Assessment of level of compliance with the use of condoms among discordant HIV-infected couples in Kaduna State, Nigeria.

doi:10.21203/rs.3.rs-1434083/v1

Download PDF

Research Article

Assessment of level of compliance with the use of condoms among discordant HIV-infected couples in Kaduna State, Nigeria.

https://doi.org/10.21203/rs.3.rs-1434083/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background: The use of condoms is key in the global fight against HIV and AIDS. This helps to reduce the rate of infection and disease burden in the general population. Furthermore, it underscores the need to intermittently study or assess the level of compliance with the use of condoms as a preventive measure.

Methods: The research was conducted to assess the level of compliance with condom use among HIV- infected discordant couples in Kaduna State Nigeria. The study was conducted in Antiretroviral (ART) treatment centers of 9 Local Government Areas of the 23 Local Government Areas in Kaduna State Nigeria. A total of 158 couples or 317 individuals were recruited for the study. A detailed questionnaire was used to collect data on demographics, the use of condoms, and the practice of unprotected sex.

Results: The results obtained in the study showed that the majority of the respondents 224(70.7%) were unemployed. Most of the respondents 230(72.6%) never used a condom while 87(27.4%) did use condoms. The study also revealed that the Educational status of respondents had a strong association with their perceived attitude towards the use of condoms during sex (p-value 0.009) while attitude towards the practice of unprotected sex was statistically insignificant (p-value 0.404). There is a need to improve on the educational coverage for the entire population to mitigate the scourge of HIV transmission.

Epidemiology

Antiretroviral treatment

Condoms

Sexually transmitted infections

Local government area

Condoms became so popular in the early days of the discovery of human immunodeficiency virus/ acquired immune deficiency syndrome (HIV AIDS) in the early 1980s. This was as a result of intensive research aimed at getting a solution for the problem “HIV AIDS”. The coming of AIDS made it clearer how useful condoms can be, in terms of protection against sexually transmitted infections (STI) and unwanted/unexpected pregnancy (1). With the aggressive campaign against HIV transmission globally, condoms became more acceptable among sexually active sections of the population. Availability of condoms without prescription makes them handy and hence increased efficiency in mitigating HIV transmission. However for some reasons such as a moderately high failure rate when used improperly or inconsistently, the potential for diminished sensation or pleasure during sexual activity, skin irritation such as contact dermatitis due to latex sensitivity or allergy, allergic reactions to spermicides, lubes, scents, and other chemicals in the condom; some people refuse the idea of using condoms when necessary. HIV-infected couples are expected to be committed to the use of condoms to prevent transmission (in case of discordant couples) and re-infection in addition to the use of anti-retroviral treatment ART (2). It is also pertinent to state here that a UN/WHO position statement also made it clear that condom use is a critical element in a comprehensive, effective and sustainable approach to HIV prevention and treatment (3). One can say that the most significant barriers such as lack of privacy in stores and social stigma are associated with condom use. The reported problems related to not using condoms include not being accepted by a sexual partner, perceived ineffectiveness, less comfort, lack of sexual satisfaction with condoms, husband's alcohol use, depression, anxiety, and non-availability at the time of need (4). Other factors negatively associated with condom use are non-disclosure, reporting a casual sex partner, and desiring a pregnancy (5).

Study area/ design

This study was conducted in HIV treatment centers situated in all general hospitals in Kaduna State. Kaduna State is one of the 19 northern states of Nigeria and has long been seen as the Major capital of the northern region, and now the capital of the North West (6). It is ranked 4th by land area and 3rd by population in Nigeria. The state capital was the former capital city of the British protectorate of Northern Nigeria (1923–1966) after Zungeru (1903–1923) and Lokoja (1897–1903). It is made up of some major towns which include: Zaria, Kagoro, Kafanchan, Kachia, Zonkwa, Makarfi, and Birnin Gwari (6). Kaduna State has coordinates of 10⁰ 20’N 7⁰ 45’ E of Nigeria. It has a total land area of 46,053 km², and a total population of 6,113,503 according to the 2006 population census of Nigeria (7). Kaduna State has over 1,000 primary healthcare facilities to cater for every resident - even in the most remote village or political ward of the state. In addition to these, the government has made efforts to establish General Hospitals in each of the 23 LGA headquarters to enhance effective and accessible healthcare for its citizens. These General Hospitals have now become treatment centers for HIV anti-retroviral therapy all around the state. Kaduna State Map is available here

https://drive.google.com/file/d/1eyNtIG3tVZLDOazH8nA88IpbhzWwi7_L/view?usp=sharing

