Truck drivers, female hawkers and prostitutes are generally regarded as high-risk groups because they have a high rate of partner change, run abnormally high risks of being infected with sexually transmitted diseases (STDs) including HIV/AIDS, and are capable of transmitting them to the general population who live around them (Orubuloye, Caldwell and Caldwell 1993; Orubuloye 1995). Recent experience has shown that the prison population runs a high risk of being engulfed by AIDS. By late 1992, HIV-positive prisoners had been detected in at least one of the prisons in Nigeria and there was beginning to be concern for the safety of the prison population. Therefore a study of the prison population was planned as part of a larger continuing research program of the Ondo State University, Ado-Ekiti, Nigeria, on Sexual Networking, STDs and HIV/AIDS Transmission, supported by a grant from the Swedish Agency for Research Cooperation with Developing Countries (SAREC). The aim of the prison study was to investigate the attitudes and activities that are likely to facilitate the spread of sexually transmitted diseases, HIV and AIDS; and to develop an intervention program for the prison population and any population that may be in a similar situation

Omoniyi, O. P

Orubuloye, I. O

Shokunbi, W. A

The Australian National University

Health Transition Review, Supplement to Volume 5, 1995, 123-129Sexual networking, STDs andHIV/AIDS in four urban gaols inNigeriaI.O. Orubuloye,a O.P. Omoniyia and W.A. Shokunbiba Ondo State University, Ado-Ekiti, Nigeriab University College Hospital, Ibadan, NigeriaTruck drivers, female hawkers and prostitutes are generally regarded as high-risk groupsbecause they have a high rate of partner change, run abnormally high risks of being infectedwith sexually transmitted diseases (STDs) including HIV/AIDS, and are capable oftransmitting them to the general population who live around them (Orubuloye, Caldwell andCaldwell 1993; Orubuloye 1995). Recent experience has shown that the prison populationruns a high risk of being engulfed by AIDS. By late 1992, HIV-positive prisoners had beendetected in at least one of the prisons in Nigeria and there was beginning to be concern forthe safety of the prison population. Therefore a study of the prison population was planned aspart of a larger continuing research program of the Ondo State University, Ado-Ekiti,Nigeria, on Sexual Networking, STDs and HIV/AIDS Transmission, supported by a grantfrom the Swedish Agency for Research Cooperation with Developing Countries (SAREC).The aim of the prison study was to investigate the attitudes and activities that are likelyto facilitate the spread of sexually transmitted diseases, HIV and AIDS; and to develop anintervention program for the prison population and any population that may be in a similarsituation.The prison studyThe prison study was undertaken in the last quarter of 1992 and the sample was taken fromfour gaols in two major cities and two towns in Southwestern Nigeria. Since we made anundertaking not to reveal the identities of the gaols, the locations where the samples weretaken therefore will be identified only by the letters A,B,C,D.A total of 518 prisoners who were willing to take part in the study were interviewed inthe four gaols. The respondents are distributed as follows:Prison A: 203Prison B: 145Prison C: 130Prison D:  40The subjects posed were discussed at length but the respondents also answered aquestionnaire which was completed by the interviewers, usually in English or Yoruba. Theco-operation of the prison authorities was obtained to gain access to the prisoners. The prisonauthorities and the prisoners were assured that research was urgently needed for theimprovement of the welfare and health conditions of the inmates and that no attempt wouldbe made to record their names or identify them after the interview.The research team consisted of both social scientists and doctors. The latter took bloodsamples. The doctors noticed that a high proportion of the prisoners were suffering fromscabies and other minor but uncomfortable complaints; they obtained modest funding from124 Orubuloye, Omoniyi and ShokunbiSupplement to Health Transition Review Volume 5, 1995the