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AIDS in Africa - Nigeria
Why is Nigeria important?
Background
HIV and AIDS in Nigeria
How is HIV transmitted in Nigeria?
Factors contributing to the spread of
HIV in Nigeria
Why are so many women being infected
with HIV in Nigeria?
Nigeria has the biggest population in Africa with 1
in 6 Africans being Nigerian. Although HIV prevalence rates are much
lower in Nigeria than in other African countries such as South
Africa and Zambia, the size of Nigeria's population meant that by
the end of 2003, there were an estimated 3,600,000 people living
with HIV/AIDS. This is the largest number in the world after South
Africa and India.
Nigeria has a great deal of influence in West
Africa. It is an important member of ECOWAS (the Economic Community
of West African States) and plays a central role in ECOMOG's (the
Economic Community of West African States Monitoring Group)
peacekeeping operation. HIV/AIDS has already badly affected Nigeria
society and its economy. If the epidemic continues at its current
rate, or worsens, there could be knock on effects in other West
African countries and the whole region could be affected.
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Nigeria gained independence from Britain in 1960 and
from 1966 to 1999 was controlled for the most part by different
military governments. In May 1999, the democratically elected
government of Olusegun Obasanjo, a former military dictator, assumed
power. He was re-elected to a second term in 2003.
Nigeria has a population of around 140 million and
life expectancy is around 50 years. It is an ethnically and
religiously complex country with over 250 ethnic groups. More than
50% of the population belong to the Hausa-Fulani, Yoruba and Ibo
ethnic groups.
50% of the population are Muslim, 40% Christian and
10% hold indigenous beliefs. The official language is English, but
over 250 other languages are spoken.
Nigeria is the 5th largest oil producer in the world
and oil dominates the economy. The military governments in power
between 1966 and 1999 failed to develop the economy in other areas.
This, along with economic mismanagement and corruption, has
contributed to Nigeria's poor economic performance and rising
poverty. There is a highly unequal distribution of wealth in Nigeria
with 66% of the population falling below the poverty line of $1 a
day. This puts it among the 20 poorest countries in the world.
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The first case of AIDS was identified in Nigeria in
1986 and the HIV/AIDS prevalence rate rose from 1.8% in 1988 to 5.8%
in 2001. Since 1991, the Federal Ministry of Health has carried out
a National HIV/syphilis sentinel seroprevalence survey every 2
years. The most recent survey was in 2003 and it estimated that
there were 3,300,000 adults living with HIV/AIDS in Nigeria,
1,900,000 (57%) of these women.
In the 2003 survey, the national prevalence rate had
dropped to 5% from 5.8% in 2001. However, it found that state
prevalence rates vary from as low as 1.2% in Osun state to as high
as 12% in Cross River state. Overall, 13 of Nigeria's 36 states had
prevalence rates of over 5%. These figures give support to the claim
that there are explosive, localized epidemics in some states.
At 5.6%, HIV/AIDS prevalence rates are highest for
young people between the ages of 20 and 24 compared with other age
groups. Nigeria's STD/HIV Control estimates that over 60% of new HIV
infections are in the 15-25 year old age group.
In 2004 it was estimated there were 300,000 deaths
from AIDS and 2 million AIDS orphans in Nigeria. There has been an
alarming increase in the number of HIV positive children in recent
years, 90% of whom contract the virus from their mothers.
Currently very few Nigerians have access to basic
HIV/AIDS prevention, care, support or treatment services. Around
520, 000 people are estimated to require ART (antiretroviral
therapy) and only 17, 000 are currently receiving treatment. At
present there are 50 treatment sites for HIV/AIDS in Nigeria.
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80% of HIV infections in Nigeria are transmitted by
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 STIs such as chlamydia and gonorrhoea, which make
it easier for the virus to be transmitted. Blood transfusions are
responsible for 10% of all HIV infections. There is a high demand
for blood because of road traffic accidents, blood loss from surgery
and childbirth, and anaemia from malaria. As there is no coordinated
national blood supply system, blood isn't routinely tested for HIV,
and a study last year found that 4% of blood donors in Lagos were
HIV positive. The remaining 10% of HIV infections are acquired
through other routes such as mother-to-child transmission,
homosexual sex and intjecting drug use. The rate of mother to child
transmission in Nigeria has gone up in recent years as the number of
HIV positive women has increased.
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Sex is traditionally a very private subject in
Nigeria for cultural and religious reasons. The discussion of sex
with teenagers, girls in particular, is seen as indecent. Up until
recently there was little or no sexual health education for young
people and this has been a major barrier to reducing sexually
transmitted infection (STI) and HIV rates. 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.
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Stigma and discrimination against people living with
HIV/AIDS is commonplace in Nigeria. Both Christians and Muslims see
immoral behaviour as being the cause of the HIV/AIDS epidemic. This
affects attitudes towards people living with HIV/AIDS (PLWHA) and
HIV prevention. PLWHA often lose their jobs or are denied healthcare
services because of the ignorance and fear about HIV and AIDS. There
is so much ignorance about HIV/AIDS that 60% of healthcare workers
think HIV positive patients should be isolated from other patients.
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Over the last two decades, Nigeria's healthcare care
system has deteriorated because 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 (MTCT). Sexual health clinics providing
contraception and testing and treatment for other STIs are also few
and far between.
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Nigeria is a male dominated society and women are
seen as inferior to men. Women's traditional role is to have
children and to be responsible for the home. Their low status and
lack of access to education increases their vulnerability to HIV
infection. Certain social and cultural practices also make them
vulnerable to HIV.
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Harmful marriage practices violate women's human
rights and contribute to increasing HIV rates in women and girls. In
Nigeria there is no legal minimum age for marriage and early
marriage is still the norm in some areas. Parents see it as a way of
protecting young girls from the outside world and maintaining their
chastity.
Girls get married between the ages of 12 and 13 and
there is usually a large age gap between husband and wife. Young
married girls are at risk of contracting HIV from their husbands as
it is acceptable for men to have sexual partners outside marriage
and some men have more than one wife (polygamy). Because of their
age, lack of education and low status, young married girls are not
able to negotiate condom use to protect themselves against HIV and
STIs.
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Female circumcision/female genital mutilation (FGM)
is a cultural practice where all or part of the female genitalia is
removed by cutting. 60% of all Nigerian women experience FGM and it
is most common in the south, where up to 85% of women undergo it at
some point in their lives. FGM puts women and girls at risk of
contracting HIV from unsterilized instruments, such as knives and
broken glass that are used during the procedure.
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Although prostitution is illegal in Nigeria there
are more than 1 million female sex workers. HIV infection rates
among sex workers have been estimated to be as high as 30% in some
areas. There are low levels of condom use among sex workers because
of a lack of knowledge about HIV transmission and poor acceptance by
male clients.
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