How is HIV transmitted in Nigeria?

How is HIV transmitted in Nigeria?


Some 80% of HIV infections in Nigeria are transmitted through heterosexual sex. Factors contributing to this include a lack of information about sexual health and HIV, low levels of condom use and high levels of sexually transmitted infections (STIs) such as chlamydia and gonorrhoea, which make it easier for the virus to be transmitted.



It has been reported that blood transfusions account for up to 10 percent of new HIV infections in Nigeria11. There is a high demand for blood because of blood loss from surgery and childbirth, road-traffic accidents and anaemia and malaria. Not all Nigerian hospitals have the technology to effectively screen blood and therefore contaminated blood is often used. The Nigerian Federal Ministry of Health have responded by backing legislation that requires hospitals to only use blood from the National Blood Transfusion Service, which has far more advanced blood-screening technology12.



The other main transmission route is mother-to-child transmission. In 2005 it was estimated that 220,000 children were living with HIV, most of whom became infected from their mothers13.



Factors contributing to the spread of HIV in Nigeria

Lack of sexual health information and education

Sex is traditionally a very private subject in Nigeria and the discussion of sex with teenagers is often seen as inappropriate. Up until recently there was little or no sexual health education for young people and this has been a major barrier to reducing rates of HIV and other STDs. UNAIDS estimate that only 18 percent of women and 21 percent of men between the ages of 15 and 24 correctly identify ways to prevent HIV14. Lack of accurate information about sexual health has meant there are many myths and misconceptions about sex and HIV, contributing to increasing transmission rates as well as stigma and discrimination towards people living with HIV/AIDS.



HIV testing

Doctors seeing patients in an HIV clinic in Nigeria

Another contributing factor to the spread of HIV in Nigeria is the distinct lack of voluntary and routine HIV testing. In a 2003 survey, just 6 percent of women and 14 percent of men had ever been tested for HIV and received the results15. In 2005, only around 1 percent of pregnant women were being tested for HIV16.



In 2006 president Obasanjo publicly received an HIV test and counselling on World AIDS Day in order to promote the services and information available to people in Nigeria. He stated on the day, “A great majority of Nigerians have now come to accept the reality of AIDS”17. However, the statistics show that the Nigerian government desperately need to scale up HIV testing rates in order to bring the epidemic under control.



Cultural practices

Women are particularly affected by the epidemic in Nigeria. In 2006 UNAIDS estimated that women accounted for 61.5 percent of all adults aged 15 and above living with HIV18.



Traditionally, women in Nigeria marry young, although the average age at which they marry varies between states. A 2007 study revealed that 54 percent of girls from the North West aged between 15-24 were married by age 15, and 81 percent were married by age 1819. The study showed that the younger married girls lacked knowledge on reproductive health, which included HIV/AIDS. They also tend to lack the power and education needed to insist upon the use of a condom during sex. Coupled with the high probability that the husband will be significantly older than the girl and therefore is more likely to have had more sexual partners in the past, young women are more vulnerable to HIV infection within marriage.



AVERT.org has more about women and AIDS.



Poor healthcare system

Over the last two decades, Nigeria's healthcare system has deteriorated as a result of political instability, corruption and a mismanaged economy. Large parts of the country lack even basic healthcare provision, making it difficult to establish HIV testing and prevention services such as those for the prevention of mother-to-child transmission. Sexual health clinics providing contraception, testing and treatment for other STDs are also few and far between20. This makes it particularly difficult to keep the spread of the epidemic under control.



Prevention

Condoms

The total number of condoms provided by international donors has been relatively low. One report showed that between 2000 and 2005, the average number of condoms distributed in Nigeria by donors was 5.9 per man, per year21. A study in 2002 found that 75 percent of health service facilities that had been visited did not have any condoms or contraceptive supplies22.



The number of female condoms sold in Nigeria has significantly increased, which indicates a greater awareness of sexual health issues. In 2003 only 25,000 female condoms had been sold, which increased to 375,000 in 200623. The female condom can potentially help in reducing the spread of HIV, as it does not rely upon the willingness of the man to use a condom himself. However, the female condom is more expensive than the traditional male condom, and is too pricey for the majority of Nigerians.



Restrictions on condom promotion have hampered HIV prevention efforts. In 2001, a radio advertisement was suspended by the Advertising Practitioners Council of Nigeria (APCON) for promoting messages suggesting that it is acceptable to engage in premarital sex as long as a condom is used24. In 2006 APCON also started to enforce stricter regulations on condom advertisements that might encourage ‘indecency’25.



Education

As the majority of new HIV infections occur in young people between the ages of 15 and 25, sex education at school is an important aspect of HIV prevention. In recent years a new curriculum has been introduced for comprehensive sex education for 10-18 year olds. It focuses on improving young people's knowledge and attitudes to sexual health and reducing sexual risk-taking behaviours.



In the past, attempts at providing sex education for young people were hampered by religious and cultural objections26. However, the new curriculum was developed with consultation from religious and community leaders and is expected to remain in place in the future.



Media campaigns & public awareness

As Nigeria is such a large and diverse country, media campaigns to raise awareness of HIV are a practical way of reaching many people in different regions. Radio campaigns like the one created by the Society for Family Health are thought to have been successful in increasing knowledge and changing behaviour. "Future Dreams", was a radio serial broadcast in 2001 in nine languages on 42 radio channels. It focused on encouraging consistent condom use, increasing knowledge and increasing skills for condom negotiation in single men and women aged between 18 and 3427.



In 2005, a campaign was launched in Nigeria in a bid to raise more public awareness of HIV/AIDS. This campaign took advantage of the recent increase in owners of mobile phones and sent text messages with information about HIV/AIDS to 9 million people28.