US embassy cable - 04LAGOS1369

UNCLAS SECTION 01 OF 03 LAGOS 001369 
 
SIPDIS 
 
For S/GAC 
 
E.O. 12958: N/A 
TAGS: TBIO, SOCI, ECON, PGOV, NI 
SUBJECT: HIV/AIDS FINDINGS OF NIGERIA'S 2003 
DEMOGRAPHIC AND HEALTH SURVEY 
 
REF: LAGOS 1247 
 
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 
education. 
 
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. 
 
Orphans 
 
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. 
 
Comment 
 
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- 
positive. 
 
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. 
 
KRAMER