Risky Sexual Behaviour among Male Immigration and Correctional Personnel in Kano State, Nigeria, 2018

Background Worldwide, uniformed personnel have been recognized as a population at high risk for sexually transmitted infections because of their high mobility, power differentials and affluence. However, limited research studies have been documented on risky sexual behaviour (RSB) among male uniformed personnel in Nigeria. We conducted this study to determine the prevalence and identify the predictors of RSB among male immigration and correctional personnel in Kano State. Methods We conducted a cross-sectional study among 306 male immigration and correctional personnel using multi-stage sampling technique. A pre-tested self-administered structured questionnaire containing sociodemographic and variables associated with RSB was used for data collection. Indicators of RSB included transactional sexual intercourse, sexual intercourse with casual acquaintances and multiple non-regular sexual partner over the last 12 months. Data were analysed using descriptive statistics, Chi-square test and logistic regression (α = 0.05).


Abstract Background
Worldwide, uniformed personnel have been recognized as a population at high risk for sexually transmitted infections because of their high mobility, power differentials and affluence. However, limited research studies have been documented on risky sexual behaviour (RSB) among male uniformed personnel in Nigeria. We conducted this study to determine the prevalence and identify the predictors of RSB among male immigration and correctional personnel in Kano State.

Methods
We conducted a cross-sectional study among 306 male immigration and correctional personnel using multi-stage sampling technique. A pre-tested self-administered structured questionnaire containing sociodemographic and variables associated with RSB was used for data collection. Indicators of RSB included transactional sexual intercourse, sexual intercourse with casual acquaintances and multiple non-regular sexual partner over the last 12 months. Data were analysed using descriptive statistics, Chi-square test and logistic regression (α = 0.05).

Results
Mean age of the respondents in the immigration and correctional services were 37.9 ± 9.3 and 38.0 ± 8.1 years respectively. Overall prevalence of RSB was 15.1% (9.2% and 20.9% among correctional and immigration workers respectively). The identified predictors of RSB were service group, marital status and attending club house prior to sexual intercourse. The likelihood of RSB was lower among the correctional personnel (aOR = 0.38, CI = 0.17-0.80) than the immigration officers. Being married is protective of RSB (aOR = 0.38, CI = 0.18-0.81) while attending club house prior to sexual intercourse predisposes the uniform personnel to RSB (aOR = 3.90, CI = 1.30-11.68).

Conclusions
Risky sexual behaviour was highly prevalent among the investigated uniform men but was higher among immigration officers than the correctional personel. Effective health education on the possible implication of RSB is highly recommended for immigration and correctional personnel.

Background
Sexual behaviour is a complex private activity which is subject to social, cultural, moral and legal considerations [1]. Although there is no specific definition for risky sexual behaviour (RSB), it is usually referred to any behaviour that predisposes individuals to the risk of contracting sexually transmitted infections including HIV/AIDS and unplanned pregnancy [2]. The RSB is often classified into two broad categories; indiscriminate sexual behaviours like keeping multiple partners, having risky, casual or unknown partners and also failure to take protective actions, such as use of condoms and birth control [3].
Uniformed personnel are often described as being a high-risk population for RSB as they are primarily male, young, sexually active, and often lack access to comprehensive sexual and reproductive health information and services [4]. They belong to mobile populations group and usually spend long period of time away from home, their families, spouses, or partners, which may increase their susceptibility to engaging in casual sex with non-stable partners or sex workers [5]. Their access to ready cash in their place of deployment makes them a focus of patronage by both casual and commercial sex workers [6].
Willingness to accept and engage in risk-taking is central to many uniformed services and is strongly associated with readiness for combat [7]. This core attribute of many uniformed services might predispose personnel to engage in other high-risk behaviours, such as unprotected sex. The impact of RSB on the uniformed services in the African countries is alarming [8]. It is estimated that sexually transmitted infection rates among uniformed personnel are generally 2 to 5 times higher than in civilian populations [8,9] and prevalence rates of HIV between 5.8% and 26.7% have been reported from different studies among uniformed services personnel in countries in Africa [10]. With this high prevalence of infection and risky sexual behaviour among uniformed men, sustenance of high HIV and STIs prevalence in Africa is imminent if unchecked.
Despite the fact that uniformed personnel have been recognized as a population at high risk for sexually transmitted infections (STIs) and HIV infection [11,12], limited research exists on STIs and risky sexual behaviour among uniformed personnel most especially in Nigeria immigration and correctional services. Periodic national survey carried by the Federal Ministry of Health in Nigeria under Integrated Behavioural and Biomedical Surveillance Survey (IBBSS) has consistently involved members of armed forces and the police as study participants [13]. Conditions of service of Nigeria immigration and correctional workers are similar to those of military and police, although their risk patterns could be different because of the nature of their postings and duties. To fill this gap, this study determined the prevalence and identified predictors of risky sexual behaviour among male immigration and correctionals personnel in Kano State.

