Advances in Infectious Diseases, 2013, 3, 210-218
http://dx.doi.org/10.4236/aid.2013.33031 Published Online September 2013 (http://www.scirp.org/journal/aid)
Marital Status and HIV Prevalence in Nigeria:
Implications for Effective Prevention
Programmes for Women*
Samson B. Adebayo1,2#, Richard I. Olukolade3#, Omokhudu Idogho1, Jennifer Anyanti1,
Augustine Ankomah1,4
1The Society for Family Health, Abuja, Nigeria; 2National Agency for Food and Drug Administration and Control, Abuja, Nigeria;
3Association for Reproductive and Family Health, Abuja, Nigeria; 4Department of Population, Family and Reproductive Health,
School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana.
Received May 31st, 2013; revised June 31st, 2013; accepted July 31st, 2013
Copyright © 2013 Samson B. Adebayo et al. This is an open access article distributed under the Creative Commons Attribution Li-
cense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Objective: Until recently, HIV prevalence has been based on estimates from antenatal sentinel surveys which have
been found to overestimate HIV prevalence among the general population. Multiple studies have shown women to be
disproportionately affected by HIV and AIDS epidemic. Design: Data for this study were based on the first Nigerian
population household-based HIV biomarker survey of 2007, which used a multi-stage probability sampling technique.
Methods: Respondents were selected through probability sampling (male age 15 - 64 years and female 15 - 49 years).
This paper, therefore, examined the correlates of marital status and HIV prevalence among women in Nigeria. Results:
A descriptive analysis of the data showed that HIV prevalence of women that were formerly married: divorced, sepa-
rated or widowed were more than double that of those who were currently married/cohabiting with a sexual partner; and
more than three times those that were never married. Bivariate and multivariate levels of analysis were explored in this
paper. At bivariate level, findings showed a significant difference in HIV prevalence among women according to their
marital status (p < 0.0001), educational attainment (p = 0.004) and geo-political zones (p = 0.003). Respondents that
were formerly married were 5.6 times as likely to be infected with HIV compared with those who had never married
(OR = 5.6, p < 0.0001) while HIV prevalence increased with higher educational attainment. Conclusion: In view of
these findings, HIV programmers should design interventions that will improv e economic empowerment as well as so-
cial security for women that were formerly married. In addition, gender mainstreaming in the ongoing HIV and AIDS
preventive efforts should be strengthened and scaled-up.
Keywords: Early Marriage; Sexual Initiation; HIV Prevalence; Marital Status; Formerly Married
1. Introduction
The Human Immunodeficiency Virus (HIV) and Ac-
quired Immunodeficiency Syndrome (AIDS) have been a
major problem in many parts of the world. AIDS was
first recognized as a distinct syndrome in 1981 [1]. In
Nigeria, about 3.3 million people are infected with HIV
with an estimated 220,000 AIDS related deaths [2]. The
2010 National HIV Sero-prevalence sentinel survey
conducted among pregnant women attending antenatal
clinics in Nigeria put HIV prevalence at 4.1% [3]. The
pervading knowledge that women are burden-bearers
cannot be said to be untrue, as from the natural and bio-
logical point of view, women bear the weight of child
birth and the survival of the child greatly depends on the
care of the mother. In the same manner, the impact of
HIV and AIDS on a global level, but especially in sub
Saharan Africa, does not exclude women. This is because
HIV is the leading cause of death and disease among
women of reproductive age (15 - 49 years) worldwide
[4].
Women have constituted approximately half of all
adults living with HIV globally and are more likely to
*Conflict of Interest: The authors have no conflicts of interest to de-
clare.
#Corresponding author. become infected than men. It is estimated that for every

Marital Status and HIV Prevalence in Nigeria: Implications for Effective Prevention Programmes for Women 211
10 men infected, 13 women will be infected. Of the sev-
eral factors implicated in the unequal prevalence of the
disease among women in Africa are economic depend-
ence, feminisation of poverty, unequal distribution of
sexual power (sexual violence and coercion), including
limited educational opportunities [5]. Sub-Saharan Africa
remains the region hardest hit by the HIV epidemic [2].
