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British Journal of Healthcare and Medical Research - Vol. 10, No. 1
Publication Date: January, 25, 2023
DOI:10.14738/jbemi.101.13824. Ofurum, I. C. (2023) Prevalence and factors associated with condom use among people living with HIV/AIDS in Bayelsa state,
Nigeria. British Journal of Healthcare and Medical Research, - Vol. 10(1). 65-73.
Services for Science and Education – United Kingdom
Prevalence and factors associated with condom use among
people living with HIV/AIDS in Bayelsa state, Nigeria
Ifeoma C. Ofurum
School of Public Health,
University of Port Harcourt, Rivers State, Nigeria
ABSTRACT
Epidemiological and laboratory studies have demonstrated that latex condoms
effectively prevent HIV and other sexually transmitted diseases. However,
inconsistent use or nonuse of condoms among people living with HIV/AIDS
(PLWHAs) could propagate the spread of infection. The aim of the study was to
determine the prevalence of condom use and identify the associated factors among
PLWHAs in Bayelsa state, Nigeria. Six hundred (600) participants were recruited for
this cross-sectional study from the HIV clinics at Federal Medical Centre (FMC),
Yenagoa, and Otuasega Cottage Hospital, Ogbia in Bayelsa State, Nigeria after giving
informed consent. An interviewer-administered questionnaire was used to collect
data comprising socio-demographic characteristics, condom use and ART status of
the respondents. The data obtained were analyzed and presented as frequencies
and percentages. Chi-square and Binary logistic regression were used to test the
association between variables with statistical significance set at p<0.05. Results
showed a mean age of 34.6±6.4 years, comprising 160 males (26.7%) and 440
females (73.3%). The prevalence of condom use was 69.2%. There were statistically
significant associations between age (X2=7.305, P=0.007), sex (X2=7.919, P=0.005;
OR=1.6 (1.1-2.4), P=0.033), religion (X2=12.238, P=0.007; OR=2.7(1.1-6.8),
P=0.039), having skipped medication (X2=22.295, P<0.001; OR=2.1 (1.5-3.2),
P<0.001), revealed status to someone (X2=12.002, P=0.001; OR=2.7 (1.2-6.2),
P=0.020) and number of sexual partners (X2=14.684, P<0.001; OR=3.0 (1.7-5.4),
P<0.001) with condom use. In conclusion, condom use among PLWHAs in Bayelsa
state is sub-optimal. There is a need to explore measures that target these factors
to promote the attainment of the optimal prevalence of condom use among
PLWHAs.
Keywords: PLWHA, HIV/AIDS, Condoms, Bayelsa State
INTRODUCTION
Human immunodeficiency virus (HIV) continues to be a major public health challenge thirty
years after it was first reported in 1981. From its inception, HIV has claimed 40.1 million lives
with an estimated 38.4 million people living with HIV at the end of 2021 (1). Furthermore,
death from HIV-related causes was reported in 650,000 people with 1.5 million new HIV cases
in 2021 (1). These new HIV cases continue to increase the global burden of HIV/AIDS with its
imminent cost implication on healthcare, both regionally and globally, due to the chronic nature
of the disease and its incurability. Sub-Saharan Africa accounts for two-thirds of the global HIV
burden (1), making this region a focal point for disease control measures and interventions
geared towards preventing transmission.
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British Journal of Healthcare and Medical Research (BJHMR) Vol 10, Issue 1, January - 2023
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In 2018 when an estimated 1.7 million new HIV infections were reported globally, the WHO
African region accounted for 1.1 million of these new infections (2), representing
approximately 65% of the annual incidence of HIV infection in that year. By implication, Sub- Saharan Africa is a major contributor to both HIV infection incidence and the burden of
HIV/AIDS disease. In Africa, Nigeria ranks as global third among countries with the highest HIV
disease burden (3), with some states of the federation including Benue, FCT, Anambra, Bayelsa
and Akwa Ibom contributing the highest numbers to this HIV prevalence (4). These regions
have a high propensity to benefit from a better understanding of transmission dynamics and
effective control measures. Epidemiological and laboratory studies have demonstrated that
latex condoms are largely effective for the prevention of HIV and other sexually transmitted
diseases (STDs) (5). However, inconsistent use or nonuse of condoms, especially among people
living with HIV/AIDS (PLWHAs), minimizes the effectiveness of condoms in controlling the
transmission of HIV and STDs (5). This is particularly imperative as transmission can occur
with a single sex act with an infected partner (5). In Nigeria, the promotion of condom use as a
means of protection against STDs and as a method of contraception is not particularly targeted
at PLWHAs but towards the general public. Hence, there is a paucity of data regarding the
prevalence and factors associated with condom use among PLWHAs in Nigeria, particularly in
regions identified as high disease burden regions.
