Cablegate: Hiv/Aids Findings of Nigeria's 2003

Published: Wed 7 Jul 2004 10:32 AM
This record is a partial extract of the original cable. The full text of the original cable is not available.
071032Z Jul 04
E.O. 12958: N/A
1. Summary: The findings below are from the 2003
Nigeria Demographic and Health Survey (NDHS) and expand
on the findings presented in reftel. Knowledge of AIDS
in Nigeria is fairly widespread, but knowledge of
prevention is less so. Knowledge, attitudes, and
practices related to prevention and control of HIV/AIDS
and care of people living with the virus vary
considerably by age group, region, and education level.
These findings can be used to target programs and
tailor messages on HIV/AIDS. End summary.
Overall Impact
2. The first case of HIV infection in Nigeria was
recorded in 1986 and rates of infection have increased.
Estimates of HIV prevalence rose from 1.8 percent in
1991 to 4.5 percent in 1996, and the 2001 National
HIV/Syphilis Sentinel Survey estimated a national HIV
sero-prevalence rate of 5.8 percent. Regional
prevalence rates varied significantly, from a high of
7.7 percent in the South South to a low of 3.3 percent
in the North West. The greatest actual concern is
projected mortality due to AIDS over the next few years
and its socio-economic consequences. Projections of
annual deaths caused by AIDS in Nigeria have increased
from fewer than 50,000 in 1999 to about 350,000 in 2003-
2004. The number of Nigerian children who are likely
to lose one or both parents to AIDS is projected to be
near 2 million in 2003-2004. The magnitude of the
problem has prompted the Government of Nigeria to
review its national HIV/AIDS policy.
Knowledge of Prevention Methods
3. More men than women overall know about condom use
and limiting partners as ways to avoid AIDS, but the
pattern of knowledge by background characteristics are
similar for men and women. By age group, the youngest
and oldest men and women in the survey (ages 15-19 and
40-49) are least likely to know about these specific
ways to avoid HIV transmission. The low knowledge rates
among the youngest group (37 percent for women and 52
percent for men) are important to note because sexual
activity often begins before age 20.
4. Knowledge of prevention methods varies widely by
education level. Knowledge of condom use to avoid AIDS
ranges from 33 percent among women with no education to
74 percent among women with higher education. For men,
the rate ranges from 45 percent among those with no
education to 81 percent among those with higher
Beliefs about AIDS
5. Some of the NDHS questions gauged how many people
correctly reject local misconceptions regarding HIV and
AIDS. The survey measured the percentage of people who
know that a) it is possible for a healthy-looking
person to have the AIDS virus, b) AIDS cannot be
transmitted by mosquito bites, c) AIDS cannot be
transmitted by witchcraft or other supernatural means,
and d) a person cannot become infected by sharing food
with someone with AIDS. Again, levels of knowledge are
higher among men than women, and the greatest
variability is by level of education.
6. Overall, 53 percent of women and 73 percent of men
know that a healthy-looking person can have AIDS. For
each of the misconceptions about transmission noted
above, about 40 percent of women know that none is
really a mode of transmission; the percentage is
slightly higher for men. Respondents who know that a
healthy-looking person can have AIDS and who also
reject the two most common misconceptions about
transmission (AIDS can be transmitted by mosquitoes or
supernatural means) are in a minority: 21 percent of
women and 28 percent of men.
Stigma and Discrimination
7. To assess the level of acceptance of persons living
with HIV, respondents were asked questions regarding
behavioral treatment and attitudes. Overall, about 40
percent of respondents reported they would be willing
to care of a family member with HIV at home. The
greatest variation in this response was by region. Only
one quarter of respondents in the South West said they
would care for a sick relative at home. A majority of
respondents overall (61 percent of women and 70 percent
of men) said they believe the HIV-positive status of a
family member does not need to remain a secret. But
only 20 percent of women and 28 percent of men said
they would purchase vegetables from a person with the
AIDS virus. And only 23 percent of women and 27 percent
of men believe that a female teacher with the AIDS
virus should be allowed to continue teaching in school.
Only 3 percent of women and 7 percent of men reported
acceptance of all four indicators in this category.
Knowledge of Mother to Child Transmission
8. Overall, 24 percent of women who had given birth in
the two years preceding the survey had received
counseling about HIV/AIDS during a prenatal care visit.
This rate varied by region, ranging from about 60
percent in the South East and South West to only 15
percent and 11 percent in the North East and North
West, respectively.
Sexual Negotiation, Attitudes, and Communication
9. To assess the ability of women to negotiate safer
sex with a spouse who has a sexually transmitted
infection (STI), all respondents were asked a) whether
a wife is justified in refusing to have sex with her
husband if she knows he has a STI and b) whether she is
justified in asking her husband to use a condom. Nearly
90 percent of women and 95 percent of men responded
that a woman may either refuse to have sex with her
husband or ask him to wear a condom in this situation.
