Evaluating the Impact of Health System Strengthening on HIV and Sexual Risk Behaviors in Nigeria

October 2015 - Structural Prevention

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Eluwa, G.I., Adebajo, S., Idogho, O., et al. Journal of Acquired Immune Deficiency Syndromes (September 2015), 70(1): 67–74, doi: 10.1097/QAI.0000000000000701.

The Enhancing Nigeria’s Response to HIV/AIDS health system strengthening (HSS) project was launched in 2009 to reduce the prevalence of HIV in focus states across the country. This study evaluated the impact of this HSS initiative on HIV prevalence and sexual risk behaviors in the general population in seven states, and compared outcomes in the HSS states to those of seven socio-demographically similar control states. A total of 4,856 and 11,712 respondents were surveyed in 2007 and 2012, respectively. HIV prevalence in HSS and non-HSS states was 6.3 percent versus 5.3 percent, respectively, in 2007; and 2.96 percent versus 5.08 percent in 2012. Prevalence in rural regions declined between 2007 and 2012 in HSS states (from 7.58 percent to 5.93 percent), but increased significantly in non-HSS states (from 2.46 percent to 4.81 percent). Moreover, respondents in HSS states were more likely to report using condoms consistently in the past three months with a boyfriend or girlfriend, and had more comprehensive HIV knowledge. The authors concluded that HIV prevalence decreased, and sexual risk behaviors declined, in HSS states between 2007 and 2012, and called for wider rollout of HSS intervention in order to achieve greater success.

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