write an expository essay controlling hiv/aids in nigeria

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CONTROLLING HIV/AIDS IN NIGERIA

HIV is the short form for ..........AIDS is the abbreviation for ............ it can be contacted and controlled.....

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Nigeria has experienced a tremendous impact from HIV/AIDS on both a personal and societal level. The report presents a comprehensive problem overview referencing existing research, relevant literature, and expert insights. Due to HIV/AIDS, the Nigerian healthcare industry has experienced significant difficulties. With rising demand for testing, counseling, anti-retroviral medication (ART), and supportive care, the disease has strained healthcare resources. The disease has decreased production and resulted in a loss of human capital. The workforce has been impacted, which has reduced output across several industries, including agriculture. Concerns about the disease's prevalence have hurt foreign investment, preventing economic expansion and employment development. HIV/AIDS has impacted communities' social dynamics. Discrimination and stigma still exist, putting obstacles in support, treatment, and testing. The disease has put a strain on social welfare institutions, needing ...

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• Published: 21 December 2022

Thirty-five years (1986–2021) of HIV/AIDS in Nigeria: bibliometric and scoping analysis

• Henshaw Uchechi Okoroiwu 1 ,
• Ekementeabasi Aniebo Umoh 2 ,
• Edet Effiong Asanga 3 ,
• Uwem Okon Edet 4 ,
• Michael Raymond Atim-Ebim 5 ,
• Edum Abang Tangban 6 ,
• Elizabeth Nkagafel Mbim 7 , 8 ,
• Cynthia Amarachi Odoemena 9 ,
• Victor Kanu Uno 5 ,
• Joseph Okon Asuquo 2 ,
• Otu Otu Effiom-Ekaha 5 ,
• Ogechukwu C. Dozie-Nwakile 10 ,
• Ikenna K. Uchendu 10 ,
• Chidiebere Peter Echieh 11 ,
• Kingsley John Emmanuel 1 ,
• Regina Idu Ejemot-Nwadiaro 12 ,
• Glory Mbe Egom Nja 12 ,
• Adaeze Oreh 13 ,
• Mercy Ogechi Uchenwa 8 ,
• Emmanuel Chukwuma Ufornwa 14 ,
• Ndidi Patience Nwaiwu 15 ,
• Christopher Ogar Ogar 16 ,
• Ani Nkang 4 ,
• Obinna Justice Kabiri 17 &
• F. Javier Povedano-Montero 18 , 19 , 20  

AIDS Research and Therapy volume  19 , Article number:  64 ( 2022 ) Cite this article

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Acquired immunodeficiency syndrome (AIDS) is an acquired defect of the cellular immunity associated with the infection by the human immunodeficiency virus (HIV). The disease has reached pandemic proportion and has been considered a public health concern. This study is aimed at analyzing the trend of HIV/AIDS research in Nigeria.

We used the PUBMED database to a conduct bibliometric analysis of HIV/AIDS-related research in Nigeria from 1986 to 2021 employing “HIV”, “AIDS”, “acquired immunodeficiency syndrome”, “Human immunodeficiency virus”, and “Nigeria” as search description. The most common bibliometric indicators were applied for the selected publications.

The number of scientific research articles retrieved for HIV/AIDS-related research in Nigeria was 2796. Original research was the predominant article type. Articles authored by 4 authors consisted majority of the papers. The University of Ibadan was found to be the most productive institution. Institutions in the United States dominated external production with the University of Maryland at the top. The most utilized journal was PLoS ONE. While Iliyasu Z. was the most productive principal author, Crowel TA. was the overall most productive author with the highest collaborative strength. The keyword analysis using overlay visualization showed a gradual shift from disease characteristics to diagnosis, treatment and prevention. Trend in HIV/AIDS research in Nigeria is increasing yet evolving. Four articles were retracted while two had an expression of concern.

The growth of scientific literature in HIV/AIDS-related research in Nigeria was found to be high and increasing. However, the hotspot analysis still shows more unexplored grey areas in future.

Acquired Immunodeficiency Syndrome (AIDS) is an acquired defect of the cellular immunity associated with infection by the human immunodeficiency virus (HIV), a CD4 positive lymphocyte count of less than 200 cells/micrometer and increased susceptibility to opportunistic infection [ 1 ].

The first cases of AIDS were reported in May 1981 in the United States of America by Dr. Michael Gottlieb of the Medical School of Los Angeles, United States, and was followed by an official report by the Centre for Disease Control (CDC) on June 5, 1981. The first victims were five homosexual men who were suffering from unusual pneumonia called Pneumocystis Carinii pneumonia and Kaposi’s sarcoma. The causative organisms were first isolated and named Human T-Lymphotropic Virus type III (HTLV-III) in the US and Lymphadenopathy Associated Virus (LAV) in France [ 2 , 3 , 4 ]. Specifically, Luc Montagnier and colleagues in Pasteur Institute France in 1983 first isolated the causative organism [ 5 ]. The following year (1984) Robert Gallo of the National Institute of Health isolated the causative organism (HTLV-III) [ 6 , 7 ]. At the same time, Jay Levy and colleagues at UCSF also independently isolated the virus [ 8 , 9 ]. However, Robert Gallo was the first to lay a causative link between the virus and AIDS. In May 1986, the international community on taxonomy of viruses chaired by Harold Varmus harmonized and recommended the renaming of the virus with different names to human immunodeficiency virus, following the evidence that they (HTLV-III and LAV) were genetically indistinguishable [ 10 ].

On the African Continent, HIV/AIDS was first reported in Uganda, East Africa in 1982 [ 11 ].

The first case of HIV and AIDS in Nigeria was identified in 1985 and reported at an international conference in 1986. The first two cases as reported by the Federal Ministry of Health were; a sexually active 13 year-old girl and a female commercial sex worker from a neighboring West African country [ 2 , 4 ].

Nigeria is the most populous African country and the seventh most populous in the world with an estimated population of approximately 206,139.589 people [ 12 , 13 ]. It is located within the eastern strip of West Africa with an area of 923,768 Km 2 [ 14 ]. Nigeria is a multi-ethnic and culturally diverse federation of 36 autonomous states and the Federal Capital Territory [ 15 ]. The first HIV/AIDS sentinel survey was conducted in 1991 with a prevalence of 1.8% which since then increased to 3.8% in 1993, 4.5% in 1996, 5.4% in 1999, and peaked at 5.8% in 2001. Post 2001, decline trend was observed in 2003 (5.0%), 2005 (4.4%), 2008 (4.6%), 2010 (4.1%), 2013 (3.4%) [ 16 , 17 ] (Fig.  1 ). Despite the declining prevalence/low prevalence, HIV/AIDS in Nigeria remains a public health concern. Nigeria ranks 4 th in global HIV burden with approximately 1.8 million (estimated) persons living with HIV as of 2019 [ 18 , 19 , 20 ]. The current national prevalence of HIV in Nigeria is 1.4% and stratification based on states showed the highest prevalence in Akwa Ibom (5.6%), Benue (4.9%), Rivers (3.8%), Taraba (2.7%) and Anambra (2.7%) and the least prevalence in Jigawa (0.3%) and Katsina (0.3%) [ 21 ] (Fig.  2 ).

Trend of HIV prevalence over the years

HIV prevalence in Nigeria by states

Bibliometric studies are relevant tools in the social and scientific evaluation of a given discipline within a specified time frame. They serve as proxy markers for the activities in a given field of research. They evaluate progress/growth and identify gaps in research [ 22 , 23 ]. The performance analysis of a selected study discipline is often done via bibliometrics and social network analysis (SNA). While the bibliometric data computes the basic outputs, the social network analysis interprets the influence of social links and interactions [ 24 ].

This study was aimed at identifying the trend as well as the contribution of Nigeria to HIV/AIDS research. The findings of this study is expected to evaluate progress and identify gaps in HIV research in Nigeria as well as give direction to areas of research and research funding.

Data source

The PUBMED database was used for the bibliometric analysis. PUBMED comprises more than 34 million citations for biomedical literature from MEDLINE, life science journals and online books [ 25 ]. Ancillary data were retrieved from Google scholar. Retraction watch database was searched to complement PUBMED on retracted articles and those with an expressions of concern [ 26 ].

Data collection

We analyzed the bibliometric data on HIV/AIDS study in the PUBMED published from January 1, 1986 to December 31, 2021. The study period was chosen on the assumption that all research on HIV/AIDS in Nigeria were published from 1986 when the disease was first reported in Nigeria. The search was performed on May 15, 2022. We made use of advanced search in PUBMED using “MESH” terms “HIV” and “AIDS” and applied the following keywords: “HIV” [Title/Abstract] OR “AIDS” [Title/Abstract] OR “Acquired Immunodeficiency Syndrome” [Title/Abstract] OR “Human Immunodeficiency Virus” [Title/Abstract] AND “Nigeria” [Title/Abstract]. We retrieved all data under the above predefined search query without restriction on article type. The retrieved data were used to compute bibliometric indicators. Since PUBMED does not store citation records, we retrieved the citation information about authors and articles via Google scholar. We also re-searched PUBMED using the above search descriptors in addition to “Retraction” and Expression of concern”. We also searched the Retraction database setting the location to Nigeria. Extra detail on search query is presented in the Additional file 1 : Table S1.

Screening protocol and criteria

Only articles with focus on HIV/AIDS in Nigeria were included. Articles that were not focused on HIV/AIDS but mentioned same on passing were excluded as well as those not in Nigeria. There was no restriction on the type of article. Duplicate articles were also removed. Two review groups among the authors independently performed the article selection. Differences in opinion were settled via consensus of both grouping. The full detail of exclusion diagram is presented in the Additional file 2 : Fig. S2.

Visualization of social network analysis

We used the VOSviewer (Center for Science and Technology Studies, Leiden University, The Netherlands) version 1.6.18 to map HIV/AIDS terms and collaboration in the retrieved data from PUBMED.

Bibliometric indicators

Impact factor.

The impact factor (IF) is utilized as a measure of the journal’s influence and was originally developed by the Institute for Science Information (Philadelphia PA, USA) as a bibliometric indicator. It is updated annually in the Journal Citation Report (JCR) of Clarivate Analytics and the value is often a marker of prestige. We used JCR data of 2021.

Author/institution participation index

WE evaluated the overall 1986–2021 scientific publication in the discipline of HIV/AIDS in Nigeria. It is the number of documents on the topic in question (in this case HIV/AIDS in Nigeria) by an author/institution with respect to the total publications in that domain.

Keyword analysis

WE used keyword analysis to ratify the trend of discussion and research in view of the disease characteristics, pathology and treatment.

Co-authorship analysis

CO-authorship refers to the interaction of authors contributing to the particular field of study. The co-authorship of papers between authors shows collaboration [ 24 , 27 ]. The co-authorship network map as generated by VOSviewer show collaborative social network of research fields.

