Chronicles of challenges confronting HIV prevention and treatment in Nigeria
Main Article Content
Abstract
Background: Antiretroviral therapy reduces mortality and morbidity amongst people living with human immunodeficiency virus (HIV)/AIDS, improves their quality of life and reduces the potential to infect others. The goal of National Agency for the Control of AIDS is to achieve and sustain an AIDS-free Nigeria by 2030 hinged on its strategic framework. Achieving this goal is threatened by certain identified challenges.
Aim: This study is to review the contents of the national HIV and AIDS strategic framework in a bid to identify the challenges confronting its full implementation in the management of HIV in Nigeria.
Methods: Several published articles on HIV prevalence, factors influencing trend and spread, and sociodemographics of the affected were reviewed as well as three federal government of Nigeria national HIV and AIDS strategic framework. Articles were sourced from online indexes such as Medline; sampling about 60 peer-reviewed articles from which information relevant to the topic were retrieved. Publication by relevant bodies on HIV and AIDS was likewise reviewed, and relevant information was retrieved from them.
Results: Challenges identified include AIDS-related stigmatisation and discrimination, socio-cultural norms and practices, especially denial of women to inheritance and widow inheritance with its resultant feminisation of poverty and female genital mutilation, reduced funding following the withdrawal of donor agencies, anti-Lesbian, Gay, Bisexual, Transgender and Queer bias, bureaucratic and structural problems, as well as negative attitude of healthcare professionals.
Conclusion: The study concludes that achieving an AIDS-free Nigeria with zero new infection and zero. AIDS-related stigmatisation by 2030 will require mitigating against the aforementioned challenges.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The journal grants the right to make small numbers of printed copies for their personal non-commercial use under Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported License.
References
1. Centers for Disease Control and Prevention. HIV Basics; 2015. Available from: http://www.cdc.gov/hiv/basics/index.html. [Last accessed on 2020 Apr 04].
2. Gao F, Bailes E, Robertson DL, Chen Y, Rodenburg CM, Michael SF, et al. Origin of HIV-1 in the chimpanzee Pan troglodytes troglodytes. Nature 1999;397:436-41.
3. Chen Z, Luckay A, Sodora DL, Telfer P, Reed P, Gettie A, et al. Human immunodeficiency virus type 2 (HIV-2) seroprevalence and characterization of a distinct HIV-2 genetic subtype from the natural range of simian immunodeficiency virus-infected sooty mangabeys. J Virol 1997;71:3953-60.
4. Science News Staff. Oldest Surviving HIV Virus Tells All. Science; 1998. Available from: https://www.sciencemag.org/news/1998/02/oldest-surviving-hiv-virus-tells-all. [Last accessed on 2020 Apr 04].
5. Wain-Hobson S. 1959 and all that. Nature 1998;391:531-32.
6. U.S. Department of Health and Human Services. Facts Sheet on Understanding HIV/AIDS. AIDSinfo; 2019. Available from: https://
aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/19/46/thestages-of-hiv-infection. [Last accessed on 2020 Jul 18].
7. National Agency for the Control of AIDS. National Strategic Framework on HIV and AIDS: 2017-2021; 2017. Available from:
https://www.childrenandaids.org/sites/default/files/2017-11/NATIONAL-HIV-AND-AIDS-STRATEGIC-FRAMEWORK.pdf. [Last accessed on 2020 Apr 24].
8. The World Bank. World Development Indicators. DataBank. Available from: https://databank.worldbank.org/reports.aspxsource=worlddevelopment-indicators. [Last accessed on 2020 Feb 14].
9. CDC. Global HIV and Tuberculosis. Zambia Country Profile. Availablefrom: https://www.cdc.gov/globalhivtb/where-we-work/zambia/
zambia.html. [Last accessed on 2020 Apr 15].
10. United Nations Programmes on HIV/AIDS. Data Book; 2017. Available from: https://www.unaids.org/sites/default/files/media_
asset/20170720_Data_book_2017_en.pdf. [Last accessed on 2019 Dec 26].
11. Awofala AA, Ogundele OE. HIV epidemiology in Nigeria. Saudi J Biol Sci 2016;25:697-703.
12. Blattner W, Dakum P, Osotimehin B, Nasidi A, Abimiku A. Public health aspects of HIV/AIDS-Nigeria and West Africa. In: Celentano DD, Beyrer C, editors. Public Health Aspects of HIV/AIDS in Low and Middle Income Countries: Epidemiology, Prevention and Care. New York, NY: Springer, 2008; 217-51.
