Evaluation of the Level of Knowledge, Attitude, and Practice on HIV/AIDS among Youths in Bonny LGA of Rivers State

Nigeria currently holds the disconcerting position of being the second-highest contributor to the global HIV epidemic, with a staggering 9% of the worldwide HIV burden attributed to the country [1,2]. Globally, the number of individuals living with HIV reached 36.9 million in 2017, with 1.8 million newly diagnosed cases and 40,000 deaths from AIDS-related illnesses. The African region, in particular, bears a substantial brunt, harboring 25.7 million individuals with HIV in 2017, and accounting for over two-thirds of new global HIV cases [3]. The term “youth” encompasses individuals aged 15-39, inclusive of both males and females [4]. Unfortunately, this demographic group is particularly vulnerable to sexually transmitted infections, including HIV/AIDS, due to early engagement in sexual activities. Regardless of gender, youths exhibit a propensity for engaging in high-risk sexual practices, experimenting with sexual behaviors, identities, and habits that significantly elevate their susceptibility to STDs, including HIV/AIDS (Nneka et al. 2018).

Circumstances have led many youths to adopt risky behaviors, often overlooking the importance of HIV testing and preventive counseling care. Consequently, youths find themselves at the epicenter of the HIV epidemic (Shilpa et al. 2015). The Most-At-Risk Populations (MARPs), comprising illicit intravenous drug users, casual sex workers, and men who have sex with men, contribute significantly to the HIV burden, constituting approximately 32% of new cases in Nigeria (Sampson et al. 2017). Knowledge about a disease is a prerequisite for behavioral change and positive outcomes in primary health prevention. However, despite high levels of HIV/AIDS knowledge, some individuals exhibit poor awareness of preventive measures and remain uninformed about their HIV status, highlighting the need for more comprehensive information dissemination [5]. The spread of HIV in Nigeria is exacerbated by factors of low-risk low-risk perception, engagement in multiple sexual partnerships, and limited access to quality healthcare services [6] (Odigbo et al. 2015). Youths, in particular, are highly susceptible to sexually transmitted infections, including HIV, due to their involvement in risky sexual practices [7]. Misconceptions regarding HIV transmission and prevention persist among this demographic [8,9].

Data analysis from the 2012 National HIV/AIDS and Reproductive Health Survey (NARHS) indicates regional disparities, with the south-south geopolitical zone, where Rivers State is situated, exhibiting the highest HIV prevalence at 5.5%. Rivers State, specifically, has the highest prevalence within the region at 15.2%, as per the 2015 Global AIDS Response [6]. A more recent survey in 2019 categorized Rivers State as a highburden, low-saturation priority state with a prevalence rate of 3.8% [10]. Bonny Local Government Area (L.G.A) is not exempt from the pervasive impact of HIV/AIDS, with high prevalence rates attributed to factors such as unemployment, empowerment denial, multiple sexual partners, cohabitation, unsafe sex, and prevalent misconceptions. The presence of multinational companies in the area further exacerbates the situation, attracting sex workers who are predominantly patronized by the youth demographic. Notably, there is a death rate of studies on Youths’ Empowerment and Mitigation Campaign (EMC) in Bonny L.G.A, emphasizing the critical need for this investigation. In light of the aforementioned issues, this study aims to scrutinize the correlates of knowledge, attitude, and practice among the g youths in Bonny Local Government Area concerning HIV/AIDS.

Design/population

The research employed a descriptive cross-sectional survey design, involving a sample of 419 participants within the age range of 15-39 years in Bonny Local Government Area (LGA) of Rivers State, Nigeria.

Scope of study: The research covered eight wards in the study area, and a convenience sampling method was employed for administering the questionnaires.

Research instruments and tools: An in-house self-report questionnaire was used. The reliability of the questionnaire was assessed using Cronbach’s alpha, yielding a commendable coefficient of 0.8. This indicates a high level of internal consistency and reliability in the measurement tool, instilling confidence in the accuracy and precision of the data gathered through the survey.

Ethical consideration

Ethical clearance and approval were obtained from the Ethics and Research Committee of the Ministry of Health Rivers State.

Sampling techniques

The sampling technique utilized was stratified random sampling, encompassing 40 villages distributed across eight wards. To enhance the representativeness of the sample, a meticulous pretesting of the self-structured questionnaire was conducted in Wards 1 and 9 in Bonny LGA.

