Factors associated with poor access to HIV and sexual and reproductive health services in Nigeria for women and girls living with HIV during the COVID-19 pandemic

Aim: To determine the proportion of women and girls living with HIV (WGLHIV) who had poor access to HIV, tuberculosis and sexual and reproductive health (SRH) services in Nigeria during the COVID-19 pandemic and associated factors.Methods: This was a cross-sectional study that recruited WGLHIV with six categories of vulnerability (sex work, transactional sex, injecting or using illegal drugs, people on the move, transgender women and people with a disability) through an online survey conducted in ten Nigerian states between June and October 2021. The associations between the limited access to HIV, tuberculosis and SRH services due to COVID-19, the categories of vulnerability and the financial and non-financial barriers to these services were determined using multivariable logistics regression analysis. Results: Over 6 in 10, almost 2 in 10, and almost 4 in 10 WGLHIV had limited access to HIV, tuberculosis and SRH services respectively during the COVID-19 pandemic. Transgender women had 3.59 (95% CI 2.19­5.91) higher odds, women who engaged in sex work had 4.51 (95% CI 2.28­8.42) higher odds, and women who inject or use illegal drugs had 2.39 (95% CI 1.47­32.90) higher odds of facing limited access to sexual and reproductive health services when it was needed. In addition, the direct consequences of the COVID-19 crisis, such as the closure of HIV services and SRH service points, exacerbated pre-existing barriers significantly. Having no money, having to pay additional unofficial fees and the lack of security on the road to the health facility were the barriers with the greatest impact on access to health services. Conclusions: The COVID-19 pandemic had a negative impact on the access of WGLHIV to essential health services. This impact was disproportionately higher for marginalised groups. WGLHIV need non-discriminatory and affordable access to essential health services during the pandemic.

Associations between COVID-19 vaccine hesitancy and the experience of violence among women and girls living with and at risk of HIV in Nigeria

Aim: Women and girls living with and at high risk of HIV (WGL&RHIV) had an increased risk for gender-based violence (GBV) during COVID-19. The study aimed to assess the associations between vaccine hesitancy and GBV, HIV status and psychological distress among these vulnerable women and girls in Nigeria. Methods: This cross-sectional study collected data from WGL&RHIV in 10 states in Nigeria between June and October 2021. The dependent variable was vaccine hesitancy. The independent variables were the experience of physical, sexual, economic and emotional GBV, HIV status and psychological distress during the COVID-19 pandemic. We conducted a multivariable logistics regression analysis to test the associations between vaccine hesitancy and the independent variables and covariates. Results: Among the 3 431 participants, 1 015 (22.8%) were not willing to be vaccinated against COVID-19. Not knowing or willing to disclose HIV status (aOR 1.40) and having mild (aOR 1.36) and moderate (aOR 1.38) symptoms of anxiety and depression were significantly associated with higher odds of vaccine hesitancy. Being a survivor of intimate partner physical violence (aOR 5.76), non-intimate partner sexual violence (aOR 3.41), as well as emotional abuse (aOR 1.55) were significantly associated with respectively more than five, three and one and half times higher odds of vaccine hesitancy. One positive outcome is that HIV-positive women and girls appeared to be more likely to get the COVID-19 vaccine when available. Conclusions: Sexual and gender-based violence, low socio-economic status, psychological distress and an unknown HIV status are essential determinants of COVID-19 vaccine hesitancy among vulnerable women and girls in Nigeria. National authorities and civil society organisations need to better integrate COVID-19 mitigation activities with HIV and gender-based violence interventions through a more feminist approach that promotes gender equality and the empowerment of women and girls in all their diversity for better access to health services.

The effects of COVID-19 on food insecurity, financial vulnerability and housing insecurity among women and girls living with or at risk of HIV in Nigeria

Aim: Women and girls living with or at high risk of acquiring HIV (WGL&RHIV) in Africa are economically vulnerable. This study aims to advance understanding of the economic impact of COVID-19 on WGL&RHIV and to identify the factors associated with this insecurity.Methods: Data were collected from a cross-sectional survey conducted among a convenience sample of WGL&RHIV in Nigeria between May and September 2021. Logistic regressions enabled the study of the role of HIV status, mental health and macrosocial characteristics (people with disability, transgender women, sex workers, persons engaged in transactional sex, substance users, and people on the move) on economic vulnerability, measured by food, financial and housing insecurity, since the COVID-19 pandemic began. The model accounted for the possible interactions between the macrosocial characteristics and controlled for confounders.Results: There were 3 313 (76.1%) of 4 355 respondents facing food insecurity, 3 664 (83.6%) of 4 385 with financial vulnerability and 1 282 (36.2%) of 3 544 with housing insecurity. Being a member of the key and vulnerable groups was strongly associated with food insecurity, financial vulnerability and housing insecurity, regardless of HIV serostatus. For example, WGL&RHIV engaging in transactional sex were more than four times more likely (aOR 4.42; 95% CI 2.57­7.59) to face housing insecurity and more than twice more likely to face food insecurity (aOR 2.47, 95% CI 1.35­4.52) and financial vulnerability (aOR 2.87, 95% CI 1.39­5.93). This economic vulnerability may reduce their negotiating power for safer sex or the use of HIV prevention methods, exposing them to increased risks of HIV infection. Poor mental health was also associated with the three forms of economic vulnerability.Conclusions: As the long-term impact of the COVID-19 crisis on African economies unfolds, HIV programmes at the country level must include economic vulnerability and mental unwellness mitigation activities for WGL&RHIV

Does social vulnerability for caries predict caries status of children in sub-urban Nigeria?

It is important to identify groups of people vulnerable to a disease condition. Aim: To determine theassociation between social vulnerability to caries and caries status of children in Ile-Ife, Nigeria.Methods: A composite vulnerability index for caries was developed using data generated for 992children. Wilks’ Lambda test to verify relationship between vulnerability and its variables. Logisticregression analysis was conducted to determine if the social vulnerability for caries index was agood predictor for caries status. Results: The social vulnerability to caries index could not predictcaries status. The study found that sex, age and number of siblings were the significant predictorsof caries status in the study population. Females (AOR: 1.63; 95%CI: 1.08 – 2.46; p=0.02) andchildren with more than two siblings had higher odds of having caries (AOR: 2.61; 95%CI: 1.61 –4.24; p<0.001) while children below 5 years had lower odds of having caries (AOR: 0.62; 95%CI:0.39 – 1.00; p=0.05) Conclusions: The social vulnerability index for caries could not predict thecaries status of children in the study population. Sensitive tools to identify children with caries inthe study population should be developed.

Awareness and use of modern contraceptives among physically challenged in-school adolescents in Osun State, Nigeria

This study assessed awareness and use of modern contraceptives among physically challenged in-school adolescents in Osun State, Nigeria. A cross-sectional study was carried out among 215 adolescents in the special schools in the state. A pretested semi-structured questionnaire was administered by trained interviewers. Data analysis was done using SPSS 17 and statistical level of significance was set at p< 0.05. The mean age of the respondents was 15.5years and more than half of them (56%) were males. Only about two fifths of them (38%) had ever heard about modern contraceptives. More males, older adolescents and visually impaired respondents had significantly heard about modern contraceptives compared with females, younger ones and those with other challenges at p-values of 0.026, 0.001 and 0.003 respectively. Only 34% of sexually experienced respondents had used a modern contraceptive method. The male condom was the most commonly used method. Afr J Reprod Health 2014; 18[2]: 87-96)