Determinants of Consistent Condom use among HIV-Positive Women in Abia State , South-East Nigeria

Background: The use of condoms in marriages is a complex decision. It however plays a role in prevention of HIV and other sexually transmitted infections (STIs). The problem is, what factors and conditions determine consistent condom use among HIV positive women? This study aimed at identifying determinants of consistent condom use among HIV positive women cohabiting with their partners and attending ‘Heart to Heart’ treatment centre in Abia State University Teaching Hospital. Materials and method: This longitudinal descriptive study was conducted among 248 married HIV positive women who attended ‘Heart to Heart’ treatment centre in the Abia State University Teaching Hospital from December 2012 to February 2013 and are cohabiting with their partners. Interviewer administered semi-structured questionnaire was used to obtain data from the respondents. Data were analysed using SPSS version 17 soft ware. Results: A total of 73(29.4%) of the respondents used condom consistently. Age, level of education, and desire for more children influenced condom use (OR 7.023., CI 2.050 – 24.047, P<0.001). The older the respondents, the more condom they used (OR 164.474, CI 21.477 – 1260.2, P<0.001). Also the more educated the respondents were, (tertiary, secondary) the more likely they used condom. Women who did not desire more children used condom more than those who desired more children (OR 13.612, CI 0.04326.311, P<0.001). Women who had disclosed their HIV status to their spouses, used condom more than those who had not (OR 13.072, CI 5.836 – 29.253, P<0.001). Conclusion : The fact that only 29.4% of the respondents used condom consistently with their spouses shows lack of awareness of the benefits of condom use. Health education which will stress the importance of using condom in preventing HIV transmission and other sexually transmitted infections (STIs) is recommended for HIV positive women and their spouses. DOI : 10.14302/issn.2324-7339.jcrhap-13-321 Corresponding Author: Dr. Ezinna Ezinne Enwereji , E-mail address: hersng@yahoo.com


Introduction
Nigeria is the most populated country in Africa with an estimated population of 163 million and an annual growth rate of 2.6%. The prevalence of HIV among the general population is 3.6% with a national median prevalence of 4.1% among pregnant women (1)(2)(3)(4)(5). In sub-Saharan Africa, 60% of the people living with HIV are females. These African women make up 50% of the global epidemic (6). In Nigeria, females constitute 58% (about 1.62 million) of persons living with HIV (7).
About 55% of AIDS deaths that occur in Nigeria each year, are among females within 15-49 years of age.
This shows that the number of women infected with HIV is on the increase. (8)(9).
According to the UNAIDS 2011 report, young women Vulnerability of females to HIV in Nigeria has been linked to various factors including non-insistence on use of condom during sexual intercourse. In Nigeria, culture prohibits women from negotiating condom use during sex. As a result, most women, especially those whose spouses engage in multiple sex partners are exposed to sexually transmitted infections (STIs) including HIV (14). to increase the chances of clients benefiting from the services offered to them in the clinic.

Materials and Methods
The study was conducted among 248 married HIV

Quality control:
The questionnaire was pre-tested and administered by well trained female research assistants.

Ethical considerations
Informed consent was obtained verbally from the respondents after explaining the objectives of the study.
As a result, all the respondents positively consented to participate in the study and they were included. Ethical clearance was obtained from the Ethical Review committee of the Abia State University Teaching Hospital.

Socio -demographic Characteristics:
The ages of the respondents were varied, with the mean show that the older the respondents, 44 years and above, the more likely they used condom. Also the less educated the respondents, (no formal education and primary), the less likely they used condom.
The respondents were later examined to find out the factors that encouraged condom use. The respondents with discordant families who did not disclose their status to their partners, used condom        Women who disclosed their HIV status to their spouses used condom more consistently than those who did not disclose (OR 13.072, CI 5.836 -29.253, P<0.001).

Discussion
The result of this study showed that only 29.4% of the respondents used condoms consistently during sex. This might not be unrelated to the cultures and traditions behind the marriage institution where condom use among couples is regarded as a taboo. The effect of regarding condom use among couples as a taboo is that most couples may not consider it necessary to use condom during sex. This could make such couples unaware of the full benefits of using condom during sex. The few proportion of respondents who stated that they used condom consistently may be those who have good knowledge of the benefits of using condom during sex. The finding that the respondents who used condom consistently may be those with good knowledge of the benefits of condom use agrees with that of [3,12,16] where couples used condom consistently only when they were informed that condom use was not associated with infidelity .  [15] in Uganda, where 54% of the respondents disclosed their status to their spouses so as to protect other family members from infection. The difference between our study and that of Ugandan might be related to geographical location and not cultural differences. The main reason for non-disclosure as documented in the Ugandan study was fear of spouse abandonment. The same reason for non-disclosure in Ugandan study is also the reason for non-disclosure in the present study but of a more severe consequence as a result of the low proportion of those who disclosed.
The fact that older women 40 years and above used condoms more regularly than the younger ones could be explained that at this age, majority of the women must have had their desired number of children and as such, their prerogative is to avoid infection and prevent pregnancy at any material time of their sexual activity.
Level of education played a positive role in the use of condoms in the study. Women with higher level of education (tertiary and secondary), used condom more consistently than others in the study. This finding is consistent with studies by [17,18,22,24]. The finding could be explained by the fact that the higher the education of an individual, the more likely the individual will be exposed to correct information on HIV/AIDS transmission. Correct information on HIV and AIDs prevention will empower the individual to use relevant strategies to protect self from infection.

Limitations:
Although this study has identified some variables that