Nigeria's Mixed Epidemic Balancing Prevention Priorities Between Populations

Published: August 1, 2011

Away from the noisy, crowded streets of Lagos, the sun slowly sets over one of the city’s many beautiful white sand beaches. Hundreds of plastic tables and chairs are scattered across the beach, awaiting the arrival of the Friday night crowd. One of the bars that line the beach turns up the music as the crowd of mainly young males slowly grows.

As darkness approaches, a steady stream of young women emerges from the huts behind the cafes and bars, hovering in the darkness at the shoreline. As the night progresses, hundreds of women appear, all for the same reason—to make money. The beach is one of the city’s many outdoor hot spots for female sex workers.

What is not visible is just as significant. Do the young males fraternizing with the sex workers have girlfriends, wives, or other sex partners? The smell of marijuana wafts through the air, but are the men or women using other drugs, perhaps injecting them nearby? And what about men interested in having sex with other men? Although they may remain hidden to public gaze, they nevertheless manage to find each other.

During the daytime, it is an entirely different scene. The crowds of young men are gone. Instead, outreach workers from a local organization educate female sex workers about HIV and the correct use of condoms, and refer them to the nearby health clinic for HIV testing. Although the program focuses primarily on sex workers, all of the groups that appear at night—people who inject drugs (PWIDs), men who have sex with men (MSM), and clients of sex workers—as well as the larger community need prevention programs. This beach is a microcosm of the challenges of HIV prevention in Nigeria, which—with almost 3 million people living with HIV—has one of the largest HIV burdens in Africa.

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