In Nigeria, the first case of HIV/AIDS was reported in 1986. HIV prevalence declined from 6% in 2001 to 4.3% in 2005, 4.2% in 2008, and 4.1% in 2010. HIV response in Nigeria was health sector driven from 1986–1989,, but a multisectoral response commenced in 2000. Funding for the HIV response in Nigeria is obtained from both domestic (Federal Government of Nigeria, private sectors and state governments) and international sources like the U.S. Government, DFID, UN agencies, and global funds. It is pertinent to determinethe percentage of HIV-infected patients who require ART at registration vis-à-vis percentage benefiting from care services in order to appreciate progress made in reaching out to those in need of accessing care and treatment.
In Nigeria, prevalence among young women aged 15–24 years is estimated to be three times higher than among men of the same age. Females constitute 58% (about 1.72 million) of persons living with HIV in Nigeria and each year, 55% of AIDS death occurs among women and girls [2
] The female:male ratio in the present study of 1.6
1 is similar to 1.8
1 obtained by Omoti et al. [20
] in Benin City, Nigeria. The disparity in gender prevalence is age dependent as reported by Glynn et al. [21
] who reported HIV prevalence was six times higher in women than in men amongst sexually active 15–19 years old, but it drops to three times that in men among 20–24 years old and equal to that of men among 25–49 years old. The present study did not consider age in groups in relation to gender and HIV status. However, 59.7% of the studied population was between 31–50 years, a ratio of F
M of 1.6
1 obtained was, therefore, similar to 1
1 reported by Glynn et al. in those between 25–49 years. Generally, females are more predisposed to contracting HIV because of pregnancy or use of oral contraceptive, conditions which induced cervical ectopia in which there is replacement of squamous by columnar epithelium, thus increasing the risk of HIV infection for women 5-fold. Sexual intercourse during menstruation and presence of genital ulcer also increases the risk of HIV infection in females. Pelvic inflammatory disease predisposes to microulceration of the genital tract thus increasing risk of HIV infection. Culturally, the majority of males in this part of the world are circumcised, male circumcision affords some degree of protection, perhaps due to large numbers of langerhans cells in foreskin, so that the incidence of infection is reduced 8-fold over uncircumcised men [22
]. Glynn reported that, despite all the predisposing factors in females, women married younger than men, and marriage was a risk factor for HIV, women often had older partners and men rarely had partners much older than themselves.
The mean ages of 35.01 ± 9.34 years and 37.73 ± 9.48 years for females and males, respectively, obtained in this study are similar to earlier study [21
] of 34.41 ± 8.87 and 38 ± 9.35 for females and males, respectively, and also similar to 38 years reported by Omoti et al. [20
] in both genders. This is understandably so because the majority of patients in HIV clinic are between 31–50 years being the age when sexual activity is at its peak.
This study reported mean CD4 counts in HAART-naïve, HIV positives of 268.05 ± 230.44 and 317.55 ± 254.72 cells/mm3
, respectively, for males and females and an overall mean of 298.76 ± 246.93 cells/mm3
. This could be compared with 303.16 ± 234.32 cells/mm3
and 308.24 ± 232.2 cells/mm3
, respectively, for males and females and an overall mean CD4 count of 306.65 ± 232.24 cells/mm3
reported by Akinbami et al. in an earlier study [23
]. In both studies, females were found to a have a higher CD4 count than males.
Oladepo et al. [24
] established in healthy Nigerian adults a reference value for CD4 of 365 to 1,571 cells/μ
L. with a mean CD4 count of 847 cells/μ
L similar to the mean value of 828 cells/μ
L reported by Aina et al. [25
] in an earlier study in Nigeria. Females were found to have significantly higher values of absolute CD4 counts in Oladepo's study in contrast to the earlier limited study by Aina et al. in Nigeria. This observation of higher CD4 count in females was also reported in several other countries among Nigerians [26
], Ugandans [27
], and Ethiopians [28
]. A sex hormone effect is one possible explanation for the reported difference in CD4 counts between genders that has been suggested [28
Using the 350 cells/mm3
CD4 count as cutoff from 2010 WHO [14
] revised guideline for initiation of therapy in asymptomatic HIV patients, 72.3% males, 64.3% females and 67.4% overall registered patients require treatment on enrollment, while only 15.1% males, 20.3% females, and 18.3% overall registered patients with CD4 count >500 cells/mm3
may require antiretroviral therapy deferral at registration.
In Sub-Saharan Africa, an estimated 10 million need treatment in 2010, only 5 million received it [1
]. In Nigeria as at 2009, only 31% of people living with HIV have access to care services [29
], the government, through the National HIV/AIDS strategic framework for 2005–2009, set out to provide ARV to 80% of adults and children with advanced HIV infection and 80% of HIV-positive pregnant women, all by 2010 [30
ARV treatment coverage in Nigeria remains low, the slow progress led to revising the strategic framework, and resetting treatment goals in its revised 2010–2015 framework [31
]. By 2010, only a quarter of adults and 7% of children in need of treatment received it. Currently, 1.4 million adults and 262,000 children eligible for antiretroviral treatment remain without it [1
In Africa, Botswana at the end of 2010 has the highest coverage rate around 93%, other countries that have achieved more than 80% coverage are Rwanda and Namibia [1
]. Access to antiretroviral therapy in Somalia is the lowest in Africa at 3% while only 55% of those in need in South Africa are receiving it [32
Cameroon, Cote d'Ivoire, Chad, Nigeria, and Ghana are some of the countries in Sub-Saharan Africa where between 20–39% of people requiring antiretroviral drugs are receiving them [1
Being a retrospective study, some of the limitations of this study is the nonavailability of data on clinical manifestations of the patients, lack of data on records of distribution of the CD4 count, and percentage in need of treatment per year and lack of information on HIV risk factor, area of residence, family income, and marital status.
Extra efforts must be made by the Nigerian Government at all levels to meet the need of people living with HIV/AIDS eligible for treatment so as to reduce the spread of the pandemic.