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### Viewing cable 04LAGOS1369, HIV/AIDS FINDINGS OF NIGERIA'S 2003

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Reference ID | Created | Released | Classification | Origin
--- | --- | --- | --- | ---
04LAGOS1369 | 2004-07-07 10:32 | 2011-08-25 00:00 | UNCLASSIFIED | Consulate Lagos

`

    This record is a partial extract of the original cable. The full text of the original cable is not available.

    071032Z Jul 04

` `

    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

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