|Year : 2017 | Volume
| Issue : 1 | Page : 6-11
Qualitative study on determinants of HIV risk behaviors among Nigerian seafarers
Ibitein N Okeafor MBBS, FMCPH 1, Chukwuma U Okeafor2
1 Research Support Unit, Eagles Watch Research Centre Care, Port Harcourt, Nigeria
2 Department of Mental health/Neuropsychiatry, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria
|Date of Web Publication||5-Jul-2017|
Ibitein N Okeafor
Eagles Watch Research Centre and Care, 107 East-West Road, Port Harcourt, Rivers State
Source of Support: None, Conflict of Interest: None
Background: Seafarers constitute a highly mobile population who are vulnerable to acquiring and transmitting human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) due to their engagement in HIV risk behaviors. Hence, this study aimed to identify the determinants of HIV risk behaviors among seafarers. Materials and Methods: The study was conducted among Nigerian seafarers in Port Harcourt Seaport, Rivers State Nigeria. A qualitative study was employed using a total of four focus group discussions (FGDs) and comprised of three male groups and one female group. Snow-ball method of sampling was used to recruit participants. Data were collected using a FGD guide. Thematic analysis was performed using QSR NVivo version 10 software (QSR International Pty Ltd., Melbourne, Australia). Data were presented as quotes and charts. Results: The study had a total of 28 participants and comprised of 24 males and four females. The mean age of all participants was 39.3 ± 7.8 years. The participants were knowledgeable on HIV/AIDS risk behaviors. The major determinants of these behaviors as revealed by the participants were lack of self-discipline and not being God-fearing (individual-level factors). Other determinants were long duration (more than 6 months) on sea and not traveling with spouse during sea voyage (seafaring-related factors). The determinants on environment of the port and government-related factors included the presence of brothels in port areas and the absence of sensitization visits, respectively. Conclusion: The study noted varying determinants of HIV risk behaviors from individual level to the government level. The authors advocate the need for peer education among seafarers as well as the implementation of HIV enlightenment programs to discourage HIV risk behaviors.
Keywords: HIV, Nigeria, risk behaviors, seafarers
|How to cite this article:|
Okeafor IN, Okeafor CU. Qualitative study on determinants of HIV risk behaviors among Nigerian seafarers. Afr J Med Health Sci 2017;16:6-11
|How to cite this URL:|
Okeafor IN, Okeafor CU. Qualitative study on determinants of HIV risk behaviors among Nigerian seafarers. Afr J Med Health Sci [serial online] 2017 [cited 2017 Dec 17];16:6-11. Available from: http://www.ajmhs.org/text.asp?2017/16/1/6/209493
| Introduction|| |
Human immunodeficiency virus (HIV) risk behaviors have long been recognized for their key role in the spread of the HIV epidemic. Behavioral surveys in Nigeria, since the first one in 2003, have consistently revealed higher HIV prevalence rates among those engaged in HIV risk behaviors in comparison to the general public. These risk behaviors include unprotected sexual intercourse, multiple sexual partners, homosexuality, transactional sex, intravenous drug use, use of alcohol, and recreational drugs.
Seafarers constitute a highly mobile population responsible for transporting 95% of the world’s goods. The vulnerability of seafarers to acquiring and transmitting HIV infection has been accrued to their wide geographic mobility and long period of separation from intimate partners. In addition, seafarers are almost exclusively men within the sexually active age group who frequently visit port areas, where there are often large numbers of sex workers, and they often carry large sums of cash, which makes them attractive customers for sex workers. Unfortunately, these elements of a seafarer’s occupation encourage high-risk behaviors.
The National Demographic Health Survey 2013 of Nigeria revealed that the high level of HIV knowledge and attitude among the populace did not translate to the anticipated healthy sexual behaviors. This invariably highlights the need to explore determinants of HIV risk behaviors, especially among seafarers, a category of workers, who have also been included in the most-at-risk population for HIV/acquired immune deficiency syndrome (AIDS).
