Seroprevalence of HIV and Hepatitis B virus markers among male motor park workers in Sagamu, south-west Nigeria
Seroprevalence of HIV and Hepatitis B virus markers among male motor park workers in Sagamu, south-west Nigeria |
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Opaneye A*, Oduwole MD^, Jeminusi OA^, Vicki Ashton**, Dada OA#.
*Department of Genitourinary Medicine, The James Cook University Hospital, Middlesbrough, TS4 3BW, England.
** Medical Statistics, University of Teesside, Middlesbrough, England;
^ Department of Community Medicine and Primary Care, Olabisi Onabanjo University, Sagamu, Nigeria;
# Centre for Research in Reproductive Health, Sagamu, Nigeria.
Key words: Motor park workers, HIV, Hepatitis B, Sagamu, south-west Nigeria.
Introduction:
The 2003 National HIV Sero-prevalence Sentinel survey gave a National HIV prevalence of 5% for Nigeria. This is a drop from the 2001 figure of 5.8%. This drop was however not statistically significant and therefore other extraneous or spurious factors may be responsible for the apparent drop.(1)
The department of Community Medicine and Primary Care of the Olabisi Onabanjo University has established a rapport with the people of Sagamu in south-west Nigeria through a Community Centre in which the community members are the main stakeholders of this project. There have been health promotion activities especially in sexual and reproductive health matters with four main vulnerable groups in Sagamu since 1998. These groups are – Long distance truck drivers and Motorcyclists; Female Sex Workers; In and Out of school Adolescents; and Persons Living with HIV/AIDS.
Previous qualitative studies have been done on both Long Distance Drivers and Female Sex Workers. These studies suggest that Long Distance drivers have sexual partners at most stops on their routes from the southern part of the country to the North, and that many of their partners are sex workers who reside in brothels at these truck stops(2,3,4).
Sagamu town is strategically located on the main highway between the port city of Lagos and the northern as well as southeastern part of Nigeria. The spread of HIV infection in some African countries like Kenya and Uganda(5) and in the Indian sub-continent(6) have been traced along the major highways. It therefore believed that motor park workers (drivers, conductors, helpers etc) might be targeted in an effort to control the spread of STI and HIV(7).
Studies on Hepatitis B virus markers are few in Nigeria in general, despite the fact that the routes of transmission are similar to that of HIV and, Hepatitis B virus causes severe and often fatal disease in humans.
This aim of this study was to determine the prevalence of HIV and Hepatitis B infection in motor park workers (Long distance truck drivers, mechanics, driver assistants and motor cyclists) with a view to improving the services already being rendered by the Sagamu Community Centre.
Methodology: Between July and September 2003, contact was made through the Community Association with the Motor Park Workers’ Union in Sagamu. This was to explain the proposed study, canvas their cooperation, and suggestions about the project. The study received ethical approval from the Ethics Committee of Olabisi Onabanjo University and it was carried out at Kara Motor Park, Sagamu on one day in October 2003. One hundred and three men participated in the study. Each participant gave informed consent and was counselled. There were interpreters present to assist those who did not understand English. Demographic data, using a semi-structured questionnaire was obtained under a canopy erected at the motor park. Venepuncture took place in a room provided by the Community Association at the motor park. At venepuncture 10ml of blood was obtained. At the end of the day, serum was separated form the blood and the samples were stored in a -200C freezer until the time of analysis. Among the participants, three men who presented with urethral discharge were each treated syndromically with 1gm of Azithromycin as a once only dose.
Descriptive statistics (frequencies, means) were reported and contingency tables constructed. Simple and multiple regression analyses were used.
Serological tests: Blood specimens were screened for HIV 1 and 2 using the Genscreen ® Plus HIV Ag-Ab (Bio-Rad, France). Confirmation of results was by Western blot test. Serological tests for Hepatitis B markers were done with the Bioelisa HBsAg colour (Biokit, S.A. Barcelona).
Results: One hundred and three motor park workers were recruited for the study. Some of the demographic details and serological results are shown in tables 1 and 2.
The age of the participants ranged between 16 and 66 years, with a mean of 35.05yrs, (SD=10.87). Among the participants, 64% had secondary or post secondary education, 70% were married and 74% were Muslims. Seropositivity for HBV was more associated in those of Islamic faith, Fisher’s exact test p=0.018; Pearson chi squared =0.016.With regards to sexual activities, 41% had never used condoms, nearly 15% had contact with commercial sex workers (CSW) in the previous twelve months and 33% had two or more sexual partners in the previous three months. This figure rose to 51% in the previous twelve months. Men with past history of sexually transmitted infections were more likely to be symptomatic compared with those without a previous history, p=0.0001. Statistically, there was no correlation between seropositivity for HBV/HIV and contact with commercial sex workers, level of education or age.