Bibliometric mapping

Bibliometric mapping was divided into two parts: co-authorship mapping and co-occurrence mapping. Co-authorship refers to the interactions of authors in institutions contributing to the field of study, while co-occurrence refers to relationship among keywords.

The following keys of interpretation are utilized in the visualization of co-authorship network analysis: The size of the nodes or bubbles (circles) within the network corresponds to the frequency or number of documents from an author or institution. Secondly, the lines or arcs between nodes correlate/reflect the existence and intensity of the co-authorship link. Finally, the last legend is the color of the node: VOSviewer clustering algorithm assigns the colors to the nodes based on the estimation of a measure of similarity between them. Consequently, it is safe to conclude that nodes of same color are related. Also, the shorter the distance between two (2) nodes, the closer the relationship between them [ 24 ].

Results of publication output

We retrieved 2838 publications and only included 2796 publications after removing 9 duplicate publications and 33 publications that were either not related to Nigeria (as in, mentioned Nigeria in passing) or not related to HIV/AIDS (Only mentioned in abstract background) (total of 42). Of these, 92.13% (n = 2576) were original articles, 2.79% (n = 78) were narrative reviews, while 1.14% (n = 32) were systematic reviews. Other forms of publications recorded were Case reports/Case series (0.96%), Perspectives (0.86%), Correspondence/Letters to Editor/Comments on articles (0.71%), Gazettes/Law reviews and other official publications (0.39%), Commentary (0.29%), Erratum/Corrections (0.25%), Conference /Workshop papers (0.18%), Editorials (0.14%), Books/Book chapters (0.11%) and Expressions of concern (0.03%) (Table 1 ).

The first publications (2 in number) were published in 1986. There was a slow pace of publication of HIV/AIDS related literature from then till the year 2004 when publications shot up more than 20-fold. The tempo of research since then has been sustained and has remained ≥ 150 publications per year after 2011 (Fig.  3 ).

Trend line of publication of HIV/AIDS related literature in Nigeria from 1986 to 2021

Analysis of proportion of articles by number of authors

Our result showed a large span of number of authors per document ranging from single author documents to > 10 authors per document. Furthermore, the result showed that more than half (59.66%; n = 1668) of the published articles were by collaboration of < 6 authors (Table 2 ). The document with the most authors had 324 author signatures and the most frequent number of signatures was 4.

Analysis of most productive institutions

The top most productive institutions in HIV/AIDS research in Nigeria were represented in Table 3 . University of Ibadan, Nigeria was the most productive institution (n = 176), followed by the University of Lagos (n = 112), University of Nigeria Enugu (n = 97), Obafemi Awolowo University (n = 76) and others. Only the first top 8 institutions accounted for more than 25% (25.64%) of the total produced literature. Worthy of note is that University of Ibadan and its affiliated teaching hospital (University College Hospital) made the top list of the most productive institutions. Similarly, University of Nigeria Enugu and its affiliated institution (University of Nigeria Teaching Hospital, Enugu) also made it to the top list. University of Maryland School of Medicine was the only foreign institution that made the top 20 list (n = 47; 1.68%). Out of the top 20 institutions, 10 are federal public universities, 6 are federal tertiary health institutions, 2 federal research institutes, 1 State university resident in Nigeria and a USA-based public land—Grant University (Table 3 ).

On account of external participating countries, institutions in the USA produced 12.84% (n = 359) of the total published literature. This was followed by South Africa, United Kingdom, Canada and Netherlands (Table 3 ). Individual analysis of the USA-based institutions showed that the University of Maryland produced 1.6% (n = 45) of the literature followed by US Centre for Disease Control (0.7%; n = 20), Harvard School of Public Health (0.50%; n = 14), Emory University (0.50%; n = 14), Vanderbilt Institute for Global Health (0.46%; n = 13) and Johns Hopkins Bloomberg School of Public Health (0.39%; n = 11). Among the South African based institutions, the top productive was from University of Kwazulu—Natal (0.46%; n = 13) and University of Western Cape Town (0.23%; n = 7). The top participating institution from UK was London School of Hygiene and Tropical Medicine (0.14%; n = 4), while that of Canada and Netherlands were University of Ottawa (0.18%; n = 5) and Maastrich University, respectively (Additional file 3 : Table S3).

Analysis of co-authorship of participating institutions

Figure  4 shows the collaborative network among institutions publishing HIV/AIDS related research in Nigeria. The threshold for the mapping was set at minimum of 2 collaborations. Of the 645 qualifying institutions, only 367 (56.90%) were connected (had collaboration). The most collaborating institutions with the total link strengths are: US Military HIV Research Program (109 link strength), HJF Medical Research International Abuja (91 LS), Henry M. Jackson Foundation for advancement of Military Medicine USA (85 LS), Institute of Human Virology Abuja (58 LS) and Makerere University Walter Reeds Project Uganda (56 LS).

collaborative network among institutions publishing HIV/AIDS related research in Nigeria

Among the strongest links of the US Military Research Program Include: Institute of Human Virology University of Maryland, HJF Medical Research International Abuja, Medicine University, Population Council of Nigeria Abuja, National Hospital Abuja, US Army Medical Research, Henry M. Jackson Foundation for the advancement of Military Medicine and Institute of Human Virology Abuja.

However, the overall strongest collaboration (9 link strength) was found between the US Military HIV Research Program and Institute of Human Virology University of Maryland.

Analysis of sources with highest publication

Table 4 shows the sources with the highest number of HIV/AIDS related research in Nigeria. PLoS ONE, Pan African Medical Journal, African Journal of Reproductive Health, AIDS Care, Nigeria Journal of Medicine, Journal of Acquire Immune Deficiency Syndrome, African Journal of Medicine and Medical Science, Nigeria Journal of Medical Practice, West African Journal of Medicine and African Health Science, consisted the top most productive sources. Among these, 5 of the sources had impact factor (JCR 2021). Two among them (PLoS ONE and Journal of Acquired Immune Deficiency Syndrome) had impact factor greater than 3. Five of the journals are affiliated to Nigeria. All the journals were multidisciplinary medical journals except African Journal of Reproductive health dedicated to reproductive health and AIDS Care and Journal of Acquired Immune Deficiency Syndrome both dedicated to HIV/AIDS research.

Analysis of most cited articles

Table 5 shows the top 10 most cited articles on HIV/AIDS related research in Nigeria. The most cited article was an article on the discriminating attitude and practice of health care workers towards patients published in PLoS Medicine while the second most cited was a randomized control trial on the use of a vaginal gel for the prevention of HIV infection published in PLoS ONE. The rest were research articles on the effectiveness of intervention methods, knowledge and attitude towards HIV infection, quality of life among HIV-infected persons and provision of outreach services. Two among the most cited articles were published in PLoS Medicine, while another 2 were published in PLoS ONE. All the articles were original research. Despite being the 9th and 8th most cited articles, the articles by Abdullahi et al . in PLOS Medicine and Swartz et al. in Lancet HIV had the highest number of citation per year; 152 citations per year and 26.5 citations per year, respectively. Next were the 2nd and 1st most cited publications in PLoS ONE and PLoS Medicine with 24 citations per year and 22 citations per year, respectively.

Analysis of most productive authors by principal author analysis

Table 6 shows the most productive authors in HIVS/AIDS-related publication in Nigeria by principal author analysis. Iliyasu Z, Folayan MO, Ogoina D, Uneke CJ, Olowookere SA, Aliyu MH, Ogunbayo A, Olakunle BO, Daniel OJ, Aliyu G and Agaba PA were the top productive first authors. Thirteen of the 15 authors are affiliated to Nigeria while the other 2 are affiliated to USA.

Overall co-authorship analysis of authors

Figure  5 shows the network of co-authors made up of authors who have published at least five (5) HIV/AIDS-related research in Nigeria. The network contained 316 nodes, 2522 co-authorship links, 7258 total link strength and 16 clusters.

Co-authorship network among authors publishing HIV/AIDS related articles in Nigeria

The node symbol represents an author while the node size represents activity/publications of the author, while links between the authors represent relationship between them. Exactly 78 (19.80%) of the 394 authors who met the minimum selection criteria (at least 5 publications) had no connection (collaboration).

Based on total link strength, Crowel TA (361; turquoise cluster), Okonkwo P (284; red cluster), Ndembi N (245; turquoise cluster), Nowak R (241; turquoise cluster), Baral SD (219; turquoise cluster), Dakum P (203; orange cluster), Kanki P (190; red cluster), Charurat MP (179; orange cluster), Aliyu MH (171; golden lemon cluster), Adebajo S (170; lavender cluster) and Ezeanolue E (165; green cluster) were the most influential authors in HIV/AIDS research in Nigeria network. Considering the total number of co-authored articles (both as principal author and as co-authors), Crowell TA (n = 45), Okonkwo P (n = 43), Aliyu MH (n = 40), Ndembi N (n = 38), Dakum P (n = 37), Kanki PJ (n = 34), Ezeanolue E (n = 32), Nowak R (n = 31), Baral SD (n = 30) Adebajo S (n = 29) and Ake JA (n = 24) are in this order the most productive authors. Crowell TA, Okonkwo P and Ndembi N retained the position of the most co-authorship as well as the top total link strength. The three are affiliated to Uniformed Service University USA, Bingham University Nigeria and Africa CDC, respectively (Table 7 ).

Notably, Aliyu MH (of Vanderbilt University USA) retained the 6th most productive author position by principal author analysis (n = 19) as well as the 3rd most co-authored author (n = 40) while having the 10th highest total link strength. Similarly, Ezeanolue E made it on both list as the 12th most published principal author as well as the 7th most co-authored author and the 12th highest total link strength (Tables 6 and 7 ).

Keywords/hotspot analysis

Figure  6 shows hotspot analysis of author keywords used in HIV/AIDS related studies in Nigeria. Keywords appearing more than 10 times were included in the map. Exactly 120 keywords qualified for this. The network visualization stratified the keywords into 5 clusters. Cluster 1 (red) represented treatment, diagnosis, mortality, epidemiology and co-mobility. Tuberculosis (56) and prevalence (41) were the most occurring keywords in cluster 1. However, mortality had higher link strength (70) with other keywords, despite lower occurrence (21). Cluster 2 (green) focused on treatment, epidemiology and co-mobility. Diseases (104) and viral diseases were the most prominent keywords in cluster 2. Cluster 3 (blue) represented keywords associated with the modes of HIV prevention. Education (34), family planning (33), condoms (20) and barrier methods (16) were the most prominent keywords in cluster 3. Cluster 4 (yellow) represented keywords on disease characteristics and demographics. Behavior (55), and demographic factors were the most prominent keywords in cluster 4. However, behavior had the highest link strength (with other keywords) in cluster 4. Cluster 5 (purple) represented keywords associated with risk factors/mode of transmission of HIV. Sex behavior (19) and risk factors (13) were the most occurring keywords in cluster 5. Overall, keywords relating to co-mobility with tuberculosis and HIV prevalence were the most occurring keywords (Fig.  6 a).

