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When Culture Harms The Girls: The Globalisation of Female Genital Mutilation

Research and Capacity Building for the Promotion of Sexual Health and Well-Being in the West Africa Region
An Ethiopian girl in a meeting organised an NGO campaigning against FGM. She is worried because she doesn't know how she will get a husband if she refuses to be circumcised. credit: IRIN


When HIV was first reported in1981, there was very little concern that the disease will spread to Nigeria. Nevertheless, there have been apprehensions about the incidence and prevalence of sexually transmitted disease long before the advent of HIV/AIDS. Despite the near universal knowledge of STDs, earlier studies on the incidence and prevalence of the disease were clinically based. Hence research needs and the intervention strategies were also clinically oriented.

Our earlier studies on the social and behavior context of HIV/AIDS in Nigeria were undertaken in the shadow of the AIDS epidemic in Nigeria on two basic assumptions. The first was to increase social science presence and research capacity available to the AIDS epidemic. The second was to provide empirical information that can assist in shaping possible intervention and measuring their impact (Orubuloye et al, 1994). These approaches were important because the major protection available in much of sub-Saharan Africa countries against HIV/AIDS, and probably most STDs, in the foreseeable future, is sexual behaviour change. 

Findings from research programmes in Nigeria have shown that nearly every adult member of the Nigeria society has heard of at least one type of venereal disease, and know that it can be transmitted by sexual relations. In one of the study about one-third of all sexually active males and females reported that they have been treated for a sexually transmitted disease in their lifetime (Orubuloye, et al, 1994). It is well recognized that many men and women will eventually suffer from sexually transmitted disease during the course of their active sexual life. It is generally regarded as a form of social incompleteness among the general population, if a sexually active man had not experienced or had been treated for a venereal disease in his sexually active life. Hence venereal disease was not seen as posing a great danger to society; hence little attention was devoted to the social and behavioral context of the disease.

The situation has changed since the AIDS epidemic began, especially with the evidence that the disease is spread mainly through heterosexual relations, and that STDs is a major co-factor in the spread of HIV/AIDS.

It is now well recognized that in many developing countries, a past history of STDs is closely associated with AIDS. In sub Saharan Africa, the proportion of AIDS patients with past history of STDs varies from 35 percent in Tanzania to 50 percent in Zaire (DRC). The figures range from 67 percent in Rwanda to 75 percent in Zimbabwe, while the proportion was as 71 percent in Haiti and 70 percent ion Martinique (Pepin et al.1989). In Uganda, there is the evidence that chancroid, syphilis and gonorrhea facilitate the transmission of HIV (Berkley et al 1989). This is partly because of the high prevalence of STDs in the region, and mostly because of the growing importance of STDs as co-factor in the spread of AIDS. Thus, questions on the recognition of STDs symptoms are now nested in general survey of sexual behaviors.

In STDs survey, respondents are asked series of questions on the type of symptoms experienced, whether and where treatment was sought, type of treatment received and the outcome of such treatment (Orubuloye, et al, 1994). In Nigeria, attempts have also been made to study the health-seeking behavior of STDs patients attending hospitals and health clinics in an urban area of Southwest Nigeria (Akinnawo and Oguntimehin, 1995)

These studies are aimed at developing appropriate intervention strategies that will facilitate the treatment of STDs patients and stem the spread of the disease. 

The first case of AIDS in Nigeria, involving a sexually active thirteen year- old girl was officially reported in 1984 (Nigeria, 1992). Subsequent cases were found among commercial sex workers at the major nodes of transport and commerce: Lagos, Ibadan, Calabar, Enugu and Maiduguri. The initial reaction to the epidemic was negative. Most people believed that the disease originated from foreigners who brought it to the women in the industry. It was also general believed that the only way to avoid the disease was to refuse contact with Europeans and the women working in the sex industry. By 1991, HIV- positive truck drivers were detected and concern arose in the industry and among the general population.

The situation has change. AIDS has now been detected in all segments of the Nigerian population. Since the enthronement of democratic government in May 1999 attention has focus on the AIDS epidemic. The economic difficulties and political instability of the last decade have largely drawn the attention of government away from the AIDS epidemic.

The Nigeria 1999 sentinel survey indicated that about 5.4 percent of the Nigerian population may well be HIV positive. This translates to about 2.6 million people that are likely infected with HIV. The year 2001 sentinel survey indicated a 5.8 percent level of HIV positive cases in the country. These figures are staggering and among the highest in sub –Sahara Africa. In sub-Sahara Africa, the AIDS epidemic has been identified as a heterosexual epidemic and the degree of sexual networking (relations with partners) has been confirmed to influence the level of the disease, earlier researches were focused on the determination of the degree and nature of sexual networking. Research effort was first concentrated on the general population and subsequent efforts focused on high-risk groups and men’s sexual behavior.

In sub- Sahara Africa, sexual activity is defined by social and economic context and cultural sanctions and taboos exact behaviors to maintain the structures of power, and there are taboos against discussing sex with men of different generations, or in public or with the opposite sex (Middle 1997 4:67). The AIDS epidemic has gradually unraveled the mystery surrounding sexuality. Men and women are equally at risk of begin infected with HIV, with nearly 80percent of the risk attributable to heterosexual transmission.

The nature and structure of the African family system are important determinants of patterns of sexual relations within and outside marriage (Orubuloye et al 1997). Polygyny meant substantial delay of male first marriage, and produces a situation where half of adult males are single and sexually active. It has also taught men that relations with only one woman are not part of man’s nature. Postpartum abstinence and low level of contractception make the majority of women unavailable for sex for a considerable of their reproductive life span.

