Research Article

Knowledge and Perception towards ART Adherence among Female Sex Workers in Rivers State, Nigeria

Abstract

Female sex workers (FSWs) face individual, occupational, and social barriers that may affect adherence to antiretroviral therapy (ART). This study assessed ART knowledge, perception, associated factors, and adherence among FSWs in Rivers State, Nigeria. A cross sectional study was conducted among 394 FSWs accessing services at Diadem Consult Initiative between July and September 2025, selected by convenience sampling from 5,300 service users recorded between 2020 and 2024. Data were collected using medical records and interviewer-administered questionnaires and analysed with IBM SPSS Statistics version 27 using descriptive statistics and chi-square tests at p < 0.05. Good ART knowledge was observed among 348 (88.3%) respondents, while 46 (11.7%) had poor knowledge. Knowledge was high regarding daily medication (392; 99.5%), fixed timing (386; 98.0%), lifelong treatment (391; 99.2%), and missed-dose consequences (352; 89.3%), but lower for identifying TDF/3TC/DTG (185; 47.0%) and understanding ART’s effect on CD4 counts (199; 50.5%). ART dispensing staff (348; 88.3%) and referring physicians (339; 86.0%) were the main information sources. Good perception was reported by 276 (70.0%), while 118 (30.0%) had poor perception. Most believed in ART effectiveness (365;  92.6%) and the need to continue treatment (378; 95.9%), although 308 (78.2%) felt ashamed of taking ART. Knowledge was significantly associated with religion (χ2 = 9.307, p = 0.010), education (χ2 = 14.218, p < 0.001), income (χ2 = 11.412, p = 0.022), ART initiation year (χ2 = 9.716, p = 0.045), support-group membership (χ2 = 5.354, p = 0.021), reminder use (χ2 = 8.667, p = 0.003), duration of sex work (χ2 = 11.450, p < 0.001), viral suppression (χ2 = 8.580, p = 0.003), and ART-related side effects (χ2 = 10.653, p = 0.001). Perception was associated with reminder use (χ2 = 16.028, p < 0.001) and duration of sex work (χ2 = 6.382, p = 0.012). Good adherence level (>90%) was achieved by 184 (46.7%) while 210 (53.3%) had poor adherence level. Knowledge and perception were not significantly associated with adherence. Despite generally good knowledge and perception, adherence was suboptimal. Interventions should address treatment knowledge gaps, stigma, and occupational barriers while strengthening confidential reminders and peer support. 

Authors affiliation:

Judith Nnedinma Excellencio (ORCID): Department of Public Health Sciences, College of Medical Sciences, Rivers State University, Port Harcourt, Nigeria.
Adeniyi Francis Fagbamigbe (ORCID): Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria; Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
Clement Kevin Edet (ORCID): Department of community Medicine, College of Medical Sciences, Rivers State University, Port Harcourt, Nigeria.
Owhonka Aleruchi (ORCID): Department of Microbiology, Faculty of Science, Rivers State University, Port Harcourt, Rivers State, Nigeria.
Merit Chioma Chinda (ORCID): Department of Public Health Sciences, College of Medical Sciences, Rivers State University, Port Harcourt, Nigeria.
Anthony Ike Wegbom (ORCID): Department of Public Health Sciences, College of Medical Sciences, Rivers State University, Port Harcourt, Nigeria.

How To Cite: J.N. Excellencio, A.F. Fagbamigbe, C.K. Edet, O. Aleruchi, M.C. Chinda, and A.I. Wegbom. Knowledge and Perception towards ART Adherence among Female Sex Workers in Rivers State, Nigeria. Journal of Public Health and Environmental Research, 2(2):115–129, 2026. https://doi.org/10.58612/jpher2213