CHAPTER ONE

1.0 Background of the Study

The Human Immunodeficiency Virus (HIV) was identified in 1983, 2 years after the

first five cases of the Acquired Immunodeficiency Syndrome (AIDS) were reported by the

Centers for Disease Control and Prevention (CDC). According to the World Health

Organization, HIV is an infection that attacks and destroys the infection-fighting CD4

cells (CD4 T lymphocyte) of the immune system. The loss of CD4 cells makes it difficult for

the body to fight off infections, illnesses, and certain cancers. Without treatment, HIV can

gradually destroy the immune system, causing health decline and the onset of Acquired

immunodeficiency syndrome (AIDS), which is the most advanced stage of the disease.

The symptoms of HIV vary depending on the stage of infection. The disease spreads

more easily in the first few months after a person is infected, but many are unaware of their

status until the later stages. In the first few weeks after being infected people may not

experience symptoms. Others may have an influenza-like illness including: fever, headache,

rash, sore throat. The infection progressively weakens the immune system. This can cause

other signs and symptoms like swollen lymph nodes, weight loss, fever, diarrhoea and cough.

Without treatment, people with HIV infection can also develop severe illnesses such as

tuberculosis (TB), cryptococcal meningitis, severe bacterial infections, cancers such as

lymphomas and Kaposi's sarcoma.

HIV can be transmitted through the exchange of a variety of body fluids from people

living with HIV, such as blood, breast milk, semen and vaginal secretions. HIV can also be

transmitted during pregnancy and delivery to the child. People cannot become infected

through ordinary day-to-day contact such as kissing, hugging, shaking hands, or sharing

personal objects, food or water. It is important to note that people with HIV who are taking

antiretroviral therapy (ART) and have an undetectable viral load do not transmit HIV to their

1
sexual partners. Early access to ART and support to remain on treatment is therefore critical

not only to improve the health of people with HIV but also to prevent HIV transmission.

HIV infection has spread over years since the beginning of the epidemic and has

posed a significant impact on health, welfare, employment and criminal justice sectors;

affecting all social and ethnic groups throughout the globe. Epidemiological data have

indicated that HIV remains a global public health issue that persistently drains our economic

sector having claimed about 40.4 million [32.9–51.3 million] lives so far with an ongoing

transmission globally. (WHO Fact Sheet, 2023). By the end of 2022, the estimated overall

number of People Living with HIV (PLWHIV) worldwide was approximately 39.0 million

[33.1–45.7 million], with Sub-Saharan Africa being the most affected region, having 25.6

(24.0–28.7) million of PLWHIV, that is, nearly 1 in every 25 adults (3.2%) living with HIV,

thus, accounting for more than two-thirds of the people living with HIV worldwide.

The first two AIDS cases in Nigeria was diagnosed in 1985 and

reported in 1986 in Lagos, one of which was a young female sex worker

aged 13 years from one of the West African countries (Nasidi and Harry,

2006). Caldwell et al. (1992) claim that the early under reaction to AIDS was caused by the

syncretic aspect of African religion, which holds that events are multicausal and that death is

predestined in timing. This fatalistic attitude allowed some people to remain in denial about

the epidemic. However, People's actions when seeking medical attention and taking

precautions to avoid infection are ultimately influenced by their beliefs regarding the cause of

diseases. Many Nigerians think that illnesses have more complicated roots than what

contemporary medicine suggests.

The complexity of the HIV/AIDS epidemic stems from its links with all aspects of

society and culture. (Smith et al., 2002). In addition to having an impact on the effectiveness

2
of preventative measures and the level of compassion shown to infected individuals, social

and cultural factors also have a significant impact on the viral transmission.

Culture is one of many factors influencing human behavior; it is a determinant of

socially accepted behavior, value systems, beliefs, and practical knowledge. Culture is deeply

rooted in all aspects of a society, including local perceptions of health and illness and health

seeking behaviors. However, culture in the broader sense, includes also traditions and local

practices, taboos, religious affiliations, gender roles, marriage and kinship patterns, and so

forth. (Körner, 2007).