An intensive study of multi-partnered sexual relations undertaken in 1989 in the Ekiti District (now Ekiti State) in Southwest Nigeria found that three-quarters of single males, slightly more than half of monogamously married males and a little over a quarter of polygynously married males had extra-marital sexual relations during the previous year (Orubuloye, Caldwell and Caldwell 1991). The single and polygynously married women reported high level of participation in extra-marital relationships; nevertheless they are more discreet in such relationships than their male counterparts. Subsequently, a study of male sexual behavior and its social and ideational; context was carried out. It aimed at finding out the attitudes of men and women toward men’s need for more than one woman. It also investigated whether men are thought to be biological different from women in need for sexual variety, as well as reporting on men’s actual sexual behavior and their wives’ reaction to it.

Studies have indicated that women are much likely than a man to believe that one woman is sufficient for a man over a lifetime (Orubuloye et al, 1991). This was especially the case among women in monogamous unions than those in polygynous marriages. Most women in polygynous marriages tend to start their marital life in monogamous relationships and latter end up in polygynous union as their husbands acquired more wives. In traditional society most married women believed that as the circumstance of their husband changes, he is likely to acquire more women. Most women look up to this as an inevitatable event in their lifetime, and some may assist or encourage their husbands towards this. Most women in the rural area and the less educated one in the urban areas with grown up children are not obsessed with their husbands acquiring additional wives. Women in is situation would welcome additional women as a co- wife than the husband keeping girl friends outside. Once this happens, the status of the woman changes and she becomes less responsible to the man. Her attention will shift to her children. Educated women and Christian are far more likely to believed in insist on sexual monogamy, and they are far more likely to succeed than the less educated woman. Islamic religion considers extramarital relations that do not end up in marriage as adultery but approves of polygyny provided the man can make adequate provision for the women and love them equally. Men and women who believed that men will seek multiple female partners explains this in terms of men’s’ fundamental nature and the culture, while Christians see monogamous relationship as the Christian way of life proclaimed in the Bible and preached in the Gospel. Although Christianity preaches monogamy, it is flexible on matter relating to multiple partnership and adultery. Men who have more than one wife, and men and women who engage in extramarital relationships may be denied taking part in sacred activities such as the Holy communion, they are less likely to be sent away from the church on primarily because of sudden sexual urges and the need for variety of sexual partners. The proportion of men in this category was nevertheless below that of those who believe that they can confine themselves to one woman in their lifetime.

Because a range of social and economic factors facilitates men’s extramarital sexual transgressions, the control by their partners has been difficult. Most husbands and wives do not eat; sleeps go out together, and maintain a common budget. Therefore there is no control of what men do with their income, women are not expected to know or concern themselves with this. In polygynous households, women are not supposed to notice their husbands ‘ sexual activities or feel jealous about them; primarily because their coming into the households derives from such relationships in first instance. Most men believe or pretend that their wives have no knowledge of their extramarital affairs.

Although nearly all women with straying husbands were aware that something was going on, they often say nothing because both their husbands and the society would detest their behavior. Nevertheless, the more educated and Christian wives have most faith in their husbands, and they are far more likely to control their husbands’ sexual behavior and complaint if their husband were leading a profligate lifestyle. The majority of complaints were that the men would become infected with sexual transmitted disease or would bring disease, especially gonorrhea, into the marriage. With the AIDS epidemic well underway, majority of urban women believed that men could be induced to confine their sexuality to marriage. This is a dream not yet shared by the majority of men. Most rural women believed and agreed that men often need more than one wife, partly because polygyny is part of the culture and mostly because of the need for adequate farm labor force. In real life situation the potentials of such labor force are no longer being realized because of the jealousy and acrimonies that now surround polygynous marriages. In rural life complaints about men sexually straying are not just the business of husband and wife but all of the relatives surrounding them. Women in the rural area are often the scapegoat if they press their complaints too hard. The phenomenon of outside wife, a new variant of polygyny, is real even among the high-educated urban middle class in society (Karanja 1987).

Bigamy, the act of marring a second time when one is already legally married, is also not new. Although the act is an offence under the marriage Act, women whose husband are involved in this act seldom prosecute them for fear of bringing shame to the family. Most women tend to leave with the situation, while some opt for dissolution of their marriage without pressing for damages against the husbands, and may subsequently retain the name of their husband. Certainly wives tradition have little control over their husbands’ extramarital sexual relationships; they are far more likely to try to control their sons’ sexual activity or to see that it is conducted in safety or that it does not result in making girls pregnant. There are community sanctions on wives monitoring their husbands’ behavior; there appear not to be parallel sanctions on mothers watching their sons ‘sexual behavior. Nevertheless, mothers consider monitoring their sons’ sexual behavior as their moral rights and social obligations to them. In contrast the community experts mother to monitor their daughters’ sexual behavior and there are sanctions for failure to do so. Most parents have the fear of their daughters’ becoming pregnant before finishing at school; hence mothers to enforce premarital chastity on their daughters while their sons’ are given some degree of sexual freedom.

Traditional society continues to have a story influence on contemporary society and its mores. Traditional religion did not impose sanction on male and female extramarital and non-marital sexuality. Discreet sexual access to women was allowed or tolerated. Young wives often continued the relations they had enjoy with men before marriage, and widows or separated women maintained relationships with men for economic reasons. The advent Christianity in the 19th century had had some impact on the traditional sexual system. The elites and women more widely, were attracted by western compassionate marriage usually identified as Christian marriage. The new religion preaches monogamy, companionship and sexual fidelity. But it appears that the majority of the followers have not taken the messages very seriously. The level and intensity of polygyny, and extramarital sexual may have declined among the educated elites; they have not been eliminated completely. Educated men and women are far more likely to be more discreet about their extramarital sexual transgressions than their less educated counterparts. Educated women are far more likely to refused sex to their infected or philandering husbands than the less educated ones who lack the knowledge or the opportunity to identify infection in their husbands. The African sexual system has by and large passed through three phases: the traditional system which allowed very considerable sexual freedom for males and more discreet freedom for females in certain circumstances; the colonial and post-colonial system with its monetization, urbanization and greater mobility of male and female, and a new phase characterized by a major epidemic in human history. Experience elsewhere has shown that the AIDS epidemic is likely to lead behavioral modification. The situation in Nigeria has not indicated a significant change in multi- partner relationships. The situation may change as the AIDS epidemic intensifies. Presently only a few are really afraid of the disease and resistance to the epidemic even among the high-risk population is at present too low. Many people are pre-occupied with the problem of the economy, while only a few are apprehensive of the dangers pose by their sexual behavior. Nevertheless the control of male sexuality is important and may be an essential antidote for stemming the spread of the epidemic.