As is the case in most of sub-Saharan Africa, women
greatly surpass men in the number of people living with
HIV and AIDS, and in many areas, women double the
number of men with the virus [6].
While some long standing socio-cultural practices are
reasons for this higher prevalence of HIV among women,
other reasons are evolving with changing patterns of be-
haviour and lifestyle. These reasons include biological
and social risk factors [7]. The social factors consist of
cultural roles and norms, and harmful traditional prac-
tices [8]. Such customs include female genital mutilation,
forced marriage, low female child education, and dis-
crimination against the female gender. Protection of girls
and women from HIV infection should include protecting
them against gender-based violence and promoting eco-
nomic independence from older men [2]. Social norms
that accept extra-marital and pre-marital sexual relation-
ships among men, combined with women’s inability to
negotiate safe sex pr actices with th eir partners make HIV
infection a risk even in women who have only had one
partner in their entire lives [9]. Men tend to dominate
women’s sexuality in Africa’s dramatic context of pov-
erty [10]. Similarly, in many countries and societies,
women and girls are treated as socially inferior [11]. In
all these situations, the inability of women to insist on
condom use is a “trade off” of their inalienable right for
economic advantage.
Biologically, women are two to eight times more
likely than men to contract HIV during vaginal inter-
course [12] and this may be attributed to difference in
anatomical structures of genito-urinary tract which makes
females more susceptible to STIs [13]. Since the majority
of sexually transmitted infections do not give rise to any
symptoms in women, these are less likely to be recog-
nized or treated early enough [9 ]. During unprotected sex,
the virus can also be directly absorbed through the vagi-
nal and cervical mucous membranes. Also, the vaginal
lining in women can sometimes tear and possibly allow
HIV to enter the body during sex [14].
Marital status is reported to be a factor responsible for
the higher HIV prevalence observed among women. In-
dividuals, who are divorced, separated or widowed, tend
to have significantly higher HIV prevalence than their
counterparts who are single, married, or cohabitating;
with divorced or widowed women experiencing espe-
cially higher prevalence [8]. For instance, some studies
have shown that divorced or separated women in Guinea
are more than three times more likely to be infected with
HIV than single women, while widowed women are al-
most seven times more likely to be living with HIV than
their counterparts who are single [15]. Meanwhile in
Tanzania, studies have shown that more than one in four
of widowed women are living with HIV compared with
6% of those who are married or cohabiting and 2% of
those who have never been married [16].
Furthermore, studies in Uganda showed that the risk of
HIV among widowed individuals is almost 5 times
higher than that seen in married individuals, while the
risk of HIV among separated is twice that of married
respondents. This may be because their partners died of
AIDS. Most infections are almost three times higher
among the divorced and separated than the married [15,
17]. Higher prevalence of HIV in many African countries
has been associated with a high rate of marital separation
and widowhood [18].
Although a number of HIV and AIDS prevention and
intervention efforts are ongoing, and literature on pro-
gress made in Nigeria in addressing HIV prevalence is
available, yet more needs to be done. In Nigeria, studies
are yet to fully examine the relationship between for-
merly married women within the general population and
HIV prevalence especially at national level. This may
basically be due to the fact that data to make such infer-
ences are not available until lately.
This paper therefore examines possible correlates of
HIV prevalence among women in the general population
controlling for their marital status. Findings from this
paper will provide HIV programmers and policymakers
with the basis for improving and repositioning strategies
to combat the disease among women especially in view
of higher HIV prevalence among formerly married
women compared with their counterparts who were cur-
rently in a stable relationship or never married. This pa-
per will also review what target groups would need to be
addressed as key populations at risk of HIV.
