Exploring the why: risk factors for HIV and barriers to sexual and reproductive health service access among adolescents in Nigeria

Abstract

Background Early sexual debut, low educational attainment, history of rape and transactional and intergenerational sex have been associated with HIV infection among Nigerian adolescents, especially females. We sought to understand the “why”, and how to mitigate against these determinants and barriers to addressing adolescent sexual and reproductive health (SRH) and HIV prevention needs. Methods This qualitative study generated data from 49 focus group discussions with male and female adolescents living with and without HIV, healthcare workers, members of civil society organizations working with young people, and parents of adolescents living with HIV. Participants were recruited from all six geopolitical zones in Nigeria. Data was analysed with ATLAS.ti software. Hermeneutic units were created, and codes developed from focus group transcripts. Network View Manager was used to create maps of codes, memos and quotations, and relevant quotes were retrieved from transcripts. Results Four major themes were identified, relating to individual, parental, community and government roles in reducing the risk of HIV and unplanned pregnancy among adolescents in Nigeria. Individual factors influencing sexual risk behaviours of adolescents include peer pressure, poor risk perception for HIV, and misconceptions about the efficacy of contraceptives and condoms. Respondents entrusted State responsibilities such as facilitation of HIV-affected adolescents’ access to education, rather, to individuals, parents and the community; and placed the blame for rape on rape survivors. Findings also highlighted the inadequacy of health systems to address adolescents’ needs for treatment of sexually transmitted infections and to provide appropriate education on secondary HIV prevention for those living with HIV. Conclusion Rigorous studies are needed to understand dynamics between adolescents’ risk behavior, HIV risk perception, parental roles in mitigating HIV risk in adolescents, and the role of communities and government in HIV prevention and treatment for adolescents in Nigeria.

Associations between mental health and HIV status among sexual minority and heterosexual adolescents in Nigeria

“…The ubiquitous application of the Act represents a stark exemplar of the cultural and political institutionalisation of such exclusion, which perpetuates barriers to sexual minority individuals accessing social, health and other relational and asset-based support in their communities 59. In addition, limitations in access to healthcare services due to parental consent requirements further complicate issues for sexual minority adolescents 56 60–62…”

Prevalence and predictors of HIV testing among young men in Papua New Guinea: a cross-sectional analysis of a nationally representative sample

“…The primary outcome variable of this study was “ever tested for HIV?” and was dichotomized as “0” for “no” or “1” for “yes.” The explanatory variables were selected based on the literature and their relevance [18–20] and were divided into three categories: (1) Sociodemographic factors include age, marital status, educational level, employment status, wealth index, region, and place of residence. Also, household factors measured included exposure to mass media (listening to the radio and watching television), access to the internet, and mobile phone ownership.…”

“…Young people comprise a heterogeneous group whose sexual behaviors and susceptibility to HIV infection differ widely by social context, including increased individual autonomy and a lack of social control [8,9]. There is growing evidence that high-risk behaviors such as early sexual debut, substance use (alcohol consumption and drug use), inconsistent condom use, and multiple and concurrent sexual relationships, as well as poor HIV knowledge, low-risk perception, and sensation-seeking behaviors, increase HIV risks and transmissions among young people [10][11][12][13][14]. In addition, biological factors such as low rates of male circumcision [15,16] and manifestations of other sexually transmitted infections (STIs) (chlamydia, gonorrhea, syphilis, and trichomoniasis) [11,14,17] contribute to some of the increased HIV risk and burden among this population.…”

“…There is growing evidence that high-risk behaviors such as early sexual debut, substance use (alcohol consumption and drug use), inconsistent condom use, and multiple and concurrent sexual relationships, as well as poor HIV knowledge, low-risk perception, and sensation-seeking behaviors, increase HIV risks and transmissions among young people [10][11][12][13][14]. In addition, biological factors such as low rates of male circumcision [15,16] and manifestations of other sexually transmitted infections (STIs) (chlamydia, gonorrhea, syphilis, and trichomoniasis) [11,14,17] contribute to some of the increased HIV risk and burden among this population. They continue to be an important target group for HIV prevention and STI surveillance due to their unique behavioral and social-related vulnerability.…”

A qualitative insight into researchers’ perceptions of gender inequality in medical and dental research institutions in Nigeria

“…Three areas in which gender equality can foster progress is in science, education, and health [ 2 ]. Medical and dental researchers stand at the fulcrum of social development through their engagement in these three domains [ 3 ]. They also contribute to economic development through their work on understanding disease and promotion of medicine, vaccines, diagnostics, and effective public health messages.…”