The survey recruited 158 discordant couples which amounted to 317 individuals. Kaduna State of Nigeria has 23LGAs. These LGAs were further grouped into three senatorial zones, out of which three LGAs were finally selected by simple random sampling from each senatorial zone. This stratified sampling technique resulted in 9LGAs from which we got the 317 individuals. These LGAs are Kaduna north senatorial zone (Kudan, Lere, and Soba), Kaduna central senatorial zone (Kajuru, K/north, and Giwa), and Kaduna south senatorial zone (Kachia, Jema’a, and Kagarko).

Sample collection

A structured questionnaire containing questions on demography and other required information was issued to all the respondents with adequate guidance on how to fill in their responses correctly. This took place during the group information session (GIS). See link for questionnaire here https://drive.google.com/file/d/1_uWS7jP01VAPzbf6pmtGcm61afmWKUc6/view?usp=sharing

Statistical Analysis

The data generated were analysed using Chi-square at 95% confidence interval with the SPSS 21 statistical package. A p-value of ≤ 0.05 was considered statistically significant.

A look at Figs. 1a and 1b above shows that the majority of women 66.46% were HIV positive while a majority of the respondents 70.66% were not government employees (jobless/ unemployed).

Figure 2 above shows the condom-use distribution for respondents, with a higher population of 72.6% not using a condom while 27.4% of them use condoms during sex, even if it was not always. Below the figure is the mean value of 0.2744 and the standard deviation of 0.44694 for the usage of condoms among the study population.

Table I: Effect of Education on the use of a condom (N = 317)

Educational coverage	Use of Condom		Total (%) a	Total (%) b	P-Value
	NO	YES
No Formal Education	46	9	55(17.4)	16.4
Primary Education	58	14	72(22.7)	19.4
					0.009
Secondary Education	110	51	161(50.8)	31.7
Tertiary Education	16	13	29(9.1)	44.8
TOTAL	230	87	317(100)	27.4
Pearson Chi-square P-value

a is the percentage of participation based on educational coverage.

b is the percentage of categories that used condoms.

Table I gives a reflection of how the extent of one’s education can affect their perception of the need to use condoms in the case of HIV infection. The Table I results show that 17.4% of participants in the survey had no education. 22.7% had primary education, and a huge 50.8% of the study population had secondary education while a paltry number 9.1% were of tertiary education level. Also worthy of note is the fact that in Table I, we can see that the highest number of people 44.8% who used condoms were from the tertiary education group, then followed by the secondary school categories with 31.7%. The P-Value 0.009 is of statistical significance, being lower than α- Value 0.05. Only 27.4% of the study population used condoms.

Table II: Effect of Education on the Frequency of unprotected sex (N = 317)

	NUMBER OF TIMES
Educational Coverage	Once a while	Always	Conception
	(%)	(%)	(%)	TOTAL	P-Value
No Formal Education	9(16,4)	46(83.6)	0(0)	55(100)
					0.404
Primary Education	14(19.4)	58(80.6)	0(0)	72(100)
Secondary Education	42(26.1)	117(72.7)	2(1.2)	161(100)
Tertiary Education	9(31.0)	19(65.5)	1(3.4)	29(100)
TOTAL	74 (23.3)	240 (75.7)	3 (0.9)	317(100)
Pearson Chi-square P-value

Table II presents a p-value of 0.404 and 74(23.3%) respondents who used a condom once a while and 3(0.9%) for conception only. 240(75.7%) respondents never used any protection i.e. condoms.

This study was conducted among HIV discordant couples who accessed treatment at the various treatment centers in Kaduna state, Nigeria. The study revealed in Fig. 1a, that more women 66.46% were HIV positive than Men. Majority of the respondents 70.7% were unemployed i.e. jobless as seen in Fig. 1b. This agrees with some earlier reports by Shisana et al and Whiteside ^8,9 who both explained that poverty increases the spread of HIV and AIDS increases poverty- it’s a vicious cycle.