13. Hoffmann R. Global Fund to Fight AIDS; 2011. Available from: https://www.hivbook.com/tag/global-fund-to-fight-aids/. [Last accessed on 2020 Mar 11].
14. World Population Review. Nigeria Population. Available from: http://worldpopulationreview.com/countries/nigeria/. [Last retrieved on
2020 Apr 21].
15. CIA. The World Factbook. Available from: https://www.cia.gov/library/publications/the-world-factbook/geos/ni.html#field-anchorpeople-and-society-hiv-aids-people-living-with-hiv-aids. [Last accessed on 2020 Apr 21].
16. National Agency for the Control of AIDS. Revised National HIV and AIDS Strategic Framework 2019-2021. Available from: https://naca.
gov.ng/wp-content/uploads/2019/03/national-hiv-and-aids-strategicframework-1.pdf. [Last accessed on 2020 Apr 21].
17. PM News. Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) Reveals Progress in Ending HIV Epidemic; 2019. Available from:
https://www.pmnewsnigeria.com/2019/03/15/nigeria-hiv-aidsindicator-and-impact-survey-naiis-reveals-progress-in-ending-hivepidemic/. [Last accessed on 2020 Apr 21].
18. UNAIDS. AIDSinfo; 2019. Available from: http://aidsinfo.unaids.org/. [Last accessed on 2020 Mar 17].
19. Avert. HIV and AIDS in Nigeria. Available from: https://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/Nigeria. [Last accessed on 2020 Feb 21].
20. National Agency for the Control of AIDS. End-of-Term Desk Review Report of the 2010-2015 National HIV/AIDS Strategic Plan; 2015. Available from: https://naca.gov.ng/wp-content/uploads/2016/11/NSP-2010-2015-end-term-desk-review-report_0.pdf. [Last accessed
on 2020 Jan 02].
21. National Agency for the Control of AIDS. National HIV/AIDS Strategic Plan 2010–2015; 2010. Available from: https://nigeria.unfpa.org/pdf/nsp.pdf. [Last accessed on 2020 Apr 21].
22. Bashorun A, Nguku P, Kawu I, Ngige E, Ogundiran A, Sabitu K, et al. A description of HIV prevalence trends in Nigeria from 2001 to 2010: What is the progress, where is the problem? Pan Afr Med J 2014;18(Suppl 1):3.
23. National Agency for the Control of AIDS. Country Progress Report; 2014. Available from: https://www.unaids.org/sites/default/files/
country/documents/NGA_narrative_report_2014.pdf. [Last accessed on 2020 Jan 14].
24. Federal Ministry of Health. National HIV and AIDS and Reproductive Health Survey (NARHS Plus II, 2012); 2013. Available from: https://
naca.gov.ng/wp-content/uploads/2016/11/NARHS-Plus-2012Final-18112013.pdf. [Last accessed on 2020 Mar 01].
25. Avert. HIV and AIDS in West and Central Africa; 2017. Available from: https://www.avert.org/hiv-and-aids-west-and-central-africa. [Last accessed on 2020 Apr 23].
26. UNAIDS. UNAIDS Data; 2017. Available from: https://www.unaids.org/sites/default/files/media_asset/20170720_Data_book_2017_
en.pdf. [Last accessed on 2020 Apr 11].
27. UNAIDS. Global Report: UNAIDS Report on Global AIDS Epidemic. Geneva: Joint United Nations Programme on HIV/AIDS, 2013. Available from: https://files.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2013/gr2013/UNAIDS_Global_Report_2013_en.pdf. [Last accessed on 2020 Apr 11].
28. Sweat M, Gregorich S, Sangiwa G, Furlonge C, Balmer D, Kamenga C, et al. Cost-effectiveness of voluntary HIV-1 counselling and testing in reducing sexual transmission of HIV-1 in Kenya and Tanzania. Lancet 2000;356:113-21.
29. Getabalew EB, Ketema K, Mitswat A, Kokeb T. Assessment of knowledge, attitude, practice and determinants of VCT utilization for HIV/AIDS among Ambo University Students, West Shoa Zone, Oromia Region, Ethiopia: Cross sectional study. Sci J. Public Health 2015;3:259-64.
