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HIV and AIDS in Nigeria

In Nigeria, an estimated 3.6 percent of the population are living with HIV and AIDS.1 Although HIV prevalence is much lower in Nigeria than in other African countries such as South Africa and Zambia, the size of Nigeria’s population (around 162.5 million) means that by the end of 2009, there were an estimated 3.3 million people living with HIV.2 3

Approximately 220,000 people died from AIDS in Nigeria in 2009.4 With AIDS claiming so many lives, Nigeria’s life expectancy has declined significantly. In 2010 the overall life expectancy was only 52 years.5

back to top The history of HIV in Nigeria

The first two cases of HIV and AIDS in Nigeria were identified in 1985 and were reported at an international AIDS conference in 1986.6 In 1987 the Nigerian health sector established the National AIDS Advisory Committee, which was shortly followed by the establishment of the National Expert Advisory Committee on AIDS (NEACA).

Map of Nigeria showing population and life expectancy Map of Nigeria showing population and life expectancy

At first the Nigerian government was slow to respond to the increasing rates of HIV transmission7 and it was only in 1991 that the Federal Ministry of Health made their first attempt to assess the situation with HIV and AIDS in Nigeria. The results showed that around 1.8 percent of the population of Nigeria were infected with HIV. Subsequent surveillance reports revealed that during the 1990s HIV prevalence rose from 3.8 percent in 1993 to 5.4 percent in 1999. Following a peak of 5.8 percent in 2001, HIV prevalence then declined steadily throughout the decade.8

When Olusegun Obasanjo became the president of Nigeria in 1999, HIV prevention, treatment and care became one of the government’s primary concerns. The President’s Committee on AIDS and the National Action Committee on AIDS (NACA) were created, and in 2001, the government set up a three-year HIV/AIDS Emergency Action Plan (HEAP). In the same year, Obasanjo hosted the Organisation of African Unity’s first African Summit on HIV/AIDS, Tuberculosis, and Other Related Infectious Diseases.9

In 2005 a new framework was developed covering the period from 2005 to 2009.

Despite increased efforts to control the epidemic, by 2006 it was estimated that just 10 percent of HIV-infected women and men were receiving antiretroviral therapy and only 7 percent of pregnant women were receiving treatment to reduce the risk of mother-to-child transmission of HIV.10

In 2010 NACA launched its comprehensive National Strategic Framework to cover 2010 to 2015, which required an estimated N756 billion (around US$ 5 billion) to implement.11 Some of the main aims included in the framework are to reach 80 percent of sexually active adults and 80 percent of most at-risk populations with HIV counselling and testing by 2015, ensure 80 percent of eligible adults and 100 percent of eligible children are receiving ART by 2015; and to improve access to quality care and support services to at least 50 percent of people living with HIV by 2015.12

Despite being the largest oil producer in Africa and the 12th largest in the world,13 Nigeria is ranked 156 out of 187 on the United Nations Development Programme (UNDP) Human Poverty Index.14 This poor development position has meant that Nigeria is faced with huge challenges in fighting its HIV and AIDS epidemic.

back to top How is HIV transmitted in Nigeria?

Worldwide, Nigeria has the second highest number of new infections reported each year.15 There are three main HIV transmission routes in Nigeria:

  • Heterosexual sex. Approximately 80 percent of HIV infections in Nigeria are a result of heterosexual sex.16 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 diseases. Women are particularly affected by HIV; in 2009 women accounted for 56 percent of all adults aged 15 and above living with the virus.17
  • Blood transfusions. HIV transmission through unsafe blood accounts for the second largest source of HIV infection in Nigeria.18 19 Not all Nigerian hospitals have the technology to effectively screen blood and therefore there is a risk of using contaminated blood. 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 technology.
  • Mother-to-child transmission. Each year around 75,000 babies in Nigeria are born with HIV.20 It is estimated that 360,000 children are living with HIV in the country, most of whom became infected from their mothers.21 This has increased from 220,000 in 2007.22