Data collection

Data collection was a collaborative effort involving the primary researcher and two trained research assistants, carefully selected from the community before initiating data collection at the community level, permission was diligently sought from the house chiefs, demonstrating a commitment to ethical considerations and community engagement. This step ensured that the research activities were conducted with the approval and cooperation of the local authorities.

Demographic data of respondents

The percentage of female respondents that took part in the survey was 52.03% and more than 1/4th of the respondents were between the age of 15 and 19 (38.67%). The respondents were single (78.04%), and SSCE holders (42.24%). This is shown in Table 1 below.

Table 1:Demographic data of respondents N=419.

Knowledge of bonny youth on HIV/AIDS concept, transmission, and prevention

According to the study findings, there was a notable level of knowledge among youths in Bonny Island, Rivers State, with 85% demonstrated an understanding of the HIV/AIDS concept, 78.7% knowing HIV transmission, and 69.9% possessing information about the prevention of HIV/AIDS. While the differences in performance among individual items were not statistically significant (p=0.9999, F=2.055), certain demographic trends were observed. Specifically, the analysis revealed that the female gender exhibited a slightly higher percentage (46%) of knowledge on HIV/AIDS compared to males. Moreover, participants within the age range of 15- 19 years demonstrated a knowledge level of 32%, indicating a commendable awareness among this age group. Educational attainment, as measured by possession of the West African Senior School Certificate (WASSC), correlated positively with knowledge, with 36% of those with WASSC reporting better understanding. Furthermore, marital status appeared to influence knowledge levels, as 66% of single participants exhibited a higher degree of awareness regarding HIV/AIDS. Although these variations did not reach statistical significance, the observed trends offer valuable insights into potential factors influencing HIV/AIDS knowledge among youths in Bonny Island. There was no statistically significant difference between the level of education and knowledge of HIV/ HIDs (P=098) Table 2.

Table 2:Knowledge of bonny youth on HIV/AIDS concept, transmission, and prevention.

Attitude and practice of bonny youths towards HIV/AIDS

A generally fair attitude (61.9%) was recorded among youths in Bonny L.G.A. However, suboptimal patterns of response were observed in all the items studied under this category. In terms of practice, a poor level (65.4%) was observed among youths in Bonny L.G.A. Notably the observed practices included engaging in sexual activities before reaching puberty age, improper execution of HIV tests, and imperfect use of condoms. There was no statistically significant difference between level of education and attitude and practice of HIV/AIDs (Table 3).

Table 3:Attitude and practice of bonny youths towards HIV/AIDS.

This research examined adolescents’ knowledge, attitudes, and behaviors toward HIV/AIDS in the Bonny LGA of Rivers State. The majority of participants were male (47.97%), female (52.03%), and between the ages of 15 and 19 (8.67%). The study reported appreciable knowledge of HIV (85%), fair knowledge about HIV prevention (69.9%), a fair mentality (61.9%), and poor behavior (65.4%). Age, educational levels, marital status, and religion were identified as important determinants of research participation. Oladeinde et al. [5] conducted a study with 371 respondents, revealing high levels of awareness regarding HIV/AIDS. However, the study noted low knowledge of preventative strategies, poor knowledge of HIV, and a willingness among participants to use free, voluntary counseling and testing for HIV/AIDS services. In contrast, Kandasamy et al. [11] reported findings from a study involving 754 participants aged 16 to 40. The results indicated a strong understanding of HIV among 80% of participants, with 90% possessing knowledge of how the disease is spread, and over 80% being aware of ways to avoid HIV/AIDS. Collins et al. (2018) demonstrated in their research a sufficient awareness of HIV transmission and prevention. Despite this, some misunderstandings concerning the modes of transmission were identified. Similar reports on HIV awareness and misconceptions were found in the papers of Joseph et al. (2019) [12], and Okonkwo & Okpara, contributing to a consistent body of literature in this domain.

According to reports, it is less common for family members in sub-Saharan African nations to disclose their own positive HIV status, indicating persistent discrimination against those living with HIV/AIDS. This discrimination is expected to worsen in the region [9]. The prevalence of myths and false beliefs about HIV/ AIDS is identified as a significant factor contributing to stigma and prejudice. Many young people are believed to face an increased risk of HIV due to the associated stigma, fear of neglect, and prejudice (HI and Youth, 2018). Factors such as low-risk risk perception, engaging in multiple partnerships, and limited access to highquality healthcare services are also considered contributors to this elevated risk [6]. Yousif, & Nazik [13] reported a poor attitude toward people living with HIV/AIDS. The study recorded percentages indicating that only 7% of respondents believed they could eat and drink with People Living with HIV (PLHIV), while 16% thought they could work and live with PLWHIV. However, a69% expressed unwillingness to wear clothing previously used by PLWHIV, and a substantial 97.5% were hesitant to use needles that had been used by infected individuals. Despite these reservations, 57.5% reported a willingness to provide care for people living with HIV. The reported attitudes reflect a complex landscape of perceptions and behaviors towards individuals affected by HIV/ AIDS.

