Exploring Healthcare Access for HIV/AIDS Patients in Nigeria: Barriers and Challenges

Dissertation Title:

“To investigate the barriers and challenges to accessing quality healthcare for people with HIV/AIDS in Nigeria.”

Abstract

This research analyses the major barriers and challenges that prevent HIV/AIDS patients in Nigeria from accessing quality healthcare. This qualitative study is based on secondary data analysis, which is undertaken using a thematic approach. A total of 14 studies were retrieved from credible online resources that aligned with each of the formed themes. Likewise, social identity and intersectionality theoretical frameworks were used to carry out the data analysis. The findings revealed that the lack of education, awareness, and high religiosity levels of the Nigerian people result in the prolonged discrimination of AIDS patients. These social and cultural evils have had adverse implications for the stigmatisation of the inventions by the government of Nigeria, policymakers, the social system, as well as the media and communication platforms of the region. The study indicated a need for a political intervention which would address the social evils’ root cause and humanize the HIV/AIDS patients in Nigeria.

Contents

Abstract 2

List of Figures 5

List of Tables 5

1.0 Background Introduction: 6

1.1 Rationale for the Study: 7

1.2 Aims and Objectives: 8

1.2.1 Aim: 8

1.2.2 Objectives: 8

1.3 Research Questions: 8

1.4 Overview of the Dissertation Structure: 9

2.0 Introduction of Chapter 11

2.1 Critical Analysis of the Key Selected Studies 11

2.1.1 The situation of HIV/AIDS patients in Nigeria 11

2.1.2 The Social and cultural factors impacting the healthcare access of Nigerian Patients 12

2.1.3 The Real Reasons Behind the HIV/AIDS Spread in Nigeria 16

2.1.4 The Government and Healthcare Sector of Nigeria’s Efforts for HIV/AIDS Patients 17

2.2 Literature Gap 17

2.3 Chapter Summary 18

3.0 Introduction of Chapter 19

3.1 Research Methodology 19

3.2 Research Philosophy 20

3.3 Research Approach 21

3.4 Research Strategy & Data Extraction 22

3.4.1 Search Strategy & Screening 22

3.4.2 Inclusion Criteria 23

3.4.3 Exclusion Criteria 24

3.5 Data Synthesis & Management 24

3.6 Ethical Considerations 25

3.7 Chapter Summary 26

4.1 Chapter Introduction 27

4.2 Overview of AIDS Patients in the Nigerian Community 27

4.3 Conceptual Framework: The HIV Stigma 28

4.4 The sociocultural traditions, misconceptions, and beliefs 29

4.5 The religious perspective on discrimination 31

4.6 The role of media and communication 32

4.7 The political and legal take 34

4.8 The Healthcare industry and its workers 35

4.9 Intervention for Destigmatisation 36

4.10 The Role of the social system in destigmatisation 37

4.11 The role of education and awareness in stigmatisation 38

4.12 Theoretical Framework 39

4.13 Chapter Summary 39

5.1 Introduction of the Chapter 44

5.2 Summary of findings and their linkage to research questions 44

5.3 Implications and recommendations for policy, practice and research 46

5.3.1 For Policy 47

5.3.2 For Practice 47

5.3.2 For Research 48

5.4 Limitations and strength of research 48

List of Figures

Figure 1 – Death toll of HIV/AIDS patients in Nigeria (Statista, 2021) 13

Figure 2 – Conceptual framework of the study 29

List of Tables

Table 1 – Percentage of Nigerians having misconceptions related to HIV 30

Table 2 – Synopsis of collected data 43

Chapter One

1.0 Background Introduction:

Human immunodeficiency virus (HIV) is a fatal virus that attacks the immunity of the person and makes room for other opportunistic diseases (WHO, 2023). It directly attacks the white blood cells (CD4 Cells) of the body which in turn deteriorates the immune system (Murphy, 2023). A weak immune system makes more opportunities for diseases to attack the HIV-infected person (Cleveland Clinic, 2022). A more severe and untreated form of HIV can become a syndrome known as Acquired immunodeficiency syndrome AIDS (WHO, 2023). According to statistics 1.5 million people caught HIV and 650,000 died in the year 2021 (MSF). There has been a lesser number of people who acquired HIV in 2022 numbered 1.3 million and caused death to 630,000 people with HIV-related diseases (WHO, 2023).

HIV has a considerable stigma in society and that is why people who have HIV are treated significantly differently as compared to people who do not have HIV (CDC, 2020). For instance, there are many examples where people treat differently to people affected by HIV, they don’t receive proper treatment due to stigmatization, they receive refusal to get contact with and usually face isolation which results in their inability to get themselves treated (CDC, 2020). People living with HIV internalise the stigmas which can lead towards depression, solitude, and feeling of disgrace and can cause hindrance in getting the treatment in order to hide their disease (MHAF, 2020). Like all other African countries, a large number of Nigerians are also suffering from HIV/AIDs diseases. Around 1.9 million people in Nigeria were found suffering from HIV and Aids problems in the 2019 survey (UNODC, 2023). Around 1.1 million people are female gender and 0.629 million are males suffering from HIV/AIDs infections in Nigeria with ages above 14 years (Statista, 2023). Around 0.17 million children in Nigeria are suffering from the disease. This is showing the significance of the issue (Statista, 2023).

Keeping the issue of extreme significance, around 602 billion US dollars had been spent on the prevention and control of the HIV/AIDS issue in Nigeria (Reuters, 2022). 80% of the funding is coming from foreign donors including the USA and WHO (Reuters, 2022). Despite the changes occurring in international politics, this is important that foreign funding may not support the sector in future. Therefore, there is a need for improving the current situation and finding a way forward to overcome the issue in the country and finding the root cause of it.

In addition, cultural and social values also play an important role in the propagation and transfer of HIV/AIDs (Fauk et al., 2021). Health professionals and international organisations also create awareness programs to share knowledge and information about the disease (Alhasawi et al., 2019; U.S. Department of Health & Human Services, 2021). Despite all these efforts, programs, and campaigns, the required results are not being achieved. This is a clear indication that there are economic, sociocultural, and lack of awareness are contributing to the problem.