30. UNICEF. Statistical Tables; 2017. Available from: https://data.unicef.org/topic/hivaids/global-regional-trends. [Last accessed on 2020 Apr 01].
31. UNAIDS. Data; 2019. Available from: https://www.unaids.org/sites/default/files/media_asset/2019-UNAIDS-data_en.pdf. [Last accessed on 2020 Apr 22].
32. Faust L, Ekholuenetale M, Yaya S. HIV-related knowledge in Nigeria: A 2003-2013 trend analysis. Arch Public Health 2018;76:22.
33. NACA. National HIV/AIDS Strategic Plan 2017-2021; 2019. Available
from: https://naca.gov.ng/wp-content/uploads/2018/05/NationalHIV-and-AIDS-Strategic-Plan-FINAL1.pdf. [Last accessed on 2020 Feb 27].
34. Coates TJ, Richter L, Caceres C. Behavioural strategies to reduce HIV transmission: How to make them work better. Lancet 2008;372:669-84.
35. The Global Funds to Fight AIDS, Tuberculosis and Malaria. Community Systems Strengthening Framework; 2010. Available from:
https://www.who.int/tb/dots/comm_hss.pdf. [Last accessed on 2020 Apr 24].
36. WHO. HIV/AIDS. Condoms for HIV Prevention; 2009. Available from: https://www.who.int/hiv/topics/condoms/en/. [Last accessedon 2020 Mar 01].
37. Wikipedia. Condoms; 2020. Available from: https://en.wikipedia.org/wiki/Condom. [Last accessed on 2020 Apr 27].
38. D'Anna LH, Korosteleva O, Warner L, Douglas J, Paul S, Metcalf C, et al. Factors associated with condom use problems during vaginal sex with main and non-main partners. Sex Transm Dis 2012;39:687-93.
39. Shelton JD, Johnston B. Condom gap in Africa: Evidence from donor agencies and key informants. BMJ 2001;323:139.
40. Foss AM, Watts CH, Vickerman P, Heise L. Condoms and prevention of HIV. BMJ 2004;329:185-6.
41. Foss A, Watts C, Vickerman P, Kumaranayake L. Are People using Condoms? Current Evidence from Sub-Saharan Africa and Asia and the Implications for Microbicides. HIV Tools Research Group, London School of Hygiene and Tropical Medicine: Mimeo Report for International Family Health; 2003. Available from: www.ifh.org.uk/condom%20policy.html. [Last accessed on 2019 Mar 15].
42. Fagbamigbe AF, Adebowale AS, Olaniyan FA. A comparative analysis of condom use among unmarried youths in rural community in Nigeria. Public Health Res 2011;1:8-16.
43. Adepoju P. Why almost No One in Nigeria Is using HIV Prevention Drugs. Davex; 2018. Available from: https://www.devex.com/
news/why-almost-no-one-in-nigeria-is-using-hiv-preventiondrugs-93728. [Last accessed on 2020 Apr 24].
44. PUNCHNEWS, Donors Provide 95% of HIV/AIDS Funding in Nigeria–NACA DG; 2018. Available from: https://punchng.com/donors-provide-95-of-hivaids-funding-in-nigeria-naca-dg/. [Last accessed on 2019 Dec 12].
45. Avert. Funding for HIV and AIDS; 2020. Available from: https://www.avert.org/professionals/hiv-around-world/global-response/ funding. [Last accessed on 2020 Mar 30].
46. Onyango P. Government to Roll Out Anti-Retroviral Drug to HIV Negative People. Standard Digital; 2017. Available from: https://www.
standardmedia.co.ke/article/2001232533/government-to-roll-outanti-retroviral-drug-to-hiv-negative-people. [Last accessed on 2020 Apr 27].
47. Federal Ministry of Health. National AIDS and STI’s Control Programme. National Guidelines for HIV Prevention Treatment and
Care; 2016. Available from: https://aidsfree.usaid.gov/sites/default/files/ng_national_guidelines_hiv.pdf. [Last accessed on 2020 Apr 27].