Serology revealed 4 (3.9%) men positive for HIV and 14 (13.6%) men had markers of Hepatitis B virus infection, one man being positive for both HIV and HBV. No participant was serologically positive for syphilis. In the group of men aged 40years or more, 52% had never used condoms, 33% of them had contact with CSW in the previous twelve months, and of the 17 men positive for either HIV or HBV, six (35.3%) were in this age group.
Discussion: The importance of quantitative studies is reflected in some of the results found in this study. For instance, 50% of HIV infection was found in the age group 40 years and above. In our study, the prevalence use of condoms is low in this age group. This is similar to the finding of the 2003 National HIV Sero-Prevalence Sentinel Survey(1) which showed the highest prevalence of 5.1 % in the 40 – 49 age group in South west Nigeria. The reason for this finding is not immediately obvious though there are theories. One of these is that the older age group probably had less formal education, and indulged in high-risk behaviour.
There was a high prevalence of Hepatitis B, about 14%. Investigations on the occurrence of hepatitis B are not common in many developing countries and more studies need to be done.
More than one third of participants in the study had previously contracted a sexually transmitted infection. Some of these were treated with tablets and some parentally with injections and some with traditional medicines. The relationship between sexually transmitted infections (STIs) and HIV infection is well documented from various studies (8). Hence, the control of STIs is seen as a major strategy in the prevention of HIV infection. The rate of condom use, determined by asking if participants had ever used condoms, is high in this study (58.8%). This may be as a result of the fact that participants in the study have been recipients of a coordinated HIV/STD Management Project implemented by the Sagamu Community Centre. This has been on-going since 1998. Another contributory factor to the high prevalence of condom use is the level of secondary school education among the participants, which was also high at 59.2%. Previous studies have shown that high levels of education increase individual accessibility to health promoting information and services. Consistent condom use, which is essential to the prevention of infection, will require further exploration in subsequent studies.
The use of traditional medicines alone or in conjunction with western medicines for various diseases is widespread in Nigeria and this has been previously reported (9,10). Some of these medicines involve body scarifications with razor blades and needles. Unfortunately, many of these instruments have been re-used without adequate sterilization procedures.
These practices encourage the spread of blood borne viruses like HIV and Hepatitis B virus. The major route of spread of HIV in Africa is believed by some workers to be through injections rather than through sexual activities(11-14). The high prevalence of hepatitis B virus infection in this population lends a strong support to the theory that an important route of transmission of hepatitis B virus and HIV is through injections, scarifications etc. rather than sexual. Whatever the route of transmission, there is plenty of room for health education and health promotion. Health seeking behaviour is to be encouraged and practices injurious to health should be discouraged.
References:
1. Federal Ministry of Health (FMOH) National HIV/AIDS and Reproductive Health Survey, Nigeria 2003.
2. Adenekan AK, Oduwole MD, Akinleye OB, et al. The qualitative research on the sexual behaviour of truck drivers and their assistants in Sagamu, a major truck stop in Nigeria. A report presented by The Ogun State University Teaching Hospital research team to Liverpool Associates in Tropical Health /DFID, December, 2000.
3. Adenekan AK, Oduwole MD, Akinleye OB et al. The qualitative research on the sexual health needs of commercial sex workers in Sabo, Sagamu, Nigeria. A report presented by The Ogun State University Teaching Hospital research team to Department for International Development, Liverpool Associates in Tropical Health and Pathfinder International, July 1999.
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9. Opaneye AA. Traditional medicine in Nigeria and modern obstetric practice: need for co-operation. Central African Journal of Medicine 1998; 44(10): 258-261.
10. Osinubi TS, Amaghionyeodiwe LA. Myths surrounding contraception in Ngeria. Int. J. STD AIDS 2005; 16:84.
11. Gisselquist D, Potterat JJ, Brody S, Vachon F. Let it be sexual: how health care transmission of AIDS in Africa was ignored. Int. J. STD AIDS 2003; 14: 148-161.
12. Gisselquist D, Potterat JJ. Review of evidence from risk factor analyses associating HIV infection in African adults with medical injections and multiple sexual partners. Int. J. STD AIDS 2004; 15: 222-233.
13. Reeler AV. Injections: a fatal attraction? Soc. Sci. Med. 1990; 31: 1129-35.
14. Carael M, Holmes K. The multicentre study of factors determining the different prevalences of HIV in Sub- Saharan Africa. AIDS 2001; 15(Suppl. 4): S1-131.
Acknowledgements: This study was partly funded by the Trust funds of the departments of genitourinary medicine and pathology at The James Cook University Hospital, Middlesbrough.Other members of the team were Anne Anderson, Philip Rosenbrier, Yemisi Opaneye, Lois Sewell, and Lucy Gardner. The hospitality of the Sagamu Community Centre and the cooperation of the motor park union officers are appreciated.
Address for correspondence: Dr. A. A. Opaneye
Department of Genito-Urinary Medicine
The James Cook University Hospital,
Middlesbrough,
TS4 3BW.
E-mail: yomi.opaneye@stees.nhs.uk
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