Project – Association between HIV Stigma and Substance Abuse (Drug and Alcohol Use) among People Living with HIV/AIDS in Selected Health Facilities in Nigeria

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Human Immunodeficiency Virus (HIV) remains one of the most significant global public health challenges, particularly in Sub-Saharan Africa, where Nigeria carries one of the highest burdens of infection. Despite major improvements in antiretroviral therapy (ART), HIV continues to affect millions of people, with psychosocial challenges increasingly recognized as critical barriers to effective disease management.

One of the most persistent challenges facing People Living with HIV/AIDS (PLHIV) is HIV-related stigma, which refers to negative attitudes, discrimination, and social rejection directed toward individuals based on their HIV status. Stigma operates at multiple levels—community, institutional, and internalized—and has been shown to significantly affect health-seeking behaviour, psychological wellbeing, and treatment adherence (UNAIDS, 2023).

In Nigeria, HIV-related stigma remains widespread due to cultural beliefs, misinformation, and moral judgments attached to HIV infection. Many individuals living with HIV experience rejection from family members, discrimination in workplaces, and poor treatment in healthcare settings. These experiences often lead to emotional distress, including depression, anxiety, shame, and social withdrawal (UNAIDS, 2022).

A growing body of evidence suggests that psychological distress associated with HIV stigma may lead to maladaptive coping behaviours, particularly substance abuse. Alcohol and drug use are commonly reported among PLHIV as coping mechanisms for stress, isolation, and emotional pain. However, such behaviours often worsen health outcomes by reducing adherence to ART, weakening immune response, and increasing risky behaviours (WHO, 2021).

Substance abuse among PLHIV is a major public health concern in Nigeria. Studies have shown that alcohol is the most commonly used substance, followed by tobacco and psychoactive drugs. In high HIV burden states such as Benue State, substance use among PLHIV has been reported at concerning levels, raising questions about the psychosocial factors driving this behaviour (Federal Ministry of Health Nigeria, 2019).

The relationship between HIV stigma and substance abuse is complex. Stigma may push individuals toward alcohol and drug use as a coping strategy, while substance use may also increase stigma due to behavioural changes and social withdrawal. This creates a cycle of vulnerability that negatively affects mental health and HIV treatment outcomes (Mendenhall et al., 2017).

Despite increasing attention to HIV care in Nigeria, there remains a limited understanding of how stigma specifically contributes to substance abuse among PLHIV in Benue State. Addressing this gap is essential for designing holistic interventions that integrate mental health and substance abuse services into HIV care.

1.2 Statement of the Problem

Despite ongoing national and international efforts to reduce HIV transmission and improve care, HIV-related stigma continues to persist in Nigeria, particularly in high-prevalence states such as Benue. This stigma remains a major barrier to achieving optimal health outcomes among People Living with HIV/AIDS.

Many PLHIV continue to experience discrimination in their communities, families, and workplaces. Such discrimination leads to psychological distress, including depression, anxiety, low self-esteem, and feelings of hopelessness. Internalized stigma further worsens their condition, as individuals begin to accept negative societal perceptions about themselves (UNAIDS, 2023).

One major concern is the increasing tendency of PLHIV to engage in substance abuse as a coping mechanism. Alcohol and drug use are often adopted as temporary relief from emotional distress caused by stigma and social rejection. However, this behaviour has serious consequences, including poor adherence to ART, increased risk of opportunistic infections, and worsening mental health conditions (WHO, 2021).

In Benue State, anecdotal and empirical evidence suggests that substance use among PLHIV is rising, yet the underlying psychosocial factors—particularly HIV-related stigma—remain underexplored. Most HIV interventions focus primarily on biomedical treatment, with limited attention to behavioural and psychological determinants of health outcomes.

Furthermore, there is insufficient localized research examining the direct association between HIV stigma and substance abuse among PLHIV in Benue State. This creates a critical knowledge gap that limits the effectiveness of intervention programs aimed at improving the wellbeing of affected individuals.

Therefore, this study seeks to examine the association between HIV-related stigma and substance abuse (drug and alcohol use) among People Living with HIV/AIDS in selected health facilities in Benue State, Nigeria.

1.3 Objectives of the Study

General Objective

To examine the association between HIV-related stigma and substance abuse among People Living with HIV/AIDS in selected health facilities in Benue State, Nigeria.

Specific Objectives

1. To assess the level of HIV-related stigma among PLHIV in Benue State.
2. To determine the prevalence of substance abuse among PLHIV.
3. To examine the relationship between HIV stigma and alcohol use among PLHIV.
4. To examine the relationship between HIV stigma and drug use among PLHIV.
5. To identify psychosocial factors influencing substance abuse among PLHIV.

1.4 Research Questions

1. What is the level of HIV-related stigma among PLHIV in Benue State?
2. What is the prevalence of substance abuse among PLHIV?
3. Is there a relationship between HIV stigma and alcohol use among PLHIV?
4. Is there a relationship between HIV stigma and drug use among PLHIV?

1.5 Research Hypothesis

H₀: There is no significant association between HIV-related stigma and substance abuse (drug and alcohol use) among People Living with HIV/AIDS in selected health facilities in Benue State.

H₁: There is a significant association between HIV-related stigma and substance abuse (drug and alcohol use) among People Living with HIV/AIDS in selected health facilities in Benue State.

1.6 Significance of the Study

This study will be beneficial to multiple stakeholders. It will contribute to the understanding of psychosocial determinants of substance abuse among PLHIV, particularly the role of stigma. Healthcare providers will use the findings to improve integrated HIV care that includes mental health and substance abuse counselling.

Policymakers and public health agencies will also benefit from evidence-based recommendations for strengthening stigma reduction interventions. NGOs working in HIV prevention and care will gain insights for designing community-based psychosocial support programs.

Finally, the study will serve as a reference for future researchers in the fields of HIV/AIDS, mental health, and substance abuse.

1.7 Scope of the Study

This study is limited to People Living with HIV/AIDS receiving care in selected health facilities in Benue State, Nigeria. It focuses specifically on the association between HIV-related stigma and substance abuse (alcohol and drug use). Other mental health conditions are not the primary focus except where they relate to substance use.

1.8 Operational Definition of Terms

• HIV Stigma: Negative attitudes and discrimination toward individuals living with HIV.
• Substance Abuse: Harmful use of alcohol or drugs that affects health and functioning.
• PLHIV: People Living with HIV/AIDS.
• Mental Health: Emotional, psychological, and social wellbeing.
• Benue State: A state in North-Central Nigeria with high HIV prevalence.

Project – Association between HIV Stigma and Substance Abuse (Drug and Alcohol Use) among People Living with HIV/AIDS in Selected Health Facilities in Nigeria