[page 30] [Infectious Disease Reports 2011; 3:e7] Gender inequities in sexually transmitted infections: implications for HIV infection and control in Lagos State, Nigeria Ezekiel Oluwagbemiga Adeyemi Department of sociology, Lagos State University, Ojo, Lagos, Nigeria Abstract Beyond the statistics of sex-based differ- ences in infection rates, there are profound dif- ferences in the underlying causes and conse- quences of HIV infections in male and female which need to be examined. The study therefore examines; the gender differences in the STI knowledge and gender-related potential risks of HIV heterosexual transmission. Quantitative and qualitative data were collected. A multi- stage random sampling procedure was employed in administration of 1358 question- naires. For qualitative data, four focus group discussions (FGD) were conducted to collect information from stakeholders within the study population, while In-depth interview was employed to collect information from 188 people living with HIV/AIDS through support groups in the State. The data collected were subjected to basic demographic analytical techniques. Combination of univariate, bivariate, and multi- variate analysis were employed. Information from focus group discussions and in-depth interviews were transcribed and organized under broad headings that depict different aspects of the discussions. Majority of the respondents interviewed did not inform their partners about their infection in the study area. It was also discovered that stigmatization did not allow some women to disclose their status to their sexual partners. Some of the HIV-positive patients interviewed agreed that they did not attend the health facilities to treat the STI’s before they were finally confirmed positive. The study hypothesis revealed that communication between partners about STI’s was associated with an increase in risk reduction behaviour. The paper concluded that there is need for more information and education on communication about STI’s between the sexual partners; to reduce the spread of sexually transmitted dis- eases within the nation. Introduction In the developing countries, there has been a changing pattern of male/female HIV infec- tions. 1,2 Early cases in many countries were concentrated in male homosexuals and intra- venous drug users. But as the epidemic contin- ues to spread, there has been a progressive shift towards heterosexual transmission and increasing infection rates among females. The reality today is that, globally, more women than men are now dying of HIV/AIDS, and the age patterns of infection are significantly different for the two sexes. 3 Beyond the statistics of sex-based differ- ences in infection rates, there are profound differences in the underlying causes and con- sequences of HIV/AIDS infections in male and female, reflecting differences in biology, sexu- al behaviour, social attitudes and pressures, economic power and vulnerability 4 In many ways, the inequity that women and girls suffer as a result of HIV/AIDS serves as a barometer of their general status in society and the dis- crimination they encounter in all fields, including health, education and employment. Due to their position, African women have dif- ficulty in saying no to sex or to unprotected sex since they are socially and economically dependent on male partners. 5 Also, due to the limited livelihood opportunities and various forms of gender discrimination and harass- ment, women adopt sexual survival strategies; they sell their bodies at the work place, or at school, in order to gain access to resources, security, patronage or protection. This may be aggravated, where women lose their livelihood as they become widows through AIDS. 1 The practice of forcing young girls into mar- riages sometimes at early ages is not only trau- matic, but also devastating. It is difficult to separate the social and physiological causes, especially when young women who are at par- ticular physical risk are exposed to sexual practices over which they have limited control due to social conditions. For social reasons, women tend to have older male partners, the peak age of new infection is between 15 and 25 years, whereas men tend to become infected 5- 10 years. 6 The gender-based norms surrounding sexu- al behaviour also make the female gender to be more infected than male. Women are thought to leave sexual initiative to men and, or, behave in ways, which please men (e.g. use of virginal stimulants), whilst increasing risk to themselves 7 They are also expected to limit their sexual relations, often to marriage or long-term partnership, while men are often encouraged to express their masculinity and increase their social status by having many partners\lots of sexual experience, increasing not only their own risk of infection, but also that of their monogamous partners. 1,8,9 It is for these reasons that HIV/AIDS is inherently a gender-based issue and needs to be seen in this light if it is to be addressed effectively. That the greatest risk of sexually transmit- ted diseases (STDS) and AIDS to women in Africa is provided by their husbands and other unstable partners has long been established. 10 This is evidently different from infection through homosexual transmission character- istic of the west. The issue of concern and con- trol of the AIDS epidemic in Africa, must there- fore necessarily focus on communication about sexual issues (such as condom use, information about STI’s and other reproductive matters) between men and women in conjugal or other such intimate relationships. It was observed that the use of personal protection (condoms) against STD risk appeared not to be influenced by concern about HIV and AIDS; rather avoiding pregnancy was found to be the main reason for using condoms. 11,12 The respondents felt they were not well informed about HIV/AIDS, particularly in the emotional and social aspects of the disease. The majority of the commercial sex workers knew that using condoms protected them from STDs, only one- third were using them regularly. 11 This has a serious implication for the spread of HIV infec- tion in Nigeria. It can be difficult or impossible for sex workers to insist on safe sex, clients might react with violence or simply move on to someone willing to forego a condom. A study in India found out that clients of the commercial sex workers were willing to pay almost double the fee for sex without a condom. 12 They observed that young people are putting each other's sexual health at risk because they are too embarrassed to tell their partner they have a sexually transmitted infection (STI). A new NHS survey shows that 16% of under 25s would not tell the person that they are sleeping with if they found out they had a STI while 19% are not sure. Men were found to be much more likely to stay silent about the infection than Infectious Disease Reports 2011; volume 3:e7 Correspondence: Adeyemi Ezekiel Oluwagbemiga, Department of sociology, Lagos State University, Ojo, Lagos, Nigeria. E-mail: gbemibolaa@yahoo.com Key words: HIV/AIDS, STI's not hiv/aids, stis' Acknowledgement: I thank Council for Development of Social Research in Africa (CODESRIA) for providing the research grant for this work. Received for publication: 9 July 2009. Accepted for publication: 1 April 2011. This work is licensed under a Creative Commons Attribution NonCommercial 3.0 License (CC BY- NC 3.0). ©Copyright Ezekiel O. Adeyemi., 2011 Licensee PAGEPress, Italy Infectious Disease Reports 2011; 3:e7 doi:10.4081/idr.2011.e7