1.1 Rationale for the Study:

Social and cultural values play a key role in propagation of the HIV/AIDS; therefore, it is also important to research the root cause and identify the cultural and social barriers that hinder the success of the HIV/AIDS control program in Nigeria. Acquiring knowledge of the major barriers will help to reduce the spread of his disease and thereby an effort in reducing this stigma in Nigerian society. As soon as these factors and barriers are clearly understood, effective targeted inventions can be developed and implemented. Therefore, it has become crucial to identify and examine the reasons and factors due to which the issue is not being effectively addressed and prevented, and also the challenges for the government and healthcare authorities to ensure effective access of HIV/AIDs patients to better healthcare facilities. Determining these challenges, barriers, and shortcomings, will aid in effective planning, resource allocation, and developing control mechanisms to overcome the issue and hence better healthcare access and eradication of this stigmatized disease from Nigeria.

1.2 Aims and Objectives:

1.2.1 Aim:

The aim of this research study is to investigate and explore the sociocultural barriers and challenges faced by the people of Nigeria suffering from HIV/AIDS infection when accessing quality healthcare. The purpose of the study is to identify, understand, and uncover the major factors that cause hindrances in the way of receiving adequate and quality healthcare services to individuals living with HIV/AIDS to help them attain healthcare access and the policymakers to implement effective and result-oriented interventions based on the population’s unique needs and concerns in order to combat this stigma from the Nigerian society

1.2.2 Objectives:

To identify the key challenges and barriers that impede the access of Nigerians with HIV/AIDS to adequate and quality healthcare.
To explore the role of sociocultural factors that prevent the population from seeking quality healthcare.
To find out ways and strategies based on the data gathered for facilitating their quality healthcare access and thereby reducing the stigma of this infectious disease.
To make recommendations to healthcare providers, policymakers, and authoritative bodies to design tailored intervention policies, solution options, and treatment plans accordingly.

Research Questions:

What are the main sociocultural factors that serve as the barriers to impede the access of Nigerians with HIV/AIDS to adequate and quality healthcare?
Why is it crucial to uncover the major barriers that hinder HIV/AIDS patients in Nigeria from seeking healthcare and treatment?
How can we possibly strategize to reduce this stigma in Nigerian society?
What are some recommendations that we can propose to the policymakers, healthcare providers, and authoritative bodies in developing and implementing effective policies and interventions to eradicate this infectious disease?

Overview of the Dissertation Structure:

Following is a breakdown of each chapter highlighting the major elements and areas this research dissertation would be focusing on to ensure that it follows a logical structure:

Chapter One: Introduction

In the first chapter of this dissertation, the background of the research is described which would set the context for this research study by highlighting Nigeria’s current state of healthcare access for people with HIV/AIDS infection. It will provide the background and key stats of the situation and the challenges being faced by Nigerians with HIV/AIDS. Next, the rationale for the study would be discussed which highlights the necessity of addressing the barriers and challenges for this population in accessing quality healthcare as well as treatments. The research questions are presented in a logical flow, highlighting the major barriers, sociocultural factors, levels of knowledge and awareness, strategies for facilitating access, and thereby reducing this stigma by proposing effective recommendations. Later, the aims and objectives along with the significance of the study are also emphasised mentioning the potential impact of the findings on the well-being of the population.

Chapter Two: Background Literature

This chapter, starting with a brief introduction, would provide a critical analysis of the key studies used. This critical literature review will evaluate the relevant literature on the topic under study covering the methodologies employed, key outcomes, and gaps in the previous literature related to the barriers and challenges faced by Nigerians with HIV/AIDS in accessing healthcare. Upon identifying the key gaps of the previous studies, this study would be based on bridging the gap and thus paving the path towards better healthcare access and thereby eradicating this stigma. This chapter would conclude with a summary covering the key points that would bring to attention the need for further research in this regard.

Chapter Three: Methods

The third chapter would explain the what and why of the methodology being employed t carry out this research. It would be qualitative research and is based on secondary data in the form of credible publications including journal articles, policy reports, surveys, case studies, and other relevant data sources. The approach for data analysis would be the thematic analysis approach to present the key themes and codes comprehensively. Apart from these, the ethical considerations, dilemmas for using the primary approach, inclusion and exclusion criteria and a summary of the key information will also be presented.

Chapter Four: Results

Beginning with a brief introduction, this chapter comprises the key findings of this research and is presented in an organized manner by addressing each research question related to the identified barriers and challenges faced by the people of Nigeria with HIV/AIDS in their way to access and receive quality healthcare. It then concludes with a summary of key outcomes.

Chapter Five: Discussion & Conclusion

The final and most significant chapter begins with an overview of the chapter, with a major focus on the key findings in correspondence to the research aims, objectives, and questions. This chapter contains the scope and implications of the study for policymakers and healthcare professionals as well as the authorities and departments overseeing Nigerian healthcare. It also comprises the study’s limitations as well as the need for future research. It finally concludes with the potential impact and significance in policy and practice and presents well-researched, weighted, and carefully considered result-oriented recommendations which would help in designing tailored policies and interventions to make Nigeria free of this infectious disease and stigma of HIV/AIDs.

Chapter Two

2.0 Introduction of Chapter

This chapter is crucial to the study because it sets up the foundation on which the arguments, themes, and frameworks of the research will be formed. As a consequence, a careful consideration of the articles related to the research topic has been selected, which are then critically analysed in this chapter. The analysis of the resources would uncover the underlying themes, which would be used to finalise the relevant and crucial themes in Chapter 4. Therefore, the research has only employed credible and high-quality sources and journal articles to be incorporated into this section. After analysing the current situation of HIV and AIDS in Nigeria and the hesitation and reluctance of the patients for seeking healthcare, the gap was identified. This enabled the researcher to narrow down their research focus so that highly concentrated efforts were dedicated to finding the major reasons for this social evil. The main issues that led up to the low healthcare accessibility of Nigerian suffering from HIV/AIDS are meticulously evaluated in this section – with socio-cultural dilemma and devaluation being the most common hindrance. These also reduced the impact of the healthcare sector’s initiatives for better service delivery for HIV/AIDS patients. Other issues include poverty, lack of education, economic crisis, and the lack of resources in this region.

