Effects of Training on HIV Risk Perception,Knowledge and Sexual Behaviour Among Fisherfolks in Two Communities in North Central Nigeria

Abstract

Fisherfolks participate in unsafe sexual behaviors which can predispose them to HIV infection. This research was designed to assess the effects of training on HIV/AIDS-related knowledge and sexual behavior among fisherfolks in two fishing communities in Nigeria. Respondents were allocated into Experimental Group (EG, n = 103) and Control Group (CG, n = 105). Data were collected at baseline using a questionnaire which included questions on socio-demographic characteristics, sexual behavior among others. A 3-day HIV/AIDS training was conducted for EG. Fisherfolks in EG and CG with good knowledge were 16.5% and 54.3%, respectively at baseline. The number increased to 100.0% in EG than CG (60%) at follow-up. At baseline, fisherfolks in EG and CG with high riskperception scores were 26.2% and 59.0%, respectively; corresponding figures at post intervention for EG and CG were 100.0% and 70.0% respectively. Training increased HIV/AIDS knowledge, improved risk perception and reduced risky sexual practices among fisherfolks.

Keywords

sexual behaviour risk-perception Fisherfolks HIV/AIDS knowledge

HIV/AIDS is a global crisis. In Nigeria, HIV/AIDS is a health problem affecting people in all strata of the population.¹ The current national HIV prevalence in Nigeria is estimated at 1.4% with total estimated 1.9 million people living with the virus. The distribution of HIV burden across ages in Nigeria shows that 12.0% of people living with HIV are between ages 0–14 years while 75.0% are between 15–49 years and 13.0% are 50 years and above..² Although HIV/AIDS infection is a generalized health problem in the population, fisherfolks are particularly vulnerable. Studies of high-risk sexual behavior in fishing communities indicate that fisherfolks are significantly at risk of HIV infection.^3–7 For example, the Kenya AIDS Indicator Survey carried out in 2007 showed that the HIV prevalence among fisherfolks in Nyanza province (15.3%), which hosts the largest proportion of the fishing community in Kenya, was higher than the national average (7.4%).^8–9

The fisherfolks’ vulnerability to HIV infection is determined by biological, economic, social and cultural factors. Concerning biological factor, the majority of fisherfolks fall within the age group (15–35 years), the most sexually active and among whom there is a high HIV prevalence in the country.¹⁰ This makes the fisherfolks to be vulnerable to sexually transmitted infections, including genital ulcer diseases such as syphilis, which are known to facilitate transmission of HIV. Fisherfolks earn daily disposable income and are highly mobile; many are away from home for days due to migration of fishes and low water levels.¹¹ This mobility coupled with availability of daily disposable cash enable fisherfolks to pay for alcohol and transactional sex with many partners,¹² through a practice called ‘Jaboya’ in which sex is exchanged for fish.¹³ The chance of being exposed to HIV is increased where a small number of women have unprotected sex with many men or vice versa.^3,6,12,14

Fisherfolks make important contributions to household income and boost food security by providing a healthy diet to the people.^15,16 Therefore appropriate interventions must be directed at this population to prevent spread of HIV/AIDS in fishing communities.¹⁵ There are few HIV prevention intervention targeting fisherfolks in Nigeria. Specifically, there were no HIV prevention intervention where the current study was conducted. We describe in this article the process and outcome of a health promotion intervention aimed at addressing the HIV/AIDS education needs of fisherfolks in two communities in north central Nigeria.

Methodology

The Setting

Geregu and Kabawa, the sites for the study, are two small fishing communities in Kogi state, Nigeria where people rely primarily on fishing on the River Niger for their livelihood. In 2018 when the study began, sources at National Population Commission (NPC) offices in Ajaokuta and Lokoja LGAs, explained that estimated population of Geregu and Kabawa were 3,675 and 4,825 respectively. The Nupes are the main ethnic groups living in these communities. The majority of the fisherfolks in these communities are males. The communities are well dispersed with approximately 60 kilometers in between them.

