| Abstract|| |
Background: Human immunodeficiency virus (HIV), the pathogen responsible for the acquired immunodeficiency syndrome and the most significant emerging infectious disease is causing health, social, and developmental problems to mankind. Aims, Setting and Design: This is a cross-sectional study to evaluate the socio-demographic characteristics of adults screened for HIV infection in Ahoada Community in Rivers State in the Niger Delta of Nigeria. Materials and Methods: HIV antibodies were detected using "Determine" (Abbott Laboratories, Japan), Start-Pak (Chembio Diagnostics, USA) and SD Bioline HIV-1/2 kits (Standard Diagnostics, Korea). All test procedures were carried out according to the manufacturers' instructions. Subjects included 152) consecutively recruited adults consisting of 955 females and 566 males aged 18-54 years with a mean age of 36.257.02 years. Statistical Analysis: Data were entered and analyzed using statistical package SPSS version 9. A P-value ≤0.05 were considered statistically significant in all statistical comparisms. Results and Conclusion: Out of a total of 1521 persons screened for HIV infection, 162 persons tested positive for HIV (10.6%). HIV infection was higher among females (10.9%) compared to males (10.1%) and in the 25-34 and 45-60 years age groups (11.1%) (P= 0.08). HIV-1 was the predominant subtype (74%) compared to 26% for dual HIV-1 and 2. This study indicates the urgent need for both government and non-governmental organizations to intensify awareness campaign programme to reduce the spread of the HIV infection in the area with emphasis on behavioral change and economic empowerment of the people as well as provision of universal access to antiretroviral therapy for those with HIV infection.
Keywords: Ahoada, HIV infection, Socio-demography, Niger delta, Nigeria
|How to cite this article:|
Obi A, Osaro E, Nnenna FP. Socio-demographic characteristics of adults screened for human immunodeficiency virus infection in Ahoada-East local government area in the Niger Delta of Nigeria. J Global Infect Dis 2011;3:334-8
|How to cite this URL:|
Obi A, Osaro E, Nnenna FP. Socio-demographic characteristics of adults screened for human immunodeficiency virus infection in Ahoada-East local government area in the Niger Delta of Nigeria. J Global Infect Dis [serial online] 2011 [cited 2020 Aug 8];3:334-8. Available from: http://www.jgid.org/text.asp?2011/3/4/334/91053
| Introduction|| |
Human immunodeficiency virus (HIV), a member of the Lentivirus genus and family Retroviridae that was unknown until first discovered in 1981 among homosexual men in the United States.  The HIV is the pathogen responsible for the acquired immunodeficiency syndrome (AIDS) which is marked by a steady decline in the capacity of the body to fight infections and has been adjudged the most significant emerging infectious disease of the last century and continues to create health, social, and developmental problems particularly in Africa.  The HIV pandemic is one of the most serious health crises faced by the world today. An estimated 33.4 million people were living with HIV infection as at 2009.  In Nigeria, the prevalence of HIV has increased from 1.8% in 1991 to 3.8% in 1993, 4.5% in 1999, 5.8%, 5.0% in 2003, 4.4% in 2005 and 4.6% in 2008. 
Currently, two genetically and immunologically distinct human immunodeficiency viruses are known. They are HIV-1 and HIV-2.  HIV-1 is more virulent and has the widest distribution in Europe and America, while HIV-2 has the widest distribution in West Africa.  In developing countries, the major modes of transmission are: heterosexual sex, mother to child transmission (perinatal transmission), transfusion of infected blood and blood products, and through the use unsterilized sharp instruments like syringes, blades and needles.  Several factors contribute to the spread of HIV infection in Africa. Poverty, cultural belief, and refusal to use condoms, , maintenance of multiple sexual partners, polygamy and sharing of sharp objects such as razor blades used for circumcision.  and sexual violence. 
In Nigeria, the studies on HIV infection have concentrated on cities and not in the rural areas. Access to medical care and antiretroviral treatment are often concentrated in the cities or urban areas. Also the seroprevalence of HIV among pregnant women, a less vulnerable group is being used as indicator of the prevalence of HIV in Nigeria. This may not be a true reflection of the pandemic coupled with the fact that it shows a female gender bias. This cross-sectional population-based study was carried out to assess the socio-demographic characteristics of adults screened for HIV infection in Ahoada-East local government area in the Niger Delta of Nigeria.
| Materials and Methods|| |
This population-based cross-sectional study was carried out to determine the socio-demographic characteristics of adults residing in Ahoada East Local Government area of Rivers State Nigeria screened for HIV infection. The area is a rural local government council with a population of over 178,279 people (National Population Commission, Abuja, Nigeria, 2008) spread among -52 villages which collectively harbor 16 health centers, 1 general hospital, and 14 private clinics. The people belong to the Ekpeye speaking ethnic group. The main occupation of people in the area is farming, fishing, and trading. Inclusion criteria included age ≥18 years, residence in Ahoada Local Government Area and willingness to give a written informed consent to partake in the study after counseling. Demographic data such as age and sex were collected via an interview-administered questionnaire. Written informed consent was obtained from all subjects. Pre- and post-HIV test counseling was offered to all subjects. Ethical approval was obtained from the ethics committees of the various health facilities. Subjects consisted of 955 females and 566 males. The age range was 18-54 years (mean age 36.25±7.02 years).