2. Data and Methods
2.1. Survey Method
The data us ed for this stud y were obtain ed from the 2007
National HIV & AIDS and Reproductive Health Survey
(NARHS) in Nigeria. The primary objective of the
NARHS survey is to provide quantitative data for moni-
toring current levels of sexual and reproductive health
indicators in Nigeria, as well as the impact of reproduc-
tive health interventions. The 2007 wave was the third
round of the survey in the country with earlier rounds
conducted in 2003 and 2005. The 2007 wave was the
only one that included a serological component to deter-
mine the national HIV prevalence level among the gen-
eral population. In essence, the 2007 wave was the first

Marital Status and HIV Prevalence in Nigeria: Implications for Effective Prevention Programmes for Women 212
survey in Nigeria that provided population-based esti-
mates of HIV prevalence in Nigeria. Survey participants
were selected across the 36 states and the Federal Capital
Territory (FCT) of Nigeria through a multi-stage prob-
ability cluster sampling techn iqu e at three levels.
Eligible respondents were female aged 15 - 49 years
and male aged 15 - 64 years. Selection was based on the
sampling frame of enumeration areas which is main-
tained by the Nigerian National Population Commission
(NPC). List of localities was provided by NPC and strati-
fied into major or big towns, medium towns and rural
according to the 2006 Population Census. Localities
where the surveys were conducted were selected from
this list comprising of a mixture of the three main cate-
gories with more of rural localities according to the 2006
Nigeria population distribution.
A structured questionnaire which was pre-tested was
administered to the respondents. Research personnel
were trained with the aim of acquainting them with the
survey instruments. Questions were adapted from UN-
AIDS general population HIV & AIDS indicator and the
Demographic and Health Survey questionnaires. Due to
the language complexity in Nigeria (with over 250 lan-
guages), questionnaire was designed primarily in English
Language. Translations of keywords into local languages
were done at a central level training to enhance uniform-
ity and standardisation of questionnaire administration.
Enumerators, including HIV & AIDS counsellors/testers
were versed both in English and the local languages of
the communities where they worked. For ethical appro-
priateness, the survey instruments and materials received
the approval of the Federal and State Ministries of Health
in Nigeria before implementation through the Nigerian
Institute of Medical Research. Consent of the respon-
dents was obtained individually and they were ade-
quately informed of the survey objectives upon which an
individual has the right to participate or otherwise with-
out any fear of intimidation. A total of 11,822 respon-
dents were selected for the survey but only 11,521 re-
sponded to the questionnaire.
An HIV pre-test (to all selected eligible respondents)
and post-test (only for those that obliged HIV testing)
counselling was offered, while results of the test was
provided orally but referrals to facilities for further con-
firmation and possible placement on treatment for those
that were positive. At the end of data co llection exercise,
the HIV test results were further confirmed on the dried
blood samples collected from respondents, in a well-eq-
uipped laboratory by an external consultant.
2.2. Data
Overall, 5360 women were interviewed in the 2007
NARHS. Of these, only 4195 agreed to be tested after the
HIV pre-test counselling. Therefore, all analyses in this
paper were based on the 4195 female respondents that
answered the behavioural questionnaire and accepted
HIV testing. Marital status was grouped into “Never mar-
ried, Currently married/cohabiting, and formerly mar-
ried (i.e. separated, divorced and widowed)”. In general,
the mean age of the respondents was 27.8 years with a
standard deviation (SD) of 9.34. Mean ages according to
the marital status are 19.8 years (SD = 4.90) for never
married, 30.5 years (SD = 8.61) for currently mar-
ried/cohabiting, and 35.9 years (SD = 9.33) for formerly
married. Table 1 presents the distribution of the respon-
dents according to marital status and selected character-
istics.
2.2.1. Depend ent Variable
The outcome variable of interest in this study is the result
of the HIV test conducted among respondents who were
interviewed and volunteered to be tested. For the purp ose
of this analysis, response indicating positive HIV test
was scored “1” and “0” otherwise.