2.1 Critical Analysis of the Key Selected Studies

2.1.1 The situation of HIV/AIDS patients in Nigeria

The importance of this topic can be determined by the fact that, among all of the global states, Nigeria ranks second and has the largest burden of HIV infections (UNODC, 2023). The statistics indicating this representation are very shocking because a survey indicated that around 1.9 million Nigerians have this infectious disease; it shows that the burden on Nigeria of these patients is very huge (UNAIDS, 2019). This refers to the fact that resolving the obstacles and the pathway to quality healthcare acquisition for the Nigerian AIDS patient would solve a huge issue in the region. This is why international organisations such as the United Nations are streamlining their efforts to bring about positive changes in the lives of these sufferers (UNODC, 2023). Despite being impacted by this disease to such a large extent, AIDS remain taboo in society. Badru et al. (2020) build up on this statement as the authors indicate that illicit sexual activities are the main reason for the spread of HIV which results in people looking down upon AIDS patients. The scholars further added that people also do not have awareness about the disease due to which they ignore the symptoms until their health conditions get out of hand. Moreover, there are a lot of social and cultural hindrances that are worsening the situation of the patients as they prefer not to seek medication or treatment. The prime reasons are discussed below. These reasons would help in establishing the research argument and defining the literature gap as they would uncover the influence of societal and cultural practices and thinking on the health care access of the people. Only then would be the research gap identified. The upcoming section outlines the research that is done pertinent to this study’s topic and would identify the reason which is causing no positive change in the situation of Nigerian AIDS patients – besides the efforts put in by the Government and international authorities.

2.1.2 The Social and cultural factors impacting the healthcare access of Nigerian Patients

Stigma

HIV or AIDS have always been a topic of major concern in Nigeria because, apparently, solid steps are being taken to control the situation because of the varied issues attached to them. The first of them is the stigmatised and stereotypical behaviour displayed towards the patient, which makes them feel hurt or judged; as a result, a huge number of patients choose to refrain from accessing medications or treatment (Dahlui et al., 2015). The fear of prejudicial emotions is so strong in the hearts of HIV patients that many of them do not even know their HIV status and conceal their condition throughout, even at the stake of their own life (Oguyemi et al., 2022). It is because the social devaluation of such people is so intense in society that many people do not even think of being its victims and die in silence. The figure below shows the age gaps and death toll in Nigeria due to this deadly disease:

Figure 1 – Death toll of HIV/AIDS patients in Nigeria (Statista, 2021)

The statistics are indeed shocking because the highest ratio of deaths due to AIDS is observed in children and adults, which shows that the young generation is not safe from the threat of this disease. If not encountered, the situation might have significant implications for Nigerian society. The abovementioned figure is also showing the age of the patients. First of all, nearly all age groups have fallen victim to this infectious disease in Nigeria as even newborn babies to adults have large numbers of deaths due to AIDS. The main reason newborn babies are impacted by this disease is because many pregnant women are facing HIV infections due to which the transmission of this disease to their babies happens most of the time. The situation is so significant in the country that every one in four babies is a patient of HIV or AIDS in Nigeria (Cohen, 2018).

Lack of Awareness

The literacy rate in Nigeria is low, followed by the improper provision of educational facilities, such as a lack of classrooms, which shows the lack of education of the people (Sasu, 2023). That justifies the lack of awareness and education among HIV patients, which prevents them from knowing their right to education and makes some believe that if they felt stigmatised for their disease, there would be a fear of discrimination in society. In the same manner, a lack of education also results in improper knowledge related to diseases, which results in a delayed acquisition of healthcare facilities. For instance, the patient’s mind might ignore the initial symptoms first, and in cases where health is getting worse, consultation with a doctor might not be effective in saving their lives (Ukaegba et al., 2022).

Poverty

Wealth inequality is one of the prime indicators of the lack of awareness among HIV patients in Nigeria; this implies that people belonging to lower income classes do not know ample enough to identify a disease and take the steps needed to acquire proper treatments (Faust, Yaya, and Ekholuenetale, 2017). The working class does not have enough money for excess healthcare, due to which they then avoid treatments and healthcare when they can because they lose their income on it. The social and economic determinants prevent these people from not only having proper medical care but also acquiring a healthy diet, stable housing, and contacting the respective supportive services, which keeps aggravating their situation (Faust, Yaya, and Ekholuenetale, 2017). In contrast, Africa reduced its AIDS spread ratio by 14% during 2010-2015 by providing economical treatments (i.e., ART) to its patients; thousands of patients across the whole continent benefitted from this (Martin, 2016). It also provided the facility of caregiving facility at patients’ homes which made sure the patient’s optimal recovery (Martin, 2016). This indicates how affordable treatments can be used to overcome this issue in Nigeria too.

Rise in Sex Workers

Sex workers also belong to the vulnerable group as this discriminated and poverty-stricken segment of people is continuously on the rise in Nigeria; as a consequence, many people are joining this sector because of the declining economic conditions, unemployment, and lack of education which saves them no choice but to continue this work (NSWP, 2018). Working in the forms of brothels and independent basis and both these institutions are the main reason for the spread of this disease in Nigeria (Okafor et al., 2017). The main reason behind this is the lack of awareness due to which contraceptive and prevention methods are not adopted by these sex workers during intimacy which results in the transmission of this disease. Also, drug abuse is pertinent to sex workers due to which injecting the drugs hygienic needles increases the disease surge (Okafor et al., 2017).