In their research in Edo state, Obarisiagbone et al. 2019, used a descriptive cross-sectional survey with 440 participants and a stratified sample approach. They reported a respectable level of knowledge (61.6%), a favorable attitude (59.3%), and weak preventative actions. In Cross Rivers State, Okonkwo, Ameh, Out, and Okpara in 2017 found that while there is a high level of awareness of HIV and its routes of transmission, there are gaps in knowledge of the consequences of HIV. In a study in 2016, Adedokun, Olarinoye, and Ilesanmi found that adolescents continue to engage in hazardous sexual practices and that marital status is a strong predictor of HIV infection. Aiyedun & Ajuwon [14] used 208 respondents in their study on the knowledge of HIV/AIDS and sexual behavior among fishermen in Ajaokuta and Lokoja, Kogi State. Cross-sectional survey design was used for this research, and systematic random sampling was used as the sample method. Their findings demonstrated the ignorance and dangerous behavior of the Ajaokuta fishermen. Nwaneri et al. 2018 used a cross-sectional descriptive survey with 460 unmarried respondents aged 15 to 30 yield were recruited from a federal university in Enugu State with the aid of multistage sampling to report poor knowledge of the disease and bad practices on HIV/AIDS. Poor knowledge and inadequate preventative procedures were observed by Obarisiagbon et al., 2019, in their investigation of the state of Edo [15-35].

The study delved into exploring the factors associated with the knowledge, attitude, and practices of youths in Bonny concerning HIV. It revealed that there was a high level of knowledge regarding HIV and its transmission. However, the study identified a gap in knowledge related to the prevention of HIV, with a corresponding poor practice of preventive measures. Moreover, the research indicated that the attitude of the youths towards HIV/AIDS and people living with AIDS was fair. Despite this fair attitude, there was a notable deficiency in the implementation of preventive practices [36-55].

The Knowledge, attitude, and practice of people concerning HIV/AIDS are expected to be good. That is, the study result should been 10 perfection. On these premises, the recommendations below were made:
i. It is recommended that the knowledge on HIV/AIDS, its trans, mission, and prevention be improved upon. More understanding of what HIV/AIDS is, its nature, the mode of transmission, and the best preventive measures are needed. This can be achieved by creating more HIV/AIDS awareness among youths through the use of information, Education, and Communication (IEC) strategy of sharing information using print (posters, flyers, and leaflets or interpersonal communication in a way that is suitable to the target population. The government and concerned agencies should be of help here [56-75].
ii. On the attitude of people toward HIV/AIDS patients, it is recommended the observed trend be reversed. Poor attitude towards HIV patients is the root cause of stigmatization and discrimination. More usable manpower is lost to this act. Government and health agencies should carry out more enlightenment campaigns to the general population to dissuade negative attitudes and provide a welcoming-positive HIV-positive group.
iii. It is recommended here that the practice of youths with HIV/ AIDS be improved. This can be achieved through a behavioral change communication strategy. Improved practice may guarantee a decrease in HIV prevalence.
iv. Further enlightenment is still needed to educate the general populace about some practices that stem from ‘harmless’ traditions that fuel the spread of HIV. More effort should be channeled to the males since the females have better knowledge of HIV.

No conflict of interest is associated with this work.

We declare that this research work was done by the author(s) named in this article and all liabilities about claims relating to the content of this article will be borne by the authors. All authors read and approved the manuscript for publication.

