Sexual Characteristics and Knowledge of Adolescent Hawkers about HIV / AIDS in Ilorin , Nigeria * 1

Introduction: Adolescent street hawkers working in the informal sector in Nigeria are becoming increasingly exposed to the risk of Human Immunodeficiency Virus (HIV) infection. The objective of this study is to determine the sexual characteristics and knowledge of hawkers concerning HIV/AIDS. Methodology: This study is a descriptive cross – sectional survey carried out in Ilorin among adolescent hawkers aged 11 – 19 years. All adolescent hawkers in six selected auto-parks and markets in Ilorin were recruited until the desired sample size of 312 respondents was obtained. The sample size was determined using Fischer’s Formula. Semi-structured, pre-tested interviewer – administered questionnaire was used for data collection and entered into Epi-Info computer software for analysis. Frequency tables and cross-tabulation of variables were done and P-value <0.05 was used to determine statistical significance. Result: All the respondents have heard about HIV/AIDS. About half of the hawkers (48.8%) knew the causative agents of HIV/AIDs while 83.4% demonstrated correct knowledge in ways of contracting the infection. Almost all the hawkers 309 (97%) had not gone for HIV/AIDS test. Hawkers that have ever had sexual intercourse were 31.9%. Of those that had sexual intercourse, 24.5% ever used condom. Of those that used condom, 24.0% used it always while 76.0% do not use it always. Conclusion & Recommendations: Unprotected adolescent sexual intercourse is high among hawkers, with a background low HIV screening status. There is need for a societal re-orientation on the hazards of hawking as it relates to sexual hazards. There is need to carry out health education intervention on the causes and ways to prevent HIV/AIDS among the hawkers to bridge the knowledge gap.


INTRODUCTION
Nigeria carries the second highest burden of HIV in Africa and has an expanding population of people living with HIV (PLWH) (National Agency for the Control of AIDS/NACA, 2012 www.unaids.org/en/dataanalysis).HIV was first reported in 1986 and as at 2012 (26 years later), about 3.5 million persons now live with HIV and an estimated 1.5 million persons require Anti-Retroviral (ARV) drugs.(National Agency for the Control of AIDS, 2012 www.unaids.org/en/dataanalysis;HIV and AIDS Estimates 2011).In 2011, there were 388, 864 new infections and 217, 148 HIV deaths (NACA, 2012 (www.unaids.org/en/dataanalysis;Federal Ministry of Health 2008) in Nigeria.
Sero-prevalence level of HIV in Nigeria which was obtained from sentinel surveys of antenatal care attendees, increased from 1.8% in 1991 to 5.8% in 2001.It then declined to 5.0% in 2003 and further to 4.4% in 2005.This was followed by a rise to 4.6% in 2008 and then a recent decline to 4.1% in 2010 (National Agency for the Control of AIDS, 2012 www.unaids.org/en/dataanalysis).As at 2012, the percentage of young women and men (15-24 years) who correctly identified ways of preventing sexual transmission of HIV was 24.2% while those that had sexual intercourse before 15 years were 11.9% (NACA,2012).The percentage of young women and men (15-49 years) who had sexual intercourse with more than 1 partner in the last 12 months was 11.4% while those who used condoms in the last intercourse were 52.5%.Those who had HIV test conducted in the past were 11.7% (NACA,2012).
Young girls such as hawkers working in the informal sector of the Nigerian economy face the risk of HIV infection (Mudingayi et al, 2011).A study carried out on sexual behavior and vulnerability of 126 female street hawkers in Nigeria revealed that 79.4% were sexually active out of which 62.6% initiated sex at age 11 years or below (Ikechebelu et al, 2008).As regards knowledge of HIV, 64.3% of the adolescent hawkers mentioned sexual intercourse as the major route while 35.7% mentioned blood contacts as the major routes of transmission (Ikechebelu et al, 2008).Female hawkers that used condoms during sexual intercourse were 7.1% (Ikechebelu et al, 2008).