research program to procure adequate medication, largely because they felt the need tohelp and not in order to effect co-operation. The task was made easier because the doctors inthe team were already offering voluntary free health services to the prisoners on humanitariangrounds long before the study was undertaken.The questionnaire was designed to cover the socio-economic characteristics of theprisoners, circumstances surrounding imprisonment and an account of their sexual behaviourbefore and during imprisonment. Information was also sought on knowledge and experienceof sexually transmitted diseases and AIDS.Table 1Characteristics of the prisonersA B C D(N=230) (N=145) (N=130) (N=40)% % % %AgeUnder 20 years 16.7 9.0 10.8 -20-29 49.3 45.5 53.0 27.530-39 21.7 32.4 23.8 50.040 and above 12.3 13.1 12.4 22.5EducationNo formal schooling 13.3 20.1 19.2 5.0Primary only 38.9 42.7 30.6 30.0Secondary not completed 25.1 13.1 13.8 15.0Secondary and above 26.7 22.7 30.7 50.0No response - 1.4 5.7 -ReligionChristianity 81.7 43.4 56.2 72.5Islam 15.3 55.9 41.5 27.3Traditional 2.5 - 0.8 -Others 0.5 0.7 1.5 -Occupation (before gaol)Farming 2.8 11.5 2.5 13.8Trading/business 22.1 11.5 25.0 8.4Artisan 26.2 37.7 17.5 55.2Civil servant 4.9 3.8 10.0 3.4Professional 22.8 18.5 30.0 10.8Unemployed 15.2 13.1 2.5 5.9No response 6.0 3.9 12.5 2.5Marital statusSingle 46.8 44.8 48.5 30.0Married 53.2 52.4 50.7 67.5Divorced/separated - 1.4 0.8 2.5No response - 1.4 - -Sexual networking, STDs and HIV/AIDS in four urban gaols in Nigeria 125Supplement to Health Transition Review Volume 5, 1995The characteristics of the prisonersTable 1 shows selected characteristics of the prisoners. All the prisoners interviewed weremales. A small number of females in the four gaols were contacted but they did not show anyinterest in the survey, primarily because they were shy, so they were excluded. The majorityof the prisoners are in the age group 20-39 years, more than one-half being 20-24 except inone gaol where the majority were 30-39. Most of the prisoners had some formal educationalthough some did not complete primary or secondary school. The level of education reflectsthat of the general population of the southwest region with a long tradition of formaleducation.Christianity is the dominant religion of the prisoners in three of the gaols, while slightlymore than one-half reported their religion as Islam in the fourth gaol. The distribution reflectsthe pattern of the dominant religions in the areas where the gaols are located. One-third of therespondents in two of the gaols reported themselves as Catholics, while traditional religionwas hardly reported in any gaols. The majority of the respondents described themselves astraders or artisans before they were sent to gaol; the proportion in white collar occupations issmall. More than one-half of the prisoners in three of the gaols and two-thirds in the fourthgaol were married. In all the gaols about one-tenth had contracted more than one marriage,about the same proportion were polygynously married. Between 48 per cent and 70 per centof them had at least one child at the time of the investigation; of these, between 19 and 25 percent had more than four children.The prisoners were products of large families. The majority of them were frompolygynous households, while between 80 and 90 per cent of their fathers had more than fourchildren. The proportions of mothers with more than four children range between 58 and 70per cent. However, they were products of relatively stable marriage. Except in one of thegaols, more than four-fifths of the prisoners' mothers were in their first marriages.Nearly all the prisoners were mature before their imprisonment. In all the gaols, fewerthan one in ten were imprisoned before the age of 18. Most of the group were awaiting trialor merely suspects.Except in one of the gaols where armed robbery and murder cases account for 40 percent of the offences, housebreaking, vagrancy, assault and forgery were the major offencescommitted by the prisoners. The majority of the prisoners were serving terms rangingbetween six months and five years, while 17-30 per cent were awaiting trial for offencesranging between mere suspicion, vagrancy, housebreaking, armed robbery