BackgroundThe HIV epidemic in Nigeria is complex with diverse factors driving the epidemic. Accordingly, Nigeria's National Agency for the Control of AIDS is coordinating a large-scale initiative to conduct HIV epidemic appraisals across all states. These appraisals will help to better characterize the drivers of the epidemic and ensure that the HIV prevention programmes match the local epidemic context, with resources allocated to interventions that have the greatest impact locally. Currently, the mapping and size estimation of Female Sex Workers (FSWs) - a major component of the appraisal has been completed in seven states. These states are using the data generated to plan, prioritize and scale-up sub-national HIV prevention programmes.MethodologyIt involved a two-level process of identifying and validating locations where FSWs solicit and/or meet clients (“hotspots”). In the first level, secondary key informants were interviewed to collect information about the geographic location and description of the hotspots. For the second level, FSWs were interviewed at each hotspot and information on population size estimates, typologies and operational dynamics of the FSWs were collected.ResultsAcross the seven states, a total of 17,266 secondary key informants and 5,732 FSWs were interviewed. 10,233 hotspots were identified with an estimated 126,489 FSWs ranging from 5,920 in Anambra to 46,691 in Lagos. The most common hotspots were bars/nightclubs (30%), hotels/lodges (29.6%), streets (16.6%), and brothels (14.6%). Furthermore, the population density of FSWs (per thousand adult men) across the states ranged from 2 in Anambra to 17 in the Federal Capital Territory.ConclusionFSW populations in Nigeria are large and diverse, with substantial differences between and within states. Improved understanding of the location, population size, density, organizational typologies and clients of sex work has informed and is central to Nigeria's planning process for scaling up focused HIV prevention programmes.

Although HIV prevalence has increased in most-at-risk populations (MARPs) across Nigeria, effective programming was difficult because Nigeria lacked information for prevention programmes to target interventions that maximise coverage and cost effectiveness. Epidemic appraisals (EA) were conducted in eight states to provide evidence for the planning, implementation and co-ordination of prevention interventions. Component 1: Mapping determined the size, typology and locations of MARPs. Component 2: Venue profiling identified and profiled venues where general populations engaged in high-risk behaviours. Component 3: Rural appraisals provided insights into risk behaviours and sexual networking in villages. States used mapping results to prioritise areas with a MARP coverage of 70% – 80% and then scale up interventions for non-brothel-based female sex workers (FSWs) instead of focusing on brothel-based FSWs. The eight states prioritisedf unding for the high-coverage areas to ensure a minimum coverage level of 70% – 80% of MARPs was reached. The refocused resources led to cost efficiencies. Applying venue profiling results, six states implemented interventions at bars and night clubs – previously not covered. States also maximised intervention coverage for high-risk general populations; this led to the use of resources for general population interventions in a focused way rather than across an entire state. States focused on condom programmes in rural areas. EA results provided the evidence for focusing interventions for high MARP coverage as well as forhigh-risk general populations. The states applied the results and rapidly refocused their interventions, increasing the likelihood of having an impact on HIV transmission in those states. Nigeria is now implementing EAs in the remaining 29 states to effect national-level impact.

The present investigation was designed to determine whether the circadian rhythm of glucose utilization is based on a quantitatively different release of insulin and/or on changing secretory dynamics of the hormone. 22 healthy men received three oral glucose tolerance tests in the morning, afternoon and evening of the same day. The blood sugar levels in the afternoon and evening tests were significantly higher than those found in the morning tests. Also the plasma insulin response was higher in the afternoon than in the evening, but it showed a delayed rise and late peak response. In the evening the normal subjects responded as mild diabetics.

BackgroundThe HIV epidemic in Nigeria is complex with substantial heterogeneity in its distribution across different regions and diverse factors that drive the epidemic. Therefore, it is critical that HIV prevention programmes and strategies match the local context and that resources are allocated to interventions with the greatest impact. Nigeria’s National Agency for the Control of AIDS (NACA) is coordinating a large-scale initiative to conduct rapid epidemic appraisals across most states, including the mapping and size estimates of female sex workers (FSWs). Seven states have completed the appraisal of FSWs, and are now planning programmes accordingly.MethodologyMapping was done using a two-level process of identifying and validating locations where FSWs solicit and/or meet clients. The first level involved conducting interviews with secondary key informants to collect information on the location and profile of hotspots, size estimates and typology of FSWs. The second level was done by interviewing primary key informants (FSWs themselves) at each hotspot to validate the information collected and generate more detailed information.ResultsA total of 10,233 hotspots were identified across the states and 126,489 FSWs {Hotel/Lodge (29.6%) Bar/Nightclub (30%), Home based (4.1%), Brothel (14.6%) and Street based (16.6%)} were mapped. There was substantial variability in the population density of FSWs (per thousand adult men) across the states ranging from 17 in Abuja to 2 in Anambra. Furthermore, there were clear differences in the density of FSWs per spot with the mean number of FSWs/spot ranging from 17 in Abuja to 8 in Ondo.ConclusionThe FSW population in Nigeria is large and diverse, with substantial differences between and within states with respect to the population size, density and organisational typologies of sex work. This information is central to Nigeria’s planning process for scaling up focused HIV prevention programmes and services.

The percentage of Human Immunodeficiency Virus (HIV) positive pregnant women that receive anti-retroviral treatment in Nigeria is low and has been declining. Consequently, 14% of all new infections among children in 2020 occurred in Nigeria. A detailed analysis of available data was undertaken to generate evidence to inform remedial actions. Data from routine service delivery, national surveys and models were analyzed for the six-year period from 2015 to 2020. Numbers and percentages were calculated for antenatal registrations, HIV testing, HIV positive pregnant women and HIV positive pregnant women on antiretroviral treatment. The Mann-Kendall Trend Test was used to determine the presence of time trends when the p-value was less than 0.05. In 2020, only 35% of an estimated 7.8 million pregnant women received antenatal care at a health facility that provided and reported PMTCT services. Within these facilities, the percentage of HIV-positive pregnant women on anti-retroviral treatment from 71% in 2015 to 88% in 2020. However, declining HIV positivity rates at these antenatal clinics and an absence of expansion of PMTCT services to other pregnant women due to cost-efficiency considerations contributed to a progressive decline in national PMTCT coverage rates. To achieve elimination of mother-to-child transmission of HIV, all pregnant women should be offered a HIV test, all who are HIV positive should be given anti-retroviral treatment, and all PMTCT services should be reported.