Another study which investigated violent acts among female hawkers in south-western Nigeria showed that sexual violence was the commonest form of violence experienced.This was evidenced by the fact that 30.4% of respondents said they had experienced sexual violence in the past (Fawole et al, 2003).This underscores the point made by Morrison-Beedy et al that adolescent girls now represent one of the fastest growing groups of persons infected with HIV (Morrison-Beedy and Nelson, 2004).Similarly, Oladepo et al showed that young people are becoming increasingly exposed to the risk of HIV infection as 3.3% of young people aged 15-19 years are said to be infected in Nigeria (Oladepo and Fayemi, 2011).
As adolescent hawkers go about their daily business, they are exposed to a lot of risks.For instance, the female hawkers are exposed to the risk of being raped while hawking from house to house (Fawole et al, 2003).As the youths also interact with each other, their interaction has a profound effect on their individual and collective health especially in the area of sexual expression and negative habit formation such as drug addiction and alcohol consumption and these habits can result in increased incidence of sexually transmitted infections including HIV infection (Fawole et al, 2003).This study set out to investigate the sexual characteristics and knowledge of adolescent hawkers about HIV/AIDS.

MATERIALS AND METHODS
The study was carried out in Ilorin which is the capital of Kwara State and located in North-Central Nigeria.Hawking of goods is commonly found at auto-parks and markets.The hawkers normally patronize vehicles that are loading passengers ready to embark on a journey or they beckon to these passengers with plea to buy their products.Sometimes, they rush at vehicles just coming from a journey from which passengers are about to alight.In some instances, the female hawkers are called to bring their goods for sale and the male customers may promise to pay for all the goods and in return make sexual advances or rape the female hawker.
This study is a descriptive cross-sectional survey.The target population for sampling consisted of adolescent hawkers aged 11 -19 years who frequently hawk in and around the selected auto-parks and markets.Those that were excluded from the study were non-hawkers in the auto-parks and markets.Sample size of 312 was calculated using Fischer's formula.Three auto-parks and three markets in Ilorin were selected using simple random sampling.All adolescent hawkers that met the inclusion criteria in each of the six selected autoparks and markets were recruited until the desired sample size was obtained.Semi-structured intervieweradministered questionnaire was used for data collection.Questions that were asked were mainly closed-ended questions with few open-ended questions.The questionnaire was developed to elicit information on the sociodemographic background, knowledge, attitude to HIV/AIDS, sexual practices and experiences.The pre-testing of the research tools was carried out at the Ganmo auto-park in Ifelodun Local Government.Thirty-two (32) adolescent hawkers representing 10% of the study sample were interviewed during the pre-testing.Respondents were anonymously interviewed after obtaining informed-consent from the adolescent hawkers.Permission to conduct the study was obtained from the chairmen of the NURTW/RTEAN of the auto-parks and the market leaders.All information was treated with confidentiality.The administered questionnaire were numbered and checked for errors and accuracy.Records of the respondents which are complete were analyzed using EPI-INFO software.The data collected were presented as tables using frequency distributions and percentages.Chi-square was used to test association between variables and p-value of 0.05 was set to determine statistical significance.

RESULTS
There were a total of 312 respondents interviewed in this study.They were adolescent hawkers in six auto-parks and markets in Ilorin, kwara state.Table 1 shows that majority of the respondents (33.1% ) were within the 13 -14years age group, while the least (19.7%) were within the 17-19years age group.The mean age of the respondents is 15.67± 3.63.Higher proportions (61.9%) of the respondents were females.Respondents with secondary educational status accounted for the highest proportion (60.9%).This was followed by primary educational status (26.9%), no formal education (6.6%) and tertiary educational status (5.6%).Majority of the respondents (67.5%) live with parents, out of which the highest proportion (38.4%), live with both parents.Table 2 shows that, most of the respondents (76.3%) do not live in the community where they sell their goods.The highest proportion of those interviewed (56.9%) hawk for 4 to 6 hours per day.All the respondents (100%) have heard about HIV/AIDS with source of information being the mass media in 90.9% respondents.The highest proportion of respondents that ever used condom was from those within the age range 17-19years.(Table 5) There was a descending trend in the use of condom as the age of respondents decreased, with the least proportion of respondents that ever used condom being those within the age range 11-12 years.Similarly, the higher the educational status, the higher the use of condom, with the highest proportion of respondents that ever used condom, being those with secondary educational status.There was statistically significant association between age group, educational status and the use of condom.Concerning the sex of respondents, a higher proportion of the males (40.7%) than the females (18.7%) ever used condom.There was also statistically significant association between male sex and use of condom.