Improper Healthcare Administration

The research topic also places special emphasis on the situation of the healthcare infrastructure in Nigeria. Besides having the fastest-growing population across the globe (3.2% population growth rate), modern facilities are not available in the healthcare sector of Nigeria, which shows that it is still not developed properly (US Government, 2023). Most importantly, Nigeria is one of the countries that face inequality in rural-urban medical facilities, which shows that HIV/AIDS patients who are not residents of urban areas have extreme accessibility issues related to the healthcare facility as, given their poverty, they cannot even afford to bear the transportation costs (Nwankwo et al., 2022). In parallel, the lack of education in the country has adversely impacted the healthcare sector because there is a shortage of medical workers in Nigeria too (Nwankwo et al., 2022). In this way, the research has demonstrated the interconnection between all of the social and cultural contributors to the low healthcare accessibility of HIV/AIDS patients in Nigeria. Further, the affordability of healthcare facilities in Nigeria is also extremely low for middle-class people or the ones who fall below the poverty line (World Bank, 2022). It is because the financing of the healthcare sector is not enough to meet the expenses of running the sector that the patients also have to pay a significant amount of money themselves to acquire medication; this indicates that public health services are not accessible due to the financial problems of the patients as well as the healthcare sector (Lara Onyekonwu et al., 2020).

Gender Gap

Females are more susceptible to HIV/AIDS infection than males in Nigeria. However, the psychological impacts of this infection are far less severe for females than males, as women manage to have a good quality of life despite being affected by this life-taking disease (Lara Onyekonwu et al., 2020). On the other hand, females do not access treatment or tend to pursue it due to a lack of awareness and support from family members. A study revealed that female participation in ART (anti-retroviral therapy) for AIDS is very low; even many pregnant women are not willing to continue taking their medicines due to this issue. These patients act in this way because they do not have transportation expenses, fear the hostile behaviour of the healthcare workers, and have their loved ones’ support (Opara et al., 2022).

The Behaviour of Healthcare Workers

The attitude of the doctor determines the effectiveness of the patient’s treatment. So it was important to investigate whether the healthcare practitioners in Nigeria are maintaining a professional and congenial environment for their AIDS patients or not. Surprisingly, most of the workers were revealed to be optimistic and funny towards the patients taking VCT, ART, and other treatments; courtesy, good tone, financial support sometimes, and good interaction were found to be the key characteristics of most of the health care provided to the AIDS patient in Nigeria (Dapaah, 2016).

2.1.3 The Real Reasons Behind the HIV/AIDS Spread in Nigeria

One study discards the stigma attached to those stereotypical behaviours towards a special by mentioning that the spread of AIDS in the Nigerian adult population is very low, at around 3.2% (Afowala and Ogundele, 2018). Another factor of the common perception of the spread of this disease is that true drug addicts or sinking workers are rejected because Afowala and Ogundele (2018) have also indicated that these means are not the major reasons that result in the prevalence of this disease in Nigeria.

Unfortunately, Nigeria is still one of the societies where women face discrimination in every walk of life (Ewang, 2022). This shows how the public health system of Nigeria is deeply rooted in the social and cultural beliefs of bygone eras. Young girls are forced into marriages, and sexual violence is faced by women, which puts them at a greater risk of getting infected with HIV or AIDS (Bala et al., 2023). Parents marry their young girls to relieve their financial burdens and some even marry their daughters in exchange for money (Girls not Brides, 2019). This indicates that gender discrimination and forced marriages cause the spread of the disease in Nigeria. In addition to this, the ratio of disease amongst married and unmarried women was 3.4%, followed by a massive 5.9% in the women that were previously married; likewise, transactional intimacy was the key reason that led up to the massive spread of this disease in females (Fagbamigne, Adebayo, and Idemudia, 2016). This shows that family, sex trafficking, and intimacy with benefits are major reasons behind the spread of this disease.

2.1.4 The Government and Healthcare Sector of Nigeria’s Efforts for HIV/AIDS Patients

The healthcare sector of Nigeria recognises the rising need of taking dire steps to control the situation due to which, it has implemented several measures too. In 2016, the Minister of Health of Nigeria announced the country’s alignment of its practices with the Treat All Protocol of the World Health Organisation (WHO). In the press release by WHO, it was seen that the Nigerian government expressed concern for the betterment of the people suffering from this deadly infection (WHO, 2016). The Treat All protocol facilitates the treatment of HIV patients and also focuses on adopting a person-centred and rights-based approach to ensure optimal service delivery; it also incorporates the use of state-of-the-art and updated technology for the treatment (WHO, 2021). This programme has a “test and treat” approach, which has been extremely effective in treating AIDS and HIV patients. According to healthcare workers in Nigeria, the ‘test and treat’ concept has improved the treatment of AIDS patients (Odafe, 2019). The policymakers also contributed to it as in 2014, the HIV/AIDS Anti-Discrimination Act 2014 was also passed which protected AIDS patients as individuals and organisations were instructed to stop discriminating against people based on their HIV disease (UN AIDS, 2015). However, successful implementation of this programme requires the training of healthcare workers too, so that they can learn the benefits of starting the treatment early (Odafe, 2019). There are multiple other steps taken by the government and the healthcare sector which will be highlighted later in chapter 4.

2.2 Literature Gap

Until now, there have been multiple factors considered that are directly or indirectly impacting the accessibility of healthcare services for Nigerian AIDS patients. Plus, every factor is connected to the stigma and discrimination that have gained universality in the culture. Every piece of literature mentions that the fear of discrimination and stereotypical behaviour is preventing patients from approaching healthcare facilities. However, the work undertaken on this topic is very little. This shows that the evidence available to understand the reason for the societal discrimination towards AIDS patients is still unknown. As a consequence, there is a need to carry out a dedicated investigation into the root causes of the behaviours, beliefs and attitudes of the community that give rise to the fear and hesitation of the patients in revealing their conditions.