HIV screening was carried out using a double enzyme-linked immunosorbent assay (ELISA) method using Determine and Stat-Pak HIV-1 and -2 kits. The determine HIV-1 and -2 kits (Abbott Laboratories, Japan) is an in vitro, visually read, qualitative immunoassay for the detection of antibodies to the human immunodeficiency virus type-1 (HIV-1) and type-2 (HIV-2) in human serum, plasma, and whole blood. All initially sero-positive samples were confirmed using the Stat-Pak HIV-1 and -2 (CHEMBIO Diagnostic Systems Incorporated, United States of America). The kit is based on the immune chromatographic technique that employs a unique combination of a specific antibody binding protein conjugated to a colloidal gold dye particle and HIV-1 and -2 antigens which are bound to the membrane solid phase. Thus, in a zero-positive sample, the dye conjugated-immune complex migrates on the nitrocellulose membrane and is captured by the antigens immobilized in the test membrane producing a pink/purple line. All zero-positive samples were screened for HIV sub-type using SD Bioline HIV-1 and -2 (Standard Diagnostics Inc., Kyonggi-do, Korea) which differentiates HIV-1 and -2 infections. The SD Bioline HIV-1 and -2 test as an immunochromatographic rapid test for the qualitative detection of all antibodies of all isotypes (IgG, IgM, and IgA) specific to HIV-1 including subtype O and HIV-2 simultaneously in human serum or plasma.
Five milliliters of whole venous blood was collected from the anticubital vein of each study subject into a gel tube without anticoagulant. Sample was allowed to clot, centrifuged, and the serum samples were separated and stored at -20°C till the time of analysis.
Data were entered and analyzed using statistical package SPSS version 9 (SPSS Inc., Chicago, IL, USA). Statistical analysis included descriptive analysis of mean, standard deviation, and Chi-square analysis. A P value of ≥0.05 was considered to be statistically significant in all statistical analyses.
| Results|| |
This cross-sectional study was carried out on 1521 consecutively recruited persons visiting the various health centers at Edeoha, Ula-Upata, Ochigba, Ahoada comprehensive health center and Ahoada General Hospital consisted of 955 females and 566 males. The aim of this study was to evaluate the socio-demographic characteristics of adults screened for HIV infection in Ahoada East Local Government area of Rivers State Nigeria. Out of a total of 1521 persons screened, 162 persons tested positive for HIV (10.6%), while 1359 samples were negative (89.4%). The prevalence of HIV was higher in the 25-34 and 45-54 years age groups (11.1%) (P=0.08). [Figure 1] shows the distribution of HIV infection based on age groups.
[Figure 2] shows the distribution of HIV infection based on gender and age groups. HIV prevalence was highest in the 25-34 years age groups among males and in the 45-54 years age group among females.
|Figure 2: Distribution of HIV based on gender and age groups of subjects|
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[Figure 3] shows that the distribution of HIV infection based on gender. The prevalence of HIV was higher among females (10.9%) compared to males (10.1%).
[Figure 4] shows the distribution of HIV infection based on the viral subtype. HIV-1 was the predominant subtype among subjects positive for HIV infection (74%) compared to 26% prevalence for dual HIV-1 and 2. None of the HIV positive subjects was positive for HIV-2.
| Discussion|| |
In this hospital-based study, we observed an overall HIV prevalence of 10.6%. Our observed prevalence is higher than the national prevalence of 4.6% obtained in the 2008 sentinel surveillance.  The higher value obtained from our study may be borne from the fact that our study was hospital- based and included patients referred to the health centers and general hospital sometimes based on existing medical grounds. However, it may be a better indication on the degree of the pandemic in the community compared to the prevalence among less vulnerable pregnant women who are the target group screened for HIV infection and used as indicator of the prevalence of HIV in Nigeria. Another disadvantage is the fact that there is a female gender or age group bias. There are several reasons for the high HIV prevalence observed in Ahoada-East local government area of Rivers State, Nigeria. Several studies in Nigeria have confirmed that young adults in Nigeria are sexually active at an early age, engaging in pre-marital sex, prone to high risk behavior; maintenance of multiple sex partners, having unprotected sexual intercourse, alcohol, and intravenous drug use. ,, Traditional African values which places emphasis on chastity has been eroded and "permissive" western culture and attitudes to sexual issues are being adopted with the net result of increased sexual promiscuity and HIV infection.