48. UNAIDS. UNAIDS Report; 2018. Available from: http://aidsinfo.unaids.org/. [Last accessed on 2020 Apr 27].
49. Savolainen R. Approaches to socio-cultural barriers to information seeking. Libr Inf Sci Res 2016;38:52-9.
50. Nigeria Slow Eliminating HIV as Women Contribute 90% New Infections in Children. Vanguard News; 2017. Available from:
https://www.vanguardngr.com/2017/07/nigeria-slow-eliminatinghiv-women-contribute-90-new-infections-children/. [Last accessed on 2020 Apr 24].
51. Olugbenga-Bello A, Adebimpe W, Osundina F, Abdulsalam S. Perception on prevention of mother-to-child-transmission (PMTCT) of HIV among women of reproductive age group in Osogbo, Southwestern Nigeria. Int J Womens Health 2013;5:399-405.
52. WHO. Mother-to-Child Transmission of HIV; 2015. Available from https://www.who.int/hiv/topics/mtct/en/. [Last accessed on 2020 Apr 20].
53. WHO. Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants in Resource-Limited Settings towards Universal Access-Recommendations for a Public Health Approach 2006 Version. Available from https://www.who.int/hiv/pub/guidelines/whopmtct.pdf. [Last accessed on 2020 Apr 23].
54. WHO. Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants. Recommendations for a Public Health Approach; 2010. Available from: https://apps.who.int/iris/bitstream/handle/10665/75236/9789241599818_eng.pdf; jsession
id=A034F8644D0FCCA02FF62FCC140A5170?sequence=1. [Last accessed on 2020 Feb 20].
55. FACT SHEET: Prevention of Mother to Child Transmission (PMTCT); 2016. Available from: https://naca.gov.ng/fact-sheet-preventionmother-child-transmission-pmtct-2016/. [Last accessed on 2020 Apr 11].
56. Tomori MO. Assessing knowledge and practice of prevention of mother to child transmission of HIV documentation among health workers in Oyo State, South West, Nigeria. Texila Int J Public Health 2016;4:1-16.
57. UNAIDS. Start Free, Stay Free, AIDS Free: 2017 Progress Report; 2018. Available from: https://www.unaids.org/sites/default/files/
media_asset/JC2923_SFSFAF_2017progressreport_en.pdf. [Last accessed on 2020 Jan 01].
58. National Bureau of Statistics (NBS) and United Nations Children’s Fund (UNICEF) Multiple Indicator Cluster Survey 2016-17, Survey Findings Report; 2017. Available from: https://www.unicef.org/nigeria/NG_publications_mics_201617.pdf. [Last accessed on 2020 Jan 01].
59. Date AA, Vitoria M, Granich R, Banda M, Fox MY, Gilks C. Implementation of co-trimoxazole prophylaxis and isoniazid preventive therapy for people living with HIV. Bull World Health Organ 2010;88:253-9.
60. Idoko J. The status of HIV and AIDS Control in Nigeria. 7th Professor Adetokunbo Lucas Public Health Leadership Forum. Institute of Public Health, Obafemi Awolowo University, Ile- Ife, Nigeria; 2016.
61. Avert. HIV and AIDS in Nigeria; 2018. Available from: https://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/ Nigeria [Last accessed on 2020 Feb 14].
62. Goffman E. Stigma: Notes on the Management of Spoiled Identity. New York: Simon & Shuster Inc., 1963.
63. Jones E, Farina A, Hastorf A, Markus H, Miller DT, Scott RA. et al. Social Stigma: The Psychology of Marked Relationships. New York: Freeman & Company; 1984.
64. Crocker J, Major B, Steele CS. Social Stigma. In: Gilbert D, Fiske ST, Lindzey G, editors. The Handbook of Social Psychology. 4th ed. New York: Academic Press, 1998; 504-53.
65. Cameron E. Legal rights, human rights and AIDS: The first decade. Report from South Africa 2. AIDS Anal Afr 1993;3:3-4.
66. UNAIDS. HIV and AIDS-Related Stigmatization, Discrimination and Denial: Form, Context and Determinants (Research Studies from Uganda and India); Best Practices Collection; 2000. Available from: http://www.unaids.org.[Last accessed on 2020 Feb 28].
67. Sidibé M, Goosby E. Global action to reduce HIV stigma and discrimination. J Int AIDS Soc 2013;16:18893.
68. Kipp W, Bajenja E, Karamagi E, Tindyebwa D. AIDS-related stigma: Perceptions of family caregivers and health volunteers in Western Uganda. World Health Popul 2007;9:5-13.
