Prevalence of HIV Infection in Nigeria

HIV is a major global public health issue that has claimed the lives of over 30 Million people.

Nigeria has the second largest HIV epidemic in the world. Although HIV prevalence among adults is much less (2.8%) than other sub-Saharan African countries such as South Africa(18.8%) and Zambia (11.5%), the size of Nigeria's population means 3.1 million people were living with HIV in 2017.


It is estimated that around two-thirds of new HIV infections in West and Central Africa in 2017 occurred in Nigeria. Together with South Africa and Uganda, the country accounts for around half of all new HIV infections in sub-Saharan Africa every year. This is despite achieving a 5% reduction in new infections between 2010 and 2017.


READ MORE: NACA: Increasing efforts in the fight against HIV/AIDS

Unprotected heterosexual sex accounts for 80% of new HIV infections in Nigeria, with the majority of remaining HIV infections occurring in key affected populations such as sex workers.

Six states in Nigeria account for 41% of people living with HIV, including Kaduna, Akwa Ibom, Benue, Lagos, Oyo, and Kano. HIV prevalence is highest in Nigeria’s southern states (known as the South South Zone), and stands at 5.5%. It is lowest in the southeast (the South East Zone) where there is a prevalence of 1.8%. There are higher rates of HIV in rural areas (4%) than in urban ones (3%).

Approximately 150,000 people died from AIDS-related illnesses in Nigeria in 2017. Since 2005, the reduction in the number of annual AIDS-related deaths has been minimal, indicative of the fact that only 33% of those with a positive diagnosis in Nigeria are accessing antiretroviral treatment (ART).

Groups most affected by HIV in Nigeria

Nigeria has a mixed epidemic, meaning that while HIV prevalence among the general population is high, certain groups still carry a far greater HIV burden compared to the rest of the population. In Nigeria, Sex workers, men who have sex with men and people who inject drugs make up only 3.4% of the population, yet account for around 32% of new HIV infections.

Men who have sex with men (MSM) and HIV in Nigeria

Men who have sex with men are the only group in Nigeria where HIV prevalence is still rising. In 2017, prevalence in this group stood at 23%, significantly more than the next highest prevalence group - sex workers - at 14.4%. Of all new HIV infections in the country, 10% occur among men who have sex with men.

In 2014, the Nigerian government increased the punishment for homosexuality to 14 years in jail. Anyone ‘assisting couples’ may face up to 10 years in prison. Mass arrests of ‘suspected gay men’ in Nigeria have followed, for example in July 2017 the police arrested 40 men at a private house party.

Criminalising laws such as these have made it harder for civil society organisations to work with LGBT communities and have pushed men who have sex with men underground, making them more vulnerable to HIV. Although the NACA state that ‘no provision of this law will deny anybody in Nigeria access to HIV treatment and other medical services’, studies have shown that since the law came into action, more men who have sex with men report they are afraid to seek healthcare.

Nevertheless recent years have seen an improvement in HIV prevention among men who have sex with men. In 2010, only 18% of men who have sex with men were reached with HIV prevention programming, while recent reports show 82% of men who have sex with men used a condom at last sex with male partner and 97% had tested for HIV in the last 12 months.

Homophobia is widespread in Nigeria. A recent survey found that 87% of respondents would not be willing to accept that a family member was homosexual and only 30% of those polled thought that homosexuals should have access to healthcare. Stigma such as this poses a major barrier to HIV prevention, as research has shown that HIV prevalence among men who have sex with men is directly correlated to their experiences of sexual stigma.

READ MORE: Not less than 500 people in New Zealand could have HIV and not know it - AIDS Foundation

Sex workers and HIV in Nigeria
In 2016, it was estimated that 14.4% of sex workers were living with HIV in Nigeria. This is a significant drop since 2013 when it was estimated that 24.5% of sex workers were living with HIV.  HIV prevalence among sex workers is still eight times higher than the general population.

There are a number of factors that make sex workers more vulnerable to HIV. HIV prevalence is higher among female sex workers at 24.5% compared to male sex workers at 18.6%. Similarly, brothel-based sex workers face greater HIV risk in Nigeria, with a prevalence of 27.4%.

Progress in HIV prevention meant that, in 2016, 98.1% of sex workers reported using a condom with their last sexual partner and 97.1% of female sex workers had received an HIV test in the last 12 months.

Sex work is illegal in Nigeria. The law states that those wholly or partly supporting themselves through sex work can face two years imprisonment. There is no law that prevents healthcare workers from providing sex workers with health services, yet the criminalising law makes it difficult for individuals to disclose that they are sex workers to healthcare workers. The new law also makes sex workers more vulnerable to abuse from law enforcers.

People who inject drugs (PWID) and HIV in Nigeria
HIV prevalence among people who inject drugs(sometimes referred to as PWID) in Nigeria was 3.4% in 2017. Women who inject drugs are particularly affected with a prevalence of 13.9% compared to 2.6% among men. Female sex workers who inject drugs face the highest HIV prevalence at around 43%. It is thought that 9% of new HIV infections in Nigeria every year are among people who inject drugs.

In 2015, the National Agency for Control of AIDS (NACA) reported that around half (52.7%) of people who inject drugs share needles and syringes. Approximately 7.3% share needles and syringes all the time and more than a third (36.4%) shared needles some of the time. Although this is lower than in 2010, helped in part by efforts to reach people who inject drugs with HIV prevention services, these rates remain very high.

