[PHP Nepal Vol 2 Issue 9 Sep 2012] | Human Immunodeficiency Virus (HIV) infection is considered pandemic by the World Health Organization (WHO). UNAIDS fact sheet (2012) states that globally, over half of all People Living With HIV/AIDS (PLWHA) are men (53%). It also states that over 70% of HIV infections worldwide occur through unprotected sex between men and women, and 10% through unprotected sex among men. Sub-Saharan Africa remains by far the worst affected region, with an estimated 23.5 million people currently living with HIV (69% of the global total) and 1.7 million new infections (68% of the global total). Young people, ages 15–24, account for 40% of new HIV infections.
In Nigeria, according to the first antenatal care sero-prevalence survey, the HIV prevalence rate was 1.8% in 1991. This prevalence rate rose to 4.5% in 1995/96, and peaked at 5.8% in 2001 before it started declining. Currently, the HIV prevalence rate among adult ages 15 - 49 is 3.9% (Population Reference Bureau, 2011). However, among men who have sex with men (MSM), it is comparatively high (17.2%). Nigeria has the third-largest number of PLWHA globally, the second largest number of PLWHA in Sub-Saharan Africa and the highest in the West African sub-region.
Traditional ideas of masculinity are fuelling the global HIV/AIDS pandemic. In Nigeria, even around the world, men continue to wield the power in the majority of sexual relationships; an imbalance that often robs women of the ability to make decisions relating to their health or status. The percentage of men participating in HIV prevention, care and support programs has typically been lower than that of women. A retrospective study carried out in 16 health facilities in Kwara State, Nigeria during a period of 22 months (March, 2007 to December, 2008) showed that the prevalence of HIV was found similar in both sexes suggesting equal burden of the disease. However, men were found less likely to go for the test. The percentage of men that came for HIV Counseling and Testing (HCT) ranges from 0% to 29.0% in each of the month. In case of women, it ranged from 71% to 100% (Akhigbe et al. 2010). This shows that women are already doing a lot to cope with the pandemic.
The results of 2008 Nigeria Demographic Health Survey (NDHS) showed that 72% of men know that consistent use of condoms is a means of preventing the spread of HIV while 83% of them know that limiting sexual intercourse to one HIV-negative partner can reduce the chances of contracting HIV. Similarly, 69% of men know that using condoms/limiting sexual intercourse to one HIV-negative partner can reduce the risk of HIV infection while 78% know that abstaining from sexual intercourse can reduce the risk of HIV infection.
Male condom is relatively available, cheap and accessible, but many sexually active men do not still use it for the HIV prevention. It was revealed in a study that prevention of pregnancy was a concern among monogamous men, much more than prevention of sexually transmitted infections, including HIV/AIDS (Oyediran, 2003). Also, consistent use of condom has only been reported among 10% of MSM in Nigeria (Nnaji et al, 2010). Although men, women and children are at risk of HIV/AIDS, men’s vulnerability is made higher by their patterns of behavior, modes of socialization, peer pressure, prevailing concepts of masculinity, alcohol and drug abuse, violence, cultural practices and norms. In addition, men have significant control over women’s sexual lives. They use violence, psychological, economic or social pressure to insist on sex with their partners or outsiders and even do not use condom.
In conclusion, male contributions in the prevention of HIV/AIDS in Nigeria are currently inadequate. Enlisting men in the fight against HIV is imperative to lower prevalence and vulnerability of HIV/AIDS. Although knowledge of Nigeria men on condom is high, but the use of it is still very low, behavioral change interventions will be of immense help to ensure the consistent use among them.
Samuel Oladipupo OLALEYE — Nigeria