There is now some evidence of changed sexual behavior from countries that have witnessed a high level of the epidemic but it will take some time before this is realized in many parts of Africa, and the death toll would have certainly been unprecedented in history of epidemics. Before the advent of the AIDS epidemic, there was very limited research on sexuality and sexual relations from which to draw upon. Earlier social science researchers were reluctant to investigated sexual relations because of the sensitivity of the topic and the fear of hurting the respondents, and thus jeopardizing future social science research. Because most of the earlier studies were on fertility, infertility and family planning, researchers did not possess the armonury of methodogies and body of knowledge existing in other areas of social science research when the AIDS epidemic struck. Because of the nature and intensity of the epidemic, AIDS research has proved in practice to differ from fertility and family planning research than originally envisaged. There is substantial premarital and extramarital sexual activity in much of sub-Sahara Africa, and yet it is usually not widely discussed and interviewers may be misinformed or refuse information. There was and largely still is, extreme reluctance to discuss sexual activity even within groups where it is widely practiced. The issue of sensitivity to providing information on matters that are essentially private is therefore central to the investigation of sexual relations outside marriage. Initial research efforts in Nigeria and subsequent ones were aimed at finding out the age at first sexual intercourse, how many different sexual partners respondents had both inside and outside marriage and how such relationships were distributed over time. Descriptive data were collected both on male and female respondents and on different sexual partners.

Subsequent research attempted to identify sexual partners and investigate perceived sexual needs and male sexual behavior in greater details. The surveys were often carried first by approaching community leaders, the chiefs and other influential people to convince them of the importance and the need for the studies. Soliciting their cooperation for the studies of the measures taken to ensure the complete confidentiality of the studies and the materials gathered. It was also an important means to allay the fears and apprehensions of the respondents who were not used to being asked question about affairs that take place in private. Interviewers were often from the same sub-ethnic group but not necessarily from the immediate area, and were recognized when visiting a household and all its members and neighbors were aware of just what was taking place. Respondents and their partners were not personally identified in the sense of their names and addresses so as not to damage the interview with refusals and deceitful answers, and to avoid unwarranted invasion of their privacy. Supervisors were employed mainly to check with the interviewers the location of the sampled household and their complete schedules, and to discuss problems as they arose and the need for further interviewing. Close supervision was necessary so as to avoid slippages that could affect the quality and reliability of the information gathered.

Although the response rate and the quality of the data were high, there were some difficulties. Women tended to understate their non-marital relations, while men tended to overstate their, and there was more understatement in rural than urban areas. There was the difficulty of separating essentially commercial sex from less commercial relations especially among urban respondents where extramarital sexual relations involve a high degree of financial and material support.

In sub-Sahara Africa, there is near-universal testimony that, except in some prostitution, the male normally takes the initiative for sexual activity. Studies have also shown that men have unlimited sexual freedom in and out of marriage, and that a man can be the husband of several wives. This has raised the question of perceived male sexual needs, by both men and women, and the assumed basis of for these needs. An investigation, which aimed at exploring the extent to which such perceptions represent the situation in Nigeria, was considered necessary. This was important for placing male sexual behavior in the context of the society’s social structure and belief systems, as well as suggesting the possibility of change.

In order to achieve the objectives of the study both male and female were surveyed on their perception of male sexuality and asexual behavior. A random sample of male and females over 15 years of age was drawn in both urban and rural areas. Where possible the sample was restricted to the same ethnic group. Separate but related questionnaires were administered to the male and female respondents; they contained some common questions, which allowed lengthy answer for subsequent study. Both young and old male and female interviewers were engaged: each interviewed only respondents of their own sex, and older interviewers interviewed the older respondents. The interviewers were paired so that both the husband and wife who fell into the sample could be interviewed at the same time. This strategy was important to secure accurate information from women devoid of the influence of their husbands.

Although the response rate high, at least one or two callbacks were necessary in major urban areas, after which any respondent not found replaced with another one. Our original plan was to limit the study to the major ethnic group in the region, but because of a major political crisis on at the time of the investigation all ethnic groups found in the sample area were included. Nevertheless, more than four-fifths of the respondents came from the dominant ethnic group in Southwest Nigeria where the research was undertaken, thus making it possible to understand a single and dominant culture in what was a cultural investigation. The methodological approaches adopted in the study of male sexuality made it possible for our understanding that wives have little control over their husband’s extramarital relationships. There was substantial evidence that the Nigeria system of extramarital sexual relations, double less the whole sub-Sahara Africa, operates as it dose, not much because most of the society think that the male need for sexual diversity is uncontrolled, but because of the general perception that wives have no right to comment upon or take notice of their philandering husbands. Nevertheless, the study established a basis for change in male sexual behavior as central to the curtailment of the epidemic.

Attitude towards female sexuality varies across Africa, among ethnic and religious groups. Some ethnic and religious group suppresses and closets its women and are punitive in their pursuit of even female sexual extramarital affairs, in some women have some degree of freedom and equality with men. Heterosexual transmission of the disease is dominant in sub-Sahara Africa, and the greater majority of all the HIV-positive women in the world are found in this region. It is now clear that their partners have infected the majority of HIV seropositive women in Africa. This has been the case with STDs. Therefore understanding female sexuality and the extent to which they have control over it are important for the dynamics of the epidemic and the intervention strategies for mitigating its spread. 