In simple terms, the research is focused to figure out the sociocultural beliefs, behaviours, and practices that have led up to the development of this mentality of the people of Nigeria with respect to their interactions with AIDS/HIV patients. In the same manner, the efforts outlined by the government and supportive authorities in dealing with these issues are also to be evaluated so that the role of the healthcare system in navigating the AIDS patient through the social and cultural nuances can be determined. In this way, the policymakers would be provided with the exact ways to cure the core of the problem which lies in the thought process of the Nigerian nation.

2.3 Chapter Summary

This chapter has set up the fundamentals of the research. It is because it has incorporated scholarly resources that are shedding extensive light on the social and cultural obstacles faced by Nigerian HIV/AIDS patients which stop them from accessing healthcare. Lack of economic resources, societal stigma and discrimination, gender gap, surging number of sex workers, low literacy rate, and improper healthcare infrastructure are the reasons that are contributing to the poor quality of service delivery for HIV patients’ treatment. These reasons are deeply rooted in the society of Nigeria which makes change extremely difficult and that is why the effectiveness of the initiatives introduced by the healthcare administration of Nigeria and its government are not showing visible outcomes due to this ever-increasing spread of HIV/AIDS in the region.

Chapter Three

3.0 Introduction of Chapter

The next step in the research process was to explain the exact measures that were taken to produce the data findings followed by a detailed account of the motives and justifications for each of the chosen dimensions of the research methodology. To start with, secondary data had been considered the major form of data to be evaluated in the study because of its richness and wide availability in the Nigerian context. Next, the qualitative research strategy was the foundation on which the basis of this investigation was structured. In a similar manner, the interpretivism philosophical approach made sure a critical and thorough understanding of the social and cultural standing of Nigerian society which was necessary to understand the existing stigma of HIV/AIDs there. Interpretations were made using an inductive approach which was accomplished through the technique of thematic analysis. The data collection was primarily performed using online resources and publications. To make certain compliance between the research objectives and the extracted data, a well-structured search strategy and screening process was put forward that shed light on the importance of the terms required to be searched. As an extra layer of quality check, inclusion and exclusion criteria were set so that the inconsistency or irrelevance in the obtained data was minimised to nil. Lastly, the ethical compliance of the research with qualitative research standards has also been justified in this section.

3.1 Research Methodology

Until now, it has been significantly explained that the deep-rooted issues which Nigerian HIV/AIDs patients are facing make up the objective of this study. From this objective, is evident that the in-depth comprehension of this subject could only be realised by a research design that would incorporate a detailed analysis of the diversified range of data available on the topic. The main principles of qualitative research design comply with the requirement of this study as this technique helps in a detailed and in-depth study of scholarly work and the social and cultural content available in the given research field. This feature of qualitative data facilitated an understanding of the social and cultural stigmas prevailing in the Nigerian society related to HIV/AIDs which are not only refraining the patients from acquiring top-class healthcare but also depict the negligence of the society overall. This observation could not have been noticed if the researcher had chosen the primary data collection through quantitative analysis. It is because the people of Nigerians might not be fully aware of the healthcare facilities available to and have an empathetic approach towards the infected patients which might not have added to the motives of this inquiry. Owing to this reason, getting to the bottom of the issue becomes difficult for these types of studies as the students are not able to have a well-explained reason for the behaviour of the study participants using a brief approach i.e., quantitative (Daniel, 2016). This secondary data is collected over many years, so the overall change in the perspective and behaviours of Nigerian society was evaluated thoroughly. For example, the changes in societal thinking were evaluated by contrasting articles for the last decade. This gave resourceful information pertinent to societal thinking over extended frames; thus, a contrast of multiple decades or periods of society’s behaviour towards HIV/AIDs patients was done as well (Saunders, Lewis and Thornhill, 2019). However, this research only considered articles from the past 10 years.

In addition, the data collection method is mainly the retrieval of reliable sets of data through online mediums. The data range is extensive and the types comprising it are: journal articles, surveys, research papers, policy reports, case studies, news articles, government publications legislations and press releases. The rationale for choosing a diverse data range is the huge amount of resources available, making the comprehensive analysis of the subject matter possible. In the same manner, the resources are also screened through a strict process where the criteria and limits of the inclusion of the resources were set. The articles that did not comply with even one criterion were instantly rejected. In this regard, the data collection process was intended to be transparent and reliable. The data collection process is the backbone of any research because based on it, the insights into the actual condition of the subject matter are identified (Mwita, 2022). Without dependable resources, the background of the problems would not be revealed, resulting in the failure to attain this project’s goals. Any policy measure taken based on ineffective research only ends up causing minimal outcomes.

3.2 Research Philosophy

In Chapter 1, the research objectives are straightforwardly mentioning the analysis of the knowledge, awareness stigma and the social-cultural situation in Nigeria which refers to the high importance of the researcher’s social and cultural background awareness of the Nigerian community. In continuation to this, interpretivism philosophy is highlighted as the most appropriate philosophical basis of this exercise. First and foremost, this school of thought puts immense focus on the recognition of cultural and social features of the society that are influential on the behaviours and actions of the human – in particular, the target audience of the study (Saunders et al., 2019). The aftermath of this was a better understanding of the societal concepts that facilitated the interpretation of the data by the researcher ending in the high quality of the data findings. So, in order to suggest the most actionable steps to the Nigerian policymakers and healthcare administrative bodies, the prospective responses of the nationals and their agreements to the rules needed to be considered beforehand. Also, there is a slight possibility of reflexivity in the interpretations (Rogers, 2020). The counterstrategy of this limitation was a small task where the reflections and perspectives of the researcher were noted down. Once the researcher became aware of their perspective on the research topic, they made sure that their point of view did not clash with the perspective presented in the data resources. The prime cause due to which other philosophical stances were not selected was their application to the primary research in general. For instance, positivism is functional on a deductive approach where the theories are already available on the research topic (Park, Konge and Artino, 2020). However, in this study, the challenges of the healthcare access and acquisition of Nigerian HIV/AIDS patients are unknown followed by the reasons that have led to the situation. Likewise, knowing their possible impact on society, new workable theories/frameworks can be formed, which would help policymakers in improving the situation.