    Most-at-risk groups in Nigeria, include brothel and non-brothel based female sex workers (FSW), men-who-have-sex-with-men (MSM), injecting drug users (IDUs), transport workers, members of the Armed Forces and Police. It has been found that individuals that fall under these groups and their partners account for 40 percent of new HIV infections in Nigeria.23

back to top HIV prevention in Nigeria

HIV testing

Doctors seeing patients in an HIV clinic in Nigeria Doctors seeing patients in an HIV clinic in Nigeria

In Nigeria there is a distinct lack of HIV testing programmes. In 2010 there was only 1.4 HIV testing and counselling facilities for approximately every 100,000 Nigerian adults and only 11.7 percent of women and men aged 15-49 had received an HIV test and found out the results.24 25 This shows how desperately the government needs to scale up HIV testing services. Whilst an estimated 2.2 million people aged 15 years and above received HIV testing and counselling in 2010, this amounts to only around 31 people per 100,000 of the total adult population.26 Moreover, HIV testing and counselling of pregnant women is central to the prevention of mother-to-child transmission, yet this remains extremely low with only 1 in 7 pregnant women receiving it in 2010.

The uptake of HIV testing among most-at-risk individuals, such as sex workers, injecting drug users (IDUs) and men who have sex with men (MSM), must increase if Nigeria is to see a decline in the currently high levels of HIV prevalence reported among these groups. Despite an increase in HIV testing among female sex workers, less than half reported receiving an HIV test and the results within the previous 12 months, in 2010; testing is significantly lower among male sex workers (MSW). Reported uptake of HIV testing is also poor among MSM, only a quarter had received a test, less than in previous years; with notably low uptake among IDUs, only one in five reported to have received a test.27

Some reports have suggested that health care facilities offering HIV testing in Nigeria do not follow international standards about confidentiality and ethics.28 In one particular study, over half of people living with HIV reported that they did not know they were being tested for the virus and around one in seven health care professionals admitted to never receiving informed consent for HIV tests.29 Implementing these standards will go someway towards improving the uptake of HIV testing. However, if HIV testing is to improve among most-at-risk individuals legislation, that criminalises their activities, must be replaced by legislation that enables them to access health services free from the risk of discrimination and arrest.30

Education

Sex is traditionally a very private subject in Nigeria and the discussion of sex with teenagers is often seen as inappropriate. It is evident that some groups, particularly religious and cultural leaders, have acted as a barrier to previous attempts to provide sex education for young people in Nigeria.31 However, successful delivery of sex education to young people is reliant on increasing the participation of these community leaders in the planning and implementation of such programmes.32 In 2009 only 23 percent of schools were providing life-skills based HIV education, and just 25 percent of men and women between the ages of 15 and 24 correctly identified ways to prevent sexual transmission of HIV, in 2010.33

In some regions of Nigeria girls marry relatively young, often to much older men. In North Western Nigeria around half of girls are married by age 15 and four out of five girls are married by the time they are 18.34 Studies have found those who are married at a younger age have less knowledge about HIV and AIDS than unmarried women, and are more likely to believe they are low-risk for becoming infected with HIV.35 HIV and AIDS education initiatives need to ensure they focus on married girls, as they are less likely to have access to health information than unmarried girls.36 However, the need to improve knowledge about HIV among girls overall (both married and unmarried) remains, as twice as many girls than boys are engaging in sexual activity before the age of 15 years. Furthermore, HIV prevention knowledge is significantly less among girls (aged 15-19), compared to boys.37 Addressing the social and cultural factors that contribute to early sexual debut among girls in Nigeria is also integral to successful HIV prevention among this group.

Condoms

AIDS awareness billboard featuring Femi Kuti AIDS awareness billboard featuring Femi Kuti

The total number of condoms provided by international donors has been relatively low. Between 2000 and 2005, the average number of condoms distributed in Nigeria by donors was 5.9 per man, per year.38

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 used.39 In 2006 APCON also started to enforce stricter regulations on condom advertisements that might encourage ‘indecency’.40

The number of female condoms sold in Nigeria has significantly increased from 25,000 in 2003 to 375,000 in 2006.41

Media campaigns & public awareness

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Addressing HIV-related issues in Nigeria through television drama.

