AIDS
was discovered first in the united states in 1980s as a new disease entity in
homosexual men: 20 years later, AIDS has become a world wide epidemic that
continues to expand (Nester et al; 2004). As
of January 2006, the Joint united nations programme on HIV/AIDS (UNAIDS) and
the world health organization (WHO) estimate that AIDS has killed more than 25
million people since it was first recognized on December 1981, making it one of
the most destructive pandemics in recorded history. In 2005, AIDS claimed an
estimated 3.3 million lives, of which more than, 570,000 were children. It is
now estimated that about 0.6% of the world’s living population is infected with
HIV (Jawetz; 2007, Nester; 2004).
In
2010, an estimated 48, 079 adults and adolescent were diagnosed with HIV
infection; of these 79% of diagnoses among males and 21% were among females.
HIV has remained localized primarily to West Africa ((Jawetz et al; 2007, Nester et al; 2007).
OVERVIEW OF THE HIV EPIDEMIC
Nigeria
has the second highest number of people living with HIV in the world after
South Africa. (UNAIDS, 2009) UNAIDS estimated 33.4 million people living with
HIV in 2008 in the world. Nigeria, with about 2.98 million people living with
HIV, makes about 9% of the global HIV burden. However, there is gender
inequality in the distribution with males accounting for 1.23million and female
accounting for 1.72 million in the HIV estimates and projections for 2008.
Women are more affected in the defining Feature of the epidemic with policy
implications for prevention of mother to child transmission. Hence, addressing
gender inequality is crucial in the control of the epidemic. Nigeria recorded
the first case of acquired immunodeficiency syndrome (AIDS) in 1986. Heterosexual
sex remains the primary mode of transmission for HIV and accounts for 80 – 95%
of HIV infections in Nigeria. Tracking the course of HIV epidemic in Nigeria
requires good reporting and surveillance system. Thus, Nigeria through the
Federal Ministry of Health instituted regular surveillance system using
clinical-based and population-based surveys to monitor the epidemic. This is
needed to obtain reliable information about HIV prevalence and behaviors
associated with HIV epidemic in relation to temporal changes, geographic
distribution, magnitude, and mode of transmission. Furthermore, this
surveillance system provides opportunities to monitor trend in prevalence,
create awareness about early response, inform priority setting for new
interventions and measure the effectiveness of public health interventions in
the control of the epidemic. (Ainsworth M, Teokul W, 2000).
The
federal Ministry of Health and National Commission with support from NACA and
other relevant stakeholders conducts four main surveys namely:
- National
HIV/AIDS and Reproductive Health Survey Plus (NARHS Plus)- This is a population
based survey that estimates HIV prevalence and obtains information on the
associated factors in addition, it provides information on the sexual and
reproductive health status in the country it is usually conducted every two
years. (Jhap, et al., 20012).
- HIV/STI
Integrated Biological and Behavioral Surveillance Survey (IBBSS)- This survey
is targeted at the most at risk populations whose behaviors or occupations often
place them at higher risk of contracting sexually transmitted infections
including HIV. It estimates HIV prevalence among the most at risk populations
and provides information on drivers of the epidemic among these groups. It is
usually conducted every two years. (Federal Ministry of Health, 2001).
- Antenatal
Care Survey- This is a clinic based sentinel survey to estimate HIV prevalence
among pregnant women attending antenatal clinic. It is conducted every two to
three years. (Federal Ministry of Health, 2004).
- Nigeria Demographic and Health Survey
(NDHS) – it is a nationally representative survey. Prior to 2008 survey, the
last one was in 2003. It is conducted by National Population Commission with
international support. HIV epidemic rose from 1.8% in 1991 and peaked at 5.8%
in 2001. It is currently at 4.6% in 2008 antenatal survey. Figure 1 below shows
a rapid rise in HIV prevalence in the sentinel surveys carried out from 1991 to
2001 (1.8% in 1991 to 4.5% in 1996 and then to 5.8% in 2001). Subsequently, the
trend reversed and took a downward turn from 5.8% in 2001 to 5% in 2003 and
then to 4.4% in 2005.
Although a slight increase was
observed in HIV prevalence from 4.4% in 2005 to 4.6% in 2008. However, in each
of the sentinel survey there were significant variations in the different
states of the federation.