected sex" if the male partner refuses to use a condom. Approximately 43% had received PEP, of which only 15% completed the one-month PEP-regimen. On the other hand, 64.6% had taken PrEP medications, of which 28% admitted skipping doses. Although 41% were concerned about male partner acceptance, a total of 95% will be willing to use a microbicide. The number of sexual partners ([aOR] 1.555; 95% Cl 1.035-2.335), use of condoms ([aOR] 4.701; 95% Cl 1.418-15.584), and condom rupture experience ([aOR] 2.550; 95% Cl 1.817-7.959) were associated with greater odds of willingness to use an HIV microbicide.

Conclusion: There is a high level of willingness to use a future microbicide among the female commercial sex workers in this study. In addition, majority of the participants will prefer a microbicide product that is female controlled, affordable, and provided as an over-the-counter medication. This cohort of women engage in high-risk sexual practices and play a significant role in HIV prevention efforts. Therefore, their product preferences and concerns should be considered in microbicide development to enhance the acceptability, adherence, and efficacy of future microbicides.