Hotspot analysis of author keywords used in HIV/AIDS related studies in Nigeria

On the ground of different average appearing year of keywords, VOSviewer under overlay visualization marked keywords included in the map with different colors (Fig.  6 b). Keywords in blue appeared earlier than those in green and yellow. Keywords in cluster 1 and a few in cluster 5 appeared in more recent years, revealing epidemiology, antiretroviral therapy and prevention of mother-to-child transmission (PMTCT) as current topics of discussion in HIV/AIDS research in Nigeria (2018.36-2019.60) (Fig.  6 b).

Keywords such as antiretroviral therapy and PMTCT showed no links are therefore research areas still open for new researches.

Analysis of retracted articles and those with expression of concerns

Overall, our analysis found 4 retracted articles and 2 articles with expression of concern in HIV/AIDS related publications in Nigeria. Two of the retracted articles were systematic reviews published in Cochrane Database of Systematic Reviews published by Wiley Publishing Company. The other 2 were a conference paper published in Sexually Transmitted Infections (published by BMJ Publishing) and an original article published in African Journal of AIDS Research (published by Taylor & Francis). The 2 articles with expressions of concern were published in Kidney International (published by Elsevier). Most of the reasons for retractions/expressions of concerns were raised by the authors (Table 8 ).

This study provides a quantitative description of HIV/AIDS related research in Nigeria from 1986 to 2021 in PUBMED. The most utilized document type by the authors was original article implying that the subject matter was mostly experimental or clinical.

The trend of research output on HIV/AIDS in Nigeria showed a progressive increase and reassuring trend. However, we found that there was a sluggish growth of HIV/AIDS related literature in Nigeria until 2004 when dramatic growth was observed with an inflection point at about 2008. The earlier lag in scientific productivity could be related to the initial response to the epidemic. Balogun and colleagues [ 2 ] identified three major phases in the development of HIV/AIDS epidemic in Nigeria. First, there was an era of absolute official and personal denial of the presence of HIV/AIDS in Nigeria (1981–1986) [ 2 ]. A publication in 1987 [ 28 ] reported that government officials insisted that AIDS was non-existent in Nigeria even after 18 other African countries had reported the disease. Secondly, there was an era of skepticism and indifference (1986–1997) which was overwhelmed with misconceptions. People described AIDS literally as “American Idea to Destroy Sex” and some even bragged that Africans were immune to it. Finally, the last phase was the era of reality (1997 till date).

The core journals that served as sources for HIV/AIDS related publication in Nigeria were PLoS ONE, Pan African Medical Journal, African Journal of Reproductive Health, AIDS Care, Journal of Acquired Immune Deficiency Syndrome, African Journal of Medicine and Medical Science. These journals could possibly be avenues for future breakthroughs in HIV/AIDS research in Nigeria. More so, the patronage of PLoS ONE with a high impact factor may not be unconnected to the editorial policy of the journal. PLoS ONE emphasizes scientific rigor of a research work over novelty unlike other journals within that category [ 29 ].

The article “Discriminating attitude and practice by health workers towards patients with HIV/AIDS in Nigeria” published in PLoS Medicine was the most cited article. The article was dedicated to assessing the attitude of health care workers toward HIV infected persons in Nigeria; refusal to attend to HIV/AIDS patients, suitability to attend to HIV/AIDS patients in general ward and the need to disclose HIV status to all health workers. The second most cited article was on phases 3 double-blind randomized clinical trial of a vaginal gel intended for prevention of HIV infection. The article with the most citations per year was an article published in Lancet HIV that dwelt on effect of same sex marriage. All the top 10 most cited articles were published in journals with impact factor > 3. The feat of the article published in Lancet is not surprising considering the high impact factor (16.070) and wider coverage of the journal. However, there have been counter argument on the translation of journal impact factor to individual article citation [ 30 ].

University of Ibadan, University of Lagos and University of Nigeria, Enugu and Obafemi Awolowo University were the most outstanding in terms of productivity in HIV/AIDS related research in Nigeria. The above institutions have been consistently documented to occupy the top five (5) positions in researches in biotechnology research [ 31 ], Lassa fever research [ 32 ] and overall research [ 33 ]. They are among the early Federal Universities in Nigeria. The University of Ibadan is the first university in Nigeria founded as University College Ibadan (part of University of London) in 1948 and was later converted to indigenous university in 1962 [ 34 ]. It has been ranked 1st in Nigeria and 1172nd in the world (2022–2023 World University Ranking) [ 35 ]. University of Lagos is a public federal university founded in 1962, and is ranked 3rd in Nigeria and 1924th globally [ 36 ]. University of Nigeria, Enugu was formally opened in 1960 as the first indigenous university, and is ranked 2nd in Nigeria and 1775th globally [ 37 ]. The top 6 institutions are all institutions located in southern Nigeria.

Institutions in the United States dominated external publications in HIV/AIDS research in Nigeria and accounted for 12.84% of all publications. Prominent among these institutions were University of Maryland USA and Centre for Disease Control. The United States has been in the forefront of HIV/AIDS research/treatment and funding in Nigeria. This has been via national and corporate funding. For instance, the US President’s Emergency Plan for AIDS Relief (PEPFAR) has shown the highest commitment in HIV/AIDS research, diagnosis and antiretroviral therapies [ 38 , 39 ]. The AIDS Prevention Initiative (APIN) funded by Bill and Melinda Gates Foundation has offered substantial funds in the form of grants for HIV research and treatment [ 40 ]. The dominance of USA in various fields of study is well documented [ 22 , 23 ]. The United States has been reported to have committed 3.45% of her GDP to research and development (R & D) [ 41 ].

Crowel TA, Okonkwo P, Aliyu MH, Ndembi N, DakumP,Kanki P, Ezeanolue E, Nowak RG, Baral SD, Adebajo S, Charurat ME and Ake JA were the all-round most productive authors in HIV/AIDS related research in Nigeria. Collaborative link analysis presented Crowel TA, Okonkwo P, Ndenbi N, Nowak RG, Baral BD, Ake JA, Dakum P, Kanki PJ, and others as the most influential in terms of diversity of links. Prominent to note is Crowel TA who is the most productive author as well as the one with the highest collaborative strength. On the other hand, analysis of authors’ contribution based on principal author (first author) analysis showed Iliyasu Z, Folayan MO, Ogoina D, Uneke CJ, Olowookere SA, Aliyu MH, Ogunbayo A, Olakunde BO, Olley BO, Sam-Agudu MA, Lawson L, Ezeanolue EE, Daniel OJ, Aliyu G and Agaba PA to be the most productive authors. The above authors in the two categories are core to HIV research in Nigeria and are likely to have tremendous impact in HIV/AIDS research in future.

Analysis of the co-authorship collaboration network showed that Aliyu MH and Ezeanolue were the only authors in the top list of principal authors who had high link strength of collaboration. Also, most of the top authors with high collaborative strength were affiliated to institutions in the United States and some Nigerian government agencies with external funding. Only Okonkwo P of Bingham University (Private University) and Ezeanolue E (University of Nigeria) were the only top list authors from Universities in Nigeria in terms of collaboration. This observation is further corroborated by the institutional collaboration network analysis. The major collaborating institutions were USA-based institutions and externally funded federal agencies. Most of the federal universities only had inter-university collaboration and were in periphery of the network, hence, their exclusion in the network link map. There is poor funding of research in Nigeria, especially with regards to Nigerian Universities. Nigeria spends only 0.13% of her GDP on research and development (R&D) [ 41 ]. This is far below the recommended average of 2.3% by Organization for Economic Co-operation and Development (OECD). The only major source of academic funding in Nigerian public universities is TETFUND (Tertiary Education Trust Fund) which is limited and often rationed funds based on grant applications with limited scope (and don’t even cover private universities). The bulk of research in tertiary institutions in Nigeria are self-funded by academic staff, graduate students, staff-in-training and are driven by the demand for publication towards career development [ 42 , 43 , 44 , 45 ].

The keyword analysis using overlay visualization showed a gradual shift from disease characteristics to diagnosis, treatment and prevention. The current discussions are on mapping current epidemiology, administration of antiretroviral therapy and the prevention of mother-to-child-transmission of HIV. For instance, there have been varying current discussions on trends, predictors, spatial patterns, knowledge and the reduction of mother-to-child transmission of HIV in Nigeria [ 46 , 47 , 48 , 49 , 50 ]. Often, the first response to an epidemic is to characterize the disease followed by diagnosis and possible means of amelioration/cure. With no absolute curative means to HIV and poor access to ameliorative means, preventive measures have becomes the ultimate means to combat the disease especially in resource limited setting such as Nigeria.

The analysis of articles that had post-publication remarks showed 4 articles withdrawn (retracted) and 2 with an expression of concern. We observed that some of the articles continued to accumulate citations even after they were retracted. For example, the article “Higher risk sexual behavior among HIV patients receiving antiretroviral treatment in Ibadan Nigeria” had 18 citations in total, 7 of which occurred after retraction on May 16, 2014. This observation supports the argument and submission of some researchers [ 51 ] that most authors do not read most of the articles they cite. Rather, they copy from an already cited page. Simkin and Roychowdhury [ 52 ] have even put a number to it by concluding in their research article “Read before you cite” that only approximately 20% of citers read the original article.

The present study may contain some limitations which are inherent in bibliometric studies. First, the criteria mapped out by the PUBMED database themselves determine the subsequent product of the studied materials. Secondly, local journals that were not indexed in PUBMED within the study period would have been missed. We might have excluded HIV/AIDS research articles in Nigeria if the authors did not include our specific search descriptors. Lastly, we were limited to use PUBMED a free to use database, we may have missed some articles indexed only elsewhere. However, we believe the output is a true representation of research trend in the study domain.

Irrespective of the inherent limitations, we believe that this study has made available a significant representation of the trends in HIV/AIDS research in Nigeria. We have shown that research on HIV/AIDS in Nigeria had a slow start, possibly due to delay in accepting the reality of the disease, but has grown significantly over time. As current treatment approaches are yet to be curative, it highlights the fact that there remains enormous research potential for the future. The major collaborations were found to be from oversea institutions majorly the United States of America.

Availability of data and materials

Datasets generated and analyzed in this study are within the article. The primary source of data, PUBMED is publicly available.

Abbreviations

Acquired immunodeficiency syndrome

• Human immunodeficiency virus

Center for Disease Control

Human T-Lymphotropic virus Type III

Lymphadenopathy associated virus

Social Network Analysis

Journal Citation Report

President’s Emergency Plan for AIDS relief

AIDS Prevention in Nigeria

Research and development

Tertiary Education Trust Fund

Organization of Economic Co-operation and development

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Conceptualization: HUO; Study design: HUO, EAU and MRA; Data curation and analysis: HUO, EAU, EEA, MRA, EAT, ENB, CAO, VKU, JOA, OOE, Data interpretation: HUO, OCD, IKU, CPE, KJE, RIE, GMEN, AO, MOU, ECU, NPN, COO, AN, OJK and FJP. Data validation: RIE, AN, GMEN, AO and FJP. Figure and software analysis: HUO, NPN. Initial manuscript draft: HUO. All authors read edited and approved the final manuscript.

