Denial of AIDS and unsafe sex puts Nigerian sailors, and their partners, at risk

“AIDS is now the leading cause of death in military and police forces in some African countries, accounting for more than half of in-service mortality,” write Ugboga Nwokoji and Ademola Ajuwon in the Open Access journal BMC Public Health today. They believe that secrecy about AIDS-related deaths, and multiple sex partnering in the Nigerian navy could be helping to fuel the HIV epidemic in Nigeria, Africa’s most populated country.

Their survey of 480 Nigerian naval personnel revealed that the naval authorities are secretive about AIDS-related deaths. One naval officer insisted, “although we often hear that an officer has died of malaria or of tuberculosis, we never hear about a death from AIDS.”

“Until AIDS-related deaths are discussed openly, naval personnel will continue to deny the existence of the virus and participate in risky behaviours,” say the researchers, from the Nigerian Red Cross Society and the University of Ibadan. They are now calling for a targeted educational program to expose the risks that sailors face from indulging in unsafe sex.

Around a third of the sailors questioned had had sex with a female sex worker, and 41% of these had not used a condom on their last visit. Shockingly, those that were married were around four times less likely to use a condom than those that were single.

As these sailors live with and interact freely with civilians they are a potential bridging group for disseminating HIV into the larger population. The researchers believe that initiatives to prevent this high-risk population from contracting HIV are one of the most realistic ways of controlling further spread of the disease across Nigeria.

“The military authorities need to promote use of condoms more vigorously”, say Nwokoji and Ajuwon. Condoms should be available to all who need them. One officer claimed that, “the naval tradition is that if you are going ashore, you are issued condoms and there is no ration about this, however, due to funding constraints this is no longer practiced.”

The authors report that the HIV epidemic is continuing to grow in Nigeria, despite efforts to control it. An estimated 5.8% of adults, or 3.5 million people, are now infected in the country. According to Nwokoji and Ajuwon, “these figures probably underestimate the real magnitude of the epidemic, because of missed diagnosis and inadequate resources for testing.”

Overall the knowledge of AIDS amongst the survey respondents was good, with the sailors scoring an average of 7 out of 10 on a test about AIDS and HIV. The majority knew that HIV could be transmitted through sexual intercourse, though this hadn’t stopped them from practicing unsafe sex.

This behaviour could be explained by the fact that many sailors thought that traditional medicines could protect them from HIV infection, and over half of those questioned (52.1%) believed that a cure for AIDS was available in Nigeria.

The authors suspect that, “this misconception may have been fostered because of the tacit support the local media gave to a Nigerian surgeon who claimed to have found a cure for AIDS, but would not subject his medication to scientific scrutiny.”