Although Nigeria’s HIV prevalence appears to have stabilised in the past 10 years, the
epidemic still remains a major public health challenge. While Nigeria’s epidemic can be framed
as a generalised epidemic, there are concentrated epidemics among high-risk groups or mostat-risk
populations (MARPS), i.e. female sex workers (FSWs), men who have sex with men
(MSM) and injecting drug users (IDUs). There are also considerable variations according to
geographical area, rural/urban locality, age, gender, education and wealth quintile.
Drawing on secondary literature and primary data collection in four selected state-level sites
(Adamawa, Benue, Edo and Lagos), including key informant interviews and focus group
discussions at national and state levels, this report explores: the main drivers of HIV-related
vulnerabilities; the impacts of HIV on different groups of people and related coping
strategies/mechanisms; policy and programming responses to HIV; and social protection-type
responses and approaches and their current and potential linkages with HIV.
HIV-related vulnerabilities/drivers
A number of often interrelated drivers were identified through the review of secondary
literature and were confirmed by the case studies; however, the causal linkages are not always
clear and sometimes go against expectations. Thus, for instance, while socioeconomic and
gender inequalities are often seen to drive the AIDS epidemic, with increased HIV-related
vulnerabilities in poor settings and where gender norms are particularly inequitable, this may
not always be the case: there are states with low inequality but high HIV prevalence.
Religion and culture can influence HIV-related vulnerabilities: the mainly Christian southern
regions have a higher HIV prevalence than the mainly Muslim northern regions. This can be
attributed partly to lower alcohol consumption and to circumcision practices in the north.
Low HIV and AIDS awareness is another driver. Although 90% of women and 94% of men in
Nigeria have heard of HIV and AIDS, comprehensive knowledge about prevention is
inadequate, particularly in the three northern zones, where women’s knowledge is especially
low. Stigma and discrimination remain key factors impeding individuals from disclosing their
status and accessing HIV-related services, although there is some evidence that this is
reducing, largely because of increases in awareness.
Multiple sexual partners and low condom use both contribute to the epidemic, as does
polygamy. As a means of survival, women and, to a lesser extent, men engage in informal
transactional and intergenerational sex, both of which can increase the risk of HIV
transmission.
Finally, poor and inequitable distribution of health infrastructure and personnel has been
identified as a driver of the epidemic.
Vulnerabilities among different population categories
According to secondary sources, vulnerable groups in Nigeria include youth (mainly young
women), pregnant women, orphans and vulnerable children (OVC) (of whom there are 17.5
million in Nigeria) and the elderly. Such groups are particularly vulnerable because of
socioeconomic, age and gender characteristics as well as the location in which the live. MARPs
are also at higher risk of HIV and other sexually transmitted infections because of behaviours
or occupations that place them at risk of unsafe sex; the above mentioned demographic,
locational and structural vulnerabilities are also likely to affect them. Case study respondents
added to this list widows, migrant workers, rich people (‘they can purchase sex at all costs’),
drivers/transport workers and communities living along transport routes.