DISCUSSION
Most of the respondents 106 (33.1%) are within the age group 13-14 years, while the mean age of the respondents is 15.67 ± 3.63.An inference that can be drawn from, as it relates to sexual issues among the hawkers, is that they can easily be taken advantage of or lured into unsafe sexual practices because of the relatively young age group which is 13-14 years.
Another implication of this is that adolescent hawkers will benefit more from programs directed at the early age-group especially those aged 13-14 years.This refers to early teenage years.When this finding was compared with another study by Araoye on female adolescent hawkers in Nigeria, larger number of respondents fell within the age bracket of 15-19 years (54.1%)Araoye, M.O. (2004).This difference could have been because the respondents in Araoye study were entirely females.The findings from this study was also compared with Ikechelebu study in Eastern Nigeria.The peak age group among hawkers was found to be age 15-16 years while hawkers that fell within the age group 13-14 years were 25.8%.(Ikechebelu et al, 2008).Though slightly different, the findings are relatively similar showing peak age of hawkers to be mid teenage years.
In this study, most of the respondents 198 (61.9%) were females.This is critical because females are usually more vulnerable in the HIV/AIDS scourge.The finding that most hawkers are females further complicates the already existing vulnerability of women.However, in a study on HIV knowledge and sexual risk behavior in Kinshasa among street adolescents, they found more males (54%) than females (46%) among the respondents (Mudingayi et al, 2011).A previous study on Violence and HIV/AIDS prevention among female out-of-school youths in southwestern Nigeria carried out by Fawole et al established that young girls working in the informal sector of the Nigerian economy face the risk of HIV infection (Fawole et al, 2004).
Respondents that never had formal education were 26.9%.This is much higher when compared to a study carried out by Ikechebelu on sexual abuse among juvenile female street hawkers in Anambra state where 12.9% of respondents have never had any formal education (Ikechebelu et al, 2008).This has implication for educational programs.While it may be relatively easy to design a program for hawkers that have some level of literacy, it could be particularly challenging to design a program for young people who have no form of education in this present age.
In an Ilorin study, in-school adolescents among female hawkers were found to be 39.8%.(Araoye, M.O.2004).One hundred and forty eight (46.3%) of the respondents attends school every day while 57 (17.8%) of the respondents do not attend school every day.The level of education of any group determines the likelihood of taking and adhering to positive health messages.The level of education among the respondents therefore calls for worries.
It is also important to note that education tended to increase the level of awareness among hawkers about being infected with HIV and other Sexually Transmitted infections as found out by Ikechelebu.He found out that 67.7% of in-school hawkers were aware that they could be infected with HIV while it was only 39% of out-of-school hawkers that had such awareness.(Ikechebelu et al, 2008) Another study also pointed out that education not only affects changes in sexual behavior, but also predicts level of knowledge about the disease.A study based on data from the 1998-1999 National Family Health Survey (NFHS) of India found that the higher the level of education of women, the more likely it is that they will have greater awareness of and accurate knowledge on AIDS.(World Food Program 2006) Another significant result from this analysis was the importance of informal learning in rural areas: women's knowledge of AIDS depended on interaction with people of equal or higher education levels.A study undertaken in Nepal confirmed these results: there was a significant correlation between women's level of education, both formal and informal, and their knowledge of HIV/AIDS.(World Food Program 2006) One-third of the respondents do not live with their parents.Parental influence is very important, especially when it comes to reproductive health education.This will be lacking among this proportion of respondents.Most of the hawkers 224 (76.3%) don't live in the community where they sell their goods while 76 (23.8%) sells their goods within the community they live in.This makes the hawkers more vulnerable to sexual assault along the line of their duties as they work in places where they are not very familiar with and they can be taken advantage of considering their age.Most respondents hawk between 4-6 hours per day, 82 (25.6%) hawks between 1-3 hours per day while 56 (17.5%) of the respondents hawk more than 6 hours per day.The mean daily duration for hawking is 3.86 ± 1.94.
