CHAPTER TWO
2.6 Overview of HIV/AIDS
2.6.1 HIV/AIDS in Nigeria
The first case of HIV infection in Nigeria was identified in 1986 (Pennington, 2007). In 2003, Nigeria was declared one of the 14 most HIV-afflicted countries in the world (The White House, 2003), and as home to the largest epidemic in West Africa (UNAIDS, 2008). The epidemic is now stable at 3.1% (2.3-3.8%) prevalence (Federal Ministry of Health Nigeria, 2006). However, there is cause for concern because UNAIDS (2008) suggests the non-representativeness of sentinel data on which the prevalence is based, and hence non-reliability of such data in estimating national HIV prevalence. Moreover, the current prevalence is still highly significant with an estimated 140 million people living in Nigeria. It is not surprising then that UNAIDS/WHO (2006) ranked Nigeria third globally in respect of having the highest HIV/AIDS rates, after India and South Africa.
116 The HIV/AIDS burden among the Nigerian youth follows the same trend generally found in SSA with adolescent girls at a very high risk. Over 60.0% of Nigerians are youths, 44.0% of which are 15 years old and younger (UNDP, 2004). The same report affirms that the age of sexual debut for 25.0% of these youths is 15 years, while 50.0% initiate sex at the age of 18 years. This group is no doubt highly vulnerable. Additionally, it is estimated that 60.0% of all new infections in Nigeria occur in young people between the age of 15 and 25 (Pennington, 2007).
The UNDP (2004) argues that HIV affects all indices of human development – the ability to lead a long and healthy life; possessing knowledge required to lead a happy and productive life; and having access to resources that will enable a decent standard of living. It also predicts that if the epidemic in Nigeria continues unabated, the implications for human development are going to be devastating. These include:
Changes in the population structure as a result of high morbidity and mortality of young people (15-29), which will leave the country with a less dynamic and vibrant population
Less productivity, with a dwindling economy as a direct result of the above
An increase in the number of child-headed households due to an increased adult mortality rate
A breakdown of the social safety nets provided by the extended family system due to the increasing numbers of orphans and care needed by infected family members
Poverty at all levels – individual, community and national
Reductions in school enrolment and adult literacy levels, as well as a low quality of education
A possible decline in GDP
Food insecurity
In Nigeria, it has been documented that 80.0% of HIV infections occur through heterosexual transmission while the rest are accounted for by blood transfusion and mother-child transmission (Pennington, 2007; UNDP, 2004). The UNDP (2004) has also established documented evidence, albeit not comprehensive, of homosexuality and lesbianism in settings such as prisons, male or
117 female dominated groups and professions, and some urban settings. In addition, most members of these groups of homosexuals and lesbians in Nigeria are also bisexual.
According to the UNDP (2004), the major socio-economic and cultural factors contributing to the spread of HIV in Nigeria are its social structure, modernisation, urbanisation and poverty. It argues that Nigeria‘s patriarchal family system assigns a dominant role to men, and women are only to be seen but not heard. Women‘s subordinate role in a typical Nigerian setting makes it very difficult for them to negotiate safe sex with their partners. To worsen matters, a double standard exists that frowns at married women having extramarital affairs but permits men to do so. Nigerian women therefore have no control over their sex lives or those of their husbands. In addition, Lau and Muula (2004) argue that rapid modernisation and urbanisation has resulted in migration from rural to urban areas, where people are not under the traditional and cultural sanctions and hence a loss of traditional and cultural values occurs. This, they note, has led to multiple sexual partnerships.
Specifically, factors contributing to HIV spread in Nigeria include (Ogunbodede, 2004;
Pennington, 2007; UNDP, 2004):
Poverty, which has eaten deep into the country‘s economy. It is both the cause and the consequence of HIV infection. The poor are more vulnerable to the infection because they lack the financial power and resources to live decently. After contracting the infection, it further impoverishes them. Poverty could also increase the rate of migration to urban areas, resulting in a loss of traditional and cultural values, overcrowding, child labour and sexual coercion, all of which are determinants of HIV infection
Commercial sex work as a means of making money in urban areas
Low literacy levels, especially among females. Education affects the level and quality of safe sex information a person has access to. It has been documented that persons with high literacy levels practise safe sex than their counterparts who are illiterate. Lack of accurate sex information also leads to misconceptions about sex and HIV, with the result being increased transmission rates and stigma and discrimination against people infected with HIV/AIDS
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Cultural practices that permit men to have multiple sexual partners, such as polygamy, concubinage, wife hospitality, and wife inheritance
The erroneous belief of virgin-cleansing. It is believed that having sex with females with disability and young girls, who are most likely to be virgins, can cure HIV and other STIs. This is the reason for some cases of rape among these groups of females
A poor or weak healthcare system due to political instability and mismanaged economy has made it difficult to provide enough services for prompt diagnosis and treatment of STIs; HIV counselling, testing, prevention; and lack of antiretrovirals. Prescription drugs can easily be obtained without prescriptions, leading to self-medication and sub-optimal treatment of STIs
Poor community support for HIV/AIDS prevention programmes and condom use
Harmful traditional practices such as female genital mutilation, scarification and tribal marks
2.6.2 Challenges of measuring adolescents’ sexual behaviours and HIV-related knowledge,