Components of the Study

The research project was implemented in three phases: Baseline, Intervention and Evaluation. Details of activities in each component are provided below.

Baseline Assessment

Sample Size Calculation

Data from a similar previous study among fisherfolks on knowledge of HIV and AIDS, risk-perception toward HIV infection and sexual behaviour¹⁰ was used in calculating the sample size for the current study. An expected attrition of 50% and non-response rate were added to arrive at a sample of 100 respondents in each study arm (total 200).

Sampling Procedure

The researchers enumerated and compiled the names of all fisherfolks in both communities with the help of officials of local fishing association in each of the study communities. The list of both male and female fisherfolks served as the sampling frame for recruitment into the study. There were approximately 350 fisherfolks in Geregu as at the time of this study; 35 of these person were women. Proportionate sample allocation was used to determine the number of male and female fisherfolks to be enrolled into the study which gave 10 female and 90 male fisherfolks. Equally, there were about 550 fisherfolks in Kabawa fishing community. A proportionate sample allocation was used to determine the number of male and female fisherfolks that participated in both study communities. Thus, 7 female fisherfolks and 93 male fisherfolks were sampled for the study in Kabawa fishing community and 10 women and 90 men fisherfolks were in Geregu. The sampling interval was determined with the use of these lists. The sampling interval was calculated to be 4

A simple random sampling technique was used to select the first respondent. Since the sampling interval was K = 4, a random number between 1 and 4 was selected. The corresponding name on the sampling frame using the random number was the first respondent. With the use of the sampling interval, 90 male and 10 female fisherfolks were systematically selected in Geregu. The same method was adopted in selecting the 7 females and 93 males fisherfolks in Kabawa.

Based on the outcome of the baseline, it was observed that fisherfolks in Geregu had poorer knowledge of HIV/AIDS, low risk-perception toward HIV infection and were reportedly involved in more risky sexual behaviour than their counterparts in Kabawa. Hence fisherfolks in Geregu were allocated to experimental group while fisherfolks in Kabawa were in control group.

Tool for Data Collection

A pretested self- administered questionnaire was used for data collection. The questionnaire was pretested among a comparable fisherfolks in Idah, a community with similar features as the study areas. The Cronbach’s Alpha was .783. The questionnaire was divided into 6 for ease of administration. Section A focused on socio-demographic information while section B explored the sources of information on HIV and AIDS. Section C assessed knowledge about HIV and AIDS. Section D focused on risk-perception of fisherfolks toward HIV infection while section E was on behaviour that favour the spread of HIV and AIDS. Section F elicited responses from the fisherfolks about their opinion on prevention and control of HIV and AIDS. Examples of knowledge questions were: “What have you heard about HIV/AIDS?” “What are the risks involved in sexual intercourse?” and “How can HIV be prevented?”

Data Collection Procedure

Before the commencement of the research, advocacy visits were paid to the traditional leaders and officials of the local fisherfolks association in the communities to solicit their support and co-operation. Baseline data were collected by Trained Research Assistants (RA) who conducted face-to-face interviews with 208 respondents. The training contents consisted of purpose of the research, discussion and interview techniques, interpersonal communication, and ethical issues. The researchers envisioned that study participants will be low literate persons; to this end, the questionnaire was translated into Nupe and then back to English. Nupe language was the language widely spoken in the area and all interviews were conducted in this language. In order to reduce attrition, the executive of fishing associations, research assistants in both communities and the investigators encouraged the participants to be available during the period of the study. Marital status was the key cofounding variable identified in the study and this was controlled for by performing an analysis of sexual activities of participants by marital status at both baseline and post-intervention