Most of the respondents gave the reason that they hawk to be parental or caregiver directive, 62 (19.4%) said its personal interest while 39 (12.2%) said it is as a result of friends influence.The inference that can be drawn from this fact is that parental education has to be incorporated into any program that will be drawn up to positively affect the hawkers.This is because a greater proportion of hawkers do so at the instance of their parents.Their parents will need to be carried along to be able to institute control.162 (50.6%) of the respondents said parents owned the goods, and 62 (19.4%) owned their goods while 96 (30.0%) of the respondents said the goods were owned by other relatives.Just as the case is of parents influence in hawking, other relatives also appear to be influential as 30% of hawkers accept that other relatives own the goods.There may therefore be need for a societal re-orientation on the sexual hazards of hawking.
All the respondents have heard about HIV/AIDS.This finding is in line with the finding from Lagos in a study on family background, sexual behavior and HIV/AIDS vulnerability of female street hawkers in Lagos metropolis (Fawole et al, 2003).In the Lagos study, 100% of the respondents have also heard about HIV/AIDS.In the Ilorin study among female hawkers, 80% of the hawkers were aware of HIV/AIDS Araoye, M.O. ( 2004).This has positive implication for interventions as the population in question has awareness about HIV/AIDS.However, caution needs to be exercised in interpreting this as awareness does not necessarily translate to indepth knowledge.
In this study, 261 (81.6%) of the respondents heard about HIV/AIDS in School, 103 (32.2%) from their parent, 98 (30.6) from relatives, 56 (17.5%) from health workers while majority 291 (90.9%) heard about HIV/AIDS from Mass media.In a related study, 36.6%,25.9% and 22.9% of hawkers heard about HIV/AIDS from Television, Radio and Friends respectively Araoye, M.O. (2004).This also has implications for intervention programs that may be designed for this group.It will be good to use this media and peer education from which they got this knowledge to reach them.Particularly, peer education was demonstrated as Ajuwon et al to have produced positive result among female hawkers.(Ajuwon AJ. 2005;Ajuwon et al;Ajuwon et al, 1998).In the study in Ibadan, Nigeria, female hawkers trained as peer educators counseled 428 persons on sexuality related issues.This was found to be an important benefit given that sexuality issue is generally considered a taboo subject in Nigeria.(Ajuwon AJ. 2005;Ajuwon et al;Ajuwon et al, 1998).
About half of the hawkers, 156 (48.8%) knew the causative agent of HIV/AIDs while others 164 (51.3%) of the hawkers did not know.This is very similar to another study where 48.1% of female hawkers did not know the causative agent of HIV/AIDS Araoye, M.O. (2004).Furthermore, only 98 (62.8%) of those that knew the causative agent were correct while 58 (37.2%) were wrong.Also, 118 (36.9%) of the hawkers were correct about the knowledge of HIV/AIDS while 202 (63.1%) were wrong about the knowledge.