1. UNAID (2017a) UNAID Nigeria 2017 overview.
2. USAID (2019) Global Health, Nigeria, U.S. Agency for International.
3. WHO (2018) WHO key facts.
4. Idoko N (2007) In war as in peace: Youth violence-a challenge for international cooperation, International conference. Nigeria: Youth violence and challenges in age globalization. Centre of Peace in Africa, Nigeria.
5. Oladeinde BH, Omoregie R, Odia I, Osakue E (2017) Public knowledge of HIV/AIDS in three rural communities of Nigeria. Social Work Public Health 32(2): 131-140.
6. National agency for the control of AIDS (NACA,2015) Federal republic of Nigeria. Global AIDS response country progress report. Nigeria GARPR 2015, pp. 38.
7. Bogale A, Seme A (2014) Premarital sexual practices and its predictors among in-school youths of Shendi town, West Gojjam Zone, Northwestern Ethiopia. Reproductive Health Journal 11: 49.
8. Arodiwe I, Arodiwe E, Okeke T, Onwasigwe C (2018) Knowledge, attitude, willingness of HIV counseling and testing and factors associated with it, among long distant drivers in Enugu, Nigeria: An opportunity of reduction of HIV prevalence. Afr Health Sci 18(4): 1088-1097.
9. Dai X, Wang H (2019) Change in knowledge and attitude about HIV/AIDS in Sub-Saharan Africa, 1990-2017: An analysis of national survey data. The Lancet Global Health Journal 7(1): 90-99.
10. NAIIS (2018).
11. Kandasamy K, Kumari SS, Manohar SS, Gnanaraj VP, Rajagopal SS, et al. (2018) Assessment of knowledge and attitude of people towards HIV/AIDS in the rural area of Namakkal district, Tamilnadu. Int J Life Sci Pharma Res 8(4): 1-6.
12. Umeh GN, Nwofoke C, Nwibo SU (2018) Rural farm households knowledge, attitude and perception towards HIV/AIDS in Ebonyi State, Nigeria. Journal of Agricultural Extension 22(1): 248-265.
13. Yousif, Elbashir NA (2018) Knowledge, attitude and practice of females in the reproductive age towards HIV/ AIDs in Alsahafa health center, Sudan. D Space Repository.
14. Aiyedun AS, Ajuwon AJ (2019) Knowledge of HIV/AIDS and sexual behavior among Fisherfolks in Ajaokuta and Loko ja, Kogi State, Nigeria. Afr J Biomed Res 22(2): 115-120.
15. Adedokun B, Olarinoye OM, Ilesanmi OS (2016) HIV prevalence and predictor among sexually active Nigerian youths. International Journal of Caring Sciences 9(1): 144.
16. Advocate for Youths (2014) Sexuality education.
17. Agrasuta V (2013) The adoption of green dentistry among dentists in Thailand.
18. Ajaegbu OO (2015) Premarital sex, HIV and use of condom among youths in Nigeria. Arts Social Sci Journal 2(4): 90-111.
19. Dakkak AI, Patel S, McCann E, Gadkari A, Prajapati G, et al. (2013) The impact of specific HIV treatment-related adverse events on adherence to antiretroviral therapy: A systematic review and meta-analysis . AIDS Care 25(4): 400-414.
20. Alhasawi A, Grover SB, Sadek A, Ashoor I, Alkhabbaz I, et al. (2017) Assessing HIV/AIDS knowledge, awareness, and attitudes among senior high school students in Kuwait. Med Princ Pract 28(5):470-476.
21. Alwafi HA, Meer AMT, Shabkah A, Mehdawi FS, Haddad HE, et al. (2017) Knowledge and attitudes toward HIV/AIDS among the general population of Jeddah, Saudi Arabia. Journal of Infection and Public Health, 11(1): 80-84.
22. Andrew PO, Bhuiyan A, Mawson A, Buxbaum SG, Sung JH, et al. (2018) HIV/AIDS knowledge of undergraduate students at a historically Black College and University. Diseases 6(4): 98.
23. Arora, SK, Shah D, Chaturvedi S, Gupta P (2015) Defining and measuring vulnerability in young people. Indian Journal of Community Med 40(3): 193-197.
24. Asa UA, Nkan V (2015) Barriers to condom use by youths in rural areas of Akwa Ibom State, Nigeria. American Journal of Research Communication 3(12): 14-22.
25. Avert IO (2018) Symptoms and stages of HIV infection.
26. Ayu A, James SG (2017) Knowledge, attitude, and behavioral practices about HIV/AIDS among secondary school adolescents in Makurdi, Nigeria. CHRISMED J Health Res 4(2): 117-124.
27. Arrendodo BS, Nancy N, Ortiz SA, Akeju D, Oluwayinka AG, et al. (2018) The role of management on cost and efficiency in HIV prevention intervention for female sex workers in Nigeria: A cluster-randomized control trial. Cost Eff Resour Alloc 16: 37.