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 34.42

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 people.43

Another high profile media campaign is fronted by Femi Kuti, the son of Fela Kuti, the famous Afrobeat musician who died of AIDS in 1997. He appears on billboards alongside roads throughout Nigeria with the slogan 'AIDS: No dey show for face', which means you can't tell someone has AIDS by looking at them.44

Prevention of mother-to-child transmission of HIV

Nigeria's programme to prevent the transmission of HIV from mother to child (PMTCT) started in July 2002.45 Despite efforts to strengthen PMTCT interventions, by 2007 only 5.3 percent of HIV positive women were receiving antiretroviral drugs to reduce the risk of mother-to-child transmission. This figure had risen to almost 22 percent by 2009, but still remained far short of universal access targets which aim for 80 percent coverage.46

Single-dose nevirapine is no longer recommended for the prevention of mother-to-child transmission. Whilst 19,733, or 9 percent, of HIV-infected pregnant women in Nigeria received the most effective antiretroviral treatment regimens for PMTCT in 2010, around 6,505 pregnant women still only received single-dose nevirapine.47 Coverage for infants remains very low; in 2009 only 8 percent of children received antiretrovirals for PMTCT.48

Preventing HIV among most-at-risk groups

The high HIV prevalence reported among high-risk groups, as well as their link to the general population should place these individuals at the centre of HIV prevention programmes. Nevertheless, HIV prevention messages are not sufficiently reaching people that fall within these groups. One of the major barriers to accessing HIV prevention programmes for MSM and sex workers are laws that prohibit their activities. For example, same-sex relations in Nigeria are punishable with up to 14 years imprisonment, under Federal Law, or the death penalty, under Sharia Law.
 
MSM living in Nigeria account for one-tenth of new annual infections, with HIV prevalence reported as high as 17.4 percent in 2010, up from 13.5 percent in 2007. Despite the need for improvements in HIV knowledge and awareness among this group, HIV prevention programmes reached only half of MSM in 2007, with this figure falling further, to one-in-five, by 2010.49

Improving HIV prevention knowledge among sex workers is also critical to averting further HIV infections, yet less sex workers were reached with HIV prevention messages in 2010, than in 2007. Around a quarter of sex workers, male and female, surveyed in 2010 were living with HIV. Whilst consistent condom use has been found to be high among sex workers with their clients, many are not using condoms consistently during sex with partners. Expanding HIV prevention messages to male sex workers is of particular importance, as condom use with clients is extremely low among this group, particularly in comparison to female sex workers.50

Recent surveys indicate a slight decline (of about 1 percent) in HIV prevalence among people who inject drugs in Nigeria; it is currently reported as 4.2 percent. This group accounts for around 10 percent of new annual infections. Over the last two years, the proportion of people injecting drugs, who used sterile equipment for their last injection declined, from nearly 90 percent to 70 percent in 2012.51 Preventing any further decline should be a priority if HIV transmission through injecting drugs is to be minimised in Nigeria. Achieving this is reliant on Nigeria increasing existing harm reduction services and implementing new services, not currently available, such as needle exchanges.

back to top HIV treatment and care in Nigeria

When antiretroviral drugs (ARVs) were introduced in Nigeria in the early 1990s, they were only available to those who paid for them. As the cost of the drugs was very high at this time and the overwhelming majority of Nigerians were living on less than $2 a day, only the wealthy minority were able to afford the treatment.

In 2002 the Nigerian government started an ambitious antiretroviral treatment programme, which aimed to supply 10,000 adults and 5,000 children with antiretroviral drugs within one year. An initial $3.5 million worth of ARVs were to be imported from India and delivered at a subsidized monthly cost of $7 per person.52 The programme was announced as 'Africa’s largest antiretroviral treatment programme'.