Data Management and Analysis

Each of the questionnaire administered were checked in the field for completeness and serial numbers were given to them. Collated data from the questionnaire were entered into computer and the results were analyzed using Statistical Package for Social Science (SPSS). Knowledge of HIV/AIDS was summarized on a 21 point-scale; these consisted of 8 questions on causes of AIDS and mode of transmission of HIV, 4 questions on treatment, and remaining 9 on prevention. The knowledge questions were assigned a score of one point for every correct answer and 0-point for every wrong answer: making up a 21-point knowledge scale. Risk-perception toward HIV infection was rated on a scale of 26 points. Sexual behaviour was assessed on eight⁸ question items; the higher the score the higher the risk and the lower the score the lower the risk. There was comparison of the result of the analysis of the EG with the CG to determine the effectiveness of the intervention on knowledge of fisherfolks on HIV and AIDS, their risk-perception toward HIV infection and the risky sexual behaviour of the fisherfolks. Hence the data were analyzed according to the variables of the study and scores were graded as follows:

Pre-and post-intervention comparison of the EG and CG mean knowledge of HIV and AIDS scores using student t-test.

Pre- and post-intervention comparison of the EG and CG risk-perception toward HIV infection using student t-test.

Pre-and post-intervention comparison of the EG and CG risky sexual behaviour.

The cutoff of statistical significance was p-value = 0.05.

Inclusion and Exclusion Criteria

For inclusion criteria, both men and women fisherfolks residing in the fishing communities of Geregu and Kabawa were eligible to participate in the study. Only those willing to participate were recruited into the study. As for the exclusion criteria, fisherfolks that were not residing in the fishing communities and those that were not willing to participate in the research were excluded from the study. Equally, fisherfolks that said they would not be available during the period of the study were not included in the study.

Ethical Considerations

The Research Ethics Committee of the Kogi State Ministry of Health approved the protocol for the study prior to its implementation. The investigators obtained written informed consent from the fisherfolks after explaining the objectives of the study, that the data collected will be used for research purposes, that confidentiality will be maintained, and that their participation was voluntary.

Limitations of the Study

The data about sexual behaviour were self-reported. Given the sensitive nature of sexual behaviour, it is possible that participants may under- report their sexual activities. However, to ensure that participants provided reliable information about their sexual activities, questionnaire was designed to be anonymous and participants were assured of confidentiality of data. Training of educated and non educated respondents together might had given educated respondents advantage over non educated respondents

The Intervention

Training for Fisherfolks

Fisherfolks in the intervention group participated in two batches of training program for three days. The training contents was developed using the findings from the baseline; the contents included knowledge about HIV/AIDS, risk-perception toward HIV infection, risky sexual practices among others.

Pre-and post-evaluation test was conducted to assess immediate outcome of the training. The training was carried out in a high school which was accessible to the trainees. The numbers of trainees in the two batches were 50 and 52 respectively. Three experienced facilitators and the first author facilitated the training sessions. The training took place in April 2018. Post-training activities included 6 monthly meetings (May-October 2018) with trained fisherfolks to provide continue education.

Evaluation of the Intervention

After six months’ post-intervention, an evaluation survey was conducted for the experimental group in November 2018. In the conduct of the evaluation survey, the same methodology as applied during the baseline among the fisherfolks in both communities was adopted. The same questionnaire used during the baseline data collection was administered at the evaluation.

Results

Socio-Demographic Data

The profile of the study participants at baseline in both groups is shown in Table 1. Almost half (48.7%) of respondents in EG and 70.4% in CG were between ages 21–40 years. Less than half, (45.7%) and (73.4%) of the fisherfolks had primary and secondary education in EG and CG respectively. Majority, (91.3%) and (94.3%) of the fisherfolks in EG and CG respectively, practiced Islamic religion. More than half of the fisherfolks (64.1%) and (59.0%) in EG and CG respectively, were married.

Table 1.

Baseline Demographic Profile of Fisherfolks (N = 208).