3.3 Research Approach

Taking into account the nature of the data, the inductive approach was chosen as the key approach for carrying out this analysis as it is in line with and aims of this inquisition. For instance, qualitative research is better known for the extensive descriptions and interpretations of the data findings which cannot be accomplished without an inductive approach as the rich and extensive data sets always set up the foundation for new hypotheses and theories (Soiferman, 2010). This would not have been achievable if the researcher is dealing with the data using a deductive approach because the concepts are preconceived there and the theoretical grounds are already formed. In the same manner, the data range is very extensive in the case of qualitative research. Due to this reason, often data which is not directly related to the content could be selected but the hidden interpretations of that that are set for the research topic could only be examined using an inductive approach (University of Warwick, 2024). This shows that even if the researcher does not have a particular question in mind, an inductive approach enables them to derive implicit relations and themes in the comprehensive information resources to enrich the work. In contrast, a deductive approach requires data collection from scratch which is not only expensive but time-consuming; here, inconsistency in data might end up in the quality compromise of the study (University of Warwick, 2014). Therefore, all of these risks are avoided by adopting inductive reasoning to derive data findings in this research.

3.4 Research Strategy & Data Extraction

3.4.1 Search Strategy & Screening

After dedicating a significant proportion of time, to the search strategy the student was able to formulate one which enabled them to extract highly relevant and authoritative data which particularly considered the sociocultural backgrounds impacting the health care excess ratio of HIV patients in Nigeria. The exact process is as follows:

1) Definition of the key terms: keyword research was undertaken where important concepts such as “HIV”, “AIDS”, “Sociocultural factors”, “Nigeria” and “patients” were frequently used to make sure that the displayed articles are reflective of what the student was seeking

2) Utilisation of quotation marks: quotation marks were used in order to identify the terms because this prevents the display of irrelevant pages on the search engine result page

3) Type of resources: with each keyword the type of research to be retrieved was also mentioned – e.g., scholarly articles, case studies and government reports

4) Rechecking the authenticity of each search: throughout the process, one step was repeatedly carried out which was the authentication of the data resource from which the articles were extracted.

Following are the databases that were frequently visited during the course of the research process and data collection timeframe: Google Scholar, PubMed, Scopus, African Journals Online also known as AJOL, Nigerian Government’s website, Elsevier, Statista – for statistics and facts, Sage publications, and Taylor and Francis.

Moreover, here are the most commonly searched terms:

1) Social and cultural factors impacting the healthcare excess of Nigerian AIDS patients (journal articles)

2) Healthcare facilities for Nigerian HIV/AIDS patients (journal articles)

3) Statistics on Nigerian AIDS patients

4) Stigmas related to AIDS in Nigeria (Research papers)

5) Nigerian government’s policy for AIDS patients (Government reports)

6) Social action movement in support of the Nigerian AIDS community (case studies, journal articles)

3.4.2 Inclusion Criteria

The obtained pieces of information went through a critical scanning process where they were passed on to an including criterion. This step ascertained that only highly relevant resources from authentic and dependable mediums are finalised for data analysis. The first step in checking for the eligibility of each resource was its time frame. Articles that were more than 10 years old were automatically discarded as the information in the study is tried to be kept as recent as possible. Also, the topic is specifically referring to the hurdles faced by the patients residing in Nigeria so the articles that were specifically depicting the information related to the Nigerian HIV/AIDS patients were considered only. In the same manner, the scope of this study is restricted to HIV/AIDS only; this is because of society’s hesitation of the HIV/AIDS patient in acquiring health facilities due to the fear of discrimination which is not faced by patients suffering from other diseases in Nigeria (Dahlui, 2015). In addition, the investigation is to identify the hindrances which prevent patients from accessing high-quality healthcare in Nigeria. So, the main focus would be on the access ratio of the patients and the factors behind it. It is because unless the patient is willing to receive treatment, the offered facilities would go in vain. Also, it would focus on the types of healthcare facilities provided by the health administrative authorities in Nigeria so that the recommendations add to their effectiveness. The scholarly articles showing the types of facilities provided to the Nigerian patients along with the social and cultural issues that are bounding them to not acquire proper treatment were prioritised. There is a need to deal with the core of the issue as the willingness of the patients to maintain their health would not be changed by updating the medication and technology unless the stigmatised society not changes. Other than this, the authorities’ efforts and endeavours to resolve the main problems – i.e. poverty, stigmas, and lack of awareness – were of main interest to this practice. Last but not least, the ease of comprehension of the articles was prioritised; so, the articles published in the English language were selected only. This simplified the understanding of the concepts for the researcher.

3.4.3 Exclusion Criteria

The exclusion criteria were the complete opposite of the inclusion one and a huge number of articles were discarded during this stage. The selected articles are no more than 10 years old because the articles older than that might mention laws, regulations or stigmas that might not be present in the current which could have altered the scope of the study (Basu, 2020). The resources that discussed the obstacles faced by Nigerian patients suffering from any other disease but HIV/AIDS were automatically rejected. It is because the attitudes and perceptions of the patients in society are completely different from those of other patients in Nigeria (Dahlui et al., 2015). So, combining other diseases with HIV/AIDS put the severity of the issue at risk. At last, there were a few articles available in other languages which were of some extent relevant to this inquisition (the translated abstract showed it). However, it would have required extra effort to get them translated. Also, the translated version might have missed important points of the original paper which could impact the information quality. So, only data resources available in the English language were pinpointed out.