By 2004 the programme had suffered a major setback as too many patients were being recruited without a big enough supply of drugs to hand out. This resulted in an expanding waiting list and not enough drugs to supply the high demand. The patients who had already started the treatment then had to wait for up to three months for more drugs, which can not only reverse the progress the drugs have already made, but can also increase HIV drug resistance. Eventually, another $3.8 million worth of drugs were ordered and the programme resumed.

Pharmacy refrigerator with antiretroviral drugs in Nigeria Pharmacy refrigerator with antiretroviral drugs in Nigeria

ARVs were being administered in only 25 treatment centres across the country which was a far from adequate attempt at helping the estimated 550,000 people requiring antiretroviral therapy. As a result, in 2006 Nigeria opened up 41 new AIDS treatment centres and started handing out free ARVs to those who needed them.53 Treatment scale-up between 2006-7 was impressive, rising from 81,000 people (15 percent of those in need) to 198,000 (26 percent) by the end of 2007.

However, resources needed to provide sufficient treatment and care for those living with HIV in Nigeria remain seriously lacking. A study of health care providers found many had not received sufficient training on HIV prevention and treatment and many of the health facilities had a shortage of medications, equipment and materials.54

The government's National HIV/AIDS Strategic Framework for 2005 to 2009 set out to provide ARVs to 80 percent of adults and children with advanced HIV infection and to 80 percent of HIV-positive pregnant women, all by 2010.55 However, only 31 percent of people who needed treatment for advanced HIV infection received it in 2009.56 As a result of this slow progress the treatment goals were set back to 2015 in the revised framework (2010 to 2015).57 By 2010 antiretroviral treatment coverage remained seriously low, with only a quarter of adults and 7 percent of children in need of treatment receiving it. Currently 1.4 million adults and 262,000 children eligible for antiretroviral treatment remain without it.58

back to top Funding for HIV and AIDS in Nigeria

Most of the investment for HIV and AIDS in Nigeria comes from international sources. As of 2008, only 7.6 percent of investment was domestic public expenditure.59 The majority of the funding comes from development partners. The main donors are PEPFAR, the Global Fund and the World Bank.

In 2002, the World Bank loaned US$90.3 million to Nigeria to support the 5-year HIV/AIDS Programme Development Project.60 In May 2007 it was announced that the World Bank were to allocate a further US$50 million loan for the programme.61 Following the success of this programme, the World Bank went on to contribute a further US$225 million towards an HIV/AIDS Programme Development Project II (2009-2013) set to run until 2015, due to delays signing the credit agreement.62 63

Through PEPFAR (the President's Emergency Plan for AIDS Relief) the United States has allocated a large amount of money to Nigeria. In 2008 PEPFAR provided approximately US$448 million to Nigeria for HIV/AIDS prevention, treatment and care,64 the third highest amount out of PEPFAR’s 15 focus countries.

By August 2012, the Global Fund had approved US$360,454,493, and disbursed US$275,586,635 in funds for Nigeria to expand HIV/AIDS treatment, prevention, and care programmes.65 Most recent funding has been focused on decentralising HIV prevention, support and care to make it available in primary care facilities and at a community level, to increase gender sensitive prevention interventions and to expand antiretroviral treatment access across secondary health facilities.66

back to top The future

In the 2007 general elections, Umaru Musa Yar’Adua of the People’s Democratic Party became the second president of Nigeria’s Fourth Republic. Following in Obasanjo’s footsteps, one of Yar’Adua’s priorities was tackling the Nigerian AIDS epidemic. Yar'Adua's successor, Goodluck Jonathan, has reiterated this commitment and has expressed particular concern about the low levels of HIV testing in Nigeria.67 With the large amounts of money being donated from international funds and a government dedicated to increasing prevention measures and treatment access, some are feeling slightly more optimistic.

However, according to the latest data from the Nigerian government, around 10 percent of the global population of people with HIV live in Nigeria.68 Nigeria therefore still has a long way to go in tackling its devastating HIV and AIDS epidemic. In 2011, the Nigerian Health Minister acknowledged the extent of the challenge that Nigeria faces when he stated...