Human behavior is complex, and thus, research on identifying the determinants of HIV risk behaviors among a highly mobile population could provide the information needed to curb such behaviors. In exploring the determinants of behaviors, the qualitative method of research has been shown to uncover pertinent information, which may be missed due to the limitation of quantitative research. Therefore, this study aimed to explore the determinants of HIV risk behaviors among seafarers in Port Harcourt Seaport, Rivers State.
| Materials and Methods|| |
Ethical approval for the procedures of this study was obtained from the Research Ethics Committee of the University of Port Harcourt in Rivers State, Nigeria prior to the commencement of the study. Informed consent was obtained from all the participants. Participants were reassured of the confidentiality of information obtained.
Study location and design
The study was conducted in Port Harcourt Seaport in Rivers State. The Port Harcourt seaport is among the six designated seaports in Nigeria. It is also the major port within the Rivers Port Complex in coastal Rivers State. A cross-sectional study employing a qualitative method of research was adopted in this study.
The study population comprised of Nigerian seafarers in Port Harcourt seaport. The eligibility criteria were seafarers aged 18–60 years and those who had been working for at least 3 months in the seafaring profession at the time of study.
Four focus group discussions (FGDs) comprising of one female and three male groups were performed since almost 90% of the seafarers are males. This was also performed to harness their different perspectives. Snow-ball method of sampling was used to recruit participants for the FGDs. This sampling method was adopted in this study to access seafarers who were presently not on sea voyage during the study. Each of the male FGD had eight participants, whereas the female FGD had four participants. There were only four female seafarers available at the time of the study. Each of the FGD session lasted for about an hour and included an observer/recorder (who recorded the session) and a moderator (INO).
Data were collected using the FGD guide. This guide was based on the review of literature.,, It consisted of main questions with the corresponding probing questions, which were constructed using the funnel approach. Hence, questions on the knowledge of HIV transmission and prevention methods were first explored before questions on HIV risk behaviors and the factors promoting such behaviors.
Thematic analysis of qualitative data was employed using the QSR NVivo version 10 software (QSR International Pty Ltd., Melbourne, Australia). The recorded data from all the various FGDs were transcribed verbatim into Microsoft word document. This was then imported into QSR NVivo version 10 software. The content was read severally to identify themes, which were subsequently coded into different nodes. A coding summary node report was then generated by the software to analyze emerging themes and subthemes. Data were presented as quotes and charts. The ages of respondents were summarized using means and standard deviation. The differences in the mean ages across the four FGDs were compared by the one-way analysis of variance, whereas the differences in proportions were compared using Fisher’s exact test. These statistical analyses were performed using the Statistical Package for the Social Sciences version 20.0 software (SPSS Inc., Chicago, IL, United States). P value of less than 0.05 was considered significant.
| Results|| |
Sociodemographic characteristics of participants
The four focus groups had a total of 28 seafarers, and comprised of 24 males and four females with an age range of 24–52 years. The mean age of all 28 participants was 39.3 ± 7.8 years. The sociodemographic characteristics of the participants are shown in [Table 1]. The comparison of ages of participants across the four groups revealed significant differences (P = 0.030).
|Table 1: Socio-demographic characteristics of participants of focus group discussions|
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Knowledge on human immunodeficiency virus/acquired immune deficiency syndrome
The participants of all the four FGDs were very responsive to the question regarding what they knew about HIV/AIDS. All the participants were aware of HIV/AIDS and affirmed it as a disease transmitted mainly via sex. However, only five of the participants were able to accurately define HIV and AIDS. Several of the participants were able to mention the methods of transmission of HIV/AIDS. Some of the responses included the following: “it can be contacted through sexual intercourse, kissing, sharing sharp objects and blood transfusion.” All the females affirmed mother-to-child transmission of HIV, whereas some of the males in the male group were unsure about this mode of HIV transmission.
