Reduced stigma and discrimination against PLWHA in Nigeria: A spatio-temporal analysis of 2003-2007 population-based data

Background: People living with HIV and AIDS (PLWHA) often face stigma and discrimination especially in the developing countries. HIV stigma is expressed through social ostracism, personal rejection, direct and indirect discrimination, etc. To curtail the spread of HIV and AIDS, adequate interventions are required to reduce stigma and discrimination against PLWHA. This encourages them to disclose their status and access treatment without fear of intimidation. This paper assesses trend and geographical variations.

Methodology: National HIV/AIDS and Reproductive Health Survey is a population-based national survey in Nigeria which has been conducted three times since 2003. The surveys employed multi-stage sampling techniques for selecting the eligible respondents (male 15-64years, female 15-49years). Descriptive analysis revealed substantial geographical variations at a highly disaggregated level of states, hence the need for a more flexible modeling technique as in this case-study. Analyses are based on Bayesian inference through Markov Chain Monte Carlo technique. This permits us to simultaneously adjust for time and geographical variations (spatio-temporal technique).

Results: A positive significant trend was evident between 2003 and 2007 (p<0.05). This implies that respondents were less likely to stigmatize between 2005 vs. 2003 and 2007 vs. 2003. Other covariates adjusted for included religion, age, rural-urban locality, education, etc. The geographical variations still remain after adjusting for these covariates. While some states were less likely to stigmatize, some stigmatize against PLWHA.

Conclusion: This approach permits an effective utilization of scarce resources which is common in developing countries. Geographical variations also have programmatic implications for designing appropriate HIV prevention intervention.