The HIV and AIDS epidemic in Nigeria remains a public health problem of enormous magnitude that must be given priority attention 69
Nominet Winner 2012

References back to top

  1. UNGASS (2010) 'UNGASS Country Progress Report: Nigeria'
  2. UNAIDS (2010) 'UNAIDS report on the global AIDS epidemic'
  3. UNDP (2011) ‘Human Development Report 2011’
  4. UNAIDS (2010) 'UNAIDS report on the global AIDS epidemic'
  5. UNDP (2011) ‘Human Development Report 2011’
  6. Adeyi et al. (2006) 'AIDS in Nigeria: A nation on the threshold'. Chapter 2: The epidemiology of HIV/AIDS in Nigeria. Harvard Center for Population and Development Studies.
  7. Kanki, P.J & Adeyi, O (2006) 'AIDS in Nigeria: A nation on the threshold'. Chapter 1: Introduction. Harvard Center for Population and Development Studies.
  8. Federal Republic of Nigeria (2012) ‘Global AIDS Response Progress Report’
  9. Adeyi et al. (2006) 'AIDS in Nigeria: A nation on the threshold'. Chapter 2: The epidemiology of HIV/AIDS in Nigeria. Harvard Center for Population and Development Studies.
  10. UNAIDS (2008) 'Report on the global AIDS epidemic
  11. AllAfrica (2010, 30th March) 'Nigeria: NACA launches N756 billion national HIV and Aids response'
  12. National Agency for the Control of AIDS (NACA) (2009, December) 'National HIV/AIDS strategic framework (NSF) 2010-15'
  13. Energy Information Administration: Official Energy Statistics from the U.S. Government. (2007) 'Nigeria Energy Profile'.
  14. UNDP (2011) ‘Human Development Report 2011’
  15. WHO/UNAIDS/UNICEF (2011) ‘Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access 2011’
  16. Federal Republic of Nigeria (2012) ‘Global AIDS Response Progress Report’
  17. UNGASS (2010) 'UNGASS Country Progress Report: Nigeria'
  18. Federal Republic of Nigeria (2012) ‘Global AIDS Response Progress Report’
  19. Egesie J. & Egesie E. (2011) 'Seroprevalence of Human Immunodeficiency Virus (HIV) Among Blood Donors in Jos - Nigeria' cited in Barros E. (2011) 'HIV-infection: Impact, Awareness and Social Implications of living with HIV/AIDS', InTech
  20. WHO/UNAIDS/UNICEF (2011) ‘Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access 2011’
  21. UNAIDS (2010) 'UNAIDS report on the global AIDS epidemic'
  22. UNAIDS (2008) 'Report on the global AIDS epidemic'
  23. Federal Republic of Nigeria (2012) ‘Global AIDS Response Progress Report’
  24. Federal Republic of Nigeria (2012) ‘Global AIDS Response Progress Report’
  25. WHO/UNAIDS/UNICEF (2011) ‘Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access 2011’
  26. WHO/UNAIDS/UNICEF (2011) ‘Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access 2011’
  27. Federal Republic of Nigeria (2012) ‘Global AIDS Response Progress Report’
  28. Physicians for Human Rights (2006) 'Nigeria: Access to Health Care for People Living with HIV and AIDS'
  29. Physicians for Human Rights (2006) 'Nigeria: Access to Health Care for People Living with HIV and AIDS'
  30. UNDP (2012) 'Global Commission on HIV and the Law Risks, Rights & Health'
  31. Odutolu, O. et al (2006) 'AIDS in Nigeria: A nation on the threshold'. Chapter 11: The National Response to HIV/AIDS. Harvard Center for Population and Development Studies.
  32. Hanlon, B and Standley, EL (2012) 'Sexuality Education for Young People', Commonwealth Ministers Reference Book
  33. Federal Republic of Nigeria (2012) ‘Global AIDS Response Progress Report’
  34. The Population Council, Inc (2007) 'The experience of married adolescent girls in Northern Nigeria'.