Before the AIDS epidemic broke very little research was done on women’s control over their sexuality in Africa, and the general assumption was that the husband has right to his wife’s person, and that most women in Africa were helpless about changing their social situation. Events of the last decade have clearly indicated that the situation is changing. A survey of women in the era of AIDS in Zaire did indicated that an increasing number of number of women reported that they would stay with a sero-positive husband to care for him but would refuse to have sex with him or sharer the same bed. This is a major departure from traditionally suppresses and closets its women. 

Studies from West African where women have traditionally enjoyed some degree of autonomy clearly shed some lights on the matter. Writing on Ghana in 1931 Cardinal (1931:169) observed that the status of women in the native household is equal to that of the man and women do not hesitate to assert their liberty. In this society it is believed that women might have exercised their rights within marriage, especially when there was conflict of interest (Awusabo-Asare et.ai.1993).

In West Africa, the subsistence economy is based on a division of labor by sex and age. Women have traditionally traded and done household work, they also have their own budgets, control resources and make decision based on these resources. Although marriage confers on a husband exclusive sexual right, thecultutre has long expected women to have some control over their bodies during certain periods in their life-cycle: during menstruation and the postpartum period, and after becoming a grandmother or reaching menopause. Although the total period may have shrunk in the last few years because of modernization and increased use of contraceptives, twenty-five years ago the duration of these events accounted for 60percent of a women’s time between menarche and, menopause. It was the responsibility and right of women to defend these periods and the community sanctioned men women who deliberately broke these traditional practices.

In 1990 study of women in the Ekiti district of Southwest Nigeria (Orubuloye et. Al 1993), nearly all women reported that they had refused sex to their partners at least on one occasion in recent times for a wide range of reasons. These include the traditional forbidden period (menstruation, postpartum abstinence and too soon after birth). Others include punishment for bad behavior, quarreling, drunkenness, sickness, wives’ right of choice and when the partner has an infection. A significant proportion of women reported that their partners were hostile for refusing sexual advances from them, while some turned to other wife or went out to other women, and some accepted the situation calmly and regarded it as inevitable. Domestic violence is rarely used to resolve a matter of this nature; the men can turn to other women, while the women can return to their paternal homes temporarily. Divorce is not usually an option.

Reactions of women to infected partners present a different scenario. Nearly all the women identified gonorrhea as their partner’s type of infection. Many women were not aware of their partners’ infection because to a very considerable extent they live separate lives with sexual intimacy at night under poor illumination, and women often know little about where and when their husband urinate. Nevertheless a significant proportion of women who knew about their partners’ infection refuse sex to them until they underwent treatment, while only a few continued sexual activities but with condoms suggested by partners or insisted on by the women. Most Yoruba women are able exercise this right because of the support they will receive from the community, their family members and because of their economic independence.

A significant proportion of Yoruba women believe that they can refuse sex with infected partners’ and only a few would continue sex with condoms. Although a significant proportion of women knew about condoms and had used them before or currently using them, majority was not convinced that condoms would guarantee against infection. Many women have aversion to condoms and all contraceptives as well. While many believe that condoms are too thin to offer protection against sexually transmitted diseases, other are apprehensive about the effects on other contraceptives, especially the assumed reproductive impairment. These are genuine reasons in a society where there is little emphasis on sexual pleasure and where emphasis is on high level of reproduction.

The among the major ethnic groups in Ghana is similar to that of the Yoruba of Nigeria. A 1991 study on women’s control over their sexuality reveals that majority of women (60%) felt that a women had the right to refuse sex with a partner who is promiscuous, and 90% of women would do so when the husband is disease; for fear of infection. More than one half of the women had actually refused sex with a husband on at least on one occasion on account of jealously and to attract attention to themselves. Among women whose partners had STDs, half had unprotected sex, partly because of the belief that they could not be infected and partly because of the misconception that having sex with an infected person could cure the disease. This poses a danger if extended to AIDS cases (Awusabo-Asare et al 1993).

In Eastern and Southern Africa, women are at a relatively greater economic and decision-making disadvantage to their husbands than is the case many parts of West Africa. In this region, as evident in Uganda (Ssekiboobo 1992), and in Kenya (Muange 1998), women are seen primarily as farmers with only very limited access to urban trading and on physical separation of what they themselves produce from that of their husbands. Wives ‘ inability to refuse husbands sex, insist on safe with them or force them to curtail their extramarital sexual relations is an indication their powerlessness. Women in this region compared to those in West Africa are constantly oppressed by a society in which they so finally break ties on marriage with their families of origin that they are not welcome back as a matter of right after a separation from their husbands. They cannot demand access to farming land on their return, and neither their own families nor those of their husbands will expect them to bring their children. The women’s refusal of sex would be highly likely lead to divorce and to the loss of access to the resources that her marriage had provided. Women seemed relatively defenseless against their partners if infected with sexual transmitted disease or HIV.

A wide range of factors, which are external to women, often influences sub-Sahara African women’s ability or inability to control their sexuality. The economic difficulties of the few years meant economic insecurity and increased dependence of women on their husband for support to them and their children; women are therefore under pressure to remain in unions that pose great danger to their lives. The fear of losing the partner and the pressure of the family members to remain in a union that poses danger to the woman have become important more than before. The assistance from the family to the relatively poor members has shrunk to an all time low because of the current economic difficulties. This may compound the epidemic situation, as many young women across the region have now taken to commercial sex to generate income for their survival. Investigation reveals that many of those women return to their place of origin when they fall sick and subsequently infected men who latter infect their partners.

Nevertheless, women need support from the community and possibly from government to be able to refuse sex from partners who are leading dangerous sexual lives or infected with HIV. Women must be convinced that although this may not be culturally acceptable but it is morally justified.