69. De Cock. Daily HIV/AIDS Report; 2008. Available from: http://www.thebody.com/content/news/art7478.html. [Last accessed on 2020 Mar 21].
70. Dahlui M, Azahar N, Bulgiba A, Zaki R, Oche OM, Adekunjo FO, et al. HIV/AIDS related stigma and discrimination against PLWHA in Nigerian population. PLoS One 2015;10:e0143749.
71. Herek GM, Glunt EK. An epidemic of stigma. Public reactions to AIDS. Am Psychol 1988;43:886-91.
72. Thorne C, Newell ML. Mother-to-child transmission of HIV infection and its prevention. Curr HIV Res 2003;1:447-62.
73. Etiebet MA, Fransman D, Forsyth B, Goetzee N, Hussey G. Integrating prevention of mother-to-child HIV transmission into antenatal care: Learning from the experience of women in South Africa. AIDS Care 2004;16:37-46.
74. Ekanem EE, Gbadegesin A. Voluntary counselling and testing (VCT) for Human Immunodeficiency Virus: A study on acceptability by
Nigerian women attending antenatal clinics. Afr J Reprod Health 2004;8:91-100.
75. Rankin WW, Brennans S, Schell E, Laviwa J, Rankin SH. The stigma of being HIV positive in Africa. PloS Med 2005;2:e247
76. Essien EJ, Ross MW, Ezedinachi EN, Meremikwu M. Cross-national HIV infection control practices and fear of AIDS: A comparison between Nigeria and the USA. Int J STD AIDS 1997;8:764-71.
77. Nnorom CC. Female genital mutilation practice in Nigeria: Patterns, preference and remedies. Am J Trop Med Hyg 2000;77:770-8.
78. Onuh SO, Igberase GO, Umeora JO, Okogbenin SA, Otoide VO, Gharoro EP. Female genital mutilation: Knowledge, attitude and practice among nurses. J Natl Med Assoc 2006;98:409-14.
79. WHO. Female Genital Mutilation; 2018. Available from: https://www.who.int/news-room/fact-sheets/detail/female-genitalmutilation. [Last accessed on 2020 Apr 04].
80. UNICEF. Female Genital Mutilation; 2018. Available from: https://www.who.int/news-room/fact-sheets/detail/female-genitalmutilation. [Last accessed on 2020 Mar 01].
81. Gruenbaum E. The movement against clitoridectomy and infibulations in Sudan: Public health policy and the women’s movement. Med Anthropol Newsl 1982;13:4-12.
82. Gordon D. Female circumcision and genital operations in Egypt and the Sudan a dilemma for Medical Anthropology. Med Anthropol 1991;5:1-3.
83. Inhorn MC, Buss KA. Infertility, infection, and iatrogenesis in Egypt: The anthropological epidemiology of blocked tubes. Med Anthropol 1993;15:217-44.
84. Larsen UA. The effects of type of female circumcision on infertility and fertility. Sudan. J Biosoc Sci 2002;34:363-77.
85. Hrdy DB. Cultural practices contributing to the transmission of human immunodeficiency virus in Africa. Rev Infect Dis 1987;9:1109-19.
86. Kadiri KK, Ahmad MK, Mustaffa CS. HIV/AIDS and cultural practices in Nigeria: An implication for HIV/AIDS preventive communication campaign. New Media Mass Commun 2014;27:19-28.
87. Salaam T. A Brief Analysis on the Situation of Women in NIGERIA Today; 2003. Available from: http://socialistnigeria.org/women/1-3-03.html. [Last accessed on 2020 Mar 25].
88. Edosa GN. Son Preference in Idumodin-Igbanke; 2006. Available from https://www.academia.edu/14260167/Son_Preference_in_ Nigeria. [Last retrieved on 2020 Feb 01].
89. Elele C. Culture-Nigeria: Male Child Remains a Family Pride and Honour. Inter Press Services, 2020. Available from: http://www.ipsnews.net/2002/05/culture-nigeria-male-child-remains-a-familypride-and-honour/. [Last accessed on 2020 Feb 01].