The activities through which society defines and identifies itself are unique but many

and vary from society to society. These activities manifest themselves through values norms

beliefs and practices which may have positive and negative implication for the wellbeing or

otherwise of the population. Most of these cultural norms and practices are related to human

sexuality while others are related to day to day activities or practices of the society. (Maxim

et al., 2011). Some of these cultural norms and practices relating to sexuality contribute to the

risk of HIV infection. Some of these practices include but are not limited to early marriage,

polygamy, multiple and concurrent sex partners, delivery outside the health

facility without a skilled birth attendant, female genital mutilation,

unsterile traditional bloodletting and traditional marking and tattooing,

among others.

In Nigeria, HIV prevalence clearly varies by states. While HIV/AIDS

tends to be generally low in most parts of the country, the highest

numbers of HIV prevalence were found mostly in Benue, FCT, Anambra,

Bayelsa and Akwa Ibom States of the federation. These marked

differences in the prevalence rates among these states could be due to a

number of factors including but not limited to cultural differences, varying

3
levels of education, religion and differing socioeconomic structures.

Indeed, there must be interplay of these factors on HIV/AIDS outcomes in

these states. The variations in socio-cultural and religious practices

among about 400 different ethnic groups in Nigeria have implications on

the risk of HIV transmission. Notably, some practices that include multiple

and concurrent sex partners, delivery outside the health facility without a

skilled birth attendant, female genital mutilation, unsterile traditional

bloodletting and traditional marking and tattooing will lead to an increase

in the risk of HIV transmission (Nigeria National Agency for the Control of

AIDS, 2010).

According to Adeokun (2006), in Nigeria, about 95% of HIV infections are due to

heterosexual transmission, where having multiple sexual partners has been a major behavioral

element fuelling the epidemic. However, there is also a close relationship between culture

and other routes of transmission. Mother-to-child transmission of HIV is an inevitable aspect

of the unfolding epidemic due to high fertility choices, heightened female infection rates, and

low levels of voluntary counseling and testing (VCT). Also, significant portions of the

impoverished urban and rural populations are exposed to unscreened blood due to the uneven

distribution of HIV screening programs. Additionally, a sizable number of people are at risk

of infection via nonsexual traditional practices, particularly the male and female

circumcision, and the custom of creating facial and body markings with shared, non-sterile

skin-piercing tools. (Okochi et al., 2000).

However, in addressing this sociocultural and economic divide; The

Joint United Nations Program on HIV/AIDS emphasized the need to address

the sociocultural behaviours and values of communities that expose

individuals to HIV risk behaviours. This approach is believed would lead to

4
effective HIV/AIDS intervention strategies (UNAIDS, 2006). Furthermore,

UNAIDS (2002) noted that sexual behaviour is the most important factor

influencing the spread of HIV in Africa, Nigeria in particular and that

behaviour varies greatly across cultures, age groups, socio-economic class

and gender.

Orubuloye and Oguntimehin (1999) demonstrated that this indifference to the

prospect of death produces a high risk-taking sexual culture among men and little behaviour

change in response to HIV prevention interventions. The reluctance to talk about sex within

marriages and between generations also has delayed the public health response to a sexually

transmitted epidemic. Many Nigerians believe that fertility-associated diseases are in a

special category, treatable by indigenous practitioners. Wasting, a dominant feature of AIDS,

also is perceived as linked to witchcraft. The alien image of AIDS adds to its stigma and

encourages the perception of AIDS as retribution for those who engage in immoral activities.