We also saw in Fig. 2, that majority of infected couples 72.6% did not use a condom as against 27.4% who used condoms; this agrees with Donta et al ⁴ who reported that more sexually active unmarried population, 72.4% women and 98% men used condoms than the married populations. It is evident here that married HIV-infected couples do not give attention to the use of condoms as much as unmarried people do. This may be large because the unmarried sexually active people are bothered with problems of unwanted pregnancy and STIs; a problem that is no longer an issue with the discordant couples- one of the partners is already infected after all, and most of the women are already on birth control pills. Also, the low compliance results recorded agree with the 29.4% rate and the various reasons for using condoms among the married as previously reported by Nduka et al ¹⁰ There is no gainsaying that the discordant couple still needs to use a condom correctly and consistently to reduce the disease burden and also to minimize re-infection and transmission of HIV. Condoms remain of utmost importance in the prevention of STI/HIV and offer maximum protection (more than 90%) against HIV hence, its importance in HIV discordance cannot be over-emphasized.¹¹ Education they say is the bedrock of every development; so it is with the use of a condom by HIV infected couples. The figures in Table I show us that majority of the couples who participated in this study 50.8% had secondary education while the least 9.1% had tertiary education. We can as well deduce that majority of HIV-infected people in Kaduna State had secondary education. The Table also shows us that the group of people who used condoms mostly were the 9.1% tertiary educated with 44.8% of them complying. On the other hand, the least compliant with the use of condoms was 16.4% of the 17.4% with no education. The p-value of 0.009 in our study analysis confers statistical significance to the association between educational coverage and the use of a condom. This agrees with Sani et al ¹² who also reported a p-value of 0.002 for the association between the client’s educational status and frequency of condom use. There is also agreement with Prata et al ¹³ who discovered that consistent condom use was positively associated with higher levels of education. This means lack of education in the population affects the use of condoms as prevention negatively; we need to increase literacy in the society for the condom strategy to be effective. Unprotected sex is a predisposing factor to HIV discordance among infected couples, as posited by Tadesse.² The results in Table I somewhat agree with him because the lack of use of condoms means unprotected sex and hence the prevalence of discordance in the study population. Table II also shows the relationship between education and the frequency of having unprotected sex in the population. A huge number of the study population 240, always practiced unsafe sex while a small portion 77 did safe sex. A look into their educational qualification reveals that 83.6% of people who practiced unprotected sex were from the no- education group while 65.5% who practiced unprotected sex were from the tertiary education group. On the other hand, 34.4% of those who practiced safe sex from the tertiary education group were more than the 16.4% who did the same from the no- education group but the p-value of 0.404 in Table II shows no statistical significance. This means that in the practice of unprotected sex, there is no significant difference between whether a respondent is educated or not. It may be significant if we look at it from the protection side or the safe sex angle.

In this study, it was observed that the majority 105(66.46%) of women were HIV positive, and the unemployment rate 224(70.7%) was high; hence joblessness was a dominant feature in the population. The study also revealed that many people did not use condoms 230(72.6%) against 87(27.4%) who used condoms. This also brought to fore the marked difference between married and unmarried people when it comes to the use of condoms. Unmarried people adhered to the use of condoms more than married ones. Education was also seen to be effective in the attitude of HIV-infected people, in terms of the use of a condom. P-Value of 0.009 was suggestive of a strong association between the client's educational status and the use of condoms. The study also revealed that there was a statistical difference when we studied unprotected sex; from when it was protected sex hence the p-value 0.404 when we analyzed the frequency of unprotected sex. Government policies should be channeled towards improvement in educational coverage and educational quality for the population. HIV treatment centers should focus more on strategies that will improve the attitude of infected couples towards the use of condoms as this will help in the mitigation of the spread of HIV infection in the population.

HIV, AIDS, STI, LGA.