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Additional file 1: table s1.

. Search Strategy For The Study In Pubmed.

Additional file 2: Fig. S2.

. Screening protocol of retrieved data

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Table S3 . Countries with the most published articles.

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Okoroiwu, H.U., Umoh, E.A., Asanga, E.E. et al. Thirty-five years (1986–2021) of HIV/AIDS in Nigeria: bibliometric and scoping analysis. AIDS Res Ther 19 , 64 (2022). https://doi.org/10.1186/s12981-022-00489-6

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32 Nigeria’s Response to the HIV Epidemic

Olusoji Adeyi is Director of the Health, Nutrition, and Population Global Practice at the World Bank Group.

Oluwole Odutolu is Senior Health Specialist in the Africa Region at the World Bank. He contributed and edited the first edition of AIDS in Nigeria: A Nation on a Threshold and The Africa Multi-Country HIV/AIDS Program (MAP) 2000–2006: Results of the World Bank's Response to a Development Crisis.

John Idoko trained in Internal Medicine, Infectious Diseases, and Immunology of infections and has been an HIV physician since 1995. He is currently Professor of Medicine at the University of Jos and an Adjunct professor of Global Health at Northwestern University in Chicago. Professor Idoko was Principal Investigator of the Harvard University/AIDS Prevention Initiative in Nigeria (APIN) and of the Presidential Emergency Program for AIDS Relief (PEPFAR) at the Jos University Teaching Hospital in North Central Nigeria. He was formerly Director General of the Nigerian National Agency for the Control of AIDS (NACA) and currently the President of the Society for AIDS in Africa (SAA).

Phyllis Kanki is Professor of Immunology and Infectious Diseases at Harvard University. She created and directed the AIDS Prevention Initiative in Nigeria (APIN).

• Published: 07 November 2018
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Nigeria bears one of the largest burdens of HIV infection in the world. Key features of the country’s response to the HIV/AIDS epidemic illustrate the experiences of many low- and middle-income countries. The country’s response is the result of an interplay of policy and political commitment, the work of professionals from multiple disciplines, cross-sectoral programming, and financing from domestic government budgets, household expenditures, and development partners. Sustained progress in Nigeria’s response to HIV/AIDS requires improvements in the effective coverage of services along the spectrum of prevention, treatment, care, and support for those infected. These will also benefit from an effective health system in the context of Universal Health Coverage. Achieving sustainable financing remains a key challenge.

Introduction

Nigeria , the most populous country in sub-Saharan Africa, is home to one in every five Africans. Therefore, it may come as no surprise that the story of the HIV epidemic in Nigeria can be told through numbers of great magnitude. Perhaps most telling is the fact that the number of Nigerians infected with HIV—estimated at over three million—is greater than the population of some African nations. Despite a nationwide prevalence of 3 percent, which is low in comparison to many East and South African countries, due to its large population, Nigeria still has the second-largest burden of HIV infection worldwide ( UNAIDS 2016 ).

Nigeria’s first AIDS case was diagnosed in 1986, in a young woman in Lagos ( Nasidi et al. 1986 ), followed by a period of denial in the midst of confusion and scarce human and financial resources to combat the fledging epidemic. There was a late response, as in many other African countries. The association of HIV/AIDS with sex, disease, and death-fueled initial reactions of denial and fear, and bred stigmatization and discrimination ( Barnett and Whiteside 2002 ). Marked stigma and discrimination led to hiding of symptoms, silent deaths, and abandonment of “victims” even by close family members ( Jegede 2006 ; Ahamefule 2005). The fear of contagion was rife as there was little or no knowledge of means of transmission; it was a period of gloom and helplessness. Nigeria was faced with “a number of challenges in its efforts to control the HIV/AIDS epidemic, including widespread poverty, a large and youthful population, extensive variations in epidemic trends, and viral heterogeneity” ( Kanki and Adeyi 2006 , p. 9).

After the first AIDS cases were recognized, the first notable response to control of HIV/AIDS was a medical one, directed at diagnosis of HIV and safe blood transfusion (FMOH 1987); this was followed by a civil society response of awareness creation and health education; and lastly, the building of institutions for the control of HIV/AIDS ( Odutolu et al. 2006 ). Beginning in 1991, Nigeria instituted and maintained a national sentinel surveillance system, later augmented with biological and behavioral surveillance of high-risk groups such as commercial sex workers, men having sex with men, and intravenous drug-users. The national response has been synchronized with global efforts as coordinated by UNAIDS with the National Agency for the Control of AIDS (NACA) providing leadership and promoting ownership ( NACA 2015 ).

More recently, Nigeria has committed to achieving Universal Health Coverage, which includes the effective coverage of all the people with essential health services, and the avoidance of financial hardship because of payments at the point of service delivery ( Okpani and Abimbola 2015 ). This raises the question of the sources, adequacy, equity, efficiency, and sustainability of financing for essential health services, including those for HIV/AIDS services. In this chapter, we summarize the key historical features of Nigeria’s response to the HIV epidemic over the past three decades ( Adeyi et al. 2006 ). The latter part of the chapter examines the sources, adequacy, and sustainability of financing. A detailed exploration of equity and efficiency of expenditures on HIV/AIDS is outside the scope of the current discussion. We also examine the contributions of HIV programming to building public institutions and resilient partnerships, development of the private-sector and civil society organizations, and strengthening of the health systems.

Nigeria recognized its first cases of AIDS in 1986 ( Nasidi et al. 1986 ). That year, under the leadership of the minister of health, the late Professor Olikoye Ransome-Kuti, the Nigerian government officially acknowledged the first HIV infection in the country ( Raufu 2003 ). As a result of persistent advocacy by a number of expert virologists and physicians, the Nigerian government formed the first National Expert Advisory Committee on AIDS in 1986. HIV infection and AIDS cases continued to be identified in the late 1980s throughout the country.

In late 1987, the Federal Ministry of Health, with technical assistance from the Overseas Development Administration of the United Kingdom and the World Health Organization, sought to ensure transfusion safety by establishing HIV antibody testing in the blood banks and transfusions centers of thirteen teaching hospitals throughout the country (Schneider 2013). The number of such HIV screening centers would later increase to cover more hospitals. The results of HIV testing in the first 2,000 blood units were negative. To some extent, these early data led to an optimistic view that Nigeria would be spared from the epidemic and this may have lured government officials into a false sense of complacency.

In 1988, the National AIDS and STDs Control Program (NASCP) replaced the earlier national committee. Coordinated by the Federal Ministry of Health, NASCP continues to be responsible for the Nigerian health sector component of the response to HIV/AIDS, developing guidelines on key interventions, supporting the monitoring and surveillance of the epidemic, and coordinating HIV treatment and care efforts across the nation. The first national HIV sentinel surveillance survey for Nigeria, conducted in 1991 among pregnant women attending antenatal clinics, revealed the country’s HIV prevalence rate to be 1.8 percent (FMOH 1991).

Nigeria was under military rule during the 1990s, a period marked by coups, fraudulent and postponed elections, a devastated economy, and civil unrest. Democracy was restored in 1999 with the election of President Olusegun Obasanjo, who presided for eight years during a period of rebuilding. He established a presidential committee on AIDS and a National Action Committee on AIDS (NACA). A three-year HIV/AIDS Emergency Action Plan was developed in 2001 with assistance from UNAIDS and other international development groups. During his tenure, the international development community began to return to Nigeria and initiate aid programs, many of these addressing the HIV/AIDS epidemic. The World Bank initiated the Multicountry HIV/AIDS Program, to fund national HIV prevention, treatment, and care in a number of African countries; Nigeria received U.S.$100 million. In late 2000, the Bill and Melinda Gates Foundation announced a U.S.$25 million grant to the Harvard School of Public Health to create the AIDS Prevention Initiative in Nigeria (APIN) ( Kanki 2009 ). In 2004, Nigeria successfully applied for funds from the Global Fund to Fight AIDS, Tuberculosis, and Malaria and received support from the President’s Emergency Plan for AIDS Relief, or PEPFAR. Nigeria was one of the first fifteen countries targeted by the PEPFAR program for support. At the same time, the government, local professionals, and civil society groups, inspired by the increased resources, strengthened their own commitments to the prevention, treatment, and care of HIV/AIDS.

By 2001, the national median HIV seroprevalence increased to its highest at 5.8 percent and has hovered around 3 percent from 2012 to 2016 (FMOH 2001–16). However, there is a tremendous range in infection rates amongst the thirty-six states, with some states as high as 15 percent and some lower than 1 percent (see Figure 32.1 ). Differences among geopolitical zones, ethnic traditions, religious practices, and sexual networking habits are among the many possible factors that may have contributed to the disparities in HIV infection. As HIV has continued its spread across Nigeria, it has become increasingly apparent that the epidemic does not follow the same course in different geographic locales or among various population subgroups (see Figure 32.1 ).

At the outset, the impact of the AIDS epidemic fell on the Nigerian health sector, as the disease was viewed solely as a health problem. As the epidemic evolved, however, the sentinel surveys demonstrated significant HIV infection and disease in young men and women who constituted the mainstay of agriculture, education, commerce, and industry. By 2000, Nigerian government officials recognized that the impact of the epidemic had transcended the health sector to also include the socioeconomic and developmental sectors. HIV/AIDS thus became the most important health and developmental problem in Nigeria, requiring an immediate response. This underscored the fact that despite all the preventive interventions available, the need to mount an expanded program for care and support of the millions already living with HIV/AIDS had grown urgent. The situation called for an expanded multisectoral national response to the epidemic.

HIV Prevalence by State in Nigeria, 2012.

In the mid 1990s, HIV-infected individuals in Nigeria in need of antiretroviral therapy (ART) purchased expensive antiretrovirals in Europe or the United States. Nigeria’s elite teaching hospitals—such as Lagos University Teaching Hospital, Jos University Teaching Hospital, 68 Military Hospital, and the University College Hospital in Ibadan—were among the first Nigerian hospitals to monitor AIDS patients who had purchased drugs with their own money. Consequently, even before the national ART program began, some physicians were gaining experience in treating AIDS patients. Even so, these physicians were hampered in their efforts to provide optimal care because their hospitals lacked the laboratory tests needed to monitor patients on ART, which was standard care in the developed world. As a result, early ART experience heavily depended on the patient’s willingness and ability to spend significant funds on both drugs and laboratory tests.