Demographic characteristics	EG (n = 103) No (%)	CG (n = 105) No (%)	Total	X² (Fishers Exact test)	p-value
Age
Less or equal to 20 years	14 (13.4)	24 (22.9)	38	4.80	0.000
21–30	24 (23.5)	41 (39.0)	65
31–40	26 (25.2)	33 (31.4)	59
41–50	31 (30.1)	7 (6.7)	38
51 and above	8 (7.8)	0 (0.0)	8
Mean age	35.9 ± 11.7	28.4 ± 8.1
Sex
Male	92 (89.3)	97 (92.4)	189	0.76	0.479
Female	11 (10.7)	8 (7.6)	19
Educational Qualification
No formal education	41 (39.8)	12 (11.4)	53	2.32	0.000
Primary school	18 (17.5)	28 (26.7)	46
Secondary school	29 (28.2)	49 (46.7)	78
Vocational/Tertiary	15 (14.5)	16 (15.2)	31
Marital status
Single/never married	27 (26.2)	38 (36.2)	65	1.56	0.071
Married	66 (64.1)	62 (59.0)	128
Divorced	7 (6.8)	2 (1.9)	9
Separated	1 (1.0)	2 (1.9)	3
Widower	2 (1.9)	1 (1.0)	3
Ethnic group
Bassa	38 (36.9)	10 (9.5)	48	4.47	0.000
Hausa	24 (23.3)	15 (14.3)	39
Nupe	19 (18.4)	54 (51.4)	73
Others*	22 (21.4)	26 (24.8)	48
Religion
Islam	94 (91.3)	99 (94.3)	193	0.28	0.599
Christianity	7 (6.8)	5 (4.7)	12
Traditional	2 (1.9)	1 (1.0)	3

*Others include Yoruba, Igbo, Ebira, Igbira-koto and Igala.

Knowledge About HIV and AIDS

Baseline HIV and AIDS knowledge scores for the experimental group rose from 5.8 at baseline to 17.9 at follow-up (p < 0.05); there was a slight increase from 11.8 at baseline to 12.3 at follow-up for the control group, but the difference was not significant (p > 0.05) (Table 2).

Table 2.

Fisherfolks’ HIV/AIDS Mean Knowledge Scores Obtained for EG and CG at Baseline and Post-Intervention.

	Mean HIV and AIDS knowledge score
Group	Baseline	Post-intervention	t-value	p-value
EG	5.80 ± 5.60	17.95 ± 3.74	11.57	0.000
CG	11.81 ± 7.10	12.38 ± 7.51	0.40	0.42
Mean difference	6.0	5.57
t-value	6.24	6.57
p-value	0.000	0.000

Fisherfolks’ Risk-Perception Toward HIV Infection

Fisherfolks in the CG had higher mean scores (16.59 ± 10.12) on risk perception towards HIV infection than those in the EG (9.64 ± 9.11) at baseline (0.000). Comparisons of fisherfolks’ mean risk-perception score shows that there was significant increase from 9.64 ± 9.11 at baseline to (23.29 ± 4.54) at post-intervention in the mean risk-perception score of fisherfolks for EG. Although there was also increase in the same score from 16.59 ± 10.12 at baseline to 17.19 ± 10.31 among the CG, the difference was not significant (Table 3).

Table 3.

Fisherfolks’ Risk-Perception Scores Obtained for EG and CG at Baseline and Post-Intervention.

	Mean risk-perception score
Group	Baseline	Post-intervention	t-value	p-value	Remark
EG	9.64 ± 9.11	23.29 ± 4.54	9.16	0.000	Significant
CG	16.59 ± 10.12	17.19 ± 10.31	0.30	0.800	Not significant
Mean difference	6.95	6.1
t-value	4.82	5.25
p-value	0.000	0.000

Sexual Behavior of Fisherfolks

Comparison of sexual behavior score of fisherfolks in EG (8.38 ± 8.10) and CG (7.59 ± 1.40) at baseline were not significant with the p-value at 0.42. There was a significant difference (p-value = 0.000) at post-intervention in the sexual behavior score of EG (4.26 ± 1.53) when compared with the sexual behavior score of CG (7.67 ± 1.41). Also, there was a significant difference in the sexual behavior score in EG at baseline and post-intervention since there was a decrease in risky sexual behavior of fisherfolks in EG at post-intervention. The comparison of mean sexual behavior score of fisherfolks in CG at baseline and post intervention was not significant (Table 4).

