INTRODUCTION

The first case of AIDS in Nigeria was identified in 1986, and HIV prevalence rose from 1.8% in 1988 to 5.8% in 2001. In 2003, a survey carried out by the Federal Ministry of Health showed that 3,300,000 adults living with HIV/AIDS, with 1,900,000 (57%) of the women.

In much of the world, HIV/AIDS has for a long time been seen as a problem that affects men, specifically gay men, and as a result of this preconception the harm that it does to women around the world has largely been overlooked. Yet today nearly half of all adults living with HIV/AIDS around the world are women. At 5.6% HIV/AIDS prevalence is highest among young people between the ages of 20 and 24 compared with other age groups. Nigeria’s STD/HIV control estimates that over 60% of new HIV infections are in the 15-25-year-old group.

Women are more at risk because they have greater chances of infection. Physically, women are more susceptible than men to HIV infection through heterosexual sex. Women are about twice as likely to become infected with HIV from men as men are from women. Also crucial is the issue of mother-to-child transmission during pregnancy, delivery and after birth.

MODE OF HIV TRANSMISSION
• Sexual intercourse.
Eighty percent of HIV infections in Nigeria are transmitted by heterosexual sex. Factors contributing to this include lack of information about sexual health and HIV, low levels of condom use and high levels of sexually transmitted infections (STIs) such as chlamydia and gonorrhoea, which make it easier for the virus to be transmitted.

• Blood transfusion
Blood transfusions are responsible for about 10% of all HIV infections. There is high demand for blood because of road traffic accidents, blood loss from surgery and childbirth and malaria-related anaemia

• Mother-to-child transmission
• Homosexual sex
• Drug use and abuse
• Sharing of sharp instruments

FACTORS CONTRIBUTING TO THE SPREAD OF HIV
a) Lack of sexual health information and education
Sex traditionally is a private subject in Nigeria for cultural and religious reason. The discussion of sex with teenagers is seen as indecent. Up until recently there was little or no sexual health education for young people and this has been a major barrier to reducing rates of HIV and other STIs. Lack of accurate information about sexual health has contributed to increase in transmission rates as well as stigma and discrimination against people living with HIV/AIDS.

b) Stigma and discrimination
Stigma and discrimination are commonplace in Nigeria and this affects attitudes toward people living with HIV/AIDS and HIV prevention. Because of this people don’t come out to state their status.

c) Poor health services
Nigeria’s healthcare system has deteriorated because of political instability, corruption and a mismanaged economy. Large parts of the country lack even basic healthcare provision, making it difficult to establish HIV testing and prevention services such as those for the prevention of mother-to-child transmission, providing contraception, testing and treating STIs.

REASONS WHY MANY WOMEN ARE BEING INFECTED

Inequalities.
Nigeria is a male-dominated society and women are seen as inferior to men. Women’s traditional role is to have children and be responsible for the home. Their low status and lack of access to education increases their vulnerability to HIV infection. In a situation where the man has all the powers, a woman is unlikely to be able insist on the use of condoms or to take measures to protect herself from HIV.

Marriage practices.
Harmful marriage practices violate women’s human rights and contribute to increasing HIV rates among women and girls. Early marriage is a norm in some parts of the country for women and girls between ages 12 and 13. Most young girls are at risk of contracting HIV from partners, as it is acceptable for men to have extramarital sexual relationships, seek the services of sexworkers and actively practise polygamists. Because of their age and lack of education and low status, young married girls are not able to negotiate the use of condoms to protect themselves.

Female circumcision
Female circumcision or female genital mutilation is a common practice whereby all or part of the female external genitalia is removed by cutting. FGM puts women and girls at risk of contracting HIV from unsterilised instruments such as knives and broken glass that are used during the procedure.

Prostitution
Another way in which women’s lack of economic power enables their sexual exploitation is via prostitution as a result of poverty. Female sexworkers are a very high-risk group because of low levels of condom use among sex workers due to the poor acceptance by male clients. Also stigma makes it difficult for sexworkers to access the healthcare services.