In April 2001, President Obasanjo had served as host to the first African Summit on HIV/AIDS, Tuberculosis, and Other Related Infectious Diseases on behalf of the Heads of State and Government of the Organisation of African Unity. There he reminded participants that AIDS had killed 11.6 million Africans in the previous fifteen years. He called on other African nations to commit more resources to the pandemic; Nigeria had already increased its annual AIDS spending from U.S.$100,000 to U.S.$20 million. “We are an endangered continent,” President Obasanjo declared. “The sad reality is we are a dying continent and it will be a challenge to prevent a monumental catastrophe” ( Donnelly 2001 ).

In addition to his strong advocacy at that summit for continued support for HIV/AIDS programs in Africa, President Obasanjo announced the initiation of the Nigerian National Antiretroviral Therapy Program and the purchase of antiretroviral drugs for 10,000 adults and 5,000 children, at an annual cost of 500 million naira, or U.S.$3.7 million ( Kanki 2009 ). The purchase of these drugs from the Indian generic drug manufacturer Cipla was facilitated by the company’s lowering of the drug cocktail price from U.S.$600 to U.S.$350 per patient per year. Cipla was willing to cover the discounted price to any African nation that would provide the drug to eligible patients for free. Nigeria was the first African nation to make such a large purchase of such drugs (U.S.$3.5 million). In order for patients to qualify to receive these free drugs, they needed to demonstrate that their CD4+ T-cells were below 200 cells/mm3. The cost of this laboratory test at the time was approximately 9,000 naira or U.S.$30 and this was cost-prohibitive for many patients (FMOH 2004). As a result it is estimated that only 6,000 Nigerian patients were ultimately treated with these drugs.

The federal Ministry of Health designated the Nigeria National ART Committee, which drafted the original guidelines for the provision of ART (FMOH 2001). This technical advisory body included a number of ART center directors, donor partners, and representatives from the Federal Ministry of Health, the National Food and Drug Administration and Control, UNAIDS, and the Global Fund Country Coordinating Mechanism. Professor John Idoko from Jos University Teaching Hospital chaired the committee ( Idoko 2012 ). The Nigerian ART guidelines largely followed the World Health Organization guidelines with respect to ART eligibility, diagnosis, monitoring criteria, and first-line regimen recommendations. Patient management recommendations and toxicity guidelines were included to help guide physicians and nurses.

At the same time, the Federal Ministry of Health issued guidelines for voluntary counseling and testing and prevention of mother-to-child transmission (PMTCT) (FMOH 2001; 2002). These represented critical entry points for ART programs as well as important opportunities for providing prevention messages and the guidelines assisted healthcare providers in proper counseling and HIV testing methods. The Nigerian PMTCT program began in 2001 with the establishment of seven federal PMTCT centers. These centers provided HIV testing to pregnant women and single-dose nevirapine (NVP) to HIV-infected women and their babies, the drug provided by UNICEF. Since this program also identified pregnant women in need of complete ART, a particularly important patient population, it was integral to the national ART program. The PMTCT program also allowed for the follow-up of HIV-infected pregnant women after their delivery to determine whether exposed infants were infected and in need of care and treatment.

The Nigerian National ART program, which began in February 2002, designated twenty-five treatment centers distributed across the country’s six geopolitical zones. Treatment slots were allocated to each of the centers with provision of twelve months of drugs for a total of 625 eligible adult patients. In the first year, more than 6,000 adults were treated with a combination of the generic brands of ART. Under the Nigerian national program, the monthly cost of treatment was 1,000 naira (equivalent to approximately U.S.$7); the government highly subsidized the remaining drug costs. As described, the cost of laboratory tests required to qualify for the program and for continual monitoring was borne by the patient.

Most HIV/AIDS services are provided in the public sector, supported by a significant fraction of Nigeria’s dedicated resources and qualified staff. Nigeria has been very fortunate; despite the deterioration of the education and health sector that resulted from its long military rule, Nigeria was able to maintain its strengths in educating healthcare workers. Nigeria’s professional schools annually graduate thousands of physicians, nurses, laboratory technicians, and social workers. Unlike many other African nations, Nigeria’s educated and skilled workforce has been able to provide an important foundation for HIV/AIDS prevention, treatment, and care programs, although there is still disparity in the distribution of trained healthcare workers to rural settings where the need is the highest. In addition, Nigerian physicians, nurses, and other healthcare workers often represent a significant proportion of the healthcare workforce in the treatment and care programs of other African countries, resulting in a “brain drain” for the country.

Nigeria is served by a variety of public and private health facilities. Private health institutions include a network of private for-profit entities, nongovernmental organizations, and faith-based organizations that provide healthcare to millions of Nigerians (FMOH 2004). There are limited formal linkages between private and the public-sector ART programs, except for the referral of patients for drugs and other laboratory-related services. In 2004, per patient costs in the public sector was estimated at U.S.$913 per year. The largest components of this cost were: staff salaries (U.S.$336); generic antiretrovirals (U.S.$300); and laboratory monitoring tests (U.S.$204). Smaller costs included laboratory equipment, patient and drug transportation, and staff training. An analysis of treatment costs in the private sector revealed a much higher per patient cost of U.S.$2,263, with 60 percent of the cost for antiretrovirals, as indicated in Figure 32.2 . (FMOH 2004).

The UNAIDS launched the Drug Access Initiative (1997–2003) which was evaluated in Chile, Côte d’Ivoire, Uganda, Vietnam, and Senegal. These pilot programs explored the feasibility of structured introduction of price-reduced ARV therapy, measured short-term clinical outcomes with a final goal of understanding the infrastructure and procedural requirements to sustained ARV provision ( Katzenstein et al. AIDS 2003 ).

In 2005, the AIDS Prevention Initiative in Nigeria, or APIN, provided the first evidence of the success of the Nigerian ART program, laying to rest the uncertainty about whether the requirements of ART and monitoring could be met in developing countries. APIN researchers found a 75 percent efficacy rate among the first fifty patients enrolled at the National Institute of Medical Research who had received generic antiretrovirals from the Nigerian government. This efficacy rate was comparable to those in U.S.- and European-based trial data for branded antiretrovirals ( Idigbe et al. 2005 ).

Costs of ART Provision in the Public and Private Sectors.

In late 2003, President George W. Bush launched the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, to provide prevention, care, and treatment to fifteen focus countries (PEPFAR 2017). The legislation authorized U.S.$15 billion to a comprehensive program to combat HIV/AIDS in partner countries in southern Africa, East Africa, West Africa, the Caribbean, and Asia. Nigeria was one of two West African countries selected.

The following year, the Harvard School of Public Health and the AIDS Relief Consortium initiated PEPFAR-funded HIV treatment and care programs in Nigeria ( Kanki 2009 ). The program provided funding for all aspects of treatment and care following the Nigerian ART guidelines for eligibility, drug regimens, and monitoring. In collaboration with the Nigerian National ART Program, which had initiated treatment for 13,000 patients by mid-2004, PEPFAR-funded clinics provided free treatment and care to an additional 8,000 patients during the first year of the program. Given that the estimated burden of disease was at least 3 million people, this represented less than 1 percent of the AIDS burden in the country.

The Nigeria PEPFAR grew substantially over the next four years ( Kanki 2009 ). Family Health International, the University of Maryland, and Columbia University’s Mailman School of Public Health initiated treatment and care programs at various sites across the country. Annual PEPFAR funding increases enabled a rise in the number of patients on ART, the addition of new sites, the training of personnel, and the development of infrastructure and capacity-building critical to meeting programmatic goals. By the end of 2005, nearly 50,000 Nigerians with HIV were receiving free ART.

In 2004, Nigeria received more than U.S.$28 million in the first round of funding by the Global Fund to Fight AIDS, Tuberculosis, and Malaria. These funds, largely granted to the National Action Committee on AIDS, provided substantial support for HIV prevention efforts. In 2007, the Nigerian government received a fifth-round award of more than U.S.$46 million to help provide direct support for antiretroviral treatment and care (Global Fund 2008). The Clinton Foundation, active in supporting HIV/AIDS treatment programs in Africa, also provided funding for the Nigerian ART program in 2006–7. Through an established collaboration with the government of Nigeria, the Clinton HIV/AIDS Initiative organized for the donation and distribution of antiretrovirals for pediatric patients and certain second-line drugs for adults to ART sites across the country. The donation of these drugs and laboratory test reagents meant that the estimated per-patient costs of ART provision for both adults and pediatric patients were reduced by 20 percent (Clinton HIV/AIDS Initiative 2008).

Current Situational Analysis

Estimates show that new infections have declined from an estimated 316,733 in 2003 to 239,155 a decade later in 2013 to a current estimate of 250,000 In 2016 (UNIADS 2016). A total of 180,000 died from AIDS-related cases in 2015, which is lower than 210,031 people in 2013. Figure 32.3 shows that there are marked variations in the prevalence of HIV across states.

Overall HIV Infection Rate.

Nigeria’s HIV epidemic is mixed, and most of the new infections are attributable to high-risk subpopulations. The national Mode of Transmission Study 2010 (NACA 2010) attributed 40 percent of new infections occurring in the country to Most At Risk Populations (MARPS) and their clients even though this subpopulation group constitutes only 4 percent of the adult population in the country. Thus, prevention efforts have been concentrated geographically in states and communities with the greatest burden of HIV, and amongst this subpopulation of MARPS. With the aid of the World Bank-supported HIV/AIDS Program Development Project, over 500 community service organizations utilized the combination prevention approach as outlined in the national HIV Prevention plan in many communities across the country with very good measurable impact.

In 2015, UNAIDS developed a set of ambitious but achievable targets of interrupting the Global AIDS epidemic called the 90–90–90 targets ( UNAIDS 2016 ) These include:

By 2020, 90 percent of all people living with HIV will know their HIV status.

By 2020, 90 percent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.

By 2020, 90 percent of all people receiving antiretroviral therapy will have durable viral suppression.

The recent Nigerian National ART guidelines (FMOH 2016), which aim to maximize the therapeutic and preventive benefits of ART, have increased the estimated number of people eligible for ART from roughly 2 million to 3 million in Nigeria. With almost 1 million people on treatment now, that leaves about 2 million people living with HIV in need of these life-saving drugs.

However, in order to identify those in need of drugs, Nigeria must deliver on the First 90—ensuring that 90 percent of people living with HIV know their HIV status and get linked to treatment. This has posed a huge challenge, as the number of people testing for HIV even though rising has been consistently low. The number of women and men aged 15 years or more who have received HIV counseling and testing (HCT) has increased from 3.5 million in 2013 to 12.7 million in 2015. Also the number of HIV testing sites in the same period has increased from 2,600 to over 7,000 (FMOH 2016). In spite of these increases, the proportion of the general population accessing HIV testing and counseling remains low and far from reaching the national targets of the First 90. Challenges to scaling up testing include shortage of HIV test kits, weak supply-chain management, low-risk perception, and stigma associated with HIV infection. Some measures that have been recently put in place to address these challenges include ensuring the provision of several models of delivering and optimizing counseling and testing people close to their homes. In addition, couples counseling and using contact tracing to test sexual partners and family members have strengthened the national HCT program. Other innovations that have been employed include the use of self-testing and providing HCT as a component of multidisease campaigns in various communities across the country. Measures have also been put in place to strengthen the supply chain management of HIV commodities by establishing a common National Procurement Supply Chain Management Program.