Study Area
This study was conducted in Kano State which is located in the North-western geopolitical zone of LGAs. Both immigration and correctional services have small health facility each and limited accommodation was provided for their personnel. The personnel are posted from different parts of Nigeria and in most situation, they may not move with their families with the view that they could be reposted to another location at any time. All immigration and corrected personnel are adults (aged 18 years and above) and predominantly belong to sexually active population.

Study population consisted of personnel of Nigeria immigration and correctional services in Kano
State. Immigration and correctional personnel (n=306) with minimum of 12 months at duty post in Kano State were included in the study.

Study Design
It was a cross-sectional descriptive study.

Sampling Technique
A 2-stage sampling technique was used to select the eligible participants for this study. At the first stage, 3 units each were randomly selected from the 7 units and 9 units in the immigration offices and correctional centers in Kano state respectively. The 3 units selected among the immigration offices are farm center passport office, immigration training school and the command headquarters while command headquarters, Goron Dutse correctional and Kano central correctional centers were the 3 units selected among the correctional centers. The list of the personnel in the selected units was compiled based on their cadre (rank). Thereafter, a proportionate allocation of sample to each cadre in each selected unit was done. Thereafter, the participants were selected from each cadre in each unit using simple random sampling technique.

Data Collection Tool
A pre-tested self-administered structured questionnaires was used to collect information on respondents' socio-demographic variables (age, level of education, marital status), rank, duration in service, keeping multiple non regular sexual partners, engagement in casual and transactional sex.

Variables
Independent variables were age, duration in service, educational qualifications, rank, marital status, religion and ethnic group. The dependent variable, risky sexual behaviour, was measured using a series of high-risk sexual behaviour questions based on the past 12 months sexual experience [14].
The high-risk sexual behaviours examined are; transactional sexual intercourse in the past 12 months, having more than one non-regular sexual partner in the past 12 months and sexual intercourse with casual acquitances in the past 12 months. To measure transactional sex, participants were asked how many non-regular partner with whom they had sexual intercourse in exchange for money/favours or gifts during the past 12 months. Respondents that reported at least one non-regular partner were classified as having transactional sex.
For sex with multiple sexual partners during the past 12 months, respondents were asked how many non-regular partners they had sex with during the past 12 months, those that reported more than one non-regular sexual partner were classified as having multiple sexual partners. Sex with casual acquaintances was measured by asking the the respondents the sexual experience with partner to whom they were not married to, had never lived with, were not their boyfriend or girlfriend and did not pay for sex during the past 12 months. Respondents that reported at least one casual partner were classified as having sex with casual acquitances.

Statistical Analyses
The data were cleaned prior to analysis using IBM SPSS statistical software version 20.0 [15].
Frequency distributions of variables were generated and represented in tables and charts. Chi-square test was used to examine the association between RSB and socio-demographic characteristics.
Factors significantly associated with RSB at bivariate level (at most 10% level of significance) and those that were found to be important predictors of risky sexual practices from the literature [16] were used in the logistic regression model for the identification of predictors of RSB. The level of significance was 5.0%.

Ethical Considerations
The study ethical approval was obtained from the Health Research Ethics Committee of the Aminu

Results
The mean ages of respondents in the immigration and correctional services were 38.1 ± 9.4 and 39.4 ± 7.9 years respectively. Most of the respondents (49.5%) in the study were in the age group 35-49 years. About a third (30.9%) of immigration and correctional respondents were junior officer.
A significantly higher proportion (18.4%) of correctional officers had sexual intercourse with nonregular partners after clubbing compared to 9.8% among immigration personnel. However, over a tenth of immigration (11.8%) and 9.2% of correctional personnel drank alcohol prior to sexual intercourse with non-regular partner (Table 2).
Overall, about one-fifth (15.1%) of correctional and immigration personnel engaged in risky sexual behaviours in the last 12 months. Specifically, 9.2% of correctional personnel compared to 20.9% of immigration officers were involved in risky sexual behaviours (Fig. 1).
Ethnicity, marital status and clubbing were significantly associated with risky sexual behaviour among correctional workers while Use of performance enhancing drug, alcohol misuse and clubbing were significantly associated with risky sexual behaviour among immigration personnel (Table 3).
At the multivariate level, after adjusting for the covariates, service group, marital status and clubbing remained significant predictors of risky sexual behaviour among correctional and immigration personnel. Respondents from the correctional service were 62% less likely to engage in risky sexual behaviour compared with those from immigration service (aOR = 0.38, 95% CI = 0.17-0.80).
Correctional and immigration personnel who were single were 38% more likely to get involved in risky sexual behaviour compared with those that were married. (aOR = 0.38, 95% CI = 0.18-0.81).
Correctional and immigration personnel who went for clubbing prior to sexual intercourse were abused drugs 3 times as likely to be involved in risky sexual behaviour compared with those who did not go for clubbing (aOR = 3.90, 95% CI = 1.30-11.68) ( Table 4).