2.2.2. Independent Variables
The key independent variables in this paper are: “marital
status”, “location of residence”, “geo-political zones”,
“age”, “tribe”, “age at first sex”, “experience of sexually
transmitted infections (STIs)”, “multiple partnering”,
“transactional sex i.e. sex in exchange for gifts/favour”,
religion, “k nowledge of HIV p revention ”, “knowledge of
HIV transmission”, and “education”. Marital status with
never married as reference category. Place of residence:
urban and rural (reference category). Others include
educational attainment: Qur’anic/primary, secondary,
higher, and no formal education (reference category).
Nigeria is divided into six geo-political zones: North
West, North East, South West, South East, South South
and North Central (the North Central zone was used as
the reference). Respondents’ age was grouped into four
categories; 15 - 19 years, 20 - 24 years, 25 - 34 years,
and 35 - 49 years (reference). Tribe was put into: Hau sa,
Igbo, Yoruba, and others (reference). Religion was clas-
sified into three; Christianity, Islam and others (refer-
ence).
Background characteristics (demographic variables)
and other correlates of HIV prevalence which are impor-
tant predictors were adjusted for in multiple logistic re-
gression models. These include location, marital status,
education, geo-political zones, respondents’ age, tribe,
religion, knowledge about modes of transmission and
prevention of HIV and AIDS, and sexual behavioural
indicators such as age at sexual debut, multiple sexual
partnering; sex in exchange for gifts, favour or money,
and self-report of sexually transmitted infections in the
las 12 months. t

Marital Status and HIV Prevalence in Nigeria: Implications for Effective Prevention Programmes for Women 213
Table 1. Descriptive information about the respondents according to demographic characteristics.
Variables Never marriedCurrently married/cohabiting Formerly married Total frequency
HIV Status
Positive
Negative
2.9
97.1
4.0
96.0
10.6
89.4
170
4025
Place of residence
Rural
Urban
56.7
43.3
69.3
30.7
70.3
29.7
2761
1434
Educational attainment
None
Qur’anic
Primary
Secondary
Higher
5.7
1.9
10.9
68.6
12.9
36.5
8.8
24.3
24.1
6.3
42.4
8.1
28.4
18.2
3.0
1182
285
870
1524
334
Geo-political zones
North West
North East
North Central
South West
South East
South South
9.5
11.1
16.5
23.0
20.0
19.9
26.1
15.9
18.4
17.4
8.2
14.0
17.4
14.0
17.9
17.0
15.7
17.9
876
605
745
792
501
665
Ethnicity
Hausa
Igbo
Yoruba
Others
16.1
23.9
22.9
37.1
37.0
10.7
17.4
34.9
21.6
17.4
19.5
41.5
1269
621
799
1506
Religion
Islam
Christian (Catholic and Protestants)
Traditional/No religion/Others
30.4
69.4
0.3
54.5
44.9
0.7
41.1
57.6
1.3
1966
2201
24
Knowledge of mode of HIV transmission
Correct knowledge of all (i.e. all five)
Otherwise
27.2
72.8
18.6
81.4
15.7
84.3
875
3320
Knowledge of m ode of prevention
Correct knowledge
Otherwise
48.2
51.8
36.4
63.6
33.1
66.9
1658
2537
Exchange sex for a gift
Yes
No
12.7
87.3
96.5
3.5
6.0
94.0
170
3269
Experienced STI symptoms
Had STI
Did not have STI
12.6
87.4
89.9
10.1
90.7
9.3
452
3743
Age at first sex
First sex below 15 years
15 years and above
Never
Can’t remember
5.1
33.7
59.5
1.7
21.0
71.7
0.3
6.9
22.0
64.8
N/A
13.1
694
2543
715
243
3. Data Analyses and Results
3.1. Descriptive Analysis
Table 1 presents the descriptive information about the
respondents considered in this paper. HIV prevalence
was highest among those who were formerly married
compared with those currently married/cohabitating, and
those who were never married.