This present study aims to determine the prevalence of condom use among PLWHAs in Bayelsa
state and identify the associated factors.
METHODS
Study Design and Study Site
This cross-sectional survey was carried out in Bayelsa state, Nigeria. One secondary and one
tertiary health facility were selected for this study. The choice of the facilities where the study
was carried out was achieved by independently balloting for the secondary and tertiary health
facilities. Federal Medical Centre (FMC), Yenagoa was the tertiary health facility selected while
Otuasega Cottage Hospital, Ogbia was the secondary health facility selected. The study was
carried out between August and November 2021.
Ethical Consideration
Ethical approval was obtained from the ethics committee of FMC, Yenagoa with the number
FMCY/REC/ECC/2021/JUNE/365. Administrative approval/permission was also obtained
from the Ministry of Health, Yenagoa, Bayelsa state. Written informed consent was obtained
from all study participants after carefully explaining the study protocol and its significance. All
materials used were de-identified by using randomly assigned research identifiers. The study
participants were assured of the confidentiality of the information they provide.
Participants
Study participants were selected using a multistage sampling technique. Following the
selection of health facilities by balloting, the list of PLWHA who visited the health facilities was
generated from the database of the HIV clinics. PLWHAs who attended the ART clinic had been
on ART for at least one year, women of reproductive age (15-49 years) were included while
acutely ill persons who were unable to communicate were excluded. These comprised of one
thousand five hundred (1500) patients who then constituted the sampling frame from which
participants were drawn. The probability proportional to size (PPS) method was used to
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Ofurum, I. C. (2023) Prevalence and factors associated with condom use among people living with HIV/AIDS in Bayelsa state, Nigeria. British Journal
of Healthcare and Medical Research, - Vol. 10(1). 65-73.
URL: http://dx.doi.org/10.14738/jbemi.101.13824
determine the number of participants to be selected from each facility. This amounted to five
hundred and forty (540) participants from FMC Yenagoa that had one thousand three hundred
and fifty (1350) patients who visited the HIV clinic in the previous month, and sixty (60)
participants from Otuasega Cottage Hospital, Ogbia that had one hundred and fifty (150)
patients who visited the HIV clinic in the previous month. All patients on the sampling frame
were assigned numbers and the random start number of 3 and an interval of 2 were applied for
the selection of participants from the sampling frame. A total of six hundred (600) participants
were recruited for this study.
Study Instrument and Data Collection
A pre-tested interviewer-administered semi-structured questionnaire was used to collect data
in this study. The questionnaire was divided into three sections covering socio-demographic
characteristics, condom use and ART status.
Statistical Analysis
The data obtained were entered into an excel file and cleaned before exporting into the
software, IBM Statistical Product and Service Solution (SPSS) version 25 for analysis. Data
obtained from the study were analyzed and presented as frequencies and percentages. Chi- square and Binary logistic regression were used to test the association between variables.
Statistical significance was set at p<0.05.
RESULTS
A total of 600 PLWHA were recruited and a response rate of 100% was recorded in this study.
The study comprised 160 males (26.7%) and 440 females (73.3%). Most of the respondents
340 (56.7%) were between 31-40 years, 457 (76.2%) were married, 338 (56.3%) had
vocational/technical education as their highest level of education and 284 (47.3) were of the
Pentecostal religion. The mean age of the respondents was 34.6±6.4 years. (Table 1)
The majority of the PLWHA had been aware of their status and on HAART for 2-4 years (309,
51.5% and 336, 56.0% respectively). Study participants mostly indicated that they always get
their medications (584, 97.3%) yet a higher proportion indicated skipping medication (339,
56.5%), and 535(89.2%) had revealed their status to someone else. Most of the study
participants had been sexually active within 6 months before the study (577, 96.2%) with 178
(30.8%) indicating non-use of condom during sexual intercourse (Table 2 and Figure 1)
Test of association showed that the demographic characteristics, age (X2=7.305, P=0.007), sex
(X2=7.919, P=0.005), and religion (X2=12.238, P=0.007) were significantly associated with
condom use. Furthermore, having skipped medication (X2=22.295, P<0.001), revealed status to
someone (X2=12.002, P=0.001) and the number of sexual partners (X2=14.684, P<0.001) were
significantly associated with condom use. (Table 3)
Binary logistic regression analysis showed 1.6 (1.1-2.4) times higher odds of condom use
among female PLWHAs compared to males. There were also significantly higher odds of
condom use among PLWHAs who were Catholics compared to PLWHAs of other religious
affiliations (OR: 2.7(1.1-6.8)). PLWHAs who had skipped medication had higher odds of
condom use (OR: 2.1 (1.5-3.2)) than those who had not. The odds of condom use were higher
among PLWHAs who had not revealed their status to someone else (OR: 2.7 (1.2-6.2)) than
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those who revealed their status to someone else. A higher odd of condom use was observed
among PLWHAs who had more than one sexual partner (OR: 3.0 (1.7-5.4)) compared to those
who had one sexual partner. (Table 4)
Table 1: Social Demographic characteristics
Variable Frequency(n=600) Percent (%)
Sex
Male 160 26.7
Female 440 73.3
Ages
≤20 years 15 2.5
21-30 years 140 23.3
31-40 years 340 56.7
41-50 years 100 16.7
> 50 years 5 0.8
Mean±SD 34.6±6.4
Education
No formal education 10 1.7
Basic primary 15 2.5
Secondary 78 13
Technical/vocational 328 54.7
Undergraduate 30 5
Graduate 65 10.8
Postgraduate 74 12.3
Marital status
Single 78 13.0
Married 457 76.2
Separated 24 4.0
Divorced 6 1.0
Widowed 13 2.2
Cohabiting 22 3.7
Religion
Pentecostal 284 47.3
Protestant 87 14.5
Catholic 206 34.3
Islam 11 1.8
Traditionalist 8 1.3
Others 4 0.7
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Ofurum, I. C. (2023) Prevalence and factors associated with condom use among people living with HIV/AIDS in Bayelsa state, Nigeria. British Journal
of Healthcare and Medical Research, - Vol. 10(1). 65-73.