90. Okorafor. An Evaluation of Inheritance Practices among Widows in Nigeria: A Study of Selected Urban and Rural Communities in Enugu State. Master’s Thesis Submitted to Institute for Development Studies University of Nigeria, Enugu Campus; 2011. Available from: http://
www.unn.edu.ng/publications/files/images/NKEM%20PROJECT.pdf. [Last accessed on 2019 Dec 25].
91. Johnson OA. Widows and Inheritance Hijacking Practices in Ilara Mokin, Ondo State, Nigeria. Afr J Criminol Justice Stud 2016;9:1-9.
92. Azubike OA. Potential Liberation of Widows Right of Inheritance in Nigeria. Available from https://afribary.com/works/anekwe-v-nwekea-potential-liberation-of-widows-right-of-inheritance. [Last accessed on 2020 Apr 24].
93. Emery V. Women’s Inheritance Rights in Nigeria: Transformative Practices. Womens UN Report Network; 2006. Available from: http://
www.widowsrights.org/researchnews3.html. [Last accessed on 2020 Apr 24].
94. Canada: Immigration and Refugee Board of Canada, Nigeria: Rights of Widows to Inherit Property in a Civil Marriage Where There Was
Neither Will Nor Children; Inheritor of the Property upon Her Death; 28 August, 2000; NGA35236.E. Available from: https://www.refworld.
org/docid/3ae6ad6f0.html. [Last accessed on 2020 Apr 24].
95. Diala A. Reform of the customary law of inheritance in Nigeria: Lessons from South Africa. Afr Hum Rights Law J 2014;15:65.
96. Ukaegbu CC. Entrepreneurial succession and post-founder durability: A study of indigenous private manufacturing firms in Igbo States of
Nigeria. J Contemp Afr Stud 2003;21:27-45.
97. Trivedi JK, Sareen H, Dhyani M. Psychological aspects of widowhood and divorce. Mens Sana Monogr 2009;7:37-49.
98. Modo IV, Modo FN, Enang PI. Socio-cultural factors responsible for increasing rate of HIV/AIDS in Akwa Ibom State of Nigeria. Ethno Med 2011;5:141-7.
99. Afigbo AE. Widowhood practices in Africa: A preliminary survey and analysis. In: Widowhood practices in Imo State. Proceedings of
better life programme for rural women workshop on widowhood practices in Imo State, Owerri; 1989. Available from: https://openlibrary.org/books/OL1474614M/Widowhood_practices_in_Imo_State?v=2. [Last accessed on 2020 Jul 24].
100. Nwoga DI. Widowhood practices in Imo State. Paper presented at the Workshop on Widowhood Practices in Imo State. Owerri; 1989;42,6-7.
101. Korieh C. Widowhood among the Igbo of Eastern Nigeria. Thesis submitted for the Degree of Master of Philosophy in History. University of Bergen. Norway: University of Norway; 1996.
102. Ahonsi BA. Society, culture and the status of widows in contemporary Nigeria: A gender analysis. In: Owasonoye B, Ahonsi B, editors. Widowhood in Nigeria: Issues, Problems and Prospects. Lagos: Fredrick Ebert Foundation and Human Development Initiatives; 1997.
103. Akumadu T. Beasts of Burden: A Study of Women’s Legal Status and Reproductive Rights in Nigeria. The Women’s Right Project, Civil Liberty Organization; 1998.
104. Kantiyok CD. Widowhood rites and wife inheritance in Kano State. In Rights and Widowhood Rites in Nigeria. Vol. 3. Inter-African Committee (Nigeria) on Traditional Practices Affecting the Health of Women and Children, Lagos, Nigeria, Monograph 2000;61-78.
105. Sidang A. Widow Inheritance: Throwing out the Baby with the Bath Water; 2019. Available from: https://www.theelephant.info/
culture/2019/08/29/widow-inheritance-throwing-out-the-baby-withthe-bath-water/. [Last accessed on 2019 Aug 29].
106. Onuoha RA. Discriminatory Property Inheritance under Customary Law in Nigeria: NGOs to the Rescue. Int J Not-for-Profit Law 2008;10. Available from: www.icnl.org. [Last accessed on 2020 Feb 01].
107. Aransiola JO, Ige A. Widowhood Practices among the Yorubas of South West Nigeria: Are there differences in what women experience due to their status? Gender Behav 2010;8:3152-67. Available from: https://www.questia.com/library/journal/1P3-2187713301/
widowhood-practices-among-the-yorubas-of-south-west. [Last accessed on 2020 Jul 24].