Among the formerly married, 6.0% had exchanged sex
for gifts, favour or money, compared with 96.5% of cur-
rently married and 12.7% of never married who had ex-
changed sex for g ift, favour or mone y. In general, 90.7%
of those who were formerly married, 89.9% among cur-
rently married/cohabiting respondents, and 12.6% among
never married reported to have experienced STIs.
3.2. Bivariate Analysis
Bivariate analyses were performed to establish any sig-
nificant relationship between HIV status and its corre-
lates i.e. demographic characteristics and other factors
that are suspected to be associated with HIV status con-
sidered in this paper. In order to assess the degree of as-
sociation between HIV prevalence (status) and the se-
lected variables, Pearson Chi-square (X2) test of associa-
tion between the dependent and independent variables
was used. Results of the bivariate analyses are shown in
Table 2. HIV status was foun d to be significantly associ-
ated with marital status. Findings revealed a significant
and higher HIV prevalence among women who were
formerly married (10.6%), compared with those currently
married (4.0%) and never married (2.9% ) ( p < 0.0 001 ).

Marital Status and HIV Prevalence in Nigeria: Implications for Effective Prevention Programmes for Women 214
HIV prevalence varies considerably according to edu-
cational attainment, geographical regions, age and relig-
ion. Respondents with primary education and above are
about twice as likely as those with Qur’anic and no for-
mal education to be infected with HIV (p = 0.004). Con-
sidering the geo-political zones, HIV prevalence was
highest among formerly married women in North Central
zone. Results showed that formerly married women in
age group 20 - 34 have higher HIV prevalence compared
with their counterparts in other age groups (p < 0.0001).
HIV prevalence was highest among those practising
Christianity (Protestants and Catholics combined) (p <
Table 2. Percentage distributions of the level of HIV prevalence according to selected characteristics. p-values are based on
Pearson chi-square (X2).
Variables HIV prevalence p-value
Place of residence
Rural
Urban
3.7
4.7 0.142
Marital status
Currently married/cohabiting
Formerly married
Never married
4.0
10.6
2.9
<0.0001
Educational attainment
None
Qur’anic
Primary
Secondary
Higher
2.6
2.1
5.5
4.5
5.1
0.004
Geo-political zones
North West
North East
North Central
South West
South East
South South
2.3
4.6
6.3
4.0
3.8
3.5
0.003
Age categorized
15 to 19
20 to 24
25 to 34
35 to 49
1.4
4.4
6.0
3.4
<0.0001
Tribe
Hausa
Igbo
Yoruba
Others
3.4
4.3
3.6
4.7
0.303
Religion
Islam
Christian (Catholic and Protestants)
Traditional/No religion/Others
2.6
5.3
4.2
<0.0001
Knowledge of mode of HIV transmission
Correct knowledge
Otherwise
3.9
4.5 0.495
Knowledge of mode of prevention
Correct knowledge
Otherwise
3.4
5.0 0.011
Sexual behaviour in the last 12 months
Multiple sexual partners
Did not
13.5
4.4 <0.0001
Exchange sex for a gift
Yes
No
5.9
4.6 0.423
Experienced STI symptoms
Had STI
Did not have STI
6.5
3.7 0.004
Age at first sex
First sex below 15 years
15 years and above
Never
Can’t remember
3.3
5.0
1.3
4.1
<0.0001

Marital Status and HIV Prevalence in Nigeria: Implications for Effective Prevention Programmes for Women 215
0.0001) compared with those practising Islam or no re-
ligion. Knowledge of modes of prevention and modes of
transmission was positively associated with HIV infec-
tion. Prevalence was higher among those with incorrect
knowledge than those with correct knowledge. This as-
sociation is only significant for modes of prevention (p =
0.011). Respondents that had experienced STIs in the last
three months are almost twice as likely to be HIV posi-
tive compared with those who have never experienced
STIs (6.5 vs. 3.7) (p = 0.004).
