HIV/AIDS Vulnerabilities, Discrimination, and Service Accessibility Among Nigeria's Youth

"Nigerian youth continue to be a vulnerable group. The imbalance between high-risk sex, condom use in high-risk sex, and uptake of HIV testing raises concern for HIV prevention. This young population should have access to comprehensive SRH services and youth-focused sexuality education that goes beyond abstinence-only messages."

This is the key conclusion outlined in this 52-page report and corresponding fact sheet, which discuss findings of a study conducted between August 2011 and July 2012 to: provide a comprehensive, evidence-based picture of HIV and sexual health and rights (SHR) related issues facing Nigerian youth; as well as explore legal, policy, and programmatic responses. The study was designed to inform a more focused approach for youth within the national response to HIV, particularly around responding to youth needs and vulnerabilities, including stigma and discrimination, especially for the most vulnerable populations such as men who have sex with men, the lesbian, gay, bisexual, transgender and intersex (LGBTI) community, female sex workers, married adolescents, orphans, prisoners, and migrants.

Researchers undertook a literature review to better understand factors associated with HIV risk-taking and health seeking behaviours among young people aged 15-24 in Nigeria, followed by qualitative and quantitative analyses that included focus groups and in-depth interviews. The study resulted in a number of key findings, outlined in detail in the report, that can inform youth-oriented programming, as well as policy decisions. National policies and laws were found not to be responsive to youth needs, largely because of lack of implementation. Most vulnerable populations are particularly underserved, due to social stigma. The national strategic plan targets youth as part of the general population, but lacks youth specific strategies.

In terms of behaviours, research found that more males (14.5% - 17.9%) reported involvement in multiple concurrent partnerships, than females (2.0% - 2.3%), but both reported low levels of condom use. "The low level of condom use among Nigerian youth is particularly worrisome given the relatively high levels of high-risk sexual behavior. Increased condom messaging and distribution, and the inclusion of condom/sexual negotiation skills in youth sexuality education/HIV prevention programs, are essential." Research also showed that uptake of HIV testing remained low among youth in Nigeria "ranging from 3.8% to 14.7% of young people having had an HIV test and received the test result."

In terms of knowledge, less than 35% of youth demonstrated comprehensive knowledge of HIV/AIDS as assessed by the five United Nations General Assembly Special Session (UNGASS) indicators for HIV knowledge, though more urban than rural youth and more males than females were found to have comprehensive knowledge. This is considered significant because the health-belief model "is founded on the principle that there is a relationship between beliefs, attitudes, and behavior. Knowledge influences beliefs and perceptions and this fact has been key in HIV-prevention programs..."

The study also examined HIV youth-focused responses from individual and structural perspectives. Qualitative inquiries showed that most young people considered SRH to be a significant need among youth, but felt "overwhelmingly disempowered to adequately respond to their HIV and SRH vulnerabilities because of inadequate knowledge, issues with service providers and set-up of services, and livelihood struggles. At the structural level, "the failures of institutional responses can be tied to the broader issue of denial and lack of openness about youth sexuality. Participants stated that sex education in primary and secondary schools only covers a narrow set of topics, mostly limited to abstinence. Condom use, family planning, and HIV counseling and testing (HCT) appear not to be taught, yet study participants viewed them as important in taking preventative action."

Based on the results of the study, the following recommendations are made:

• "Improving sexual health-seeking behaviors, especially uptake of HCT and condom use by all youth, through a combination of youth-accessible communication channels, is imperative.
• Evidence-based advocacy needs to be targeted at policymakers and donors to bring greater attention to the youth dimensions of the HIV epidemic, especially in relation to neglected vulnerable youth.
• Innovative operational research is called for to better understand how to increase the meaningful involvement of young people in the conception, planning, and implementation of SRH and HIV/AIDS policies and programs.
• Efforts to promote the mainstreaming of youth-friendly SRH and HIV services are required given the challenges of scaling up and sustaining the few model stand-alone services provided largely by nongovernmental organizations (NGOs).
• A strong case exists for systematic domestication of key international regional protocols.
• Alignment of national and subnational laws and of civil, customary, and religious laws need to be advocated for strongly to ensure that laws and policies are not contradictory, and implementation of existing youth-specific laws and policies need to be improved.
• The National Agency for the Control of AIDS (NACA) must live up to its oversight function of ensuring that young people are not neglected in national HIV policies and programs.
• The government needs to increase funding and demonstrate ownership and sustainability of youth-based HIV programs.

Click here to download the fact sheet in PDF format.