Discussion
The study aimed to determine the prevalence and identify the predictors of risky sexual behaviour among immigration and correctional workers in Kano State. Overall, prevalence of risky sexual behaviour was found to be high among study participants. The study showed that one in every five immigration and correctional workers in Kano State engaged in risky sexual behaviour. Looking at each arm of the study participants, there appeared to be higher proportions of immigration personnel engaging in risky sexual behaviour compared with correctional workers. However, the prevalence of risky sexual behaviour from the study was far lower than that reported in southwest Nigeria [17,18].
The variation in results could be due to the differences in terms of study participants, data collection procedure and operational definition of sexual risk behavior in these studies and ours.
About one-tenth of both immigration and correctional workers had more than one non-regular sexual partner. This figure is far below 46% reported among uniformed personnel in Cote D'Ivoire [19]. The contextual nature of the studies environment can explain the difference in the outcomes. The conservative and restrictive nature of northern Nigerian culture (sharia laws are being enforced), especially, in the ancient city of Kano and other parts of the state where this study was conducted could be an important reason for the low prevalence found in our study. Less than one-tenth of the study participants had sexual intercourse with casual acquaintances. This finding contrasts with what was reported in Dominican Republic and Haiti in which 40% of uniformed personnel stationed across the border zone reported having casual sex [20].
Over a tenth of correctional (12.8%) and immigration (15.2%) personnel in Kano State were found to have paid or exchanged gifts with sexual partners in the last 12 months. These findings corroborate earlier outcome of a similar study which was conducted among uniformed personnel in Rwanda and Afghanistan [21]. However, our findings were much lower than 43% that was reported in a nationwide survey among Thai uniformed personnel. The differences in findings could be due to the fact that most new recruits are likely to be single or have non-regular partners, less inclined to abstinence and more likely to engage in transactional sex [22].

The proportion of immigration and correctional personnel who had multiple sexual partners in Kano
State was in line with to what was reported in Southeast Nigeria [23]. However, the higher percentage of immigration and correctional personnel who had multiple sexual partners was still lower than what was reported among Ethiopian officers [24].
Service group, marital status and clubbing were identified to be independent predictors of risky sexual behaviour among the correctional personnel in Kano State. These findings were in contrast to a survey which evaluated sexual risk taking and related behaviours among uniformed personnel in four regions of Angola [25] in which alcohol misuse before sex was found as an independent predictor of risky sexual behaviour. Alcohol and drug use were found to be associated with risky sexual behaviour among correctional and immigration personnel however, the two variables were found not to be predictors of risky sexual behaviour among the immigration and correctional personnel in Kano State.
The study is not without limitation. Due to self-reporting nature of the study, there may be some level of social desirability bias because some study participants might have under or over reported the degree to which they engaged in high-risk sexual behaviours. Assurance of confidentiality likely minimized this bias.

Conclusions
Risky sexual behaviour was highly prevalent among the investigated uniform men. However, the prevalence of RSB was higher among immigration officers than the correctional personel. Effective health education on the possible implication of RSB is highly recommended for immigration and correctional personnel. Comptrollers of immigration and correctional Services in Kano State. Informed written consent was obtained from the study participants before the commencement of the study. Participants were informed that participation was entirely voluntary and were given the option of voluntary withdrawal of their participation at any stage of the study without sanction or penalty. Information obtained from the respondents was treated as confidential.

Consent for publication
Not applicable.

Availability of data and materials
Data can be made available by the corresponding author based on reasonable request.

Competing interests
The authors declare that they have no competing interests.

Funding
No funding was received for the research work

Authors' contributions
NA was the Principal Investigator, conceptualized and designed the study, collected, analysed and interpreted the data, and wrote draft manuscript. ZI and AMJ were academic supervisors and contributed to study design, data interpretation, drafting and formatting of manuscript. AAS and ABU contributed in data interpretation, drafting, and revision of the manuscript for intellectual content. All authors read and approved the final revised manuscript.

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Argaw R, Seyoum B, Egata G.     Figure 1 Prevalence of risky sexual behaviour among immigration and correctional personnel in Kano State, Nigeria