Female Commercial Sex Workers
Our first attempt at studying people in high-risk occupations was that of female commercial sex workers. In much of sub-Sahara Africa, there is a substantial male demon for sex outside marriage, and this has led the growth of commercial sex industry in the region. The growth of the commercial sex industry has long exposed and many women employed in it and their clients to increased risk of sexually transmitted diseases, and in the last one decade presents the danger of infection with HIV/AIDS. Opinions tend to converge regarding the origin, nature and causes of commercial sex in Africa. In a recent publication, pellow (1997) wrote that prostitution has been prevalent and visible in Africa cities since the nineteenth century, rooted in the colonial past and poverty; a way in which women have used and manipulated their sexuality because they have been denied active participation in the economy. Writing on the Hausa Muslim w omen of Northern Nigeria, where according to pellow, marriage is normative but rarely stable, women become prostitutes out of economic need because they do not want to be married, and prostitution provides an alternative lifestyle (p.70). in a similar vain white (1997) wrote that: prostitution in Africa like prostitution anywhere else is not a form of social pathology or cultural predisposition. She also went further that it is one of the ways women’s work supports their families and that the ways women in Africa has prostituted themselves have to do with the kinds of families they are supporting and creating, and the kinds of support their families required at that time.

Pittin (1983) discussing the house of women in Katsina in Nigeria, observed that there are houses that accommodate women on their own, who support themselves completely or in part by selling their sexual services. Oppong (1983) identified and reported on a group of white-collar women in Accra Ghana whom she described as single wealthy and potentially mobile, who chose to content themselves with the steady improvement of their economic resources and enhancement of theirs bargaining positions by exchanging sex for money. In Gambia, the economic incentives were powerful motivations to prostitution (Pickering et al.1992).

The economic difficulties faced by many of the Africa countries since the early 1980s have resulted in the growth of commercial industry. Many poor families encourage their young girls to migrate to the major towns and commercial centers for wage employment, which is not easy to come by quickly thereby putting pressure on them to go into commercial sex. The movement to the major towns and commercial centers was facilitated by the rapid growth of the educational system and of the transport network. The growth of the commercial sex industry has longed exposed many women in it as well as their clients, to increased risk of sexually transmitted diseases, which were know to affect one third of the population, and now presents the danger of infection with HIV/AIDS. Over two-thirds of all the people now living with HIV in the world –nearly 21million men, women and children are reported living in sub-Saharan Africa the home of 9percent of the worlds population (UNAIDS1998).since the advent of the epidemic, HIV in sub-Sahara Africa has mostly spread through sex between men and women and the commercial sex industry and the people working in it have played a major role in the course of the epidemic.

Across sub-Saharan Africa, prostitution takes place in large towns or cities where there is demand for it. The majority of sex workers work in places where alcohol i9s sold and where dancing is also a common feature. The young women in the trade live a more restricted and institutional life in the place where they work. They isolate themselves to retain their anonymity and maintain close contact with their hometown by sending money regularly to their family and where they plan to return at the end of their sojourn in the city (Orubuloye,et al.1994).

Nowadays the sex workers are young, mostly single less than30 years of age, better educated and do not seem to stay a lifetime in the trade. The majority of the young women now in the trade appear to have no real occupation between leaving school and taking up prostitution, and the unemployment situation has driven many to seek alternative jobs. Prostitution for this new generation of sex workers is an opportunity for intensive savings, in order to establish themselves in small business for the rest of their lives. Nearly all the women in commercial sex trade do make substantial savings beyond their remittances, expenditure on health, cosmetics, and deductions for board and food. Prostitution guarantees an income level higher than what people of the same qualification earn in government employment.

Many sex workers tend to remain anonymous, and there are no great disabilities connected with profession. Most keep contact with their relatives and many relatives probably have some ideas of what the young women are doing for a living in the city. Many return to their homeland at the end of their sojourn in the city to establish businesses and lead respectable lives for the rest of their lives. In addition, those who had retired from the business provide necessary information for young recruits into it, and sometimes act as recruitment agents for the managers of hotels, brothels and bars in the cities.

There are no clear socio-economic groups from which the sex workers come. They are likely to come from both urban and rural areas as well as from all the ethnic groups in a country. A significant aspect of commercial sex in recent years is the spread across international boundaries, and the trade is almost synonymous with migration. Commercial sex workers are highly mobile, so are their clients. It is also unique that most of the sex workers do not practice their trade among their ethnic groups or where they can easily be recognized. Most sex workers see the trade as a stage in life and an investment for later life, and inability to make a substantial saving leave them in the profession for a considerable length of time.

The AIDS epidemic has raised the issue o f safe sex for the sex workers and their clients. A significant number of the sex workers had adequate knowledge of condom and the potential effects on minimizing the infection of HIV. Sex workers had effectively used condoms as protection against STDs and pregnancy, and about one-third of those in the cities now attempt to use condoms regularly, while over one half now regularly suggest the use to their customers. Trust in the condom has significantly increased among sex workers and their clients a situation, which can largely be attributed to the massive campaign currently going on and the regular supply condoms. Nevertheless, the current economic difficulties and political instability are jeopardizing the supply of cheap condoms. A significant number of the clients of the sex workers who normally provide condoms during sexual encounter are no longer able to afford them. Many are now willing to trade in free condoms for cash to pay the sex workers. This may well pose a serious danger of the spread of AIDS and other sexually transmitted disease to the sex workers, their clients and the general population.

The sex workers and their clients are now sufficiently aware of AIDS, as has been the case for STDs for generations. They would be receptive to any organized program to combat them. Nevertheless, neither the AIDS epidemic, nor the government information program has done anything to reduce the flow of young and attractive women and their clients into the trade or to alter its essential nature. The economic difficulties faced by many families and the high level of unemployment among high school graduates that now dominant the trade may continue to guarantee the supply of new comers into it. Increased supply and promotion of highly subsidized condoms will be a critical factor in slowing or halting the AIDS epidemic. Government legislation against prostitution or constant police raids on sex workers cannot provide a quick solution to the dangers posed by those involved in the trade and the general population around them. The study of commercial sex workers in the hotels, bars and brothel entails a different methodologically approach from the study of the general population. In the study of rural and small towns in Southern Nigeria, the number of institutions and the sex workers was small hence all the institutions and the sex workers were included in the sample. Whereas in the large urban centers and cities, the number of institution was so great that they had to be sample and then appropriate weighting was achieved within establishment by interviewing a fixed proportion of the young women working in the sex industry. The cooperation of the managers was secured before gaining access to the women and young male interviewers who agreed to pose as potential customers were employed to interview them. Cigarettes and drinks were provide and in a substantial number of cases the interviews were completed only by additionally making a payment for time lost as a result of the interview. This was the only way to gain the total support of the sex workers whose chief aim was to maximize earnings in a very highly competitive trade. The approach yielded a robust type of sample but excluded a substantial number of the high-class prostitutes who solicit for customers in the street and around the hotels.

