Drivers of Human Immunodeficiency Virus among Pregnant Women in Conflict and Non-conflict Zones of Nigeria

Amina A. Umar​1,MBBS, MPH, 

Hassan Adam Murtala2 MBBS, MPH, MIPC, MBA, 

Aisha Adam Abdullahi2 MBBS, MSc,

Amina Aminu2 MBBS, 

Muktar H. Aliyu3 MD, DrPH, 

Sani H. Aliyu4 MBBS, MSc, 

Ololade D. Adeyemi5 MD, MPH, MLA, 

Deepa Dongarwar6 MS, 

Jordi B. Torrelles7 PhD, 

Gambo Aliyu8 MBBS, PhD, 

Hamisu M. Salihu2MD, PhD

1Department of Community Medicine, College of Health Sciences, Bayero University, Kano, Nigeria

2Department of Epidemiology and Population Health, Kano Independent Research Center Trust, Kano, Nigeria

3Vanderbilt Institute for Global Health, Nashville, Tennessee, United States of America

4Addenbrooke’s Hospital, Cambridge, United Kingdom

5Federal Ministry of Health, Abuja, Nigeria

6University of Texas Health Sciences Center, Houston, Texas, United States of America

7Population Health Program, The International Center for the Advancement of Research and Education, Texas Biomedical Research Institute, San Antonio, Texas, United States of America

8National Agency for the Control of AIDS, Abuja, Nigeria.

-Corresponding author: Amina A. Umar, Department of Community Medicine, College of Health Sciences, Bayero University, Nigeria. amina7420@yahoo.com

Received: 2025-05-20, Accepted: 2025-05-27, Published: 2025-06-05

© 2025 The Author(s). Published by Global Health and Education Projects, Inc., USA.

Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Umar AA, Murtala HA, Abdullahi AA, Aminu A, Aliyu MH, Aliyu SH, et al. Drivers of human immunodeficiency virus among pregnant women in conflict and non-conflict zones of Nigeria. Int J MCH AIDS. 2025;14:e013. doi: 10.25259/IJMA_31_2025

Abstract

Background and Objective:

Human immunodeficiency virus (HIV) is a major public health concern among pregnant women in Nigeria, with seven in every hundred women likely to have an HIV infection. Understanding factors associated with HIV infection among pregnant women is critical to improving prevention strategies, especially in conflict regions. This study investigates demographic, socio-economic, and behavioral determinants of HIV among pregnant women in Nigeria, with conflict exposure included as a key predictor in the analysis.

Methods:

This study is a cross-sectional design using data from the 2018 Nigeria HIV/Acquired Immunodeficiency Syndrome (AIDS) Indicator and Impact Survey, the largest population-based HIV survey globally, implemented between July and December 2018 across all 36 states and the Federal Capital Territory of Nigeria. We analyzed weighted data from 3,879,192 pregnant women (both HIV-positive and negative), conducting bivariate and multivariate analyses to identify predictors of HIV infection among women aged 15–49 years while adjusting for potential confounders. Adjusted Odds Ratios (AORs) with 95% confidence intervals (CIs) were generated using unconditional logistic regression models to determine significant predictors.

Results:

Our analysis revealed that women in conflict zones were younger, less educated, and more likely to be in polygynous marriages and the lowest wealth quintile compared to those in non-conflict zones. In a multivariable analysis, residence in a conflict zone was associated with nearly twofold adjusted odds of HIV positivity (AOR = 1.93; CI: 0.98–3.82; p = 0.057). Increasing maternal age (AOR = 1.06; CI: 1.02–1.10; p = 0.002) and middle to fourth wealth quintile status (AOR = 4.10 and 3.80, respectively; p < 0.05) were significantly associated with a higher likelihood of HIV infection. Recent non-marital sexual activity was also significantly associated with HIV positivity (AOR = 2.96; p = 0.037).

Conclusion and Global Health Implications:

The study identifies conflict exposure and socio-economic status as significant predictors of HIV infection among pregnant women in Nigeria. Our analysis reveals important demographic, socio-economic, and behavioral factors associated with HIV prevalence in this population. These findings underscore the need for comprehensive HIV prevention strategies that address the complex interplay of social determinants, particularly in vulnerable populations.

Keywords: Behavior, Conflict, Human Immunodeficiency, Virus, Pregnancy, Risk, Women

INTRODUCTION

Human immunodeficiency virus (HIV)/Acquired immunodeficiency syndrome (AIDS) remains a significant public health challenge in sub-Saharan Africa, particularly among women of reproductive age.[1] In Nigeria, approximately 1.2 million women aged 15 and over were living with HIV in 2023, with a prevalence rate of 1.7% among women aged 15–49.[2] HIV among women significantly increases the chance of vertical transmission, also known as mother-to-child transmission (MTCT) during pregnancy, labor, and breastfeeding.[3]

Despite the widespread scale-up of prevention of MTCT (PMTCT) services, coverage remains suboptimal, with only 33% of pregnant women receiving antiretroviral therapy (ART) in 2023.[2] This has contributed to continued vertical transmission, with an estimated 8,200 new HIV infections averted due to PMTCT programs that year,[2] while advancements in highly active ART have significantly improved survival and quality of life for people living with HIV, challenges, including armed conflict continue to affect equitable access to prevention and treatment services.[4] Conflict-affected settings exacerbate women’s vulnerability to HIV infection through mechanisms such as gender-based violence, family disintegration due to displacement, and the collapse of healthcare systems.[4] Understanding the unique drivers of HIV among pregnant women in these volatile settings is essential for designing targeted interventions that can mitigate disparities and improve outcomes.

Recent literature has drawn attention to the destabilizing effect of conflict on HIV care services. Armed conflicts often disrupt epidemiological patterns by displacing large populations, eroding healthcare infrastructure, and increasing the risk of HIV transmission through violence and limited access to care.