Both men and women are more likely to report that a
woman is justified to refuse to have sex than to
propose use of a condom.
10. The NDHS assessed whether male respondents agreed
with various statements regarding condoms. Thirty
percent of men agreed with the statement that condoms
are inconvenient to use, and 37 percent agreed that
condoms reduce sexual pleasure. Most men know that
condoms cannot be reused, and a majority agree that a
condom protects against disease. Overall, 30 percent of
men agreed with the statement that a woman has no right
to tell a man to use a condom. This rate varies by
region: 73 percent of male respondents agreed with the
statement in the North West, while between 10 and 25
percent of the male respondents in the other regions of
the country agreed with the statement.
11. Nationally, 36 percent of married women and 58
percent of married men said they had discussed
prevention of AIDS with their partners. Over 90 percent
of respondents said that discussion of AIDS is
acceptable in the media, at home, and in schools,
churches, and mosques.
High Risk Sex and Condom Use
12. For both men and women, the percentage of
respondents engaging in high-risk sex (sex with a non-
marital, non-cohabiting partner) increases with level
of education, from 2 percent of women and 11 percent of
men with no education to 33 percent of women and 48
percent of men with higher education. The percentage of
respondents who use a condom when they engage in high-
risk sex also increases with education level.
13. Compared to overall percentages, high-risk sexual
behavior is more prevalent among young men and women
(age 15 to 24). Among these respondents, 29 percent of
women and 78 percent of men reported having high-risk
sex in the 12 months preceding the survey. As with
respondents overall, the percentage of young men and
women engaging in high-risk sex increased with
education level: from 3 percent among women with no
education to 75 percent among women with higher
education. There was an insufficient number of cases of
men to allow for analysis by education level. High-risk
sexual behavior also varies by region for women. Most
female respondents in the southern regions reported
having engaged in high-risk sex, while only 35 percent
in North Central and fewer than 10 percent in North
East and North West reported similarly. Nationally,
most young women who are sexually active live with a
partner, while more young men who are sexually active
do not live exclusively with a single partner. The
percentage of young people with multiple partners is
fairly low: 2 percent of women and 8 percent of men.
Sexual Behavior among Young People
14. One fifth of women age 15-19 had sex before the age
of 15, and half of women aged 20-24 had sex before age
18. Percentages among men are lower (8 percent and 22
percent, respectively). The percentage of women who had
sex before age 15 declined with increasing education,
from 42 percent among women with no education, to less
than 1 percent among women with higher education.
15. Overall, young women are less than half as likely
as young men to know of a source of condoms. For both
men and women, the likelihood of knowing of a source is
greater for respondents with higher education levels
and in the southern regions. Among sexually active
respondents aged 15-24, only 6 percent of women and 17
percent of men reported using a condom the first time
they had sex. No urban-rural variation was found among
young persons as to whether or not they had had
premarital sex, but urban women and men were about
twice as likely to have used a condom the last time
they had sex.
Sexually Transmitted Infections (STIs)
16. Overall, 55 percent of women had never heard of
STIs. One-fifth of all women could identify a symptom a
man might have, and one-fifth could identify a symptom
a woman might have. Most men have heard of an STI (71
percent), though not all who had heard of an STI could
identify a symptom a man or woman might have.
17. Overall, the NDHS found that fewer than 1 percent
of children had lost both parents as a result of AIDS;
however, 6 percent of children under age 15 had lost at
least one parent. The highest prevalence is in the
South East, where 11 percent of children have lost one
or both parents. Nationwide, 11 percent of children
under age 15 are living with neither mother nor father,
as are 18 percent of the children aged 10-14.
18. The NDHS findings can help to target programs and
tailor messages on HIV/AIDS for different age groups,
regions, and education levels. Several findings raise
questions that warrant further explanation or
investigation. With regard to beliefs and social
stigma, for example, while 45 percent of women and 59
percent of men knew that a person cannot become
infected by sharing food with someone who has the AIDS
virus, only 20 percent of women and 28 percent of men
reported they would buy vegetables from a shopkeeper
who has AIDS. Also related to beliefs and such stigma,
men in the South West are least likely to be willing to
care for a family member with HIV, but most likely to
believe that the HIV-positive status of a family member
does not need to remain a secret. Perhaps this second
belief does not reflect an acceptance of openness per
se, but rather a desire to know the HIV-status of
potential partners to better avoid those who are HIV-
19. Generally, men and women with higher education
levels are more likely to know about HIV/AIDS and
prevention methods and to engage in behaviors that help
prevent the spread of HIV/AIDS. The notable exception
to this correlation is in regard to having sex with non-
married, non-cohabiting partners, where likelihood
rises with education level for both men and women.
Reliable data on HIV prevalence among these groups are
needed to determine whether this high-risk behavior is
of great concern or whether it is offset by the higher
rates of condom use and other preventative behavior.
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