3.5 Data Synthesis & Management

The acquisition of data is already explained in the previous section. The resources from online mediums would be synthesised and managed in a way that would guarantee a high-quality data set with multiple resourceful takeaways from it so that the research questions are answered fully. For this purpose, the data analysis technique for this investigation could be none but thematic analysis owing to multiple reasons. Thematic analysis is in line with the research strategy, design, philosophy and approach because it also uncovers the hidden meanings and interpretations present in the information resources that might have significant impacts on the data findings or theories (Dawadi, 2020). On multiple occasions, this helped in understanding the recurring themes in the attitude of the Nigerian community towards HIV/AIDS patients followed by the social economic conditions of the patients themselves which further worsened their health. The fear of being judged and the unavailability of enough financial resources to meet their treatment expenses were the main themes mentioned in most of the acquired data resources (US Government, 2021). These two themes were helpful in answering multiple research questions which demonstrate the effectiveness of thematic analysis. Other analysis techniques – e.g., content analysis – were not chosen because they are involved in the analysis of numerical data which did not serve the type of data involved in this investigation (Saunders, Lewis and Thornhill, 2019). An explanation of the exact process of data synthesis and management using the thematic approach is as follows:

Data familiarisation: an overview of the available resources was done
Coding: relevant pieces of information were highlighted
Theme identification: the codes were gathered in the form of themes
Mapping: the implicit relationships between the variables and themes were made conceptually in order to interpret the recurring patterns
Review and definition: the precision of the teams was checked after which accurate titles were given to them
Drafting: the interpretations were drafted as per their themes
Evaluation: the accuracy of the interpretations was rechecked
Data storage: meanwhile all of the collected data was secured in a Google Docs folder protected by a password

3.6 Ethical Considerations

Besides the previously indicated rationale for conducting secondary qualitative research, the ethical considerations associated with it also played an instrumental part in its finalisation as the main research strategy. While opting for the research design, the ethical limitations of primary research were studied comprehensively and many complexities were found. For example, the privacy and confidentiality of the research participants need to be protected at all costs. This data is mainly stored online, which is a continuous threat of unintentional disclosure of the privacy of the research participants which might happen due to hackers or online malware software (Nikiforova, 2022). In addition, taking consent of the study participant is of utmost importance in primary research and their also made free to walk away during the data collection process if they are uncomfortable with the research questions. In case of sensitive or vulnerable topics, data collection would be extremely difficult because there is a possibility that the study participants could not understand the motives and objectives by reading the consent form which is provided prior to the data collection process; walking away from many research participants would cost a large proportion of time and money (Rahman, 2020). With that being mentioned, primary research is expensive to perform because surveys require travelling, enumerators hiring, training, tools, and printing to forbear by students (Rahman, 2020). This is why secondary qualitative analysis was the best option for this inquisition as the biggest ethical limitation which might arise is only plagiarism. To avoid this issue the researcher used their access to Turnitin, provided by the institution which made sure that any involuntary similarity between their work and other scholarly work was modified immediately. Secondly, the inability of the students to understand the context of the secondary data might also impact the quality of the research (University College London, 2022). As a result, the inclusion and exclusion criteria have been set so that each selected article resonates with the requirements of this fact-based exercise.

3.7 Chapter Summary

In conclusion, this chapter made the research choice crystal clear because not only it has explained the rationale for choosing secondary data for the research but it has also justified the advantages of selecting a qualitative approach to comprehensively get to the bottom of the concerned issue. The research philosophy, approach and data collection methods are in alignment with the chosen research strategy which has made the thematic analysis reliable as well as replicable because this chapter has broken down all of the details involved in carrying out this research. The inclusion and exclusion criteria made sure the selection of high-quality data. Throughout the study, the student complied with the ethical considerations of secondary research.

Chapter Four

4.1 Chapter Introduction

This chapter is the foundation of the study, as it lays down the conceptual and theoretical framework on which the whole data analysis has been structured. In addition, a detailed assessment of the social and cultural sectors impeding the healthcare access of AIDS patients in the region is undertaken in this chapter. To put it succinctly, the societal norms, religious beliefs, and the prevalent stigma in the society of Nigeria have made the lives of AIDS patients extremely difficult. This results in the discontinuation of the medication and treatment of the diseases as the fear of social exclusion and discrimination overpowers the patients’ will to use their right to healthcare acquisition.

4.2 Conceptual Framework: The synthesis of results

Despite being a core problem in society, AIDS is still stigmatised in Nigeria. In chapter 2, it has been thoroughly indicated that Nigerian society is largely influenced by stigmas due to which AIDS and HIV patients are looked down upon and discriminated against. The major disadvantage of this attitude is the abandonment of AIDS and HIV patients, which prevents them from acquiring medication or therapy (Odimegwu, Akinyemi and Alabi, 2017). The most serious implication of this hesitation of the patients is that it is costing their lives, which they should have to pay as the number of deaths in Nigeria due to HIV or AIDS is continuously rising with each passing year. Therefore, the real reason behind the prevalence of the stigma and its continued influence on Nigerian society was investigated.

As indicated below, the themes represent the coding, frequently occurring patterns and observations made throughout the data collection and selection processes. These themes have been finalised after going through a large set of data, and each of them is highly relevant to access to the health facility by HIV-infected Nigerian patients. Therefore, the conceptual Framework below describes the relationship between the highlighted themes and the stigmatisation of society, which prevents patients from using their right to access high-quality healthcare.

Figure 2 – Conceptual framework of the study

Also, below is the synthesis of the included studies in the analysis.