Most of the participants mentioned that HIV had no cure, whereas few of them reported that they have only heard of a traditional medicine that cures the disease but have not yet seen anyone cured through traditional medicine. Concerning the knowledge on HIV prevention methods, almost all the participants have heard of the "ABC" acronym (A − abstinence, B − be faithful, and C − condom use) for HIV prevention. “Not sharing sharp objects, screening of blood before transfusion, fleeing from prostitutes, always using condom…” were some of the prominent responses on ways of preventing HIV/AIDS.
Human immunodeficiency virus risk behaviors
The participants expressed several answers on HIV risk behaviors. The common responses in all the groups were nonuse of condom, having several sex partners, and sharing sharp objects. In one of the male groups, “going to night clubs” was also mentioned as a risk behavior for HIV. However, some of the participants’ in this group disagreed, vehemently stating: “going to night club cannot be a risk behavior that increases one’s chance of getting HIV/AIDS as some people go to night club and are disciplined and do not get drunk,” whereas the others opined that “night club is an avenue to meet new women and take excessive alcohol which could make one forget to use condom and get HIV.” Almost all participants in all groups upheld the view that sexual transmission is the main way HIV is transmitted and unprotected sex greatly increases one’s chance of getting HIV/AIDS. Other responses included “patronizing prostitutes, having too many sex partners, and excessive alcohol intake.” Some of the participants opined flippantly that such behaviors are part of the seafaring profession.
Hence, the emerging themes on HIV risk behaviors among seafarers from all the focus groups were multiple sex partners, patronizing prostitutes, not using condom, sharing sharp objects, excessive alcohol intake, and going to places that could increase HIV risk behaviors such as nightclubs.
Determinants of human immunodeficiency virus risk behaviors among seafarers
A myriad of responses were given on factors that encourage HIV risk behaviors. These responses from the seafarers were grouped into themes comprising of individual factors, seafaring related factors, factors related to the environment of the port, and government factors.
In all the four FGDs, the majority of the participants identified individual factors as a determinant of HIV risk behaviors. Some of the responses included: “lack of discipline among seafarers leads to HIV risk behaviors” and “when there is no fear of God, seafarers engage in such risky behaviors.”
One of the prominent responses was:
“the number one factor that determines these HIV risk behaviors is the individual mindset and lack of carefulness.”
– FGD 1, Mr. B, 36 years old, tertiary level of education.
Another theme that emerged from the FGDs was the seafaring-related factor. In all the four FGDs, long time on sea was mentioned as a factor that could encourage seafarers to engage in HIV risk behavior. Prominent responses included:
“as seafarers when we are on the sea for so long, it is as if we are sex starved and feel sick so any opportunity to misbehave we succumb.”
– FGD 1, Mr. H, 42 years old, secondary level of education.
“…not travelling along with spouse could cause seafarers to engage in risky behaviors.”
– FGD 4, Miss D, 32 years old, secondary level of education.
Hence, the seafaring-related factors that could lead to HIV risk behaviors were long duration on sea and not traveling with spouse during voyage.
The themes on the environment of the port and government factors were of concern to the seafarers, as some of them expressed displeasure with the port authorities in the course of their responses. Some of the responses were:
“As soon as the ship berths at the port, there are several women, prostitutes waiting for you, so how will we not engage in HIV risk behaviors?”
– FGD 3, Mr B, 47 years old, tertiary level of education.
“The port authority and government are also responsible, they do not care about the health of seafarers, no free condoms, no health talk, no encouragement, our work is not easy.”
– FGD 2, Mr F, 36 years old, tertiary level of education.
The determinants of HIV risk behaviors among seafarers identified from the FGDs are summarized in [Figure 1].
|Figure 1: Summary chart on determinants of HIV risk behaviors among the participants|
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| Discussion|| |
The significant differences in the mean ages of the participants across the different focus groups could further buttress the variability of the groups. This enhances the robustness of this study, because the views across the varying ages were expected to be represented.