Practising multiple sexual partnering showed a signi-
ficantly positive association with HIV status. Respon-
dents with multiple sexual partners in the last 12 months
are over 3 times more likely to be HIV positive com-
pared with those with at most one sexual partner (p <
0.0001).
3.3. Multivariate Analysis
Multiple logistic regression was used to assess possible
association between HIV status and marital status while
controlling for other factors. First, a simple logistic re-
gression of the dependence of HIV status on marital
status was fitted. This was aimed at investigating the
relationship between HIV status and marital status.
Hosmer and Lemeshow statistic [19] was used as a test
of goodness-of-fit for model checking. While respon-
dents who were currently married or cohabiting with
sexual partners were 40% (OR = 1.402, CI: 0.949, 2.073,
p = 0.09) more likely to be HIV infected, those who were
formerly married were over three times (OR = 4.014, CI:
2.347, 6.867, p < 0.0001) more likely to be HIV infected
(results not shown). In addition to marital status; demo-
graphic variables were controlled for in a multiple logis-
tic regression model at a further stage. This was aimed at
assessing the net-effect of association between HIV
status in the presence of demographic variables. Table 3
presents findings from the three models reported in this
paper. Findings showed significant association with
marital status. Respondents who were currently married
or cohabiting with sexu al partn ers are 80% more likely to
be HIV infected compared with those never married (OR
= 1.80, C.I.:1.19, 2.88). However, respondents who were
formerly married are 5.6 times more likely to be HIV
infected (OR = 5.6, CI: 3.09, 10.28).
Education and religion are found to be significantly
related to HIV status (p < 0.05). While respondents with
higher education level are 1.4 times more likely to be
HIV infected than those with no formal education (OR =
2.4, C.I: 1.21, 4.83), those with Qur’anic or Primary
education are 100% more likely to be HIV infected than
their counterparts with no formal education (OR = 2.0,
C.I.: 1.25, 3.24). Considerable regional variation exists in
HIV prevalence. All regions are less likely to be HIV
infected compared with the North Central region.
Model 2 controls for knowledge about modes of pre-
vention and transmissions in addition to the demographic
variables controlled for in model 1. The significant asso-
ciation between HIV status and knowledge that was seen
in bivariate analysis disappears with the inclusion of
other variables. The implication is that, some of the
demographic variables can explain this association seen
at bivariate level. In model 3 after sexual behaviour in-
dicators were controlled for in addition to Model 2, edu-
cation was found to be significantly asso ciated with HIV
status. Those with Qur’anic or primary education are
more than 100% more likely to be HIV infected than
those with no formal education (OR = 2.11, C.I: 1.29,
3.431). Those with secondary education are 1.51 times
more likely to be HIV infected th an those with no formal
education (OR = 2.51, C.I: 1.47, 4.30) . Thos e with high er
education are 1.41 times more likely to be HIV positive
than respondents without formal education (OR = 2.41,
C.I.18, 4.91). Also, multiple sexual partnering is signifi-
cantly related to HIV status. Respondents with multiple
sexual partners are 2.87 times more likely to be HIV
positive.
4. Discussions and Conclusions
This study examines possible determinants o f HIV infec-
tion among women age 15 - 49 years in Nigeria. Of spe-
cial interest in this paper is the very high HIV prevalence
among formerly married women. At the preliminary
analyses, marital status was explored as a proximate cor-
relate of HIV prevalence. To further understand other
correlates of HIV infection among this group, attempts
were made to control for demographic variables, knowl-
edge and sexual behaviours of the respondents. The aim
is to provide more insight into the issue of HIV preva-
lence among the female group, with a view to providing
more information for policy makers and stakeholders
interested in the health and quality of life for women in
Nigeria and by extension, in the sub Saharan region.
Findings revealed disproportionate HIV prevalence
across differential marital levels with formerly married
women worst affected. This finding could be attributed to
reasons such as lack of economic independence, lack of
formal education, low knowledge about HIV transmis-
sion and prevention which could result into poor or in-
ability to negotiate safe sex.