We obtained a higher prevalence of HIV among the 25-34 and 45-54 years age groups. Previous report has found a higher HIV prevalence in the 20-24 years age group.  Young adults in the 25-34 years age group are more sexually active and are more prone to high risk sexual behaviors that make them prone to infection with HIV. Older men preference for sex with young girls and socioeconomic factors prevalent in Ahoada East Local Government area including young female lack of access to education, employment, or personal income drive young ladies into monetary sex with older men who offer them money in return for sex.  Cultural myth in some places in Africa that having sex with a virgin can free a man from HIV infection has led to child rape and to older HIV-infected men seeking sex with young girls.
We observed a higher female gender predisposition to HIV infection. This finding parallels data obtained from other sub-Saharan African countries which indicated a female gender vulnerability to HIV infection. , Biological, cultural, and socioeconomic factors contribute to this female gender vulnerability to HIV infection. Globally females are four times more at risk of becoming infected with HIV especially among young adult females whose vagina is not fully mature and prone to laceration during unprotected vaginal intercourse coupled with the vagina greater area of susceptible tissue.  Cultural traditions such as forced marriage, polygamy, older men preferences for sex with younger women, female genital mutilation all prevalent in the area contribute to women's lack of power and predisposition to HIV infection.  Gender inequality compounded by poverty that puts women at risk of exploitation, makes it difficult for women to insist on condom use with their spouses or sexual partners even if they know that their polygamous or promiscuous partner's behaviour puts them at risk of contracting HIV. , Refusal to use condoms is one of the factors that contribute to the spread of HIV infection among African communities. Microbicides may be a possible prevention approach to HIV prevention among African women in the light of poor condom use. There is the dire need to pursue research into the development, provision, and the use of microbicides for African women in communities like Ahoada. The economic burden that HIV poses to the population of the area can only be imagined since the culture and tradition of the people of the area entrusts the sole responsibility of farming and fishing on women who do peasant farming with little to sell particularly when in surplus to meet the family needs. HIV infection will reduce productivity and low income yield for those families who depend solely on farming for livelihood.  More importantly, HIV infection places an economic burden on families whose relatives are hit by this scourge and thus expose children to risk of early marriage, sexual harassment, child hawking, and trafficking in order to get money for treatment of relatives who are infected by HIV.  Perhaps, the effect of the HIV scourge in Ahoada-East local government area cannot be over-looked because with more people falling sick, the available health facilities will be over-stretched and government will be left with no choice but to divert funds which would have been used for other developmental projects like building of schools, roads and provision of good drinking water to focusing on health care and orphanages to carter for children that may have been orphaned by the death of their parents or guardian due to HIV infection and related diseases. 
Our study found HIV-1 as the predominant viral subtype among the subjects positive for HIV. A significant number of subjects (26%) had dual HIV-1 and -2 infections. This finding is consistent with previous authors in Nigeria , which found HIV-1 as the predominant viral subtype responsible for infection in Nigeria. Our observed prevalence of dual HIV-1 and -2 although higher is consistent with a prevalence of 5.3% of dual HIV-1 and -2 infections observed among abandoned babies in Port Harcourt Nigeria.  Previous report has indicated that HIV-1 is more virulent and has the widest distribution in Europe and America, while HIV-2 has the widest distribution in West Africa. 
| Conclusion|| |
The millennium development goal initiative provides a unique opportunity to refocus and accelerate programme efforts by donors, governments, and civil society to improve the awareness, treatment and control of HIV infection, most especially among rural dwellers that are mostly hit by prevailing factors, which encourage the spread of HIV infection. There is need for intervention in education, health, and economic empowerment of the people of the area. Aggressive drive for behavioral change from prevalent high risk behaviors, better health, and economic advancement of Ahoada-East local government area is advocated. There is need for universal access to antiretroviral therapy for persons living with HIV infection in the area. There is also the need to optimize the Prevention of Mother to Child Transmission of HIV programme (PMTCT) in the area to protect the future generation from the scourge of HIV. Implementation and access to Voluntary Counseling and Testing (VCT) programme in the area has the potential to reduce the fear associated with taking an HIV test and will reduce the stigma from the society to persons living with HIV infection in the area.
| Acknowledgments|| |
We wish to thank the Rivers State University of Science and Technology ICT center who provided the enabling environment and infrastructure for the statistical analysis and sourcing of literature. Also we wish to thank the subjects and staffs of Edeoha, Ula-Upata, Ochigba, Ahoada comprehensive health center and Ahoada General Hospital for their collaboration.
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Department of Haematology and Immunology College of Health Sciences University of Port Harcourt
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4]