The number of sites providing ART has risen to more than 1,000 across the country (FMOH 2016) but this is far from meeting the demands of the Second 90 target. Additionally, decentralization of PMTCT services has contributed to increasing the number of sites providing PMTCT services to 6,548 in 2014. The number of pregnant women who were counseled, tested, and received results almost doubled from 1,706,524 in 2013 to 3,067,514 in 2014. This represents 30 percent of all pregnant women in the country.

Aggregate spending on HIV/AIDS in Nigeria, 2010–14.

Expenditures and Financing

There have been historical challenges in compiling comprehensive data on sources and aggregate expenditures on HIV/AIDS, their composition, and trends in Nigeria. An early exploration concluded, inter alia, that: HIV was imposing a significant financial burden on Nigerian households; extending treatment to everyone who needed it would impose a significant financial burden on the government; there was significant external funding, with the caveat that since development aid was not guaranteed forever, Nigeria would face an even greater financial burden as aid agencies withdrew ( Canning et al. 2006 ).

Against this background, this section presents estimates of total expenditures on HIV/AIDS programs in Nigeria for 2010–14 (Figure 32.4 ) from government ministries, firms, insurance agencies, non-profit NGOs, firms, and others.

Figure 32.4 shows that Nigeria spent between $0.9 to $1.8 billion per annum between 2010 and 2014 on HIV and AIDS prevention, treatment, and care. The expenditure increased by about 40 percent in 2014 compared to 2010. Total HIV/AIDS expenditure was about 9.3 percent of total health expenditure in 2014 ( Federal Ministry of Health 2016 ) Government health expenditure, at 8 percent of total government expenditure (WHO Global Health Expenditure Database), was far below the Abuja target of 15 percent.

Donor contributions increased by 350 percent over the same period; this can be attributed mostly to investments from the United States PEPFAR, Global Fund, and the World Bank-funded Multicountry AIDS Project (MAP2). Domestic funding from government expenditure on HIV dipped to a low of $125 million in 2012 but rose again to almost double of the funding for 2010 by 2014. Household expenditures remained substantial during the period. Donor contribution to HIV programming in Nigeria is substantial, at about a third of all spending on HIV. More than 50 percent of the PEPFAR and Global Fund funding went to the treatment and care program ( Schneider MT et al. 2016 ).

The total health expenditure increased during the same period on an annual basis, to almost double from $10.08 billion in 2010 to $19.75 billion in 2014 ( NACA 2015 ). But the total health expenditure as a percentage of GDP remained around 3.5 per cent. This figure is lower than the sub-Saharan Africa average of 5.5 percent. The total expenditure on HIV as percentage of total health expenditure ranges between 5.67 and 16.7 percent and was 9.31 percent in 2014. In summary, with the second-largest global burden of HIV and AIDS, Nigeria is underspending on HIV and AIDS prevention, treatment, and care compared to the average of 19.2 percent for sub-Saharan Africa ( Amico et al. 2010 ). There are wide variations among countries, but the burden of disease also varies significantly. The percentage of HIV spending is a useful indicator for better understanding healthcare resources and their allocation patterns.

The expenditure on HIV is not broken down into the categories of major interventions for HIV prevention, treatment, and care, but some donor expenditures are disaggregated. For example, data for the U.S. PEPFAR program in 2008 shows that treatment received more than half of the entire budget at $212.8 million, care received nearly 30 percent ($106 million), and prevention received 16.5 percent ($63 million). Similarly, the Global Fund to Fight AIDS, Tuberculosis, and Malaria expended $276.6 million on treatment, care, and support between 2010 and 2014 through the grant to Nigeria—to reduce morbidity and mortality from HIV and AIDS in the country. Nigeria’s National Agency for the Control of AIDS (NACA) is the principal recipient for the grant. Another overlapping grant is the Health Systems and Community Strengthening grant of $73.6 between 2006 and 2015. Most of these grants were for treatment, care, and support, including voluntary counseling and testing and the prevention of mother-to-child transmission of HIV. But the $225 million World Bank-financed HIV Program Development Project II, which was implemented within the same period, focused on stewardship, voluntary counseling and testing, and engagement of civil society organizations for prevention activities. The project supported the promotion of behavior change, condom promotion, prevention of stigma and discrimination, and strengthening transparency and accountability of the NACA and State Agencies for the Control of AIDS (SACAs) through capacity-building for public procurement, and public financial management system.

In summary, the substantial external financing of HIV/AIDS programs in Nigeria have occurred in a broader context of low total health expenditures relative to GDP, and high out-of-pocket (OOP) expenditure by households. Crosscountry studies provide more information on challenges faced by countries, including Nigeria, in ensuring adequate domestic funding for health services, including those for HIV/AIDS, in an era in which there is declining or shaky support for externally funded HIV/AIDS programs ( Hecht et al. 2010 ; Resch et al. 2015 ). Given the continuing need to treat those currently on ART and anticipated additions to those needing treatment, the financial sustainability of HIV/AIDS program is precarious.

Prior work indicated that ART subsidization was not enough to eliminate the economic burden of treatment on HIV patients. Service decentralization to reduce travel costs, and subsidy on other components of HIV treatment services were suggested as measures to eliminate inequities in effective coverage of ART services. Finally, the authors recommended the inclusion of ART services within the benefit package of the National Health Insurance Scheme (Etiaba et al. 2016).

In the foregoing context, current health financing policy and practices in Nigeria do not enable the sustainable financing of ART services. Out-of-pocket expenditures remain high (FMOH 2017), and the government is yet to translate from paper to reality the provisions of the National Health Act of 2014, central to which is the establishment of the Basic Health Care Provision Fund to be funded from a federal government annual grant of not less than 1 percent of its Consolidated Revenue Fund, grants by international donor partners, and funds from other sources. Doing so would make it possible for the country to get an overarching grip on progress toward universal health coverage (Adeyi 2016), including ART services.

Health System Development and Service Delivery

Investments in Nigeria’s health services and systems over the past several decades have yielded mixed results. The infant and under-five mortality rates have fallen, but not fast enough for Nigeria to meet the Millennium Development Goals (MDGs). The maternal mortality ratio, although much reduced from levels seen in the 1990s, has hovered around 576 deaths per 100,000 births during the past decade. There has also been no significant change in childhood stunting in the last ten years (NPC and ICF 2014).

The health system is weak (Adeyi 2016), with underlying systemic failures: fragmentation and poor coordination; lack of accountability; and poor incentives and gross inefficiency in the face of poor public financial management system. All these are reflected in service delivery, where many of the indicators have stagnated in the last thirty years. There are also wide variations in service coverage across regions and income groups; the southern parts of country generally outperform the northern parts, and people in higher income quintiles fair better than those in the lower income quintiles.

On the other hand, there has been progress in HIV prevention, treatment, and care, with one of the greatest achievement being in HIV prevalence, which has fallen to 3 percent in 2012 from the highest point of 5.8 percent in 2001 (FMOH 2012). This progress is plausibly due to the combination of large investments and efforts to ensure marked improvements in effective implementation of programs covering prevention, treatment, and care ( NACA 2015 ), but increased spending alone does not necessarily improve overall performance ( Berman and Bitran 2011 ). A more likely case is that increases in resources and massive institutional and health-system strengthening efforts around HIV/AIDS programs contributed to improved results. The national HIV prevalence average dropped by almost 20 percent between 2007 and 2012 from 3.6 percent to 3.0 percent. There was similar reduction in prevalence in five geopolitical zones of the country while in the south-south zone there was an increase of 3.5 percent to 5.5 percent. However, four states have the highest prevalence: Rivers (15.2 percent), Taraba (10.5 percent ), Kaduna (9.2 percent ), and Nasarawa (8.1 percent ) respectively. High risk groups also show a decrease in HIV prevalence between 2007 and 2010—for nonbrothel-based sex workers from 37.4 percent to 27.4 percent ; for brothel-based sex workers from 30.2 percent to 21.7 percent and for intravenous drug-users 5.6 percent to 4.2 percent . But there was an increase in prevalence among men having sex with men (MSM) from 13.5 percent to 17.2 percent . The reduction in prevalence in these high-risk groups might be due to better targeting and more confidence of the high-risk communities on the nongovernmental organizations working with them and the wider system in general.

The ultimate indicators of health-system performance are health status, financial protection, and customer satisfaction ( Roberts et al. 2004 ). These goals also align with the principles of universal health coverage (World Bank 2015; Kutzin 2012 ) which emphasizes coverage with quality healthcare and financial protection. Ceteris paribus, if coverage with HIV/AIDS services improve and if those services are of good quality, HIV/AIDS programs will have positive effects on individual and aggregate health status. Customer satisfaction studies shows mixed results across the board depending on where the services were provided; available supporting care; and reduction in stigma and discrimination ( NACA 2015b ).

The Intermediate Indicators of Coverage, Quality and Efficiency are also Very Important

On coverage , while the success of the treatment program is remarkable there are still many people left behind because of lack of adequate human and financial resources to put them on treatment program and there have been several modifications of policies of the CD4 count threshold to enroll people living with HIV. It is estimated that a total of 1,665,403 (1,454,565 adults and 210,838 children) required antiretroviral drugs (ARV) in 2014 ( UNAIDS and NACA 2014 ) but only 747,387 adults were on ART that year. ART coverage for children aged less than fifteen years has witnessed some improvement but remains low at less than 12 percent. PMTCT coverage has also improved but is still low at 30 percent (NACA 2014).

Quality of HIV/AIDS care has improved, based on the predictors of perceived quality of care for the Nigeria program: which are patients who adhered to hospital appointment; the punctuality of providers on scheduled clinic days; patients with easy access to a facility; and patients with improvement in CD4+ T-cell count ( NACA 2015 ) The improvement in CD4 was the strongest predictor of quality of care followed by adherence to appointment and easily accessible facility. But as treatment, care, and support are scaled up to primary health centers there is the need for more vigilance and augmentation of quality of care at the lower levels of care.

Regarding efficiency , there is no definitive evidence of the efficiency of the program, but there are plausible efficiency gains from pooled procurement of test kits and condoms through the World Bank HIV Program Development Project, the U.S. Government private-sector-led logistic and supply-chain management, intensive use of private-sector savvy implementation planners, and the use of data for policies and program management ( USG 2010 ).