In the Northern Muslim area the approach was different, more of the commercial sexual activity is unconnected to institutions, and a substantial numbers of sex workers who are from Southern Nigeria roam around the major hotels and streets in the major cities soliciting for customers every night. Matured women health workers who succeeded in gaining interviews by emphasizing their concern with sex workers’ health interviewed many of these street prostitutes in a snowball kind of sample. The introduction of stiff laws and penalties in the Muslim regions of Nigeria is likely to drive the sex workers under ground and make it a well nigh impossible task to identify and study them.

A recent project focused on interventions among the sex workers in Ado-Ekiti, a process that was rendered easy by our previous contact with them and their managers. A one-day seminar was first organized in one of the hotels for all the sex workers and their managers working in the town. The seminar aimed at educating the sex workers and the manager about sexually transmitted diseases including HIV/AIDS and the need to protect the sex workers against being infected by their clients or they infecting their clients. Condoms were distributed free at the end of the meeting, and subsequently fortnight for a period of six months during which records of use and problems associated with it were identified and solutions found to them. The project has increased the use of condoms by the sex workers and their clients, and many sex workers are now able to refuse sex with clients who refuse condom, and many clients now bring their own condom. Nearly all the young women who engage in commercial sex go the city to make quick money, and most intending to stay only long enough to make enough money to set themselves up in business back home and to secure a good marriage and become respectable members of their communities. This raises a difficult survey methodological question, for most intend to go back home and make on mention of their actual occupation to their families and future husbands. This will pose a serious methodological problem of identification in any attempt to survey this will group of people as has successful been done in the case of return labor migrants.

Truck Drivers
Across Africa, long-distance haulage drivers play important role in the economies of the countries. Similarly the drivers are a major source of STD and now HIV/AIDS infection and the levels of disease are considerably higher along they ply frequently. The research project undertaken in the early stage of the epidemic aimed at investigating and identifying those aspects of the drives’ behavior and way of life that made them vulnerable to infection and thus pose dangers to themselves, their wives and the society. A major methodological obstacle arose from the mobility of the drivers. In order to overcome this interview were conducted at highway truck stops along the major highway that run from the Southwest part to the Northwest of Nigeria where the drivers stop for meals, serviced or repair their truck, sleep and have sex. The truck stops are large laces often filled with huge trucks parked for half a mile, producing a great deal of noise and movement as engines oil and tyres are changed, and where mechanics and hawkers are everywhere. The truck stops are often busy, rough, tough and dangerous places. The fluid situation at truck stops made it impossible to obtain a complete listing of all drivers stopping there from which to draw a sample. All drivers who stopped and willing to be interviewed were interviewed.

It was more appropriate to use attractive young ladies who are rarely seen in the truck stoops and whom the drivers were willing to give some attention to while doing other things and whom the drivers think they can establish some kind of relation with. The drivers soon discovered that most of them were university undergraduate students who were less likely to accede to their request. Because the drivers were always in haste, the questions were short and were best to memorize them as well as the answers and complete the questionnaire later. The response rate was high and the drivers who refused to be interviewed were only those who were too busy to give up their time to be interview or in haste to meet up with some specific requirements of their employers.

A later project among truck drivers included an intervention program preceded by a one-day open seminar in one of the major lorry parks on safety on the highway. The seminar was to sensitize the driver to the dangers, which unprotected sex, can pose to them and their wives in the course of their daily activities. The intervention included demonstration on proper use and distribution of condoms. Subsequent follow-ups confirm a general rise in the use of condoms among the drivers, especially with sex workers itinerant traders.

The great majority of African women farm or trade. Most of the trading is in raw foodstuffs; cooked food, textiles, palm oil, kola and groundnuts, cooking utensils, jewelry and a wide range of other locally manufactured and import goods. In the rural areas, most trading activities are in front of the houses or from house to house or in the markets on every fives days. In urban areas, most trading is far more likely to take place far away from the usual place of residence of the traders. Most girls have traditionally assisted their mother in hawking goods from house to house or at market places. The advent of motor vehicles created new market places at the lorry parks or at the bus and truck stops along the road. Female hawkers, who sell few items from portable tray, from a fly- proof box made of glass and wood, or from a temporarily erected stand, are common in sub-Sahara Africa. The investments and returns in this type of trading are usually small. Most of these young women hope to have a small stall in the market some day, perhaps capitalized by a future husband. Investigation among the itinerant traders in Ibadan shows that the majorities of the traders are usually single, sexually experienced, practice contraception and has multiple sexual partners. The goods they sell range from cooked food items, ice water mineral drinks to chewing gums, coconuts, sugar and kola nuts. These are items that are often in high demand by drivers and their passengers.