Table 4.

Fisherfolks’ Sexual Behavior Scores Obtained for EG and CG at Baseline and Post-Intervention.

	Mean sexual behavior scores
Group	Baseline	Post-intervention	t-value	p-value	Remark
EG	8.38 ± 8.10	4.26 ± 1.53	−3.43	0.000	Significant
CG	7.59 ± 1.40	7.67 ± 1.41	0.20	0.50	Not significant
Mean difference	0.79	3.41
t-value	0.80	9.74
p-value	0.422	0.000

Comparison of fisherfolks’ sexual behavior of EG and CG at baseline and post intervention is shown in Table 5. At baseline, 26.6% of fisherfolks in EG used condom always. But at post-intervention the figure increased to 58.5%.

Table 5.

Comparison of Fisherfolks’ Sexual Behaviour of EG and CG at Baseline and Post-Intervention.

Variable	Baseline (N = 208)		Post-intervention (N = 203)
Variable	EG (n = 103) Freq (%)	CG (n = 105) Freq (%)	EG (n = 101) Freq (%)	CG (n = 102) Freq (%)
Have you had sex before or after baseline?
Yes	94 (91.3)	91 (86.7)	94 (93.1)	91 (89.2)
No	9 (8.7)	14 (13.3)	7 (6.9)	11 (10.8)
Total	103 (100)	105 (100)	101 (100)	102 (100)
No of non-primary sexual partner
≤1	33 (62.2)	52 (60.5)	83 (88.3)	81 (89.8)
2–3 and above	20 (37.8)	34 (39.4)	11 (11.7)	10 (11.0)
Total	53 (100)	86 (100)	94 (100)	91 (100)
Have you used condom before or after baseline?
Always	25 (26.6)	28 (30.8)	55 (58.5)	30 (33.0)
Sometimes	38 (40 4)	42 (46.2)	29 (30.9)	48 (52.7)
Not at all	31 (33.0)	21 (23.1)	10 (10.6)	13 (14.2)
Total	94 (100)	91 (100)	94 (100)	91 (100)
Used condom with sexual partner/spouse
Yes	51 (54.3)	62 (68.1)	61 (64.8)	54 (59.3)
No	43 (45.7)	29 (31.9)	33 (35.1)	37 (40.7)
Total	94 (100)	91 (100)	94 (100)	91 (100)
Reasons for using condom
To prevent STD/HIV infections	43 (68.3)	56 (80.0)	56 (59.5)	27 (29.6)
To prevent pregnancy	14 (22.2)	12 (17.1)	23 (24.5)	49 (53.8)
Partner requested	3 (4.8)	2 (2.9)	11 (11.7)	11 (12.0)
Others	3 (4.8)	0 (0.0)	4 (4.2)	4 (4.3)
Total	63 (100)	70 (100)	94 (100)	91 (100)

Discussion

Fisherfolks’ Condom Use by Marital Status

Fisherfolks’ condom use by marital status at baseline and post intervention are in Tables 6 and 7. At baseline, 71.4% of never married in EG had never used condom. But at post intervention all the singles in EG used condom. For the married fisherfolks in EG at baseline, 48.0% indicated that they used condom sometimes. But at post intervention the figure increased to 62.5%.

Table 6.

Fisherfolks’ Condom Use by Marital Status at Baseline.

Marital status	Have you used condom before?	EG N (%)	CG N (%)	Total	Fishers Exact	P value
Single/Never married	Always	8 (53.3)	7 (46.7)	15	0.26	0.18
	Sometimes	9 (37.5)	15 (62.5)	24
	Not at all	5 (71.4)	2 (28.6)	7
Married	Always	15 (43.0)	20 (57.1)	35	0.38	0.41
	Sometimes	23 (48.0)	25 (52.1)	48
	Not at all	24 (58.5)	17 (41.5)	41

Table 7.