Drugs
Drug use is a social problem affecting women just as much as men. In fact, many injecting drug users are women. They are vulnerable to sexual exploitation and prone to infection from injecting equipment.

Violence against women
There is a greater likelihood for a woman’s first sexual experience to be forced or in some way coerced. Rape can be a devastating experience for any woman and can also carry the risk of HIV infection.

WOMEN AND CHILDREN
Another way in which the HIV/AIDS epidemic spreads is through childbirth. HIV can be transmitted from a HIV-positive mother to her child during pregnancy, labour and delivery, after birth and during breastfeeding. HIV infection during pregnancy is associated with poor pregnancy outcome, an increase in the risk of stillbirth, preterm delivery, intrauterine growth retardation. Worst of all is transmission to the child.

SIGNS OF HIV IN CHILDREN
Abnormal weight loss
Abnormally slow growth
Chronic diarrhoea lasting over a month
Developmental delay or regression
The incubation period of HIV/AIDS in children is on average 2 years but in older adults might be 10 to 15 years.

HIV TRANSMISSION TO INFANTS
1. Transmission before birth (prepartum) HIV transmission via the placenta can occur even in the first three months of pregnancy.
2. Transmission during birth. Transmission of HIV from an infected mother to their infant can occur during birth, probably because of the high level of virus shed in the cervical and vaginal secretions and the baby is exposed to a large amount of HIV-infected maternal blood during delivery.
3. Transmission after birth. Postnatal. Through breastfeeding. The risk of transmission via breast milk is probably greatest if the mother is infected after birth.

PREVENTION OF MOTHER-TO-CHILD TRANSMISSION
Perinatal infection can be reduced by counselling, testing, antiretroviral treatment and infant formula feeding.
Antenatal treatment. Zidovudine can be administered at 14 to 34 weeks of pregnancy, and also given intravenous at labour to the mother. The baby will be given orally within 72 hours of delivery for 6 weeks in the absence of breastfeeding.
Perinatal. Elective caesarean section is another option in preventing mother-to-child transmission
Postnatal, after delivery. Avoid breastfeeding, supplementary feeding (infant formula) can be given, or you seek a surrogate mother that can help in breastfeeding the baby.

Women living with HIV/AIDS suffer from the same conditions as men do, but they also experience separate illnesses, such as pelvic inflammatory diseases, which increase the risk of cervical cancer.

PREVENTION OF HIV/AIDS IN WOMEN

EDUCATION

1. Nigeria’s STD/HIV control estimates that 60% of all new HIV infection occurs in young people between 15 and 25 years. Comprehensive sex education that will focus on improving young people’s knowledge and attitudes to sexual health and reducing sexual risk taking behaviours.

2. CONDOMS Condoms have become universally available in Nigeria but the uptake and use by individuals is affected by their perceptions of how effective condoms are perceived effects on sexual satisfaction and people not wanting to be seen as promiscuous as a result of buying them, people should be encouraged especially women on the use of condoms during sex. Condoms should also be used during and after pregnancy.

3. GENDER ROLES Negative assumptions about women’s roles and discrimination against them must be challenged and women must be empowered to help themselves and to protect themselves.

4. Women who have been raped need to have access to post exposure prophylaxis. Medical techniques, which can reduce the chances of HIV infection if the victim of a rape is treated quickly.

5. Protecting women from HIV is not solely women’s responsibility. Most HIV-positive women were infected through unprotected sex with an infected man. Preventing infection is the responsibility of both partners, and men must play an equal role in this.

6. Violence against women, discrimination, gender-based inequalities, prostitution. These are all social issues which undeniably need to be changed, but which might take decades to alter. Women who have HIV need to have access to treatment and women who don’t have the virus need to be able to protect themselves.

Many women may not think they are at risk for HIV infection. There is still in some places a myth a HIV infection is something that happens only to other people, to men, to injecting drug users, to people of other ethnic groups. This falsehood needs to be cleared up and countries around the world need to empower women to be able to protect themselves.