Factors driving continued HIV Transmission along key Transport Corridors in Nigeria

This study provides insights into the structures, knowledge, attitude and practices in four popular towns along the major transport corridors in Nigeria. It demonstrates that the unique configuration of these towns as well as the knowledge and attitude of people that live in them and travel through still provides an environment for high risk behaviour.

Deepening our understanding of the community architecture of these communities is a necessary step to ensure that interventions can be developed to address the needs of the populations at these specific locations.

The mix of commercial sex workers and mobile transport workers around these locations provides a perfect opportunity for casual and transactional sex. The host communities at these locations have also become cosmopolitan and include a large number of migrants, transport workers and artisans who have settled for varying time periods mostly for commercial purposes. Commercial sex workers, resident at these locations form important nodes in the sexual networks that include artisans and transport workers. Stable and long term relationships are not the norm here.

These findings also demonstrate the potential for prevention from targeted HIV/AIDS programming.

At this stage of the epidemic in Nigeria, it is important to start linking HIV infection vulnerability to economic empowerment and linking HIV intervention programme to livelihood issues. Currently, HIV prevention and care interventions have often focused on the biomedical approaches, which though effective in specific contexts, need to be placed within broader structural and behavioural interventions. T

his rapid assessment suggests that biomedical prevention without considering economic and livelihood challenges faced by people living in these locations will have little chance of success, considering that most persons on the corridor are there for economic
reasons.
The wide variety of professions among the individuals in these locations, diverse cultural norms, and religious persuasions means that broad brush programming will not work in this context. Targeted and location specific programming is required. One approach could be the forming of forming peer or support groups among the commercial sex workers. Another approach will be to provide sign posting and linkage with community structures and relevant health services. Programmes should also consider identifying and providing services at locations relevant to the local context (e.g. transport hot-spots, cinemas, tertiary institutions).

The study revealed that a few small film viewing centers and makeshift student hostels exist in these locations. Such locations are useful locations to interact with the customers of these facilities on HIV prevention. When developing prevention programmes for people who are most vulnerable to HIV, in addition to targeting specific groups as defined by their profession (e.g. MARPs), it would also be effective to target specific locations like these ones. These locations will have large numbers of students of tertiary institutions and other out-of-school youths who are in the transient stage of either waiting to get into higher institutions or learning some life skills.

There are a few public health facilities, private dispensaries and hospitals around these locations, providing very few health services dedicated to providing comprehensive sexual and reproductive health care. Without these services, people have little or no access to services that reduce the prevalence of Sexually Transmitted Infections which in turn will reduce the risk of HIV transmissions.
This study also shows that many people are still not using condoms, even when engaging in risky sex behavior. Condoms are hard to get to in locations where risky sexual activity is likely to happen. These findings suggest that placing condoms within non-traditional outlets and providing occasional training and prevention messages in these settings may promote the use of condoms. The study also shows that there was an expressed desire for more HIV counselling and testing services in these communities. The findings from the report indicate that perception of vulnerability to HIV is still low. Many people still belief that God will protect or that it is not in ones “destiny” to contract HIV or other STIs. Some respondents are still convinced that mosquitoes can transmit the virus.

Stigma and discrimination while on the decline is still present amongst the studied population. In this context, people will want persons infected with the virus to be as far away from them as possible. Religious beliefs and judgemental attitudes appear to be major drivers of stigma and discrimination. This reinforces the need to engage gatekeepers and law enforcement agents on these corridors in all subsequent programmes.

The results from this study showed an overwhelming desire by most respondents to participate actively in future intervention activities in response to the HIV epidemic. The results support the need for effective and efficient collaboration among organizations that implement HIV interventions that co-exist in towns on the same transport corridor. This collaboration will reduce unnecessary rivalry and competition and enhance complementary programming. Collaboration is important because no single organization will have the capacity and resources to address all the needs and challenges of a suitable transport corridor project.

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Here in Nigeria, we have recorded a steady decline in HIV prevalence from a peak of 5.8 per cent in 2001 to 3.0 per cent in 2014, But this has not been an easy ride and challenges still exist – condom use is still too low and covers less than half of our need in sub-Saharan Africa. There is a dearth of knowledge on HIV among young people, with only a third having enough HIV knowledge to safeguard themselves

Dr. Sani Aliyu
DG, NACA