Fisherfolks’ Condom Use by Marital Status at Post Intervention.

Marital status	Have you used condom before?	EG N (%)	CG N (%)	Total	Fishers Exact	P value
Single/never married	Always	14 (37.8)	11 (42.2)	25	0.83	0.42
	Sometimes	5 (45.5)	6 (54.5)	11
	Not at all	0 (0.0)	1 (100.0)	1
Married	Always	15 (71.4)	6 (28.6)	21	0.48	0.12
	Sometimes	25 (62.5)	15 (37.5)	40
	Not at all	25 (60.0)	17 (40.5)	42

Discussion

Fisherfolks are a vulnerable group and an appropriate target for HIV prevention. We implemented an intervention to respond to the educational needs of fisherfolks in one fishing community in north central Nigeria. Fisherfolks in the EG had poor knowledge of HIV and AIDS at baseline compared with their counterparts in CG who had high knowledge on the same subject. The poor knowledge of fisherfolks in EG at baseline is consistent with the result obtained by¹⁷ in which 94.0% of the respondents in the study did not know what HIV and AIDS was all about. This is also in line with the findings of¹⁸ in their study in which their findings revealed that 98.4% of the fisherfolks were aware of HIV and AIDS but lacked adequate knowledge on mode of transmission and prevention of the disease.

The evaluation results indicate several positive outcomes of intervention. Fisherfolks in the intervention group had superior knowledge of HIV/AIDS than their counterparts in control group. Whereas at baseline the comparison group had better knowledge of HIV/AIDS, the situation was reversed at post-intervention when the EG had better knowledge than CG. It is encouraging that despite being relatively less educated, study participants in the EG had superior knowledge on HIV/AIDS than their counterparts in the CG at post-intervention. This is an indication that low literacy level is not a barrier to training.

This improvement may be attributed to the new knowledge of HIV/AIDS gained during the training as well as the effects of the continue education at follow-up. This finding confirms the results of previous intervention studies that show that knowledge of secondary school students¹⁹ (and out of school youths)²⁰ concerning reproductive health can increase after any educational intervention.^19,20 This improvement is not only encouraging but also desirable because acquisition of knowledge is usually the first logical stage in the process of changes in risky behaviour.²¹ Also, this result is consistent with Akinbami’s research²² which documented increase in apprentices’ knowledge of HIV/AIDS from what was obtained during the baseline. Other researchers have reported similar findings.^23–29

Another positive outcome of the intervention was improvement in fisherfolks’ risk-perception to HIV infection, which is also similar to findings from Bedford’s research³⁰ in which some category of people was made to be aware of HIV/AIDS by interacting with someone who is HIV positive. There was reduction in reported risky sexual behavior of fisherfolks in the intervention group at end-line when respondents reported fewer numbers of sexual partners and increase in condom use. Other researchers have reported similar results.^19,31,32 For example, Lori and colleagues³¹ found that intervention among South African youths resulted in delayed sexual intercourse, increased their condom use and there was reduction in the number of sexual partners better than respondents in the control group.

We are surprised that more married than never married fisherfolks used condoms at both baseline and post-intervention. By virtue of been married, these respondents are sexually active. It is possible the married fisherfolks might had used condom as a form of contraceptive with their spouses or used the same product during sexual encounter with non-marital partners. Future investigation would be necessary to identify the context and partners with whom these respondents had used the condom.

Conclusion

The training intervention improved HIV/AIDS knowledge, risk perception and reduction in risky sexual behavior among the fisherfolks thus meeting the education needs of this population. We provide the following recommendations:

Continuous HIV/AIDS education should be conducted among the fisherfolks in Ajaokuta and Lokoja fishing communities in order to sustain the benefits of this study.