Pricilla et al. (2003) stated that sexual behavior is influenced by the social and

cultural context in which an individual lives, suggesting that socio-cultural attitudes and

practices appear to be the main drivers of sexual activity in sub-Saharan Africa. This is

supported by the reality that HIV prevalence rates varies based on the geographic location,

owing to the fact that every community has its own distinctive cultural practices. Studies on

HIV transmission and culture carried out in South Africa and Nigeria reveal a connection

between HIV transmission and cultural practices. Some of the cultural practices that

researchers have looked into and which have been proven to have impact on HIV

transmission are polygamy, wife inheritance, dry sex, and virginity testing, among others.

Wife inheritance and widow cleansing is practiced among many African

countries notably Uganda, Malawi, Zambia, Ghana, Senegal, Cote d’Ivore,

Democratic Republic of the Congo (DRC) and Nigeria. It is well recognized

5
that these practices play vital roles in the rapid spread of HIV infection in

the aforementioned nations. (Kawango et al, 2010). The obligation to fulfil

societal expectation and gender roles creates room for individual to

engage in unprotected sex even when the serostatus of the individual is

not known. This reality undoubtedly puts the participants at the risk of HIV

infection. Despite the campaigns for HIV and AIDS awareness and

education, it is clear that these efforts have simply raised awareness but

have not been enough to stop the spread of HIV transmission.

1.1 Statement of Problem

Nigeria ranks third among countries with highest burden of HIV infection in the

world, reporting over 1.9million people living with HIV, 1.3% of which are adult, with over

74,000 of new reported cases, and 51,000 AIDS-related deaths. (WHO Fact Sheet, 2023)

According to a recent community diagnosis carried out in some parts of Asa Local

Government Area of Kwara state by the Clinical Care and Clinical Research, Nigeria

(CCCRN), a Non-Governmental Organization, it was observed that at least 4 of every 10

people (40%) screened for HIV in these communities are reactive i.e. tested positive to

having contracted the virus. These figures are much higher than the 2.2% prevalence rate

among the general population of Kwara state reported by Ahmed et al., (2021), and also

much more higher than that of the Kwara State AIDS Control Agency’s (KWASACA) claim

in 2023, that the state has a prevalence of 1%. Hence, this poses a great threat to public health

and the overall wellbeing of the people within and outside these communities, and the urgent

need for a study to understanding the socio-cultural dynamics that may have influenced HIV

prevalence in these LGA differently compared to other parts of the state.

6
1.2 Justification of the Study

HIV continues to pose a significant public health burden globally,

and Nigeria is one of the countries heavily affected. Also, Asa LGA of

Kwara state has its unique socio-cultural dynamics that may influence HIV

prevalence differently compared to other regions. Therefore, conducting

this study in selected communities within Asa LGA will provide context-

specific insights that can inform local policies and programs, as well as

help provide more understanding of the socio-cultural factors contributing

to HIV transmission, which is a crucial component for designing targeted

interventions and prevention strategies.

While various studies have explored biomedical and clinical factors

contributing to HIV transmission, there is still a gap in understanding the

behavioural and socio-cultural determinants, particularly within Asa LGA,

Kwara state. This study seeks to fill this gap by providing empirical

evidence on how socio-cultural factors shape HIV prevalence.

Findings from this study will not only contribute to the academic

literature but also provide actionable insights for policymakers, public

health practitioners, and community leaders. Tailoring interventions to

address socio-cultural barriers can enhance the effectiveness of HIV

prevention and control efforts in Kwara state.

1.3 General Objectives

The general objective of this study is to investigate the sociocultural

factors influencing the prevalence of HIV in Asa Local Government Area,

Kwara State.

1.3.1 Specific Study Objectives

7
a) To assess the level of awareness and knowledge about HIV among the residents of

Asa LGA, Kwara state.

b) To identify cultural beliefs and practices related to HIV transmission

and prevention within Asa LGA, Kwara state.

c) To examine the impact of sociocultural norms on HIV testing, treatment and care-

seeking behaviour in Asa LGA, Kwara state.

d) To recommend culturally appropriate interventions and strategies for mitigating the

prevalence of HIV in Asa LGA, Kwara state.