Multisectoral Systems Developed and Their Future Utility

NACA has the mandate to provide overall coordination of the national response through providing an enabling environment and stable ongoing proactive multisectoral planning, coordinated implementation, monitoring, and evaluation of HIV/AIDS prevention, and impact mitigation activities in Nigeria. At the states and local government authority levels, State Agencies for Control of AIDS (SACAs) and Local Agencies for Control of AIDS (LACAs) provide similar overall coordination. The Federal and State Ministries of Health are responsible for the health sector component of the response while other line ministries (women’s affairs, youths, information, etc.) are responsible for coordination of other interrelated thematic areas. Nonstate actors, nongovernmental, faith-based and community service organizations, and private sector) are involved in key aspects of the response including resource mobilization, advocacy, demand creation, and community interventions. NACA interfaces with representation from key stakeholders to broaden the coordination reach and effectiveness. These cooperating stakeholders include NACA–SACA, NACA–CSO, NACA–Private Sector, NACA–Public Sector, NACA–Development Partners, and NACA–Technical Working Groups. These coordination roles of NACA, SACAs, and LACAs have improved over the period of the last two National Strategic Frame Works (NSF 2004–9; 2010–15), and the current one (2016–20) with resources from the government of Nigeria and development partners, particularly the World Bank, Global Fund, and PEPFAR. Capacity has been built across nontraditional line ministries such as education, labor, women’s affairs, justice, etc., that have taken HIV programs out of the traditional ministry of health. It has also been built at the decentralized levels of state and local government and this has strengthened ownership and sustainability of the HIV response at those levels. Particularly where Nigeria excelled most is with civil society organizations across the country. Many of these NGOs participated in the HIV/AIDS Fund, where through World Bank assistance, they were trained in project management, monitoring and evaluation, and behavior-change communication. The private sector through the Nigeria Business Coalition against AIDS (NIBUCAA) has established a private-sector response to HIV/AIDS with proactive prevention activities in several industries and special programs against stigma and discrimination. Other activities include peer education and mentoring; workplace HIV policy development, provision of high-quality voluntary counseling and testing.

Conclusion: the Unfinished Agenda

Our conclusion is that Nigeria has made significant progress in containing the scourge of HIV, but more efforts and resources are needed for the country to attain the UNAIDS 90–90–90 targets by 2020.

Sustained progress in Nigeria’s response to HIV/AIDS requires improvements in the effective coverage of services along the spectrum of prevention, treatment, care, and support for those infected. As part of addressing the scaling-up of the ART coverage in Nigeria, the National Agency for Control of AIDS (NACA) and the Federal Ministry of Health (FMOH) in collaboration with all the major stakeholders have put in place the country’s strategic plan/framework for 2016–20 and the key strategies for ramping up the coverage of ART in the country include:

Working with the development partners (PEPFAR, Global Fund, World Bank) and local organizations to create political pressure to mobilize government at all levels, private sector, and CSOs around the country’s 90–90–90 targets.

Focus efforts on and fund strategies that work for patients and bring better outcomes—saturating high burdened states, LGAs, and communities with high-impact interventions and implementing treatment for all HIV-positive people including all HIV positive pregnant women.

Integrate HIV services with other services (TB, Malaria, MNCH/SRH, NCD).

Address stigma and discrimination, educate patients on HIV and ART, and promote human rights.

Implement task-shifting and task-sharing, including training and support for nurses and lay counselors

Employ community-based models of treatment and care to rapidly increase ART uptake and improve adherence and retention.

Strengthen the National Procurement and Supply Chain Program and ensure commodities reach patients thereby eliminating drug and commodity stock outs.

Ensure that key populations and vulnerable populations (adolescents, girls and women) are not left behind.

Financing remains challenging. Prior research on domestic spending in low- and middle-income countries established that Nigeria was spending less than expected on HIV/AIDS ( Resch and others 2015 ). Nigeria’s total health expenditure of $118 per capita in 2014 was 0.7 percent of GDP and 2.2 percent of government expenditure. Of the total health expenditure, 25 percent was general government health expenditure and 72 percent was private out-of-pocket, the latter being among the highest in the world (World Health Organization 2014). The combination of low public spending on health in general and high out-of-pocket spending leads to a straightforward conclusion: there is a pressing need to increase public spending on health in general, and to devise pooled financing options that reduce out-of-pocket expenditures, since the latter cause financial hardships for individuals and households.

A continuation of significant reliance on development assistance for HIV/AIDS programs is neither feasible nor prudent. Switching largely to domestic financing will not be easy, but there are a number of concurrent measures available to the country. One is to implement the National Health Act of 2014, central to which is the establishment of the Basic Health Care Provision Fund to be funded from a federal government annual grant of not less than 1 percent of its Consolidated Revenue Fund in addition to grants from international donor partners. The other is to recognize that in very resource-constrained contexts, the achievement of Universal Health Coverage, including effective coverage of services in HIV/AIDS programs, is more likely to be achieved through gradual improvements than through massive gains in the short term (Ly and others 2017). Rigorous monitoring and evaluation are needed to inform progress along the way.

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Controlling hiv/aids in nigeria essay

Hello there! Today, I would like to delve into a crucial issue that affects millions of lives in Nigeria: HIV/AIDS. This comprehensive essay aims to provide you with a wealth of information on the topic, covering various aspects such as the current situation, challenges faced, prevention strategies, treatment options, and the importance of education and awareness campaigns. So, grab a cup of tea, settle in, and let’s explore the world of HIV/AIDS control in Nigeria together!

• The Current Situation: Nigeria, like many other countries, faces a significant challenge in controlling the spread of HIV/AIDS . According to recent statistics, Nigeria has one of the highest numbers of people living with HIV/AIDS in the world. The prevalence rate varies across different regions, with the southern states experiencing higher rates compared to the northern regions . Factors contributing to the spread of HIV/AIDS include limited access to healthcare, cultural beliefs, stigma, poverty, and inadequate education about the disease.
• Challenges Faced: Controlling HIV/AIDS in Nigeria comes with its fair share of challenges. The first hurdle is ensuring widespread access to proper healthcare services, especially in remote areas. This includes the availability of antiretroviral therapy (ART) drugs, testing facilities, and specialized clinics. Additionally, combating the prevailing stigma associated with HIV/AIDS remains a significant obstacle in encouraging people to get tested and seek treatment.
• Prevention Strategies: Prevention is undeniably the cornerstone of HIV/AIDS control. Implementing a comprehensive range of prevention strategies is crucial. These strategies should include promoting safe sexual practices, such as condom use and the provision of free or low-cost contraceptives. Education on the importance of regular HIV testing, encouraging voluntary counseling and testing (VCT) centers, and promoting abstinence and fidelity can significantly contribute to prevention efforts.
• Treatment Options: Ensuring access to effective treatment is paramount in controlling HIV/AIDS. ART plays a pivotal role in managing the disease and improving the quality of life for individuals living with HIV/AIDS. It is vital to expand the availability of ART drugs and strengthen healthcare infrastructure to provide comprehensive care and support services. Collaboration with international organizations and pharmaceutical companies can help negotiate affordable drug prices and increase the availability of treatment options.
• Education and Awareness Campaigns: Education and awareness campaigns play a vital role in reducing HIV/AIDS transmission rates. Investing in comprehensive sex education programs in schools, colleges, and communities can help dispel myths, challenge cultural taboos, and promote healthy behaviors. Additionally, media platforms, including television, radio, and social media, can be utilized to disseminate accurate information, share personal stories, and address the stigma associated with HIV/AIDS.

Conclusion:

In conclusion, the battle against HIV/AIDS in Nigeria requires a multi-faceted approach involving government commitment, healthcare infrastructure development, prevention strategies, increased access to treatment, and comprehensive education and awareness campaigns. By addressing these key aspects, Nigeria can make significant strides towards controlling the spread of HIV/AIDS and improving the lives of those affected. Together, let us work towards a future where HIV/AIDS is no longer a widespread public health concern in Nigeria.

Remember, the fight against HIV/AIDS is not just about statistics or keywords; it is about real people and their stories. By prioritizing empathy, compassion, and understanding, we can make a difference in the lives of millions affected by this disease. Stay informed, spread awareness, and let’s create a world free from the burden of HIV/AIDS.

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The HIV/AIDS epidemic in Nigeria: progress, problems and prospects

Affiliation.

• 1 Vanderbilt University Institute for Global Health, Nashville, Tennessee, USA.
• PMID: 21416794

Nigeria is Africa's most populous country, and is home to the third largest number of persons living with HIV/ AIDS in the world. Poverty, stigma, discrimination, and a poorly coordinated health system constitute major barriers to HIV treatment and prevention efforts. The purpose of this paper is to review the current status of the HIV/AIDS epidemic in Nigeria, analyze the challenges facing provision of HIV/AIDS services, examine the prospects of attaining universal access to HIV prevention, treatment, care and support, and advance recommendations for developing quality, sustainable and efficient HIV/AIDS services in Nigeria. HIV programs in Nigeria must emphasize sustainability of current foreign-donor driven treatment and prevention initiatives by engaging all segments of the society and enhancing community leadership and ownership of the programs.

Publication types

• Acquired Immunodeficiency Syndrome / epidemiology*
• Acquired Immunodeficiency Syndrome / prevention & control
• Capacity Building
• Delivery of Health Care / organization & administration
• Delivery of Health Care / trends
• Financing, Organized
• HIV Infections / epidemiology*
• HIV Infections / prevention & control
• Health Knowledge, Attitudes, Practice*
• Health Promotion / organization & administration*
• Health Services Accessibility / organization & administration*
• Health Services Accessibility / trends
• Nigeria / epidemiology
• Nigeria / ethnology

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WRITING AN EXPOSITORY ESSAY ON CONTROLLING HIV AIDS IN NIGERIA

Introduction Since the first reported case of AIDS in Nigeria in 1986, the HIV/AIDS epidemic has posed a serious threat to public health and development in the country. Despite significant efforts to control the disease over the past three decades, HIV prevalence remains high in Nigeria, with an estimated 1.9 million people living with HIV in 2018 according to UNAIDS figures. This expository essay will examine the major challenges facing HIV prevention and control efforts in Nigeria and propose strategic solutions to curb the spread of the virus and improve access to treatment.

Challenges in Controlling HIV/AIDS in Nigeria There are several entrenched challenges that have hindered Nigeria’s progress in controlling the HIV/AIDS epidemic. Some of the most significant include:

Cultural and Social Factors: Certain cultural practices and social norms in parts of Nigeria have increased vulnerability to HIV infection. For example, polygamy is still common in some regions and this can facilitate transmission between spouses. Also, traditional beliefs around sexual purity and virginity testing discourage open discussion of sex and condom use among young people. Additionally, stigma and discrimination against people living with HIV remains widespread due to associating the disease with promiscuity or sinfulness. This stigma pushes people away from getting tested and accessing treatment.

Poverty and Economic Vulnerability: Nigeria has a high poverty rate, particularly in rural areas where over 60% of the population live below the poverty line. Poverty increases risk of HIV through factors like transactional and intergenerational sex, lack of access to healthcare, and malnutrition. Economic vulnerability makes it harder for people to adopt preventive behaviors or consistently take antiretroviral treatment. Migrant and mobile populations who move long distances for work are also at higher risk.

