Nigeria carries one of the largest HIV burdens globally, making the national response a major focus for international efforts to control the epidemic. Progress has been made in recent years, but the country continues to grapple with significant rates of new infections and a large population requiring lifelong care.
Current Epidemiological Landscape
The epidemic is concentrated, showing significant variations across the nation. The estimated national HIV prevalence among adults aged 15–49 is approximately 1.4%, representing about 1.9 million people living with HIV. This total number makes Nigeria the country with the second-highest number of people living with HIV globally.
Geographic distribution of the virus is highly unequal, pointing to regional epidemics rather than a uniform national crisis. The South-South geopolitical zone consistently reports the highest prevalence rate, estimated at 3.1% among adults. In contrast, the North West zone records the lowest prevalence, at 0.6%. This variation is starkly seen at the state level, where states like Akwa Ibom, Benue, and Rivers have prevalence rates exceeding 3%.
Demographic disparities show a disproportionate impact on women. Women aged 15–49 are more than twice as likely to be living with HIV compared to men in the same age bracket. This gender gap is most pronounced among young people, with young women aged 20–24 being over three times more likely to be infected than their male counterparts. In 2023, the National Agency for the Control of AIDS (NACA) reported 75,000 new HIV infections and 45,000 AIDS-related deaths.
Drivers of Transmission and Vulnerable Populations
The persistence of the epidemic is driven by a combination of biological, socio-economic, and structural factors. While heterosexual contact is the primary mode of transmission in the general population, new infections are heavily concentrated within specific Key Affected Populations (KAPs). These groups experience significantly higher prevalence rates than the national average due to a confluence of risk factors and social marginalization.
Prevalence is high among Key Affected Populations (KAPs). The criminalization of associated behaviors, such as same-sex relations and sex work, creates a climate of fear that severely limits access to health services.
- Transgender people (28.8%)
- Men who have sex with men (MSM) (25.0%)
- Female sex workers (FSWs) (15.5%)
- People who inject drugs (PWID) (10.9%)
Poverty and migration patterns increase vulnerability and disrupt care continuity, sustaining the spread of the virus. Low rates of comprehensive knowledge about HIV prevention among young people further contribute to risk-taking behavior. These social determinants, coupled with limited access to targeted prevention tools, allow the epidemic to circulate within both the general and key populations.
Access to Treatment and Prevention Efforts
Nigeria’s response hinges on the widespread availability of Antiretroviral Therapy (ART) and robust prevention programs. Nearly 2 million people living with HIV are currently receiving ART, a substantial achievement that has reduced AIDS-related deaths and new infections. Treatment success is high, with an estimated 95% of those on ART achieving viral suppression, which means the virus is undetectable and cannot be sexually transmitted.
Achieving universal access to treatment remains challenging, with notable gaps in coverage across the country. Some states with very high HIV prevalence, such as Akwa Ibom and Rivers, also demonstrate relatively low ART coverage rates. This disparity highlights a need for better resource allocation and infrastructure development in high-burden areas.
Prevention of Mother-to-Child Transmission (PMTCT) programs are a focus, yet the country is not meeting its targets, with coverage hovering between 35% and 40%. Prevention efforts incorporate advanced tools like Pre-Exposure Prophylaxis (PrEP) and HIV self-testing, which increase convenience and uptake among at-risk populations. These efforts are largely supported by international partners, including the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund.
Addressing Societal Barriers to Care
Beyond the clinical challenges, deeply entrenched societal issues of stigma and discrimination continue to impede a successful HIV response. Fear of social rejection or public exposure prevents many individuals from seeking testing, disclosing their status, or consistently adhering to treatment. People living with HIV frequently report discrimination in their communities, from family members, and even within healthcare settings.
Incidents of health workers displaying discriminatory attitudes, such as providing poor quality care or breaching confidentiality, create significant barriers to trust and utilization of services. Such negative experiences can drive the epidemic underground, making it harder to reach those who need care most. Community-level strategies are therefore necessary to dismantle these prejudices and foster an environment of acceptance.
The government has attempted to address these issues through the enactment of anti-discrimination laws, but enforcement and attitudinal change remain slow. Integrating HIV services into general health systems is a strategy aimed at normalizing testing and treatment, thereby reducing the visibility and associated stigma of seeking specialized HIV care. Advocacy groups composed of people living with HIV play a role in promoting human rights and ensuring that the focus remains on dignity and equitable access.