URL: http://dx.doi.org/10.14738/jbemi.101.13824
Table 2: ART-related characteristics of the respondents
Variable Frequency n=600 Percent (%)
Duration of status awareness
≤1 year 29 4.8
2-4 years 309 51.5
≥ 5 years 262 43.7
Duration of ART
≤1 year 32 5.3
2-4 years 336 56.0
≥ 5 years 232 38.7
Always get medication
Yes 584 97.3
No 16 2.7
Ever skipped medication
Yes 339 56.5
No 261 43.5
Revealed status to anyone
Yes 535 89.2
No 60 10
Don’t remember 5 0.8
Sexually active (in last 6
months)
Yes 577 96.2
No 23 3.8
Figure 1: Prevalence of Condom use among sexually active HIV patients
Yes, represents the percentage of patients who used condoms consistently
No represents the proportion of patients who were either inconsistent with condom use or non- use
399(69.2%)
178(30.8%)
YES NO
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Table 3: Factors associated with condom use
Variable Condom use X2(P-value)
Yes n(%) No n(%)
Age
<40 years 319(72.0) 124(28.0) 7.305(0.007)*
≥40 years 80(59.7) 54(40.3)
Education
Secondary education and
below
313(70.7) 130(29.3) 2.2022(0.155)
Tertiary education 86(64.2) 48(35.8)
Sex
Males 96(60.4) 63(39.6) 7.919(0.005)*
Females 303(72.5) 115(27.5)
Marital status
Single/Divorced/Widowed 87(88.8) 11(11.2) 21.312(<0.001)*
Married/Cohabiting 312(65.1) 167(34.9)
Religion
Pentecostal 177(65.8) 92(34.2) 12.238(0.007)*
Protestant 70(82.4) 15(17.6)
Catholic 141(70.1) 60(29.9)
Others 11(50.0) 11(50.0)
Duration of status
awareness
≤ 4 years 235(70.6) 98(29.4) 0.744(0.388)
>4 years 164(67.2) 80(32.8)
ART Duration
≤ 4 years 258(71.1) 105(28.9) 1.698(0.193)
>4 years 141(65.9) 73(34.1)
Always gotten medication
Yes 388(69.2) 173(30.8) 0.001(0.972)
No 11(68.8) 5(31.3)
Ever skipped medication
Yes 248(77.3) 73(22.7) 22.295(<0.001)*
No 151(59.0) 105(41.0)
Revealed your status to
others
Yes 345(66.9) 171(33.1) 12.002(0.001)*
No 54(88.5) 7(11.5)
Sexual partners
One 301(65.4) 159(34.6) 14.684(<0.001)*
More than one 98(83.8) 19(16.2)
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Ofurum, I. C. (2023) Prevalence and factors associated with condom use among people living with HIV/AIDS in Bayelsa state, Nigeria. British Journal
of Healthcare and Medical Research, - Vol. 10(1). 65-73.
URL: http://dx.doi.org/10.14738/jbemi.101.13824
Table 4: Predictors of Condom use
Variable AOR (95% C.I.) P-value
Age
<40 years 1.2(0.8-1.8) 0.463
≥40 years R
Sex
Females 1.6(1.1-2.4) 0.033*
Males R
Religion
Pentecostal/Protestants 2.1(0.8-5.4) 0.095
Catholic 2.7(1.1-6.8) 0.039*
Others R
Ever skipped medication
Yes 2.1(1.5-3.2) <0.001*
No R
Revealed your status to
others
No 2.7(1.2-6.2) 0.020*
Yes R
Sexual partners
More than one 3.0(1.7-5.4) <0.001*
One R
*Significant at p<0.05
DISCUSSION
This present study determined the prevalence of condom use among PLWHAs in Bayelsa state
and identified the associated factors. The prevalence of condom use among sexually active
PLWHAs observed in this study was 69.2%, similar to 70.6% reported in Kogi state, Nigeria (6).