and murder.Sexual behaviourThe prisoners in all the four gaols were sexually active; nearly all had had sexual experiencebefore imprisonment. The mean age of first sexual experience is about 18 years, and themajority had had their first sexual experience before reaching the age of 20 years. Betweentwo and ten per cent had their first sexual encounter before the age of ten years (Table 2).Except in one of the gaols, between one half and two-thirds reported at least one currentsexual partner. Since nearly all the prisoners in the gaols were males, and, since males andfemales are physically separated in the prisons, it is probable that some kind of homosexualintercourse was occurring; in order to avoid trouble or hurt we did not press the matterfurther. However, some of the prison officers believed that the congestion in the prison cellscould facilitate such practices.The responses to the question on number of lifetime sexual partners indicate that theprisoners had a large variety of sexual partners before they were sent to gaol. Between 35 and126 Orubuloye, Omoniyi and ShokunbiSupplement to Health Transition Review Volume 5, 199559 per cent had more than one lifetime sexual partner, while about 22 and 40 per cent couldnot easily remember or estimate the number of their lifetime sexual partners.Table 2Age at first sexual experienceA B C D(N=230) (N=145) (N=130) (N=40)% % % %Under 10 years 8.4 2.1 2.3 2.510-14 18.2 17.2 15.3 15.015-19 48.3 42.9 48.5 40.020-24 11.4 23.5 17.7 20.025 and above 6.5 7.6 5.5 15.0Other response 7.2 6.7 10.7 7.5Between 28 and 39 per cent of the prisoners had had sexual relations with prostitutes,usually in hotels, bars and brothels (Table 3). The majority of the prisoners reported that theyhad sexual relations with prostitutes on several occasions. Altogether, the sexual life of theprisoners is similar to that of the general population and other high-risk groups in the society(Orubuloye, Caldwell and Caldwell 1991, 1993).Table 3Sex with prostitutesA B C D(N=230) (N=145) (N=130) (N=40)% % % %Have you ever had sex withcommercial sex workers?Yes 27.6 37.9 38.5 37.5No 65.0 54.5 57.7 52.5No response 7.4 7.6 3.8 10.0If yes, where?Hotel/bar/brothel 21.7 37.2 26.2 32.5In a house 1.0 - 2.3 -On a trip 4.4 0.7 10.0 5.0Not applicable 72.4 61.4 59.2 62.5No response 0.5 0.7 2.3 -How many times?Once 4.5 8.2 8.4 5.0More than once 5.5 16.0 14.0 15.0Too many to remember 17.6 13.8 16.5 17.5NA/no response 72.4 62.0 61.1 62.5Sexual networking, STDs and HIV/AIDS in four urban gaols in Nigeria 127Supplement to Health Transition Review Volume 5, 1995Sexually transmitted diseases, HIV/AIDSThe level of sexually transmitted disease is high: between 28 and 39 per cent reported thatthey had been infected (Table 4). Nearly all reported gonorrhoea as the major STD, whilefewer than three per cent reported syphilis. The majority reported that they caught the diseasefrom their girl friends and prostitutes, while about two per cent in one of the gaols said theyhad caught it from fellow-prisoners. Nearly all reported the symptoms and discomforts whichthey experienced as inability to urinate, discharge and itching.Table 4Sexually transmitted diseasesA B C D(N=230) (N=145) (N=130) (N=40)% % % %Have you ever contracted a STD?Yes 36.0 39.3 33.8 27.5No 64.0 57.9 65.4 72.5No response - 2.8 0.8 -If yes, what type?Gonorrhoea 35.5 36.6 29.2 25.0Syphilis - 1.4 3.1 2.5Other 0.5 2.1 0.8 -Don't know - 0.7 - -Not applicable 64.0 59.2 66.9 72.5Who infected you?Girl/woman friend 25.7 22.0 20.0 10.0Sex workers 8.9 11.0 10.8 17.5Wife 0.5 - - -Others - - 1.5 -Not applicable/NR 64.9 67.0 67.7 72.5Did you receive any treatment?Yes 33.0 36.6 31.5 27.5No 2.0 3.4 0.8 -Not applicable/NR 65.0 60.0 67.7 72.5Where did you receive treatment?Modern hospital 23.2 16.6 14.6 15.0Chemist/dispensary 1.5 4.8 6.2 7.5Self medication 2.5 5.5 5.4 5.0Not applicable/NR 72.8 73.1 73.8 72.5The majority of prisoners infected with sexually transmitted diseases sought and receivedtreatment from chemists and modern doctors, while a few were treated by traditional doctorsand spiritual healers. While a few reported that their partners sought and received treatmentfrom modern doctors, traditional and spiritual healers, the majority were