In this part of the world, widows are defenceless with
no provision for social security on the part of government.
On the other hand, the society often stigmatizes divorced
women. This double barrelled tragedy has its conse-
quences on women. In addition, in the Nigerian context,
and similarly in other part of Africa, women who were
once married readily draw the attention of other interested

Marital Status and HIV Prevalence in Nigeria: Implications for Effective Prevention Programmes for Women 216
Table 3. Estimates of adjusted odds ratios for HIV prevalence from multiple logistic regression.
Model 1 Model 2 Model 3
95% Conf Int. 95% Conf Int. 95% Conf Int.
Characteristics OR
Lower UpperOR LowerUpper OR Lower Upper
Marital Status
Never married (ref) 1.00 1.00 1.00
Currently married/cohabiting 1.8** 1.19 2.88 1.8** 1.19 2.88 1.38 0.81 2.34
Formerly married 5.6*** 3.09 10.28 5.60*** 3.11 10.37 4.10*** 2.15 8.08
Locality
Rural (ref) 1.00 1.00
Urban 1.24 0.87 1.77 1.23 0.87 1.76 1.21 0.84 1.76
Age
35 to 49 years (ref) 1.00 1 .00 1. 00
15 to 19 years 0.53 0.18 1.51 0.54 0.19 1.56 0.51 0.67 3.95
20 to 24 years 1.52 0.86 2.68 1.53 0.87 2.71 1.51 0.83 2.73
25 to 34 years 0.63 0.29 1.37 0.63 0.29 1.37 0.58 0.26 1.28
Education
None 1.00 1.00 1.00
Qur’anic/Primary 2.00** 1.25 3.24 1.90** 1.21 3.16 2.11** 1.29 3.431
Secondary 2.30** 1.38 3.89 2.20** 1.30 3.73 2.51** 1.47 4.30
Higher 2.40* 1.21 4.83 2.20* 1.10 4.54 2.41* 1.18 4.91
Religion
Islam & Others (ref) 1.00 1.00 1.00
Christianity 2.40*** 1.59 3.85 2.40*** 1.56 3.80 2.19** 1.38 3.46
Tribe
Other tribes (ref) 1.00 1.00 1.00
Hausa 1.18 0.71 1.96 1.17 0.71 1.95 1.11 0.66 1.86
Igbo 0.89 0.40 1.99 0.89 0.40 1.99 0.97 0.43 2.21
Yoruba 0.57 0.27 1.14 0.56 0.27 1.15 0.55 0.25 1.20
Geo-political zone
North central (ref) 1.00 1.00 1.00
North West 0.40* 0.23 0.83 0.40* 0.24 0.86 0.47* 0.24 0.93
North East 0.90 0.52 1.52 0.89 0.52 1.53 0.96 0.55 1.69
South East 0.40 0.16 0.95 0.39 0.16 0.97 0.34 0.13 0.88
South South 0.30*** 0.18 0.52 0.30*** 0.18 0.52 0.29*** 0.16 0.51
South West 0.70 0.35 1.42 0.69 0.34 1.40 0.67 0.31 1.42
Knowledge of modes of HIV prevention
Have no knowledge (ref) 1.00 1.00
Have knowledge 1.19 0.83 1.66 1.17 0.83 1.67
Knowledge of HIV transmission
Have no knowledge (ref) 1.00 1.00
Have knowledge 1.05 0.71 1.54 0.99 0.66 1.49
Age at first sex
Never had sex & below age 15 (ref) 1.00
Above 15 years 1.15 0.70 1.89

Marital Status and HIV Prevalence in Nigeria: Implications for Effective Prevention Programmes for Women 217
Continued
Can’t remember 1.21 0.54 2.70
Experience of sexually transmitted infections
Had no STI (ref) 1.00
Had STI 1.29 0.82 2.02
Multiple Partnering
Had no multiple sexual partners (ref) 1.00
Had multiple sexual partners 2.87** 1.46 6.02
Transactional sex
Never received gift/money for sex (ref) 1.00
Ever received gift/money for sex 0.99 0.49 1.99
*p < 0.05; **p < 0.01; ***p < 0.0001.
