Human Immunodeficiency Virus infection is a major public health challenge in the Federal Republic of Nigeria. Nigeria is the second most affected country in sub-Saharan Africa (SSA) with HIV disease, representing 14% of HIV/AIDS cases in the region1
. While official reports have suggested that the HIV epidemic has been slower to impact Nigeria than other countries in Africa, research evidence in Nigeria suggests that HIV prevalence is high, as well as geographically and socially widely distributed. For example, Esu-Williams et al.2
report that in a sample of 2,300 persons from five states in Nigeria, HIV-1 appears in over 60% of commercial sex workers (CSW), 8% of blood donors in some states, with male clients of CSWs, truck drivers, and STD patients having respectively 8%, 9%, and 21%. More recently, a United States Naval Health Research Center funded study found a 15% Seroprevalence rate among Nigerian military personnel.3
As the most populous country in Africa (Population > 130 million) and one of the most populous countries in the world, even a small increase in the HIV/AIDS prevalence rate in Nigeria would represent a significant share of the global HIV/AIDS burden4
In 2007 women accounted for 58 percent of all adults aged 15 and above living with HIV. 5
Some of the factors responsible for the growing epidemic among women in Nigeria include various cultural practices like polygamy and a culture of silence over sexuality, the rising popularity of multi-partner mating among urban-based women in the 15-29 years' age group, women's inability to negotiate safe sex with their partners, lack of sexual education both at home and in schools, religious leaders' teaching which has led to stigma and which has not been empowering to women and an unwillingness of most men to use condoms. Research has also shown that because of cultural and economic reasons, many women feel unable to refuse the sexual advances of partners even when they know they risk infection. 6, 7
Poverty has pushed some young women between the ages of 15 and 25 into sex work 6
or to be involved in transactional sex with older men (sugar daddies) who give them monies, school fees or gifts in exchange for sex. In exploring the reasons for extramarital sexual relationships among married women in South-western Nigeria, Oruboloye and others 7
noted that 60% of married urban women and 33% of rural married women have extramarital sex for enjoyment, while 34% of married rural women and 14% of married urban women had sex as a means of securing economic benefits. This is particularly important since unprotected sex among married couples is the norm, yet many married men and women engage in unprotected extramarital sexual relations, and thus risk infecting their spouses. Thus, the level of high-risk sexual networking within or outside marriage in Nigeria tends to expose large sections of the population to the risk of HIV and other sexually transmissible diseases.
Epidemiologic evidence has consistently shown that military personnel are a high risk subpopulation with social norms that place them at an elevated risk of HIV infection.8, 9
Nwokoji and Ajuwon 10
explored the HIV related risk behaviors among military personnel in Nigeria by asking 480 enlisted men to complete a 70-item questionnaire that assessed HIV/AIDS knowledge, sexual behavior and risk-perception. The study revealed that 41% of the respondents did not use a condom during their last sexual encounter with a commercial sex worker and posting on international assignments was a positive predictor of lack of condom use. Similarly, Essien et al 11, 12
examined the determinants of HIV risk behaviors among Nigerian military personnel and found a direct correlation between alcohol and marijuana use and HIV risk perception. Their study also showed that knowledge of how to correctly wear a condom and male gender were positive predictors of intent to wear a condom. From a broader perspective, other investigators 10, 13
have shown a positive relationship between alcohol and marijuana use and inconsistent condom use among Nigerian military personnel.
A few reports in the literature have addressed the issue of HIV transmission among Nigerian military personnel. Most soldiers are young and sexually active with a sense of invulnerability that may lead to risky sexual behaviors and reduced condom use.13
Soldiers are often deployed from home for extended periods of time, have a regular income and the opportunity for casual sex.14
For instance, it has been reported that almost half of the military personnel that participated in the various peacekeeping operations admitted having sexual partners during their time away from home and with these sexual partners, only half of the respondents used condoms.8
In addition, societal norms that do not support condom use have been known to also contribute to the efficiency of HIV transmission among Nigerian military personnel.15
Like their male counterparts, the high mobility of women in the armed forces also places them at risk of HIV infection for the same reasons they share. Also, female military personnel sexual interactions with local partners while on peacekeeping missions, and with officers returning from peacekeeping missions to the barracks may also put them at risk of HIV infection since the lifestyles of militaries on such missions are often characterized by high levels of multiple sexual partners, including sex with commercial sex workers; low condom use, and exposure to blood transfusions in the line of duty. In addition, they are subject to sex under duress, transactional sex for favors from superior officers; and sometimes are at risk of outright rape. Therefore, the complexity of sexual networking within or outside the militaries suggest that some female military personnel may serve as a significant vector in a concentrated HIV epidemic in the barracks, as well as being a potential bridge to the general population through sexual relationship with civilians. While there is a growing body of literature examining HIV risk behaviors among Nigerian military personnel, these studies have been based predominantly on male samples and provide only limited information about risk behaviors among female military personnel. The current research sought to address this void in the literature by examining the correlates of HIV knowledge and risk behaviors among Nigerian female military personnel.