not interested inwhat happened to their partners.128 Orubuloye, Omoniyi and ShokunbiSupplement to Health Transition Review Volume 5, 1995On the question of whether the prisoners knew anyone ever treated for sexuallytransmitted diseases, between 43 and 68 per cent reported that they knew of such persons.The majority of these persons were males, friends or workmates of the prisoners, both singleand married, and between the ages of 20 and 34 years.Knowledge of AIDS is widespread: between 65 and 77 per cent of the prisoners hadheard of it. Most of the information came from the radio, television and newspapers andmagazines in that order. Between two and three per cent knew persons, mainly male friendsor workmates, who had been treated for AIDS. The majority of the affected persons weresingle. Clinical evidence has shown that five out of the 100 cases of blood samples taken inone of the gaols are suspected of being HIV-positive. One hundred and forty five maleprisoners out of a total number of 600 inmates in that prison were interviewed. This showsthat five per cent of the blood samples taken or 3.5 per cent of the respondents or 0.01 percent of all the inmates of one of the four gaols were likely to be HIV-positive. This is a veryserious matter because 68 per cent of the respondents in the same prison reported at least onecurrent sexual partner. Similarly, about 40 per cent of the respondents in the same prisonreported that they had previously contracted sexually transmitted diseases. About three percent of the respondents in this prison reported that they had used a needle to inject drugs.A closer look at the background of the five cases shows that they were between 25 and34 years of age, sexually active, serving long prison terms and convicted for murder or armedrobbery. Although blood samples were not taken in three out of the four gaols, Nigerianprisons may well soon be engulfed in STDs and HIV/AIDS.ConclusionIt is now evident that prisoners belong to the sexually active group. A large proportion hadexperienced both a high level of partner change and infection with sexually transmitteddisease before they were sentenced to prison. They run an abnormally high risk of beinginfected with HIV/AIDS, and are capable of transmitting it to other inmates in the prisonsand to the general population when they are eventually out of gaol.Three other factors are worthy of note: the congestion in the prison cells which results inan outbreak of scabies in one of the prisons and suspicion that homosexual intercourse wasgoing on in the cells; the sharing of needles and injection of substances believed to bedangerous drugs; and the evidence of HIV-positive cases. Given the nature of the prisons andprison life, it is an explosive situation which requires intervention programs that will focus oneradication of STDs and other infectious diseases in the prison. This will be a pragmaticapproach towards minimizing the risk of HIV/AIDS transmission. In addition, screening forHIV of all prison inmates and removal of HIV-positive prisoners will also help to contain thespread of the epidemics.Finally, there is an urgent need to improve the living conditions of the prisoners.Overcrowding, and poor sanitary and nutritional conditions for which the Nigerian prisonsare notorious, could aid the spread of STDs and AIDS.ReferencesOrubuloye, I.O. 1995. Patterns of sexual behaviour of high-risk population groups and theirimplications for STDs and HIV/AIDS transmission in Nigeria. Pp. 235-246 in ConceivingSexuality: Approaches to Sex Research in a Post Modern World, ed. R.G. Parker and J.H. Gagnon.New York: Routledge.Orubuloye, I.O., J.C. Caldwell and Pat Caldwell. 1991. Sexual networking in the Ekiti District ofNigeria. Studies in Family Planning 22,1:61-73.Sexual networking, STDs and HIV/AIDS in four urban gaols in Nigeria 129Supplement to Health Transition Review Volume 5, 1995Orubuloye, I.O., J.C. Caldwell and Pat Caldwell. 1993. The role of high-risk occupations in the spreadof AIDS: truck drivers and itinerant market women in Nigeria. International Family PlanningPerspectives 19,2:43-48.

Sexual networking, STDs and HIV/AIDS in four urban gaols in Nigeria

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