Harm reduction services such as opioid substitution therapy and clean needle exchanges are currently not available in Nigeria. Available services are limited to targeted information, education and communication, condom distribution and hepatitis C treatment. However, discussions on developing a national harm reduction strategy began in 2015.

The National Strategic Framework identifies providing people who inject drugs with harm reduction and needle exchanges as being a key goal in the coming years.

In addition to this in 2015 NACA began working with the United Nations Office on Drugs and Crime on a draft national HIV response strategy to target people who inject drugs. It has also begun to train staff from its National Drug Law Enforcement Agency and 11 civil society organisations working with people who use drugs on HIV responses targeted to this group’s needs.

Young people and HIV in Nigeria
In 2016, 240,000 adolescents (between the ages of 10-19) were living with HIV, making up 7% of the total number of people with HIV in Nigeria. HIV prevalence among this age group varies regionally, with 4.3% of 15-19 year olds living with HIV in the South South, compared to 1.3% in the South East. Health outcomes for adolescents living with HIV in Nigeria are poor, and Nigeria is the only country in the world where mortality in 10-14 year olds is rising.

Young women have a higher HIV prevalence and are infected earlier in life than men of the same age group. In 2016, more than 46,000 young women were infected with HIV compared to 33,900 young men.

There are a number of factors that increase HIV vulnerability among young people, including a lack of knowledge and appropriate sexual reproductive health services. Reports from a 2017 National Health Survey showed that only 29% of women and 27.9% of men between the ages of 15 to 24 could correctly identify ways of preventing sexual transmission of HIV, and reject major myths around transmission. Early sexual debut is common in Nigeria, with 15% of girls and 4% of boys having sex before they are 15 years old. Inter-generational relationships are also common in Nigeria. A 2017 survey found that 41.2% of women between the ages of 15 and 24 had had a sexual partner ten or more years older than them in the last 12 months. This increases HIV risk among this group as often the virus is passed from older men to younger women.

Despite their elevated risk, reports show that few adolescents test for HIV regularly. In 2017 only 2% of males between 15 and 19 and 4% of females had tested for HIV in the last 12 months.

National targets commit to a 90% treatment coverage and 50% testing rate among young people by 2020.

In addition to the National Strategic Framework, Nigeria released a National HIV Strategy for Adolescents and Young People in 2016, which provides a set of guidelines co-created with young people. This recognises negative provider attitudes towards young people and their sexual activities, limited access to youth-friendly services, low awareness of HIV and fear of stigma as being key challenges preventing young people from taking up sexual health services.

Children and those orphaned by AIDS in Nigeria
In 2017, 220,000 children (0 to 14 years) in Nigeria were living with HIV. However, only 26% were receiving antiretroviral treatment (ART). The UNAIDS Catch-Up Plan for West and Central Africa, outlines a target to enrol an additional 140,000 children across the region on ART by 2020.

In 2017, an estimated 1.8 million children were orphaned by AIDS, which can have a huge impact on their health, safety and wellbeing. Around 20% of orphans and vulnerable children do not attend school regularly and around 18% are sexually abused.

HIV also has an indirect impact on children in Nigeria, whereby often they become the caregivers for parents who are living with HIV. Normally, this responsibility lies with girls rather than boys and can contribute to the imbalance in schooling between the two genders in Nigeria, with girls missing out on HIV education that could teach them how to protect themselves from infection.

READ MORE: 432 Children in Kwara infected with HIV in 6 months

Women and HIV in Nigeria
In Nigeria it is estimated that 58% of the people living with HIV are women. Part of the reason why so many more women and girls are affected by HIV is the deep roots that gender inequality has in Nigerian society, culture and law.

In the most recent rankings, Nigeria was placed 122nd out of 144 for the size of its ‘gender gap’, meaning that it is has one of the most unequal balances of power between men and women in the world.

Gender power imbalances mean that women often face barriers in dictating their own sexual partner selection, use of contraception, number and spacing of children, and their own healthcare, all of which put them at greater risk of HIV.

Barriers to land ownership disadvantages women in particular. Although women have land rights, their rights are weaker than men’s. This is not only economically disempowering, but puts pressure on women to give birth to boys, leading to a high fertility rate of 5.5 children per woman. Women who have girls first, are likely to have more children, not use contraceptives, have short periods between pregnancies, and be subjected to polygamy. All of these increase a woman's vulnerability to HIV.

Women who have been formerly married are also more at risk of HIV, as they face a lack of economic opportunities and high rates of sexual exploitation. HIV prevalence among formerly married women is as high as 5.9% (almost double the prevalence of currently married and never married women – 3.4%). Recent studies have shown that being formerly married can be one of the strongest HIV risk factors among women. 

Although Nigeria has several strategies on gender equality and HIV, less than 1% of spending on HIV goes towards them. In 2015, the National Agency for the Control of AIDS developed a set of Guidelines to help make gender part of the mainstream HIV response, aiming to raise awareness amongst health practitioners on issues around gender inequality and how to address these issues in their HIV programming. Reducing violence and coercion, and increasing legal protection for women and girls, are particular areas of focus for reducing HIV risk among women and girls.



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