Inadequate Prevention Programs: Despite expansion of prevention campaigns in recent years, awareness of HIV remains low in many communities. Critical gaps also exist in effectively reaching key populations like sex workers, men who have sex with men, and truck drivers with tailored prevention messages and services. Condom promotion and distribution is still inadequate while comprehensive sexuality education programs have faced resistance in parts of the country.

Weak Healthcare System: Nigeria’s overburdened public health system struggles with chronic underfunding, lack of infrastructure and equipment, shortage of health workers, and inefficient management especially in rural areas. As a result, access to HIV testing, counseling, treatment and care is limited. Even in urban areas, long wait times and stock-outs of commodities like test kits and antiretroviral drugs have undermined the effectiveness of the national response.

Proposed Solutions for Controlling HIV/AIDS

Based on the various challenges reviewed, there are several strategic solutions that Nigeria must implement to make meaningful progress in controlling the HIV epidemic. These include:

Strengthen Prevention through Behavior Change: It is critical to redouble efforts to promote behavior change through well-designed, evidence-based programs. This involves addressing socio-cultural drivers of the epidemic, reducing stigma, and targeting key populations, genders and age groups. Addressing root causes like poverty and lack of education through socioeconomic empowerment initiatives will also improve prevention outcomes. Comprehensive sexuality education should be scaled up nationwide.

Improve Access to Testing and Treatment: The national testing strategy needs strengthening with a focus on expanding testing sites, using new technologies like self-testing, and integrating testing services into other public facilities like antenatal clinics. Treatment programs must address health systems barriers through staff training, supply chain management, task-shifting to community health workers and decentralization to primary facilities. User fees should be reduced to expand access.

Leverage Strategic Partnerships: Given the magnitude and complexity of the challenges, strategic partnerships will be critical to control the epidemic at scale. The government must further engage development partners, civil society groups, faith-based organizations, private sector, media and community leaders in designing and implementing multi-sectoral responses. Innovative approaches to catalyze resources, skills and solutions should be explored.

Mobilize Domestic Resources: In the long run, Nigeria needs to sufficiently fund its own HIV response given the funding transitions underway with development partners. The government must progressively increase domestic budget allocations to HIV, make efficient use of resources, and explore innovative financing options like taxes on alcohol and tobacco. Out of pocket spending on healthcare also needs to be reduced.

Address Legal and Policy Barriers: Existing HIV-related laws and policies require review and reforms to ensure a human rights-based, evidence-informed approach and remove punitive aspects that undermine public health goals. Key populations should be legally protected from discrimination. Best practices from other countries need to inform ongoing legal and policy reforms.

Conclusion Controlling HIV/AIDS in Nigeria requires concerted multi-sectoral action, strategic solutions, and sustained political will and resources over many years. With over 1.9 million people living with HIV nationwide, the potential consequences of inaction are severe for public health, socio-economic development and human welfare. By addressing systemic challenges through an approach that integrates prevention, treatment, care, support, human rights and development responses – Nigeria can make significant strides in curbing new infections and achieving epidemic control. This will depend on stakeholders working together cohesively towards a shared goal of an HIV-free future.

By Alma Torres

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Expository Essay on HIV AIDS

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Introduction

One of the most feared diseases of the twentieth century is HIV. The Human Immunodeficiency Virus (HIV) causes AIDS by destroying the human immune system. It has claimed the lives of more than 29% of the world’s population. AIDS has spread like wildfire over the world since its discovery. The maximum population knows about this dangerous disease, AIDS, thanks to the efforts of the government and non-governmental organizations.

AIDS – Causes and Spread

The Human Immunodeficiency Virus, also known as HIV, is the primary cause of AIDS. This virus replicates itself in the human body by injecting a copy of its DNA into the human host cells. The virus is also known as a retrovirus because of its property and capabilities. WBCs (White Blood Cells), which are part of the human immune system, are the host cells in which HIV lives.

HIV destroys WBCs, and the human immune system is weakened as a result. The immune system’s deterioration impacts a person’s ability to combat diseases quickly. A cut or a wound, for example, takes much longer to heal or the blood to clot. The injury may never recover in rare circumstances.

The direct transmission of HIV is through one of three routes: blood, prenatal, or sexual transmission. During the early stages of HIV transmission, blood transfusions were extremely popular. However, in today’s world, all developed and developing countries have vital processes in place to ensure that blood is clear of the virus before it is transfused. Sharing needles can also transmit HIV from one infected person to another.

HIV can transmit through body fluids during sexual activity as part of sexual transmission. HIV can quickly spread from an infected person to a healthy person through oral, genital, or rectal areas if they engage in unprotective sexual intercourse.

Prenatal transmission means that an HIV-positive woman can easily transmit the virus to her kid during pregnancy, breastfeeding, or even childbirth.

AIDS – Symptoms

HIV reduces the general immune system of the human body by attacking and infecting the WBCs, leaving the infected individual exposed to any other sickness or minor infection. In comparison to other diseases, AIDS has a substantially longer incubation time. The symptoms occur gradually over 0-12 years.

Fever, exhaustion, and weight loss are frequent AIDS symptoms, including diarrhea, enlarged nodes, yeast infection, and herpes zoster. Because of their decreased immunity, the infectious individual is susceptible to various unusual diseases, including persistent fever, nocturnal sweating, skin rashes, oral sores, and more.

AIDS – Treatment and Prevention

There is currently no treatment or cure for AIDS, making it a life-threatening condition. According to medical professionals, antiretroviral therapy, or ART, is the best approach to stop it from spreading. It is a drug therapy that prevents HIV from replicating and thus slows the progression of the disease. To minimize immune system damage, it is always best to begin treatment as soon as possible. However, it is only a precaution and does not guarantee that it will prevent you from AIDS.

The process of halting the spread of AIDS is AIDS prevention. Before engaging in any sexual activity, an individual should be aware of his or her own HIV status and that of his or her partner. It is imperative to practice safe sex at all times. Males should always use condoms during sexual encounters, and they should limit the number of individuals with whom they have sex.

It is not advisable to become addicted to illegal substances or narcotics. Multiple public awareness campaigns led by the United Nations, local governments, and nonprofit organizations have reduced the danger of AIDS spreading by raising a general understanding of the disease’s spread and prevention.

AIDS prevention is the method of preventing the spread of AIDS. It is mandatory to perform a regular check of AIDS. An individual should be aware of his or her own HIV status and that of his or her partner before engaging in any sexual activity. Males should always wear condoms during sexual interactions and keep the number of people they have intercourse with to a minimum.

Addiction to illegal substances or narcotics is not a good idea. Needles and razors that haven’t been sterilized should be avoided at all costs. Multiple public awareness efforts conducted by the UN, local governments, and nonprofit organizations have helped minimize the risk of AIDS spreading by increasing public awareness of the disease’s spread and prevention.

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Essay on AIDS for Students and Children

500+ words essay on aids.

Acquired Immune Deficiency Syndrome or better known as AIDS is a life-threatening disease. It is one of the most dreaded diseases of the 20 th century. AIDS is caused by HIV or Human Immunodeficiency Virus, which attacks the immune system of the human body. It has, so far, ended more than twenty-nine million lives all over the world. Since its discovery, AIDS has spread around the world like a wildfire. It is due to the continuous efforts of the Government and non-government organizations; AIDS awareness has been spread to the masses.

AIDS – Causes and Spread

The cause of AIDS is primarily HIV or the Human Immunodeficiency Virus. This virus replicates itself into the human body by inserting a copy of its DNA into the human host cells. Due to such property and capability of the virus, it is also known as a retrovirus. The host cells in which the HIV resides are the WBCs (White Blood Cells) that are the part of the Human Immune system.

HIV destroys the WBCs and weakens the human immune system. The weakening of the immune system affects an individual’s ability to fight diseases in time. For example, a cut or a wound takes much more time to heal or the blood to clot. In some cases, the wound never heals.

HIV majorly transmits in one of the three ways – Blood, Pre-natal and Sexual transmission. Transfusion of HIV through blood has been very common during the initial time of its spread. But nowadays all the developed and developing countries have stringent measures to check the blood for infection before transfusing. Usage of shared needles also transmits HIV from an infected person to a healthy individual.

As part of sexual transmission, HIV transfers through body fluids while performing sexual activity. HIV can easily be spread from an infected person to a healthy person if they perform unprotective sexual intercourse through oral, genital or rectal parts.

Pre-natal transmission implies that an HIV infected mother can easily pass the virus to her child during pregnancy, breastfeeding or even during delivery of the baby.

AIDS – Symptoms

Since HIV attacks and infects the WBCs of the human body, it lowers the overall immune system of the human body and resulting in the infected individual, vulnerable to any other disease or minor infection. The incubation period for AIDS is much longer as compared to other diseases. It takes around 0-12 years for the symptoms to appear promptly.

Few of the common symptoms of AIDS include fever , fatigue, loss of weight, dysentery, swollen nodes, yeast infection, and herpes zoster. Due to weakened immunity, the infectious person falls prey to some of the uncommon infections namely persistent fever, night sweating, skin rashes, lesions in mouth and more.

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AIDS – Treatment, and Prevention

Till date, no treatment or cure is available for curing AIDS, and as a result, it is a life-threatening disease. As a practice by medical practitioners, the best way to curb its spread is antiretroviral therapy or ART. It is a drug therapy which prevents HIV from replicating and hence slows down its progress. It is always advisable to start the treatment at the earliest to minimize the damage to the immune system. But again, it is just a measure and doesn’t guarantee the cure of AIDS.

AIDS prevention lies in the process of curbing its spread. One should regularly and routinely get tested for HIV. It is important for an individual to know his/her own and partner’s HIV status, before performing any sexual intercourse activity. One should always practice safe sex. Use of condoms by males during sexual intercourse is a must and also one should restrict oneself on the number of partners he/she is having sex with.

One should not addict himself/herself to banned substances and drugs. One should keep away from the non-sterilized needles or razors.  Multiple awareness drives by the UN, local government bodies and various nonprofit organizations have reduced the risk of spread by making the people aware of the AIDS – spread and prevention.

Life for an individual becomes hell after being tested positive for AIDS. It is not only the disease but also the social stigma and discrimination, felling of being not loved and being hated acts as a slow poison. We need to instill the belief among them, through our love and care, that the HIV positive patients can still lead a long and healthy life.

Though AIDS is a disease, which cannot be cured or eradicated from society, the only solution to AIDS lies in its prevention and awareness. We must have our regular and periodical health checkup so that we don’t fall prey to such deadly diseases. We must also encourage and educate others to do the same. With the widespread awareness about the disease, much fewer adults and children are dying of AIDS. The only way to fight the AIDS disease is through creating awareness.

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