Demographic profile and work conditions
The ages of the respondents ranged from 18 to 66 years with a mean of 34 years (SD 8.3). The largest percentage (41.1%) belonged to the 35–44 years age group (Table
1). Virtually all the respondents were males (94.4%) and most (63.5%) were married. Forty four percent had secondary school education and 81% were Christians. The majority of the respondents (75.2%) are ratings, 24.8% are officers. The respondents' military service ranged from one to thirty-three years with a mean of 13.4 years. Among those ever-transferred, the number of transfers ranged from 1 to 25 times with a mean of 4.5 times. At the time of the study only 9.7% of the respondents had never been transferred, 91.3% had experienced at least one transfer. Of these, three-fourth (75.4%) had been transferred up to 8 times. Only 15% of the transferred respondents traveled with their spouses to the most recent posting site. The major reasons for leaving spouses behind were lack of accommodation, service exigencies (sea operations, courses or military training, peacekeeping operations) and spouse's own job commitment. Of those who had been transferred, 28.2% were posted to United Kingdom, India, Germany, United States of America, and Ghana for training and to Liberia, Sierra Leone and Congo for peace keeping. The mean duration of period of the time spent abroad was 11.5 months.
Sexual behavior and risk-perception
Virtually all (96.7%) the respondents had had sex. Three-quarters (75%) had experienced their first sexual contact by the age of 20 years. The majority (88.1%) of the respondents had had multiple sexual partners, with lifetime number of partners ranging from 1 to 40 with a mean of 5.1. During the six months preceding the study, 54.9% of the respondents had one sexual partner, 25.8% had no partner and 19.3% had multiple partners.
Slightly more than a third of male respondents (32.5%) reported that they had ever had sexual contact with a FSW, 60.2% had not, but 7.3% did not answer this question. Of the 156 who had sex with a FSW, 19.9% did so in the six months preceding the survey. Although more married respondents (36.7%) than single ones (31.5%) reported ever having had sex with a FSW, the difference was not significant (p > 0.05). Similarly, more officers (39.4%) than ratings (32.4%) had had sex with a FSW, the difference was not significant (p > 0.05). However, older respondents (aged 45 years and above) reported significantly more sexual contacts with FSW than others (p < 0.05) (Table
3). Overall, the frequency of sexual contact with FSW during the six months preceding the survey ranged from 1–5 times; 32.1% had done so once, 25% two times, 16% three times and 10% four times. Their main reasons were the need to relief sexual tension because regular partner was not available and being under the influence of alcohol.
Table 3
Pattern of risky sexual practices among Nigerian naval personnel in Lagos, Nigeria
Marital status |
Yes
|
No
| |
|
No
|
(%)
|
No
|
(%)
| |
Single | 45 | (31.5) | 98 | (68.5) | 0.466 |
Married | 108 | (36.7) | 186 | (63.3) | |
Others | 3 | (67) | 5 | (33) | |
Status | | | | | |
Rating | 101 | (32.4) | 211 | (67.6) | 0.221 |
Officers | 43 | (39.4) | 66 | (60.6) | |
Age group (in years) | | | | | |
15–24 | 16 | (20.8) | 61 | (79.2) | 0.012* |
25–34 | 36 | (31.9) | 77 | (68.1) | |
35–44 | 79 | (38.7) | 125 | (61.3) | |
45 and above | 24 | (48.9) | 25 | (51.1) | |
Years in service | | | | | |
1–5 | 24 | (22.6) | 82 | (77.4) | 0.018* |
6–10 | 16 | (43.2) | 21 | (56.8) | |
11–15 | 23 | (30.3) | 53 | (67.3) | |
> 15 | 51 | (37.2) | 56 | (62.8) | |
More than half (59%) of the 156 respondents who had ever had sex with a FSW reportedly used a condom during their last contact, 41% did not. Greater proportion of single respondents (42.2%) than married ones (10.2%) significantly used a condom during their most recent sexual contact with a FSW (p < 0.05). Although more officers (25.6%) than ratings (17.8%) used a condom during their last sexual encounter, the difference was not significant (p > 0.05). Those who did not use a condom with a FSW offered seven reasons for not doing so including belief that they were not susceptible to HIV infection (36.1%), sex was not planned (17.5%), dislike for condom (17.5%), lack of knowledge about AIDS (10.3%), condom was not available (7.7%), need for full satisfaction (5.1%) and the fact that FSW was a regular partner (5.2%).
Overall, more respondents who had ever been transferred locally or abroad (85.2%), reported having sex with a FSW than those who had not (23.2%). In order to explore the relationship between transfers and risky sexual behaviors, we performed a bivariate analysis between personnel who have been posted abroad and their counterparts who had been transferred locally. The results are shown in Table
4. Respondents who had been posted abroad were significantly more likely than others to have had sex with a FSW (39.1% vs. 32.8%) (p < 0.05), less likely to have used a condom during last episode of sex with a FSW (42.3% vs. 52%) (p < 0.05) and more likely to have higher mean number of sexual partners (2.8 vs. 2.0) (p < 0.05).