male partners who may promise to relieve the ir e cono mic
burden, but in disguise, only want to establish a sexual
relationship. The low ability of a large proportion of Ni-
gerian women to negotiate safer sex and offer an alterna-
tive safe method, such as use of the female condom, are
likely to have also contributed to the heightened probable
causes of the findings of this study.
The harsh economic condition that culminated into
high rate of unemployment irrespective of the educa-
tional status, and high cost of living, may also likely be
responsible fo r this problem. Th e erosion of moral v alues
in the society cannot be undermined. The high tendency
of linking people who were formerly married with be-
haviour that is considered improper and immoral may
have also prevent many women in this category from
seeking HIV Counselling and Testing (HCT). In this pa-
per, most independent variables considered were signifi-
cantly associated with HIV prevalence at bivariate level.
These relationships were further established at the mul-
tivariate level. This provided evidence that special inter-
vention strategies are necessary to stem this tide. Find-
ings revealed geographical variations in HIV prevalence
across geo-political zones. Highest prevalence was ob-
served in the North Central. To gain better insight into
the geographical variations of HIV prevalence, an analy-
sis at a highly disaggregated level of states will be u seful
for policy formulation. This is consequent on the fact that
information may be masked at the geopolitical level
since each geo-political zone comprises of six to seven
states. This will provide policy makers with adequate
tools for enhancing effective HIV & AIDS preventive
interventions. From the fitted logistic models, it became
apparent that multiple sexual partnering was a key de-
terminant of HIV infection among women with a higher
proportion of formerly married females engaged in mul-
tiple sexual partnering.
A key insightful finding from this study suggests that
gender mainstreaming in the on-going preventive efforts
should be strengthened and scaled-up, to particularly
target formerly married women. Findings further rein-
force the need for economic empowerment, social secu-
rity and welfare relief packages for women in this cate-
gory. HIV programming and policies that focuses on
formerly married women will continue to reduce the in-
cidence and prevalence of HIV and AIDS amongst this
group and at large, among women in general.
5. Limitations of the Study
The data used for this paper were obtained from a single
round of a national survey. This means that trend cannot
yet be ascertained. In order to further assess the vulner-
ability of formerly married women to contracting HIV
and AIDS, data at more time points will be desirable. As
in any cross-sectional study, causal relationships cannot
be established. Therefore, one cannot be certain whether
some of the factors precede or post-date HIV infection,
given the asymptomatic nature of HIV. Furthermore,
information on sexual behaviour was based on self-re-
ported responses by the respondents.
6. Acknowledgements
The authors would like to thank the Federal Ministry of
Health of Nigeria for granting us the permission to use
the 2007 NARHS data sets. The grants from DFID and
USAID to implement this survey are gratefully ac-
knowledged. Appreciation goes to colleagues at the Re-
search and Evaluation Division of the Society for Family
Health Nigeria for reading the first draft of this paper.
Their comments have led to substantial improvement of
this manuscript.
The work was carried out in a collaborative effort. AA,
JA, and SBA designed the survey, wrote the survey
protocol and supervised data collection. SBA and RIO

Marital Status and HIV Prevalence in Nigeria: Implications for Effective Prevention Programmes for Women 218
carried out the data analyses. All authors read and ap-
proved the final manuscriptt.
7. Conflicts of Inte rest and Sources of
Funding
None of the authors declared any conflict of interest. The
2007 National HIV & AIDS and Reproductive Health
Survey Plus from where data for this paper was gener-
ated, was funded by the United States Agency for Inter-
national Development (USAID) and the British Depart-
ment for International Development with the support of
the Federal Government of Nigeria.
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