28. Boikhutso T (2019) The influence of marital status on HIV Infection in an HIV hyperendemic area of rural South Africa 2000-2017. African Journal of AIDS Research 18(1): 65-71.
29. Calderon CT, Amovelero JD, Blázquez CG, Ferreras BA, Rubio OR, et al. (2015) Knowledge, attitude, and practice on HIV/AIDS and prevalence of HIV in the general population of Sucre, Bolivia. Brazilian Journal of Infectious Disease 19(4): 369-375.
30. Centers for Disease Control and Prevention (2016) Updated guidelines for antiretroviral post-exposure prophylaxis after sexual, injection drug use, or other non-occupational exposure to HIV-United States. pp. 1-91.
31. Cooper V, Horne R, Gellaitry G, Vrijens B, Lange AC (2010) The impact of once-nightly versus twice daily dosing and baseline beliefs about HAART on adherence to efavirenz-based HAART over 48 weeks: The NOCTE study. J Acquir Immune Defic Syndr 53(3): 369-377.
32. Dauda RS (2018) Impact of HIV/aids epidemic on human capital development in West Africa. J Health Plann Manage 33(2): 460-478.
33. Dzah SM, Tarkang EE, Lutala PM (2019) Knowledge, attitudes, and practices regarding HIV/AIDS among senior high school students in Sekondi-Takoradi metropolis, Ghana. African Journal of Primary Health Care & Family Medicine 11(1): e1-e11.
34. Ehiri JE, Iwelunmor J, Iheanacho T, Blackstone S, Obiefune MC, et al. (2016) Using a cultural framework to understand factors influencing HIV testing in Nigeria. Int Q Community Health Educ 37(1): 33-42.
35. Enahoro FO, Abah SO, Okoedion E, Orjiakor IC (2015) Assessment of knowledge, attitude and risky practices regarding HIV/AIDS infection among secondary school students in Ekpoma, Edo State, Nigeria. International Journal of Community Research 3(1): 2315-06562.
36. Envuladu EA, Kwaak AV, Zwanikken P, Zoakah AI (2017) Exploring the factors influencing adolescent sexual behavior in Plateau State Nigeria. American Journal of Medicine and Medical Sciences 7(1): 1-6.
37. Essam MJ, Sakina M, Sajeda A, Mariam A, Ghada NF (2016) Public knowledge, perceptions and attitudes towards HIV/AIDS in Bahrain: A cross-sectional study. J Infect Dev Ctries 10(9): 1003-1011.
38. Federal Republic of Nigeria (2006) Population and housing census: Priority table Volume IV. Population Distribution by Age & Sex (State & Local Government Area). National Population Commission Abuja, Nigeria.
39. Fincham JE (2008) Response rates and responsiveness for surveys, standards, and the Journal. Am J Pharm Educ 72(2): 43.
40. Job NG, Asuquo EO, Alabere DI (2018) Determinants of the age at sexual debut among adolescents in secondary schools in Obio/Akpor local government area of rivers state, Nigeria. Port Harcourt Medical Journal 12(2): 81-87.
41. Iliyasu Z, Galadanci HS, Ibrahim YA, Babashani M, Mijinyawa MS, et al. (2017) Should they also have babies: Community attitudes toward sexual and reproductive rights of people living with HIV/AIDS in Nigeria. Ann Glob Health 83(2): 320-327.
42. Kawale SK, Sharma V, Thaware PP, Mohankar AD (2018) A study to assess awareness about HIV/AIDS among the rural population of central India. International Journal of Community Medicine and Public Health 5(1): 373-376.
43. Maijama’a D, Mohammed BK (2013). Impact of HIV/AIDS on economic growth and development in Nigeria. pp. 1-16
44. Mitzel LD, Vanable PA, Carey MP (2018) HIV- related stigmatization and medication adherence: Indirect effects of disclosure concerns and depression. Stigma and Health 4(3): 282-292.
45. Mustafa ZUM, Salman MSK, Afridi N, Asif N, Shehzadi K, et al. (2019) A cross-sectional assessment of knowledge, attitude, and beliefs concerning HIV/AIDS among Pakistani university population. Indian J Pharm Sci 80(1): 210-214.
46. Neha S, Xiao Z (2017) Knowle, age, attitude and practice regarding HIV/AIDS among students in China. World Journal of AIDS 7(4): 247-259.
47. Noroozi M, Taleghani F, Khoei MES, Tavakoli M (2014) Premarital sexual relationships: Explanation of the actions and functions of the family. Iranian Journal of Nursing and Midwifery Research 19(4): 424-431.
