Knowledge, Attitudes, and Sexual Behaviour Among the Nigerian Military Concerning HIV/AIDS and STDs Armed Forces Programme on AIDS Control (AFPAC) By Dr. Sylvia B. Adebajo Dr. Jerome Mafeni Dr. Scott Moreland Dr. Nancy Murray September 2002 POLICY is a five-year project funded by the U.S. Agency for International Development under Contract No. HRN-C-00-00-00006-00, beginning July 7, 2000. The project is implemented by The Futures Group International in collaboration with Research Triangle Institute (RTI) and The Centre for Development and Population Activities (CEDPA). Armed Forces Programme on AIDS Control (AFPAC) Knowledge, Attitudes, and Sexual Behaviour Among the Nigerian Military Concerning HIV/AIDS and STDs Final Technical Report September 2002 by Dr. Sylvia B. Adebajo, Project Consultant Dr. Jerome Mafeni, POLICY Project Dr. Scott Moreland, POLICY Project Dr. Nancy Murray, POLICY Project POLICY Project/Nigeria The opinions expressed herein by the authors do not necessary represent any official position of the POLICY Project, its funders, or partners. Table of Contents List of Figures and Tables...........................................................................................................iii List of Abbreviations .................................................................................................................. iv 1. Executive Summary......................................................................................................... 1 2. Introduction...................................................................................................................... 3 3. Project Objectives ............................................................................................................ 5 3.1 Specific Objectives...................................................................................................... 5 3.2 Research Questions...................................................................................................... 5 4. Research Methodology .................................................................................................... 6 4.1 The Armed Forces Structure........................................................................................ 6 4.2 Study Population.......................................................................................................... 7 4.3 Study Design and Methods .......................................................................................... 7 4.4 Selection of Study Areas and Study Population .......................................................... 7 4.5 Sample Size.................................................................................................................. 8 4.6 Sampling Methods....................................................................................................... 8 5. Project Limitations......................................................................................................... 10 5.1 Study Design.............................................................................................................. 10 5.2 Determination of HIV Prevalence Using Proxy Data................................................ 10 5.3 Financial Constraints................................................................................................. 10 6. Main Findings ................................................................................................................ 11 6.1 Background Characteristics of the Sample................................................................ 11 6.1.1 Socio-demographic Characteristics ................................................................. 11 6.1.2 Experience in the Nigerian Military ................................................................ 12 6.2 Sexual History and Behaviour of the Respondents.................................................... 13 6.2.1 Types of Sexual Relationships......................................................................... 14 6.2.2 Multiple Partnering .......................................................................................... 17 6.2.3 Knowledge of and Patterns of Condom Use.................................................... 19 6.2.3.1 Indulging in Paid Sex and Condom Use with Paid Sex................................. 22 6.3. Time Away from Home and Participation in Peace-keeping Operations.................. 23 6.3.1 Sexual Relations During Peace-keeping.......................................................... 26 6.4 Knowledge of and Experience with STDs and HIV/AIDS ....................................... 28 6.4.1 Knowledge of STDs......................................................................................... 28 6.4.2 Prevalence of Genital Ulcers ........................................................................... 28 6.4.3 Health-seeking Behaviour of the Respondents................................................ 30 6.4.4 Knowledge of and Attitudes of Respondents to HIV ...................................... 30 6.5 HIV/AIDS Knowledge Score.................................................................................... 31 6.6 Perceived Risk of Contracting HIV ........................................................................... 35 6.7 What Respondents Did to Reduce Their Risks of HIV ............................................. 37 6.8 Attitude of Respondents Toward HIV Testing .......................................................... 38 7. Summary........................................................................................................................ 40 7.1 Risky Behaviour.........................................................................................................40 7.2 Risk Reduction Behaviour ......................................................................................... 41 7.3 Level of Knowledge of STDs and HIV/AIDS........................................................... 41 8. Recommendations.......................................................................................................... 42 9. References...................................................................................................................... 45 i APPENDIX 1: Study Procedure ............................................................................................... 47 APPENDIX 2: Ranking Structure in the Nigerian Armed Forces............................................ 51 APPENDIX 3: Selected Study Sites and Sub-divisions ........................................................... 52 APPENDIX 4: Ethical Considerations ..................................................................................... 54 APPENDIX 5: Training Manual for Field Workers................................................................. 56 APPENDIX 6: Training Manual for Field Supervisors............................................................ 62 APPENDIX 7: Trainer’s Manual.............................................................................................. 66 APPENDIX 8: The Survey ....................................................................................................... 74 91 ii List of Figures and Tables Figure 1. Structure of the Defence Headquarters.................................................................... 6 Figure 2. Respondents Who Participated in Peace-keeping Operations................................23 Figure 3. Respondents Who Had Sexual Relations During Peace-keeping Operations....... 26 Figure 4. Treatment-seeking Behaviour of Respondents with Genital Ulcers or Genital Discharge. ............................................................................................................. 30 Table 1. Demographic Characteristics of the Respondents ................................................ 12 Table 2 . Military Experience of Respondents..................................................................... 13 Table 3. Percentage Distribution of Respondents According to Their Sexual Activity Status..................................................................................................................... 14 Table 4. Distribution of Respondents’ Marital Status and Partnerships by Respondents’ Sex......................................................................................................................... 14 Table 5. Distribution of Sexual Partnerships by Type of Relationship with Partners in Past 12 Months, by Number of Partners and by Partner’s Age ............................ 16 Table 6. Percentage Distribution of Number of Sexual Partnerships in Last 12 Months by Respondent Characteristics.............................................................................. 18 Table 7. Distribution of Respondents by Their Patterns of Condom Usage....................... 19 Table 8. Condom Usage by Respondent Characteristics.................................................... 21 Table 9. Condom Use at First and Last Sexual Contact with all Sexual Partners in the Past 12 Months by Type of Relationship with Partner ......................................... 22 Table 10. Paid for Sex in the Last 12 Months and Condom Use at Last Paid Sex............... 22 Table 11. Characteristics of Respondents Who Went on Operations.................................... 24 Table 12. Percentage Distribution by Type of Operation and Duration of Stay.................... 25 Table 13. Condom Usage by Respondents Who Had Sexual Relations During Peace-keeping Operations