  35. The Population Council, Inc (2007) 'The experience of married adolescent girls in Northern Nigeria'.
  36. The Population Council, Inc (2007) 'The experience of married adolescent girls in Northern Nigeria'.
  37. Federal Republic of Nigeria (2012) ‘Global AIDS Response Progress Report’
  38. UNFPA (2005) 'Donor support for contraceptives and condoms for STI/HIV prevention 2005'.
  39. Population Services International (2003, March) 'Nigerian radio campaign generates safer behaviour'
  40. UN Integrated Regional Information Networks/AllAfrica (2006, 27th March) 'Condom ads stir passionate debate'
  41. UNFPA (2007, 30th November) 'A right to choose: expanding access to the female condom in Nigeria'.
  42. Population Services International (2003, March) 'Nigerian radio campaign generates safer behaviour'
  43. BBC News (2005, 9th November) 'Texts used for Nigeria HIV drive'.
  44. Reuters NewMedia (2003, 9th February) 'Nigeria Grammy nominee fights to win for the poor'
  45. National Agency for the Control of AIDS (2010) 'National HIV/AIDS response review 2005-09'
  46. WHO/UNAIDS/UNICEF (2010) 'Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector'
  47. WHO/UNAIDS/UNICEF (2011) ‘Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access 2011’
  48. UNICEF (2010) 'Nigeria: PMTCT'
  49. Federal Republic of Nigeria (2012) ‘Global AIDS Response Progress Report’
  50. Federal Republic of Nigeria (2012) ‘Global AIDS Response Progress Report’
  51. Harm Reduction International (2012) ‘Global State of Harm Reduction 2012’
  52. Odutolu, O, Ahonsi, B.A, Gboun, M & Jolayemi, O.M (2006) 'AIDS in Nigeria: A nation on the threshold'. Chapter 11: The National Response to HIV/AIDS. Harvard Center for Population and Development Studies.
  53. Reuters Limited (2006, 14th March) 'Nigeria opens 41 new AIDS treatment centres'
  54. Physicians for Human Rights (2006) 'Nigeria: Access to Health Care for People Living with HIV and AIDS'
  55. WHO, UNAIDS & UNICEF (2007) 'Towards universal access: scaling up priority HIV/AIDS interventions in the health sector'
  56. WHO/UNAIDS/UNICEF (2010) 'Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector'
  57. National Agency for the Control of AIDS (NACA) (2009, December) 'National HIV/AIDS strategic framework (NSF) 2010-15'
  58. WHO/UNAIDS/UNICEF (2011) ‘Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access 2011’
  59. UNAIDS (2010) 'UNAIDS report on the global AIDS epidemic'
  60. Health Reform Foundation of Nigeria (HERFON) (2007, August) 'Impact, challenges and long-term implications of antiretroviral therapy programme in Nigeria'.
  61. The World Bank (2008) 'Nigeria receives US million additional funding for HIV/AIDS project program'.
  62. The World Bank (2009, August) 'IDA at Work: Expanding Systems to Fight HIV/AIDS' Accessed 13th September 2012
  63. The World Bank (2012) 'Nigeria HIV/AIDS Program Development Project II' Accessed 13th September 2012
  64. PEPFAR (2008) 'FY2008 Country profile: Nigeria'. Annual report to congress.
  65. The Global Fund (2012, August) 'Nigeria and the Global Fund'
  66. The Global Fund (2012, August) 'Nigeria: Scaling up gender sensitive HIV/AIDS Prevention, Treatment, Care and Support Interventions for Adults and Children in Nigeria'
  67. Vanguard (2010, December 2nd) 'FG to include HIV/AIDS in budget'
  68. UNAIDS (2010) 'UNAIDS report on the global AIDS epidemic'
  69. PM News (2011) 'About 3.1 Million People Infected with HIV in Nigeria: Health Minister'