A qualitative exploration of perceived risks, motivations, and risk management strategies among brothel-based female sex workers in Ibadan, Nigeria

Abstract

Female sex workers (FSWs) experience a higher burden of Human Immunodeficiency Virus (HIV), and other sexually transmitted infections (STIs) compared to the general population due to the nature of their work. In Nigeria, challenges such as poverty, stigma, and poor access to healthcare continue to heighten their vulnerability, even though prevention programmes are in place. However, limited qualitative evidence exists on how FSWs perceive sexual risks, the motivations driving unsafe practices, and the strategies used to mitigate them. This study draws from the constructs of the Health Belief Model (HBM) to examine the experiences of brothel-based FSWs on vaginal, oral, and Anogenital sexual activity. This qualitative study was conducted in brothels located in Ibadan, Oyo State, Nigeria, as part of the SHINI Project. Two focus group. discussions (FGDs) with 19 participants and five in-depth interviews (IDIs) were held with purposively selected FSWs aged 18–45 years. Data were collected between August and October 2016, audio-recorded, transcribed, translated into English, and coded using NVivo 11. Thematic analysis was applied to identify patterns related to perceived risks, motivations, and coping strategies. FSWs perceived oral and Anogenital sexual activity as high-risk practices, linking them to infections such as syphilis, gonorrhoea, herpes, and human papillomavirus (HPV), as well as long-term complications including mouth cancer, faecal incontinence, and rectal trauma. Motivations for engaging in unsafe sexual behaviours included financial incentives, fear of losing clients, peer influence, and curiosity. While some participants demonstrated agency by refusing unsafe sex or negotiating safer alternatives, economic hardship, client coercion, and stigma often limited their ability to act. Coping strategies included outright refusal, condom use, negotiation for alternative styles, and frequent medical check-ups, though stigma and discriminatory health services reduced care-seeking. The findings highlight the complex balance between economic survival and health risk awareness among brothel-based FSWs. To reduce these risks, this study recommends the implementation of targeted interventions targeted interventions are needed, including comprehensive sexual health education, stigma-free healthcare services, improved access to condoms and lubricants, and economic empowerment initiatives. Collaboration between government agencies, NGOs, healthcare providers, and community organisations is essential to reduce vulnerabilities and improve the health outcomes of this key population.