The investigators received a lot of support from the traditional leaders during this study. For example, the traditional leaders in the experimental group assisted in the provision of training venue. This is a clear indication that there are community resources that can be utilized for HIV prevention activities if well harnessed. Local personnel and media resources such as community theatres and troupes can be used to effectively reinforce HIV prevention activities if well harnessed.

Suggestions for Future Research

Based on the findings from this study, the following areas were suggested for future research:

There is need to conduct training intervention on HIV and AIDS prevention for fisherfolks and female fish processors in the fishing communities in Kotonkafe, Itobe, Idah and other fishing communities along River Niger in Kogi State. This has become imperative because going by the nature of their profession fish processors do interact a lot with the fisherfolks. This is important because other interesting characteristics may be discovered among this group of people in these riverine areas.

Footnotes

Acknowledgment

We would like to acknowledge the people that assisted in this study: the respondents, research assistants, religious leaders and traditional leaders in the two communities.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Aiyedun Sunday Abiodun

Author Biographies

Aiyedun Sunday Abiodun, MPH, PhD is from the Department of Health Promotion and Education, College of Medicine, University of Ibadan, Nigeria. His areas of research interests include adolescents reproductive health and HIV/AIDS Prevention.

Ademola J. Ajuwon, MPH, PhD, is a Professor of Health Promotion and Education, College of Medicine, University of Ibadan, Nigeria. His areas of research interests include adolescents reproductive health, HIV/AIDS prevention, social media, and research ethics.

References

Olowosegun

Sule

Sanni

, et al. Awareness of HIV/AIDS pandemic in selected fishing communities in North Central Nigeria. AIDS 2008; 75: 218–432.

Nigeria HIV/AIDS Indicator and Impact Survey. National Summary Sheet, 2019. A publication of Federal Ministry of Health, Abuja Nigeria.

Allison

Seeley

JA.

HIV/AIDS among fisherfolk. A threat to responsible fish and fisheries. Fish Fisheries 2004; 5: 215–234.

Husken

SMC

Heck

The ‘fish trader+’ model: reducing female fish traders’ vulnerability to HIV. Afr J Aids Res 2012; 11: 17–26.

Lampinen

Chan

Sexual risk behaviour of canadian participants in the first efficacy trial of a preventive HIV-1 vaccine. Cmaj 2005; 172: 479–483.

Markussen

Coping with uncertainty women in the informal fish processing and marketing sector of Lake Victoria. NIBR Work Paper, 2002.

Merten S. “Fish for sex” exchange in the Kafue flats: risky opportunities of rural women, in proceedings of the international workshop on “responding to HIV and AIDS in the fishery sector in Africa. World Fish Centre 2006; 97: 45–98.

Allison

Ellis

The livelihoods approach and management of small-scale fisheries. Mar Policy J 2001; 25: 377–388.

Sergon

Omolo

Mohmmed

, et al. EAC/AMREF LakeVictoria partnership (EALP) programme. HIV and AIDS baseline sero-behavioural study among fishing communities lake Victoria, Kenya. J AIDS 2010; 67: 365–560.

10.

Olowosegun

Akangbe

Olowosegun

, et al. Assessment of awareness level and sources of information on HIV/AIDS among fisherfolks around Kainji lake basin. Niger J Fish Aquacult 2017; 5: 50–63.

11.

Mojola

SA.

Fishing in dangerous waters: Ecology, gender and economy in HIV risk, Soc.Sci Med 2011: 72; 149–156.

12.

Kissling

Allison

Seeley

, et al. Fisherfolk are among groups most at risk of HIV: cross-country analyst of prevalence and numbers infected. J AIDS 2005; 89: 683–785.

13.

Plus, News, Fish trade aiding the spread of HIV/AIDS. A UN run news service focusing on HIV/AIDS related issues, 2005. https://www.thenewhumanitarian.org/fr/node/224781

14.