108. Fasoranti O, Aruna, J.O. A cross-cultural comparison of practices relating to widowhood and widow inheritance among the Igbo and Yoruba in Nigeria. J World Anthropol 2007;3:53-73.
109. Ezejiofor AO. Patriarchy, marriage and the rights of widows in Nigeria. Unizik J Arts Humanities 2011;12:139-57. Available from: https://
www.ajol.info/index.php/ujah/article/viewFile/71750/60707. [Last accessed on 2020 Feb 01].
110. Mboya PK. A Handbook of Luo Customs. Luo Kitgi gi Timbegi: Anyange Press, 1997.
111. Ambasa-Shisanya CR. Widowhood in the era of HIV/AIDS: A case study of Slaya District, Kenya. Sahara J 2007;4:606-15.
112. Ayikukwei R, Ngare D, Sidle J, Ayuku D, Baliddawa J, Greene J. HIV/AIDS and cultural practices in western Kenya: The impact of sexual cleansing rituals on sexual behaviours. Cult Health Sex 2008;10:587-99.
113. United Nations Refugee Agency. Levirate marriage practices among the Yoruba, Igbo and Hausa-Fulani; 2019. Available from: http://
www.unhcr.org/refworld/docid/45f1478811.html. [Last accessed on 2019 Dec 14].
114. IgboEM. Basic Sociology. 1st ed. Enugu: CIDJAP Press, 2013; 130.
115. Kareem F, Otis T, Ogunjobi M. The effects of the HIV/AIDS AntiDiscrimination Act in Nigeria. Workforcepoint; 2016. Available from
https://workforcepoint.wordpress.com/2016/04/06/the-effect-ofthe-hivaids-anti-discrimination-act-in-nigeria/. [Last accessed on 2019 Nov 21].
116. Onyekwere J. HIV/AIDS Anti-Discrimination Law and Essence of Implementation; 2015. Available from: https://guardian.ng/
features/law/hivaids-anti-discrimination-law-and-essence-ofimplementation/. [Last accessed on 2020 Feb 02].
117. Okolo E. Nigeria: Survey Shows Decrease in Homophobic Attitudes. Kind of African Arguments; 2019. Available from: https://
africanarguments.org/2019/08/14/nigeria-survey-shows-decreasein-homophobic-attitudes-kind-of/. [Last accessed on 2020 Apr 24].
118. Gordon G. Tell Me Where I Can Be Safe. The Impact of Nigeria’s Same Sex Marriage (Prohibition) Act; 2016. Available from: https://
www.hrw.org/report/2016/10/20/tell-me-where-i-can-be-safe/impact-nigerias-same-sex-marriage-prohibition-act. [Last accessed on 2020 Feb 01].
119. McKenzie H. Nigeria: The Most Homophobic Country on Earth? UMSU. Available at https://umsu.unimelb.edu.au/nigeria-the-mosthomophobic-country-on-earth/. [Last accessed on 2020 Apr 24].
120. Wikipedia. LGBT Rights in Nigeria. Available from: https://en.wikipedia.org/wiki/LGBT_rights_in_Nigeria. [Last accessed on 2020 Apr 24].
121. Pew Global Attitudes Project (pages 35, 83, and 117) (PDF). Archived from the original (PDF) on 14 February, 2010. Available from: www.
pewresearch.org [Last retrieved on 2020 Feb 14].
122. Bakare T, Ndeche C, Ukiwe U. LGBTQ. In Nigeria: Between Law And Love. Guardian News; 2018. available from: https://guardian.
ng/life/lgbtq-in-nigeria-between-law-and-love/. [Last accessed on 2020 Apr 20].
123. How HIV Impacts LGBTQ People. Available from: https://www.hrc.org/resources/hrc-issue-brief-hiv-aids-and-the-lgbt-community. [Last
accessed on 2020 Apr 20].
124. WHO. Global Update on HIV Treatment 2013: Results, Impact and Opportunities Geneva: WHO, 2013. Available from: http://
www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2013/20130630_treatment_report_en.pdf. [Last accessed on 2020 Apr 17].
125. Dalhatu I, Onotu D, Odafe S, Abiri O, Debem H, Agolory S, et al. Outcomes of Nigeria’s HIV/AIDS Treatment Program for Patients Initiated on Antiretroviral Treatment between 2004-2012. PLoS One 2016;11:e0165528.