However, our finding is contrary to the report that 80.6% of sexually active PLWHAs studied in
Maiduguri, Nigeria never used condoms (7) as well as the report of condom utilization by 45.2%
of PLWHAs attending ART clinics in Addis Ababa, Ethiopia (8). Although these differences from
other studies may be a result of multifactorial dissimilarities in the populations studied but it
also demonstrates a higher level of compliance in the present study population. Nevertheless,
given the transmissibility of HIV by a single unprotected sexual contact, there remains more to
be done to ensure complete compliance among PLWHAs in Bayelsa state.
This study found significant associations between age, sex, religion, having skipped medication,
revealed status to someone and number of sexual partners with condom use among the
PLWHAs studied. The odds of condom use by female PLWHAs were 1.6 times the odds of
condom use by male PLWHAs. This is contrary to previous reports that more males than female
PLWHAs used condoms Salaudeen, Musa (6) and that male PLWHAs were more likely to utilize
condoms than female PLWHAs respectively (8). These previous studies had opined that women
were less powerful to negotiate condom use, had less ability to decide on sexual life or were
constrained by economic problems indicating subtle inequalities in sexual relationships. The
difference observed in this present study may be an indication of a more positive attitude
towards safe sex and practice of safe sex among female PLWHAs who may now be advancing a
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course towards more equitable relationships. However, further studies are required to confirm
these suggestions. It also depicts the importance of understanding the distinctness of various
populations to ensure that interventions are reasonably adaptable for better outcomes.
Our finding of an association between religion and condom use contradicts the report of
Salaudeen and Musa (6) that there was no association between religion and condom use.
However, there were only two religious affiliations considered in the study by Salaudeen, Musa
(6) which were Christianity and Islam but in this present study, due to the preponderance of
the Christian religion in the area of study, the various sub-affiliations of the Christian religion
were taken into consideration. Compared to other religious affiliations, PLWHAs who were
Catholics had 2.7 times odd condom use. This finding may be due to the open support of the
Roman Catholic Church for the use of condoms whenever a sexual act threatens to endanger
the life of one of the partners in a sexual relationship (9), while the position of other religious
affiliations is either conditional or controversial. This underscores the influence of religious
belief/affiliation on individual actions and the need for collaboration with religious bodies in
the fight against the spread of HIV infection.
This present study observed that PLWHAs who had skipped medication had 2.1 times odd of
condom use than those who had not skipped medication. Antiretroviral therapy (ART)
effectively suppresses HIV replication within an infected host resulting in reduced viral activity
and improved health (10). Lower odds of condom use among PLWHAs who do not skip
medication observed in this present study may be due to the impression of non-infectiousness
due to reduced viral load or improved health. Our finding supports the report of a previous
study that people who believe that they are less infectious when their blood viral load is
undetectable as a result of treatment adherence reduce condom use and increase unprotected
sex (11). This study also found that PLWHAs who had not revealed their status to someone else
had 2.7 times the odds of condom use than PLWHAs who had. This corroborates the findings of
previous studies (7, 8) and indicates that disclosure of HIV status could help keep PLWHAs
reminded and conscious of the need to practice safe sex. A higher odd of condom use (3 times)
was observed among PLWHAs who had more than one sexual partner compared to those who
had one sexual partner. This is contrary to the report of Geleta and Tiruneh (8) that PLWHAs
who had multiple sexual partners were 85% less likely to utilize condoms but agrees with the
report of Deuba, Kohlbrenner (12) that PLWHAs having a regular partner HIV-positive and
unknown status was associated with inconsistent condom use. Hence there is a need to
encourage PLWHAs to use condoms irrespective of the status of the number or status of their
sexual partners.
In conclusion, the prevalence of condom use among PLWHAs in Bayelsa state is still suboptimal.
Sex, religion, having skipped medication, revealed status to someone and number of sexual
partners were significantly associated with condom use among PLWHAs in Bayelsa state. There
is a need to explore measures that target these factors as a means to promote the attainment of
the optimal prevalence of condom use among PLWHAs.
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Ofurum, I. C. (2023) Prevalence and factors associated with condom use among people living with HIV/AIDS in Bayelsa state, Nigeria. British Journal
of Healthcare and Medical Research, - Vol. 10(1). 65-73.
URL: http://dx.doi.org/10.14738/jbemi.101.13824
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