Loevinsohn

Gillespie

HIV/AIDS, food security and rural livelihood: Understanding and responding. FCND Discussion Paper No 157. Washington: IFPRI, 2003.

15.

Ajani

Sustainable fish production, processing and marketing. In: Food production and food security – the role of local government councils and the rural farmers in agriculture, food production and security. NUJ Jn 8; 140–189.

16.

Family Health International360. Global Fish Alliance (G-FISH). https://www.fhi360.org/projects/global-fish-alliance-g-fish

17.

Yahaya

MK.

Indigenous Music Entertainment. Education lessons from AIDS: Batannae, Wuzana in Bida Emirate Nigeria. Ibadan: Stirling Hardens Publishers, 2000, p. 58.

18.

Olowosegun

Akangbe

J, A

Olowosegun

, et al. Sexuality and HIV/AIDS among fisherfolks in Kainji lake basin. Glob J Med Res Dis 2013; 13: 4–18.

19.

Cross

J, E

Saunder

Bartelli

The effectiveness of educational and needle exchange programme: a meta-analysis of HIV prevention strategies for IDU. Qual Quantity 1998; 32: 165–180.

20.

Osowole

O, S

Oladepo

Effects of peer education on deaf secondary school students’ HIV/AIDS knowledge, attitudes and sexual behaviour. African Journal of Reproductive Health 2000; 4: 93–103.

21.

Ajuwon

AJ.

Effects of educational intervention on reproductive health knowledge, attitude and practices among secondary school students in Oyo State, Nigeria. PhD Thesis, Department of Health Promotion and Education, University of Ibadan, Nigeria, 2000, 194 pp.

22.

Aknbami

AA.

Effects of educational interventions on HIV/AIDS knowledge, sexual behaviour and perceived self-efficacy among female apprentices in Benin-City, Nigeria. PhD Thesis, Department of Health Promotion and Education, University of Ibadan, 2013, 184 pp.

23.

Ajuwon

Komolafe-Opadeji

Ikhizama

Librarian-initiated HIV/AIDS prevention intervention programme outcome in rural communities in Oyo state, Nigeria. Int Q Community Health Educ 2014; 34: 367–390.

24.

Eni-Olorunda

JT.

Efficacy of modeling and shaping strategies on attitude of children with mild mental retardation towards reading in Ibadan, Nigeria. Eur J Soc Sci 2010; 16: 635–645.

25.

Karunwi

Effects of training on knowledge, attitude and self-efficacy of teachers to prevent lead poisoning in Ido Local Government Area, Oyo State. MPH Thesis, Department of Health Promotion and Education, University of Ibadan, 2010.

26.

Ojelade

A. Effects of training on Teachers’ knowledge, attitude and self-efficacy to deliver HIV education in primary schools of Akinyele Local Government Area, Oyo State. MPH Thesis, Department of Health Promotion and Education, University of Ibadan, 2014, 246 pp.

27.

Osiki

O. Perceived implication of fatalism, poverty and personality factors in nonchallant sexual behaviours in HIV/AIDS prevention in Africa. AIDS 2008; 45: 321–452.

28.

United Nation International Children Emergency Fund. HIV among adolescents in developing countries. New York: UNICEF Publication, 2003.

29.

United Nation Fund for Population Activities. Reports on Population and Development, 2004. https:www.unfpa.org

30.

Bedford

Teaching change: a mixed-method study of interventions, risk-perceptions and behaviour change among the Garifana of Honduras. PhD Thesis, Department of Rural Sociology and Demography, Pennsylvania State University, 2010, 241 pp.

31.

Lori

A, J

Scott

Paige

, et al. Sexual risk reduction intervention for HIV prevention among South AFRICAN youth: a meta analytic review. Curr HIV Res 2013; 7: 549–558.

32.

Semaan

Lauby

Liebman

Street and network sampling in evaluation studies of HIV risk-reduction interventions. AIDS Rev 2002; 2: 213–223.