1.4 Research Question

i. What are the predominant sociocultural practices in Asa LGA that influence the

spread of HIV?

ii. Do residents of Asa LGA, Kwara state have adequate knowledge on HIV?

iii. How does the level of awareness and knowledge about HIV in Asa LGA affect its

prevalence?

iv. What role do gender norms and relations play in the transmission of HIV in Asa

LGA?

v. How do religious beliefs and practices impact HIV prevention and treatment in Asa

LGA?

vi. How effective are local health interventions and policies in addressing sociocultural

factors related to HIV in Asa LGA?

8
References

Adeokun L. (2006). Social and Cultural Factors Affecting the HIV Epidemic. AIDS in

Nigeria. 151-173

Caldwell J. C., Orubuloye I. O., Caldwell P. (1992). Underreaction to AIDS in sub-Saharan

Africa. Soc Sci Med; 34 (11): 1169–1182.

Joint United Nations Programme on HIV and AIDS, (2004). Epidemiological Fact Sheet on

HIV/AIDS and Sexually Transmitted Infections in Nigeria: An update.

Joint United Nations Programme on HIV/AIDS (UNAIDS). (2002). Report on the Global

AIDS Epidemic 2002. Geneva.

Joint United Nations Programme on HIV/AIDS (UNAIDS). (2006). The 2006 Report on the

Global AIDS Epidemic. Geneva, Switzerland.

Körner, Henrike. (2007). Negotiating Cultures: Disclosure of HIV-Positive Status among

People from Minority Ethnic Communities in Sydney. Culture, Health &

Sexuality 9.2; 137-152.

Maxim C., Zongkui Z., Junmei X. (2011). Socio-Cultural Factors Affecting the Spread of

HIV/AIDS among Adolescents in Sierra Leone. The social sciences 6 (4); 269-276.

Nasidi, A., Harry, T.O. (2006). The Epidemiology of HIV/AIDS in Nigeria. In: Adeyi, O.,

Kanki, P.J., Odutolu, O., Idoko, J.A. (Eds.), AIDS in Nigeria: A Nation on the

Threshold. Harvard Center for Population and Development Studies, Cambridge

(Massachusetts).

Nigeria National Agency for the Control of AIDS. (2010). National HIV/AIDS Strategic Plan

2010–2015. Nigeria National Agency for the Control of AIDS, Abuja, Nigeria.

Okochi C. A., Oladepo O., Ajuwon A. J. (2000). Knowledge about AIDS and sexual

behaviors of inmates of Agodi prison in Ibadan, Nigeria. Int Q Community Health

Educ; 19 (4): 353–362.

9
Orubuloye I. O., Oguntimehin F. (1999). Death is preordained, it will come when it is due:

Attitudes of Men to Death in the Presence of AIDS in Nigeria. In: Caldwell JC,

Caldwell P, Anarfi J, et al., eds. Resistances to Behavioural Change to Reduce

HIV/AIDS Infection in Predominantly Heterosexual Epidemics in Third World

Countries. Australia: Australian National University, National Centre for

Epidemiology and Population Health, Health Transition Centre; 101–111.

Priscilla A. A., Nyovani J. M., & Andrew H. (2003). Perception of Risk of HIV/AIDS and

Sexual Behaviour in Kenya. Journal of Biosocial Sciences. 35; 385-411

Smith J., McFadyen L, Zuma K, Preston-Whyte E. (2002). Vaginal Wetness: An

Underestimated Problem Experienced by Progestogen Injectable Contraceptive. Soc.

Sci. Med; 55 (9):1511–1522.

World Health Organization Fact Sheet, (2023).. Global Update on HIV Epidemic, Geneva.

World Health Organization Fact Sheet. (2014). Global Update on the Health Sector Response

to HIV, Geneva.

10