In Figure 1 almost all the hawkers 309 (97%) had not gone for HIV/AIDS test.Only 11 (3%) of the hawkers had gone for HIV/AIDS test.This is a critical finding considering the background information of their risky sexual behaviors.The implication is that they have not had HIV counseling done for them nor are they aware of their status.This puts them and the society at large at risk.Also, in the ways of contracting HIVAIDS, 267 (83.4%) were correct while 53 (16.6) were wrong.Most hawkers, 112 (38.1%) were of the opinion that the use of condom is the way to prevent HIV/AIDS, 86 (26.9%) said abstinence, 58 (18.1%) said faithfulness while 54 (16.9%) did not know the ways to prevent HIV/AIDS.This portrays a generally poor knowledge about HIV.This is similar to findings from another study on female hawkers (Ekanemm et al, 2005).In the study, the hawkers averaged 3.2 on a 7-point AIDS knowledge scale (Ekanemm et al, 2005).Also 27% believed that there is a cure for HIV/AIDs, and 57% believed that HIV can be transmitted through use of toilet seats (Ekanemm et al, 2005).All these point to a major knowledge gap among hawkers about HIV/AIDS.
In Table 4, hawkers that have ever had sexual intercourse were 31.9%.This is similar to Araoye study where 38.3% have had sexual intercourse among female hawkers (Araoye, M.O. 2004).Of those that had sexual intercourse, 64 (62.7%) said they had their first sexual intercourse at age less than 18 years while 38 (37.3%) had their first sexual intercourse at age greater than 18 years.Also, 83 (81.4%) of those that had sexual intercourse had it in the last 3 months while 19 (18.6%) have not had sexual intercourse in the last 3 months.In addition, of those that had sexual intercourse, 39 (38.2%) of the hawkers had more than one sexual partner while 63 (61.8%) had just one sexual partner.This finding, when compared to the finding in Ukraine shows wide disparity (Busza et al, 2011).In Ukraine, about 75% of street based adolescents have had sexual intercourse compared with the finding of 38% in this part of the world.Of those that had sexual intercourse, 25 (24.5%) have ever used condom and 77 (75.5%) have not used condom.This finding is particularly important as most respondents are engaged in risky sexual practices.This is similar to the findings by Ekanemm et al where the condom use rate among commercial bus drivers was 65.2% (Ekanemm et al, 2005).This finding bears a significant relationship with female hawkers because the commercial bus drivers said that young female hawkers constituted a significant aspect of their sexual network (Ekanemm et al, 2005).
Of those that used condom, 6 (24.0%) use it always while 19 (76.0%) don't use it always.(Table 4) Also, 8 (32.0%) used it in the last intercourse while 17 (68.0%)did not use it in last intercourse.Furthermore, 11 (44.0%) of those that use condom know the correct use of it while 14 (56.0%)do not know the correct use of it.

CONCLUSION
Most adolescent hawkers are females that have no formal education.Most respondents hawk 4-6 hours per day as a result of parental or care-givers' directive.All respondents have heard about HIV mainly from the mass media and school.However, knowledge about HIV/AIDS is poor while unprotected sexual intercourse is common practice among adolescent hawkers.
Programs directed at hawkers should be structured to cater for the females that have no formal education.There is need for a societal re-orientation on the hazards of hawking as it relates to sexual hazards.There is need to carry out health education intervention on the causes and ways to prevent HIV/AIDS among the hawkers to bridge the knowledge gap.There is need to use the mass media and peer education in order to reach the hawkers with health education message.There is need for sexuality education to be introduced before teenage years.
Very important is also the need for interventions to test for HIV prevalence among these hawkers as a very small proportion of them has been tested for HIV in the past.

Figure 1 :
Figure 1: Respondents response towards HIV/AIDS Test

Table 2 : Duration and reasons for hawking Frequency Percentage Live in the community where you sell
Table3addressed knowledge of adolescent hawkers about HIV/AIDS.In ways of contracting HIV/AIDS, more than three quarters (83.4%) of respondents were correct, 61.3% know that HIV/AIDS is not curable while 97% had not gone for HIV/AIDS test.Responses towards attitude and practice revealed that 31.9% of hawkers have had sexual intercourse, 62.7% have had sexual intercourse before the age of 18years, 38.2% have more than one sexual partner and 75.5% have never used condom.