The affirmation that HIV/AIDS is transmitted mainly via sexual route by all the participants in this study possibly highlights the influence of mass media and health educators in disseminating information on HIV/AIDS. However, some of the participants showed some uncertainty with regard to mother-to-child transmission of HIV/AIDS. Hence, there is a need for the institution of robust and regular HIV enlightenment programs among them.
This study noted that the participants in all the focus groups were conversant with behaviors that could increase their chances of being infected with the disease. Although this study did not assess their individual risk perception, it found that some of the participants viewed risky behaviors as part of the seafaring profession. This correlates with studies in Kiribati, Thailand, and Philippines, which noted the practice of HIV risk behaviors among seafarers. This further justifies the need to understudy the determinants of such behaviors among seafarers.
The individual level factors of indiscipline and lack of the fear of God identified as the main determinants of HIV risk behaviors by almost all of the seafarers in this study possibly uncover the need for peer education among seafarers. Peer education targeted at promoting self-discipline and healthy behaviors is hereby advocated. This finding contrasts sharply with a similar qualitative study among Thai seafarers, in which the participants did not identify these factors as determinants. This difference could be explained by the sociocultural and religious dissimilarities. For instance, in Nigerian and most African settings, a sense of belief in God is the norm of the society and religion is strongly inculcated among the population unlike in non-African settings.
The seafaring-related determinant of long duration of sea voyage has similarly been reported in both qualitative and quantitative research. Long duration on voyage promotes risky sexual behaviors by altering the psychic function causing emotional disturbances, which may precipitate the indulgence of HIV risk behaviors. Not traveling on sea voyage with spouse was another seafaring-related determinant identified from the study. However, this was mentioned only among the female group. Nonetheless, it is hoped that instituting policies that would permit spouses of seafarers to travel along the sea voyage would curb these risky behaviors. On the other hand, the cost implications to the seafarers and shipping company may be high if this is implemented but it may be profitable to the health of seafarers in the long run.The presence of brothels around the ports serves as bait to the seafarers, because this was identified as one of the determinants of HIV risk behaviors in this study. This is not peculiar to Nigeria, because the study in Thailand also noted similar findings in Thai ports. In addition, the study in Thai noted that the government implemented 100% condom use policy in brothels. The findings of the present study expose the need to ban brothels around the ports to discourage HIV risk behaviors among this highly mobile population. However, in the context of the legalization of brothels in Nigeria, a ban may, therefore, not be feasible; nonetheless the need for HIV-preventive measures such as consistent condom use is strongly advocated.
The expression of displeasure and dissatisfaction with the port health authority by the seafarers in the present study stems from the opinion that the authority fails to organize HIV sensitization visits and, hence, they believe that they are not concerned about their health. Most of the seafarers identified lack of HIV sensitization by the port authority as a determinant of HIV risk behaviors. Therefore, this study recommends regular HIV sensitization visits and campaigns to seafarers in Nigeria.
Although the qualitative nature of this study was useful in exploring varying determinants of risky behaviors among seafarers, a limitation could be the small sample size associated with FGDs. Noteworthily, some of the findings were comparable to some quantitative studies. The strength of this study lies in its ability to identify perceived determinants of HIV risk behavior among seafarers. Furthermore, in the authors’ best of literature search, this is the first study in Nigeria to undertake an enquiry using qualitative method to identify the determinants of HIV risk behaviors among seafarers.
| Conclusion|| |
Nigerian seafarers are aware of HIV/AIDS as well as the risky behaviors associated with the disease. The determinants of these behaviors as perceived by the participants were lack of self-discipline of seafarers, lack of the fear of God, presence of brothels/sex workers around the ports, not traveling along with spouse during sea voyage, long duration of sea voyage, and lack of HIV sensitization visits by government. Hence, the need for peer education among seafarers and regular HIV enlightenment programs among this highly mobile population are advocated.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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