48. Nubed CK, Akoachere JFTK (2016) Knowledge, attitudes, and practices regarding HIV/AIDS among senior secondary school students in Fako division, Southwest Region, Cameroon. BMC Public Health 16(1): 847.
49. Nwaneri AC, Anarado AN, OnyiaJLP, Ezike OC, Ndubisi I (2018) HIV/AIDS knowledge and risk-taking behaviors among youths at a University in Enugu. Africa Journal of Nursing and Midwifery 20(1): 87-94.
50. Connor OJL, Gardner EM, Mannheimer SB, Lifson AR, Esser S, et al. (2013) Factors associated with adherence amongst 5295 people receiving ART as part of an international trial. J Infect Dis 208(1): 40-49.
51. Obarisiagbon OE, Ofili AN, Isara AR, Ighedosa SU (2019) Knowledge, attitude, practices and associated factors of HIV/AIDS among adolescents in Ora Community, Edo State. Annals of Health Research 5(1): 51-64.
52. Odimegwu CO, Akinyemi JO, Alabi OO (2017) HIV-stigma in Nigeria: Review of research studies, policies, and programs. AIDS Research and Treatment 2017:5812650.
53. Odimegwu C, Somefun OD, Chisumpa VH (2018) Regional differences in positive sexual behavior among youth in Sub-Sahara Africa. Journal of Biosocial Science 51(2):254-272.
54. Odugbesan JA, Rjoub H (2019) Relationship among HIV/AIDS prevalence, human capital, good governance, and sustainable development: Empirical evidence from Sub-Saharan Africa. Sustainability 11(5): 1348.
55. Okonkwo U, Ameh S, Out A, Okpara H (2017) HIV-related knowledge, attitude, and practices of healthy adults in cross river state Nigeria: A population survey. The Pan African Medical Journal 27:170.
56. Oluyemi JA, Adejoke JA, Bukola OL, Deborah A, Gbenga P (2019) Knowledge, beliefs, and sources of information on HIV among students of a tertiary institution in Nigeria. International Journal of Modern Anthropology 2(12):
57. Opeodu OI, Ogunrinde TJ (2015) Mode of transmission of HIV/AIDS: Perception of dental patients in a Nigeria teaching hospital. J West Afr Coll Surg 5(1): 1-19.
58. Philip O (2012) Percentages by religion of the 1952 and 1963 populations of Nigeria’s present 36 States.
59. Population & Housing Census (2006) Priority table IV: Distribution of population by five-year age group & sex. International Household Survey Network.
60. Stoebenau K, Heise L, Wamoyi J, Bobrova N (2017) Revisiting the understanding of transactional sex in sub-Saharan Africa: A review and synthesis of the literature. Social Science & Medicine 168: 186-197.
61. Sunday OA, Ameh OE, Uchechukwu A (2017) Assessment of the HIV/AIDS impact on the Nigerian economy performance: An empirical analysis. Journal of AIDS & Clinical Research 8(10): 2155-6113.
62. Thuo DN, Nyaga VK (2018) Students’ knowledge of HIV/AIDS and their attitude towards sexual behaviour in coast region, Kenya.
63. West CIT, Nwajagu S, Maduka O, Oranu E, Onyekwere VN, et al. (2017) Exploring the HIV-risk practices of men who sex men in Port Harcourt, Nigeria. Annals of Tropical Medicine and Public Health 10(3): 1755-6783.
64. Tuoyire DA, Anku PJ, Alidu L, Amo AJ (2017) Timing of first sexual intercourse and number of lifetime sexual partners in Sub-Saharan Africa. Sexuality and Culture 22: 651-668.
65. UNAIDS (2001) AIDS, poverty reduction and debt relief: A toolkit for mainstreaming HIV/AIDS programs into development instruments.
66. UNAIDS (2014) The gap report: Children and pregnant women living with HIV.
67. UNAIDS (2017b) UNAIDS Data Book. pp. 14.
68. UNAIDS (2018a) Global HIV and AIDS statistics-fact sheet.
69. UNAIDS (2018b) The sustainable development goals and HIV response.
70. UNAIDS (2019a) The community is not on the girls’ side”.
71. UNAIDS (2019b) Women and HIV-A spotlight on adolescent girls and young women.
72. UNGASS (2016) Time to put HIV at the forefront of drug policy 3(4).
73. UNICEF (2019) Gender & HIV/AIDS.
74. Vu L, Adebajo S, Tun W, Sheehy M, Karlyn A, et al. ( 2013) High HIV prevalence among men who have sex with men in Nigeria: Implications for combination prevention. J Acquir Immune Defic Syndr 6(3): 221-227.
75. WebMD (2018) Medical reference reviewed by Sabrina Felson.