126. NACA. Antiretroviral Therapy; 2014. Available from: https://naca.gov.ng/anti-retroviral-therapy/. [Last accessed on 2020 Apr 24].
127. US Embassy and consulate in Nigeria. PEPFAR. Available from https://ng.usembassy.gov/embassy-consulate/abuja/sections-offices/pepfar/. [Last accessed on 2020 Apr 27].
128. USAID. Minding the HIV and AIDS Financing Gap: HFG at Work in Nigeria. Available from: https://www.hfgproject.org/minding-thehiv-and-aids-resource-gap-in-nigeria/. [Last accessed on 2020 Apr 27].
129. National Agency for the Control of AIDS. National HIV/AIDS Epidemiology and Impact Analysis (NHEIA) Report. NACA, Abuja; 2017.
130. Babayemi O. Daniel A. Test-and-treat approach to ending HIV epidemic in Nigeria: Current status and future prospects of domestic funding. HIV AIDS Rev 2017;16:205-11.
131. Adeoye IY, Ogungbemi K, Adaoha A, Adedayo A. Out-ofpocket expenditure on HIV/AIDS: best practice from Nigeria. In: 19th International AIDS conference in Washington DC, USA, 2012. Available from: http://pag.aids2012.org/Abstracts.aspx?AID=8706. [Last accessed on 2020 May 23].
132. Olakunde BO, Ndukwe CD. Improved domestic funding enhances the sustainability of HIV/AIDS response in Nigeria. Ann Glob Health 2015;81:684-8.
133. Pai B. Von. Health. Nigeria Increases Counterpart Funding for HIV/ AIDS. 29 November, 2019. Available from: https://www.von.gov.ng/nigeria-increases-counterpart-funding-for-hiv-aids/. [Last accessed on 2020 Apr 25].
134. Callaghan M, Ford N, Schneider H. Asystematic review of task-shifting for HIV treatment and care in Africa. Human Resour Health 2010;8:8.
135. Ford N, Calmy A, Mills EJ. The first decade of antiretroviral therapy in Africa. Global Health 2011;7:33.
136. Pacqué-Margolis S, Muntifering C, Ng C, Noronha S, IntraHealth International. Population growth and the global health workforce crisis. Washington: United States Agency for International Development; 2011.
137. Decroo T, Rasschaert F, Telfer B, Remartinez D, Laga M, Ford N. Community-based antiretroviral therapy programs can overcome barriers to retention of patients and decongest health services in SubSaharan Africa: A systematic review. Int Health 2013;5:169-79.
138. Colvin CJ, Konopka S, Chalker JC, Jonas E, Albertini J, Amzel A, et al. A systematic review of health system barriers and enablers for antiretroviral therapy (ART) for HIV-infected pregnant and postpartum women. PLoS One 2014;9:e108150.
139. Nöstlinger C, Rojas Castro D, Platteau T, Dias S, Le Gall J. HIV-Related discrimination in European health care settings. AIDS Patient Care STDS 2014;28:155-61.
140. Feyissa GT, Abebe L, Girma E, Woldie M. Stigma and discrimination against people living with HIV by healthcare providers, Southwest Ethiopia. BMC Public Health 2012;12:522.
141. Wallack JJ. AIDS anxiety among health care professionals. Hosp Community Psychiatry 1989;40:507-10.
142. Ebenezer D. Attitudes and practices of health care workers towards HIV positive patients at the Federal Medical Centre Owo, Ondo State Nigeria. S Am J Acad Res 2015;2:1-28.
143. Sekoni OO, Owoaje ET. HIV/AIDS stigma among primary health care workers in Ilorin, Nigeria. Afr J Med Med Sci 2013;42:47-57.
144. PEPFAR. Nigeria Country Operational Plan (COP) 2019 Strategic Direction Summary; 2019. Available from: https://www.state.gov/
wp-content/uploads/2019/09/Nigeria_COP19-Strategic-DirectionalSummary_public.pdf [Last accessed on 2020 Apr 30].
145. World Development Indicators. What is Nigeria HIV Prevalence? Available from: https://knoema.com/atlas/Nigeria/HIVprevalence. [Last accessed on 2020 Apr 24].