Sexually transmitted diseases and condom interventions among prostitutes and their clients in Cross River State

Abstract

The Cross River State commercial sex worker project started in 1989 as a pilot program to test HIV/AIDS and sexually transmitted disease interventions among full-time and part-time sex workers, their partners and their clients. Three main locations were targeted: Calabar and Ikom in the Cross River State in the first phase of the program and Port Harcourt where outreach started in 1992 to test the replicability of the project outside the Cross River State. The project activities were co-ordinated from Calabar which is 200 kilometres from Ikom and 180 kilometres from Port Harcourt. Approximately 800 prostitutes and 2,000 clients in Cross River State have been reached through 17 sites (12 in Calabar and 5 in Ikom) for full-time sex workers and ten sites (6 in Calabar and 4 in Ikom) for part-time sex workers. In Ikom, a large population of paramilitary men, such as customs officials deployed at border posts between Cross River State and the Republic of Cameroon have been targeted. In contrast, of the 25 sites estimated for full-time and 15 sites for part-time prostitutes in Port Harcourt, only twelve were reached because they were more widely dispersed and prostitute groups were more diverse when gauged by social and economic indicators. The Port Harcourt project aimed to reach approximately 1500 sex workers and 3000 clients within an eight-month period, January to August, 1992. Preliminary contact with prostitutes and their clients was made in 1987 in Calabar by members of the Cross River State AIDS committee. At the time, AIDS was hardly a topical issue for the generality of Nigerians. Primarily it was regarded as a subject of concern for prostitutes, foreigners, and Africans in East and Central African countries. It was not possible to initiate a formal project before 1989 because of financial constraints, resulting in a prolonged period of unstructured interaction with the target group. Nonetheless, this provided the opportunity to build understanding and trust and to sustain dialogue on issues of common interest with the target group. Also during this period, key members of the population such as 'chairladies' (leading prostitutes); their assistants; 'policing agents' responsible for maintenance of law and order and welfare of prostitutes; hotel proprietors and managers and others such as security agents with substantial influence or authority over the target population were identified, and their support secured. It became apparent through this interaction that the effectiveness of any HIV/AIDS and STD prevention and control program aimed at sex workers and their partners would depend on the active participation in project design and implementation of members of the target population. The main objectives were to develop and implement an intervention program to reduce the transmission of HIV/AIDS and STDs among prostitutes, as well as their partners and clients, through providing STD services, condom promotion and health education.