Ethics approval and consent to participate- The study was conducted according to ethical standards for human studies as approved by the research and ethics review committee of the Kaduna State Ministry of Health, and Human Services. MOH/ADM/744/VOL.1/913. See document here https://drive.google.com/file/d/1_JnIr30XLQWQVNwVoAZLWY39x2cbg-mB/view?usp=sharing

Informed consent was obtained from all participants to take part in the study, after adequate explanations on the purpose, risk, method, and benefit of the research. LINK https://drive.google.com/file/d/1_uWS7jP01VAPzbf6pmtGcm61afmWKUc6/view?usp=sharing

Consent for Publication- Consent was received from participants. See LINK https://drive.google.com/file/d/1eVGYJ7F-QOuDfrfiN7o9B10PjPHvr0Bs/view?usp=sharing

Competing Interests- None declared

Funding- This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors’ contributions

Danboyi DA conceived the study and participated in its design and coordination.

Sani MN and Danboyi DA conducted the statistical analysis.

Danjuma L and Abdullahi M handled the study review.

All authors read and approved the final manuscript

ACKNOWLEDGEMENTS

The authors wish to appreciate the support of the Kaduna State Ministry of health for making their facilities and staff available for this study. The Clients who visited these treatment centers to access anti-retroviral treatment are also recognized for their cooperation.

Majra JP. Use of Condoms: Clarifying the Message. Indian J Community Med. 2010; 35(2): 362.DOI: 10.4103/0970-0218.66860
Tadesse M. Assessment of HIV discordance and associated risk factors among couples receiving HIV test in Dilla, Ethiopia. BMC Research Notes. 2014; 7: 893. https://doi.org/ 10.1186/1756-0500/7/893
WHO. Position statement on Condoms and HIV prevention. 2004. www.who.int>hiv>pub>condoms>statement. Retieved on 7/04/2021.
Donta B, Begum S, Naik DD. (2014). Acceptability of male condom: An Indian scenario. Indian J Med Res. 2014; 140(Suppl):S152–6.
Bachanas P, Medley A, Pals S, et al. Disclosure, knowledge of partner status, and Condom use among HIV- positive patients attending clinical care in Tanzania, Kenya, and Namibia. AIDS and STDs. 2013; 27(7): 425- 435.
Kaduna State- Explore Nigeria 2020. Explorenigeria.com:ng/states/Kaduna-state/ Retrieved From Wikipedia
NPC. 2006 PHC Priority Tables- NATIONAL POPULATION COMMISSION. population.gov.ng. Achieved from the original on 2017- 10- 10. Retrieved 2020- 06- 13.
Shisana O, Zungu MP, Pezi S. Poverty and HIV AIDS: HIV/AIDS in South Africa 25 years on.2010; pp. 89- 104.DOI: 10.1007/978-1-4419-0306-8_7
Whiteside A. Poverty and HIV AIDS in Africa. Third World Quarterly.2002; 23(2): 313-332, DOI: 10.1080/01436590220126667
Nduka I, Enwereji EE, Nduka EC, Ahizi ER. Determinants of consistent condom use among HIV positive women in Abia State, South- East Nigeria. JCRHAP. 2014; 2(2): 1- 12. DOI: 10.14302/issn.2324- 7339.jcrhap-13-321
Marfatai YS, Pandya I, Mehta K. Condoms: Past, present and future. Indian J Sex Transm Dis AIDS. 2015; 36(2): 133–139.doi: 10.4103/2589-0557.167135
Sani MN, Jatau ED, Olonitola SO, Gwarzo MY, Kawo AH. Demographic and social characteristics of female commercial sex workers receiving anti- retroviral treatment (ART) in north- western Nigeria. Novus Int J Med Sci. 2013; 2(1): 9- 18.www.novusscientia.org ISSN2320- 7183
Prata N, Vahidnia F, Fraser A. Gender and relationship differences in Condom use among 15- 24 year- olds in Angola. Int Family Planning Pers. 2005; 31(4): 192- 199.www.jstor.org/stable/3649535. Retrieved on 7/4/2021.

Download PDF

Version 1

posted

You are reading this latest preprint version

Assessment of level of compliance with the use of condoms among discordant HIV-infected couples in Kaduna State, Nigeria.

Status:

Version 1

Abstract

Figures

Introduction

Methods

Study area/ design

Sample collection

Statistical Analysis

Results

Discussion

Conclusion

Abbreviations

Declarations

References

Status:

Version 1