Table 4
Comparison of risky sexual behavior among Nigerian naval personnel who had experienced transfers
Had ever had sex with a female sex worker | 52 (39.1%) | 81 (32.8%) | 0.030* |
Had sex with a sex worker in 6 months preceding survey | 6 (25%) | 18 (22.2%) | 0.027* |
Did not use a condom during last sexual encounter with a sex worker | 22 (42.3%) | 41 (52%) | 0.027* |
Had sex with multiple partners (2 or more persons) | 62 (52.2%) | 100 (36.6%) | 0.004* |
Mean number of non-primary sex partners | 2.8 | 2.0 | 0.003* |
Of the entire sample, 21.3% agreed that their work conditions had affected their sexual behavior. Among those agreeing, the reported effect was that frequent transfers away from spouse predisposed them to having sex with multiple partners and that stress and tiredness from work affected their sexual performance. When asked how they coped with not having spouse with them during transfers, 32.6% abstained from sex, 25% obtained leave to visit spouse, 20% got new girlfriends, 14.3% became spiritual, 4.9% masturbated, 3.2% used condoms and others participated in sports.
Of the 480 respondents, 23.3% perceived themselves at some risk of HIV infection, 68.3% believed they were not at risk at all, and 8.3% did not answer this question. Of those who perceived themselves to be at risk, 16.1% estimated the risk to be high, 5.2% believed the risk was medium and 68.8% claimed it was low. In response to the question "do you think that you may have been exposed to HIV in the last one year?" a few (12.3%) affirmed this statement, 83.7% did not think so and 4% did not respond to this question.
Context of risky sexual behavior
The group discussants generally confirmed that unprotected sexual contact with multiple partners including FSW was common among naval personnel as a whole but especially so with ratings. However, they pointed out that this behavior was not peculiar to naval officers. On the contrary, discussants claimed that such practice was also common among long distance drivers, traders, police officers, crew members and business men and women. Discussants also believe that having multiple partners is a tradition that has persisted in the Nigerian navy. As one discussant put it, "there is a common joke that sailors are supposed to have children in each port of visit".
Discussants and informants provided two explanations for this behavior. The first is the nature of military posting which takes many officers away from their families for extended period of time. The second is influence of alcohol. FGD participants and informants believe that participation in risky sexual behavior is an inevitable consequence of use of alcohol. One informant described the connection between transfer, alcohol, and risky sex among naval personnel in this way: "The distance from family, extra cash, a little wine and stress makes it difficult for naval personnel to remain faithful to their spouses or other partners".
Concerning low utilization of condom during sex with FSW, informants said this behavior has persisted because many naval personnel deny that AIDS exists. Some believe that AIDS is a problem affecting only the "oyinbos" (foreigners); others think they are protected from HIV infection if they use traditional medicine. Discussants perceive that the major reason for denial is the fact that the authority is secretive about AIDS-related deaths in the military. As one discussant put it "as officers we often hear that one rating or officer has died of malaria, of tuberculosis but never of AIDS". Discussants believe that until AIDS-related deaths are discussed openly, naval personnel will continue to deny the existence of the virus and participate in risky behaviors.
Informants and discussants identified many deep-seated objections to use of condoms among naval personnel. Such resentments are captured in phrases such as "condom is a strange object", "condom provides half pleasure", and "condom creates a separation between partners". Another explanation for low utilization of the condom is use of alcohol. One informant claimed that naval officers involved in risky sexual behavior are less vigilant because those "under the influence perceive use of any protective device a waste of time."
Suggested interventions
The discussants and informants suggested four intervention programs that they perceive would reduce risky sexual practices in the navy. The first is sustained education using multiple format including drama, video, seminar, targeted at officers on ship and shore. Second, the presentation of statistics of naval personnel affected by HIV may drive the point home that AIDS is real and consequently encourage safe sex. In addition, discussants suggested that persons living with HIV need to be invited to discuss the challenges of living with the virus and thus confirm that AIDS exists. Third, military authority need to promote the condom vigorously and make this product readily available to all who need it. One informant lamented the fact that condoms were not readily available as they were in the past. According to him the "naval tradition is that if you are going out ashore, you are issued condoms and there is no ration about this, however, nowadays due to funding constraints this is no longer practiced". Finally, the military should promote the integrity of the family by discouraging frequent transfer and providing adequate accommodation when transfers are inevitable. Discussants believe that with careful planning there are opportunities for personnel to serve in their places of domicile and thus avoid transfers.