Because of the nature of the lorry parks and bus stops, the drivers, bus maids and passengers often regard young women who trade there as potential sexual partners. They frequently make suggestive advances, and the women often offer sex to them in return for money or goods, to supplement their income and increase their savings. Women who sell goods along the road and in lorry parks have been identified as playing a role in the spread of infection because of their way of life. Many have multiple partners and have sex with men who themselves often have sexual relations with many women including sex workers. The young women are becoming increasingly worried about the risks posed by having sexual relations with many men now that the campaign about STDs and AIDS has been extended to the lorry parks, bus stops and the major highways where the women trade. A significant number of them had suffered from STD, usually gonorrhea, while nearly all had heard of AIDS. The women are in a serious danger because many of their sexual partners especially the drivers assume that they are less likely to have HIV because they are young, because many have had little sexual experience and because they are less likely to be full-time commercial sex workers. This may become a major root for the spread of AIDS, as has been the case for STD. The contribution of the itinerant hawkers is important to the efficiency of the transport system by selling a wide range of goods at the windows of buses and trucks. The lorry parks and the bus stops offer employment and provide income for many families. The chance of the traders to make a sale depends on maintaining good relationships with the drivers, the bus maids, the porters and regular passengers who dominate the transport system. Offering sex is a way of developing acquaintance with drivers or passengers. Some of the relationships often become permanent and some of the young women may end up as additional wives to the drivers. Because of the nature of the young women educational campaigns about AIDS and other STDs at the lorry parks and bus stops are important for disseminating information to all those who work to support the transport system as well as those who work in it. Such campaign should aim at changing sexual behavior and use of condoms. Unfortunately the economic difficulties which most of the sub-Sahara African countries are currently going through have made it difficult for such campaign to have its desired effect.

The sex workers and the truck drivers are closely related to the young itinerant female hawkers who sell goods in the lorry parks, truck stops and from house to house. These women sell a few items from portable tray frequently balanced on their heads, from a fly-proof box made of glass and wood, or from a temporarily erected stand in the lorry parks, truck stops and along the highways. They sell goods that are in high demand by the drivers and the passengers as truck, buses and vans disgorge passengers or as people wait for transport or trucks and buses slow down during traffic hold ups. This is a common phenomenon in West Africa. Because of the economic difficulties now faced by many African countries and the high rate of unemployment, a significant number of young males has infiltrated into the trade that was an exclusive preserver for the women. This often leads to stiff competition and conflicts between men and women trading in these areas. The young men tend to outwit the young women when chasing their customers most of the young women are unmarried, and in the past such women usually assisted their mothers in trading. An increasing number of young women are now selling on their own, and most of them hope to have a stall in the market when they get married. Because the lorry-parks, trucks stop and the highways are rough and tough places, most of the interviewers were males: the questions were short and the interviews were conducted fairly rapidly often by memorizing the question and answers. All female hawkers in each lorry-park or truck stop were identified in the records to avoid interviewing the same women twice. The response rate was high and a lure in traffic moment, usually in the mid-afternoons, provided opportunity for more interactions between the women and the interviewers.

In 2002, the federal ministry of health carried out a behavioral sentinel survey among 7902 young people 15-24 years old consisting of 3946 female in 14 states in Nigeria. The survey describes the characteristics of Nigerian young people spread across all geopolitical zones and many ethnic groups with regards to their sexual behavior, knowledge and attitude to HIV and condoms use. Their profile is that of young people aged 15-24 with a mean age of 19.1 years and a high level of education. Only 0.5% lacked formal schooling while more than 57%had attained secondary education and majority (83%) of whom were single. More young people in the Northern Zones were married compared to those in the Southern zones.

About one-half of all respondents had had sexual experience. The median age at first sexual experience was 17 years. However the females than males had reported sexual experience in the last 12 months. The lowest rate of sexual activity was reported in Jigawa State, which incidentally also had the lowest HIV prevalence in the 2001 national survey. The most common reason given for the first sexual experience for females was the desire to have children while that for the males was for fun. In terms of age mixing, the disparity in age between sex partners of male and female respondent ranged from 1- over 20 years. For about two-thirds of all respondents the range of age disparity was 1-9 years and for about one0third it was 10years and over. About one-fifth of the females had partners who were en years and above older than them. Among the 3811 respondents who were sexual experience 53.6% did so with regular partners, 21.8%with casual partners and 17.6% had engaged in transactional sex. By gender, 56% of all male and 77% of all female respondents who were sexually active within the last one month reported having only one sex partner they considered as regular. For sex partners considered as casual about 26% of male and 28% of female respondents sexually active admitted to having sexual intercourse with at least one such partner within the last one month. Those who admitted to transactional sex with at least one partner within the same period were 22%of the males and females who admitted to transactional sex. Among male respondents 2.6% admitted to having sexual intercourse with males. Multiple partnership and sexual intercourse with sex workers and casual partners as well as men having sex with men constitute risk sex behavior. It can be inferred from these findings that a large proportion of young people were involved in sexual activity involving multiple partners and in relatively risk sexual practice. This risk is greatest when the sexual intercourse is unprotected with a condom.

The age at first sexual intercourse is an important factor in the spread of HIV sexually transmitted infections. It is also important as a cause of teenage pregnancy. The younger the age the more likely it is that such persons would be unable to have enough information to protect them apart from begin subject t to exploitation by older persons. Young people are more likely to spend youthful time at school and practice sex outside marriage. They need information to protect them from begin infected. Young people who use alcohol and drugs and engage in multiple partners are at risk for HIV and other sexually transmitted infections. So also are young people who choose partners among those that may be much older than them as such relationship may be transactional and exploitative. The level of awareness of sexually transmitted infections was generally high among both male and females across the States. However, the level of knowledge of STIs in men and women was general poor. Knowledge of the specific signs and symptoms of STI Between 20% and 33% of the respondent reported that they knew specific signs and symptoms of STIs in women compared to between 23% and 41% who reported same for overall, 10% of the respondents reported a genital discharge in the last 12 months and 3.6%reported a sore or ulcer.

Perhaps to the most difficult aspect of the series of our investigations on sexual networking was the identifications of sexual partners and mapping sexual networking conducted in Ondo Town in 1991. Research on the subject is difficult and painstaking because individuals are always reluctant to state the number of sexual partners accurately, especially those that are commercial sex. The original research described sexual behavior and characteristics of individual. Such information was by no means enough to provide an adequate description of their sexual networks or to determine the extent to which men’s sexual activities are diffused through a considered part of the society rather than focused on a small number of women providing commercial se.

