Background
One of only two West Africa “focus countries” under the President’s Emergency Plan for AIDS Relief (PEPFAR), Nigeria borders Benin, Niger, Chad and Cameroon and has a coast on the Gulf of Guinea.
Nigeria is the most populous country in Africa, comprising one-sixth of the continent’s population, and ninth in the world. In its 36 states, Nigeria has more than 250 ethnic groups. Since 1991, the capital has been Abuja. Previously it was Lagos, which remains the country’s largest city.
Nigeria declared its independence from Great Britain in 1960. For decades, Nigeria was controlled by a series of dictators, except for the period from 1979 to 1983 that was known as the second republic. In 1999, Olusegun Obasanjo became the first democratically elected president in decades. He remains in office to this day.
Nigeria has the largest Muslim population of any PEPFAR focus country: about 66 million people, or 50 percent of its population. Twelve of Nigeria’s states follow Sharia, or Islamic, law.
The face of HIV
Nigeria has the third-highest number of people living with HIV/AIDS in the world, behind India and South Africa. The first case of AIDS in Nigeria was diagnosed in 1986. HIV rates tend to be higher in urban areas than rural areas, but more research needs to be done to understand the variations found within the country.
About a third of Nigeria’s 36 states have HIV infection rates of over 5 percent. Estimates place 60 percent of new infections in the age group of 15 to 25.
As in many of the PEPFAR focus countries, women are harder hit by the HIV epidemic. According to the Joint United Nations Program on HIV/AIDS (UNAIDS), 1.6 million Nigerian women are infected with HIV, or more than half of the total adult infected population. A practice known as female genital mutilation (FGM) contributes to the high infection rates. As much as a quarter of all Nigerian women undergo the procedure, and in some areas of the country, the percentage can reach as high as 90 percent, according to the State Department.
FGM is a procedure whereby part or all of the female genitalia are removed, sometimes in very unsanitary conditions using a shard of glass or a kitchen knife, which make the girls (usually the procedure is done at an early age) more susceptible to contracting HIV.
Child marriage is also practiced in Nigeria, where there is no legal minimum age for marriage. Girls get married at age 12 or 13 and their husbands are often significantly older than they are. Sex outside of marriage, and polygamy, also contribute to the greater HIV risk facing women.
Challenges to fighting the HIV epidemic
In Nigeria, 5 percent of the population controls 80 percent of the country’s wealth while 71 percent of the population lives on less than $1 a day.
Sex education is severely lacking in Nigeria. Until recently, it was virtually nonexistent. Sex is a private matter, and talking about it is considered taboo. Lack of comprehensive sexual health education means that misconceptions and common myths about sex and sexually transmitted diseases are allowed to persist.
Stigma and discrimination against people living with HIV/AIDS also persist. Many consider HIV to be caused by immoral behavior. People who are afraid of stigmatization and discrimination are less likely to be tested and receive treatment for the disease.
Lack of access to health care is another challenge to fighting the epidemic. Some parts of the country lack even the most basic health facilities, and establishing HIV/AIDS clinics has proven difficult.
Nigerian government response
According to the Center for Strategic and International Studies, a Washington-based think tank, Nigeria’s President Obasanjo is committed to fighting HIV/AIDS not only in his country but on the continent as a whole. Before he came to office in 1999, the government was allocating a mere $3,000 annually to combat HIV/AIDS.
In 2000, Obasanjo created the National Action Committee on AIDS (NACA) to coordinate a multisectoral approach to fighting the epidemic. In 2001, NACA launched its first HIV/AIDS Emergency Action Plan, which, among other goals, aimed to promote behavior change, increase awareness and mobilize different sectors of society to fight the epidemic.
U.S. government response
A majority of PEPFAR’s funding allocated for prevention, care and treatment programs for fiscal 2005 — 57.2 percent, or $53.8 million — was spent on treatment. Prevention activities were allocated $21.1 million, or 22.5 percent, of the total funding, including $2.6 million for “condoms and related activities.” Care received $19.1 million, or 20 percent.
Among the activities that the U.S. government, through PEPFAR, has promoted are encouraging political will and popular support, recruiting indigenous partners and integrating HIV/AIDS counseling and testing and antiretroviral programs into the National Tuberculosis Control Program.
Furthermore, in fiscal 2005 the U.S. government claims to have reached nearly 2 million people with its “Abstinence” and “Be Faithful” components of the so-called ABC approach to prevention and shipped more than 3 million condoms (the “C” component, for correct and consistent Condom use). Since the beginning of PEPFAR, nearly 100,000 women have been provided with services to prevent mother-to-child transmission.