Earlier research had indicated that men were more likely than women to disclose fair accurately the extent of their sexual activities, and that men would also provide more details than women about their partner. Men were generally more aggressive than women in seeking to identify their partners other partners, primarily because men are more discreet about their sexual behavior and that men believe that women should keep to monogamously relationships than men. It was also believe that men would suffer little or know deprivation if their exmarital sexual affair becomes public compared to women. Men could always argue that they are seeking for another wife and the society will approve of this explanation. Therefore it was decided to interview men., and also important to carryout the investigation in a relatively large urban location where people are more open about sexual matters. The obstacle was partly overcome by selecting an urban area with a quarter of a million people, a place where men were more discreet about sexual networking and where there were substantial resources to support it.

The methodological approach produced a plausible result. Nearly all those men who reported extramarital or non- marital sexual partners during the year agreed to identify them. A significant proportion of the partners was described as girlfriends or women friends, fewer than one percent were described as sex workers. The practicability of establishing how many partners a man has the number and type of the partner’s partners depends on the extent to which the w hole sexual networking system is carried out openly or surreptitiously. Despite the assumed openness of the community selected for the investigation, nine out of ten of all the married men currently having extramarital relationships maintained that their wives did not know of these liaisons. Traditionally wives are not supposed to know or ask question about their husbands’ extramarital affairs. With that extension of western education to women and the movement towards monogamous and companionship unions, women are increasingly aware of their right to ask such questions from their philandering husbands. Nevertheless, three- fifth of the men reported that some of their relatives knew of their extramarital sexual relations. This is a common pattern across Africa, relations and friends often know of other relatives and associates extramarital affairs. Quite often they initiate and sustain such relationships.

Identifying partners was more problematic. Only a small fraction of the men could and willing to accurately describe their extramarital partner’s partners and the majority of the men could not be bordered and would not participate in a sexual network more complex than the ones they were in. the threat that the men might break with partners they suspect of having affairs with other men made those partners conceal the existence of other men in their lives. This often happens if a man suddenly discovers that the woman he was going out with had another partner or partners. Women are conscious of this and are apprehensive of the risk that might jeopardize the support they receive from their extramarital relationships provide additional vital income for poor families, widows, divorced or separated women, single girls seeking support to stay in school or become established careers and to married women whose husband cannot meet their financial need and who choose to lead high profile lives.

The research clearly showed that it was a difficult task to identify partners’ partners even in a society that pride itself in the openness of sexual matters. Attempts to do this may cause severe damage to network of relationships and impair future social science research. For a more complete identification, a new form of methodology will have to be invented. Perhaps it may be possible to do this in a small community where everybody knows one another, the type of relationships entered into by individuals and where the research can successfully conceal his identify.

Earlier research reports on sexual behavior and sexual network (Orubuloye et al. 1994) led us to believe that their obstacles to behavioral changes is the need to investigate an important aspect of the social and behavioral context of the AIDS epidemic. In an attempt to fill this gap a resistance, to change in Sexual behavior Project was undertaken in 1998/99 to test the earlier propositions, ascertain current situation and determine future trend.

Four research areas were selected in Southwest Nigeria: Ado-Ekiti, the capital of Ekiti State; Ibadan the capital of Oyo State; Badagry and Ojoo two sub-urban areas in Lagos and Ugep a rural district of cross river- State in Southeast Nigeria (et al Orubuloye and Oguntimehin, 1999 and Caldwell et al 1999).

The Ado- Ekiti research interview all males who frequent the hotels and bars, which offer commercial sex for a period of three months. A household sample survey of adult male was conducted in sexual affairs with more than one partner Ibadan, Lagos and ugep. The survey yielded a total sample of 1005 respondents; five more tan the anticipated size of 1000 males. Questions were asked of the men the number of their sexual partners over a period of time attitude towards STDs/AIDS and death and use condom. The refusal are was only one percent in Ugep, typical of rural areas, five percent in Ibadan, ten percent in Ado-Ekiti and 15percent in Lagos a busier and less tolerant population.

The results were not different from our previous investigations. Reported number of sexual partners was high and many men were not ready to disclose their sexual network of relationships beyond one or two partners. A larger proportion of men is yet to see the dangers inherent in their sexual behavior.

There was a general robust attitude towards death and the majority accepted death as inevitable and was willing to accommodate its timing. This a major obstacle to sexual behavior change and may be will a catalyst for the spread of the epidemic. An AIDS epidemic is well underway in Nigeria the level may well reach that of the East and southern African epidemics. Nigeria has a large population yet a few have had close contact with AIDS deaths primarily because the epidemics started late. When it was established that certain people died of AIDS friendly neighbor and relatives are not told because of the shame that may bed brought to the families of the affected people. Very few Nigerians have been buried with the mourners knowing for certain that the cause of death was AIDS. The reality of the epidemic has not yet impacted on the vast majority of the people, hence the denials of the existence of the disease.

Researching sexuality, sexual behavior and multiple sexual relationships has raised the central issue of sensitivity to providing information on matters that are generally considered to be private. Although, there is a high level of premarital and extramarital sexual activity in Nigeria, the practice is not usually widely discussed and interviewers may be misinformed or refused information. The knowledge that an investigation is see king information within a community on multiple sexual relations can cause excitement and a curiosity about which person is begin interview. There was understatement of sexual partners especially by rural females while urban males tended to overstate theirs. On the contrary men tended to understate their relations with sex workers by describing them as friends. Nevertheless, the evidence on the core data on sexual networks produced a pattern that is internally consistent t and methodological that is satisfactory and findings that can be trusted. The HIV/AIDS epidemic has facilitated research on sexuality and sexual behavior and earlier conception that sexuality and sexual behavior cannot be studied because of the sensitivity and that such investigation would distort relations with respondents and damage other inquiries has finally been put to rest.

By I. O. Orubuloye. Dr. Orubuloye is a professor at Department of Sociology, University of Ado-Ekiti, Nigeria.

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