Studies	Methodology	Research gap	Findings	Advantages	Limitations	Relevant theme
Aghaei et al. (2023)	Meta-analysis and systematic review	Media’s role in AIDS awareness	Reduces stigma	Precision	NA	The role of media and communication; political; and legal take
Ahmad et al. (2023)	Cross-sectional survey	Patients’ satisfaction with healthcare service	Patients are satisfied	Real-time data	Only discusses one institute	The healthcare industry and its workers
Agu et al. (2020)	Focus Group Discussion	Types of misconceptions	People are largely unaware	Comprehensive	Only targets unmarried adults	The role of education and awareness in stigmatization; the sociocultural traditions, misconceptions, and beliefs
Aransiola et al. (2014)	A qualitative study of patient data	How does stigma impact the healthcare access experience of patients; what is the quality of social services provided to them	Stigma prevails in society and the patient’s mental health is being negatively impacted	Real-time data of patients	The sample size is very small – 15 patients and 3 staff members of the clinic	The Healthcare industry and its workers
Ehiri et al. (2017)	Cross-sectional survey	The attitude of healthcare workers towards female patients	The staff was supportive and minimally influenced by the stigma	Shows females’ treatment by providers	Limited to Lagos might differ in other cities	The Healthcare industry and its workers
Eluwa et al. (2019)	Surveillance survey	MSM and AIDS spread in Nigeria	MSM is prevailing	Precise results	Only discusses MSM and not females who are intimate with other females	The sociocultural traditions, misconceptions, and beliefs
Muoghalu and Jegede (2013)	Questionnaires and in-depth interview	The interconnection between perceptions and religion	Nigerians link AIDS with God’s fury	Detailed and accurate results	NA	The religious perspective on discrimination
Ndibuagu, Okafor, and Omotowo (2017)	Questionnaire	To determine the extent and causes of misconceptions	A misconception prevails in rural areas; lack of awareness; education level is low; the legal system is weak	Precision	The sample size is short	The religious perspective on discrimination; the political and legal take; the sociocultural traditions, misconceptions, and beliefs
Odimegwu et al. (2013)	Cross-sectional study	Stigma and access to VCT	Stigma prevents access to VCT	Regression analysis shows dependable results	Only discusses VCT as social services	The role of the social system in destigmatisation; the role of media and communication; political and legal take
Odimegwu et al. (2018)	Data analysis	Women’s heterogeneity and HIV Stigma	HIV determinants vary as per the ethnicities of females	Explains the gender and education gap in the country	Men’s ethnicities are not considered	The role of media and communication; the sociocultural traditions, misconceptions, and beliefs
Odimegwu, Akinyemi, and Alabi (2017)	Secondary research of qualitative and quantitative data	The policies are ample but are not reducing stigma.	The planning, implementation and monitoring of policies are flawed which causes stigmatization; modification of policies is required as per the societal standards	Detailed study, credible resources analysis	None as it aligned with other scholars.	The role of education and awareness in stigmatization; Intervention for Destigmatisation;
Otokpa et al. (2013)	Semi-structured questionnarie	To figure out the miscopetions’ ratios	Uneducated people gave more misconceptions than educated ones	Accurate results; Compares rural and urban	The population sample is very small (420 people)
Schwartz et al. (2015)	Prospective data analysis	Investigation of the Impact of the Same-Sex Marriage Prohibition Act	The healthcare access declined	Real-time data	Focuses on the MSM community only	The sociocultural traditions, misconceptions, and beliefs
Somefun (2019)	Cross-sectional	The Religiosity of Nigerian Youth	Condemn AIDS patients	Extensive; large sample	Only shows the beliefs of the youth	The religious perspective on discrimination

Table 2 – Synopsis of collected data

Lastly, below is the PRISM flow diagram which represents the screening process of the previously highlighted studies.

Identification of new studies via databases and registers

Identification

Screening

Included

4.3 Overview of AIDS Patients in the Nigerian Community

Nigeria’s population is largely impacted by AIDS and HIV due to the aforementioned reasons. In the previous section, the general count of the patients was given, but this section shows the demographic breakdown of the patients. From newborn children to adults, every citizen of the country is vulnerable to this disease, which is increasingly spreading in the region. To begin with, vulnerable groups are present in large numbers in Nigeria, which is also contributing to the increased number of adult patients with this disease. As adults, transgender people are the most vulnerable group in society because they have higher chances of getting HIV infection, and they also have to face discrimination in healthcare facilities. The rights-based approach for HIV treatment is also not properly given to these people, due to which the condition worsens (Folayan et al., 2022). To put it concisely, the population aged between 15 and 39 years is most likely to be affected by AIDS or HIV; similarly, the urban population belonging to this age group is immensely infected (Abah, 2014). As per recent statistics, the number of children aged 0 to 14 years in Nigeria infected with HIV amounted to 140,000. In addition, 97,000 children between the ages of 10 and 19 were affected, which shows that this disease is not only common in infants but also targets a huge number of pre-teens and teenagers (Statista Research Department, 2022). Awofala and Ogundele (2018) validate the severity of the issue by mentioning the amounted rate of death tolls in the year 2013—i.e., 210,031; considering the number of patients in Nigeria—i.e., 3, 229, 757—the death toll indicates that a large proportion of the population is at risk of death. It is because the disease is not expected to shrink in the near future. Therefore, this chapter would critically assess the social as well as cultural lags that are fueling this lethal situation in the country.

4.4 The sociocultural traditions, misconceptions, and beliefs

Muoghalu and Jedege (2013) conducted primary research, which revealed the outcome that misconceptions are the roots of the problem of organising people, as they are massively impacted by misconceptions related to the spread of disease. In addition, the authors revealed that only a small number of respondents mentioned that the disease could affect anyone rather than just people who engage in any kind of illegal sexual activity.

However, Agu et al.’s (2020) study extended the severity of this issue because there are many misconceptions related to the transmission as well as the symptoms of the disease that prevent people from taking preventive measures. The authors carried out a comprehensive study in which focus group discussions were undertaken with school-going or out-of-school unmarried adults in Nigeria and their awareness levels were examined. For example, the people of Nigeria believe that mosquito bites or sharing the infected person’s things could result in the transmission of this infection; however, it is not infected by touch. The author says that the symptoms of the disease are highly misunderstood because people think that physical appearance changes, for instance, swelling in the abdominal area or long fingernails, indicate that the person is infected with this infection. Agu et al. (2020) also uncovered the fact that the sample population thought of antibiotics as a cure for the disease, due to which they relied on these medications rather than going to see healthcare professionals.

In the same manner, Ndibuagu, Okafor, and Omotowo (2017) conducted a cross-sectional study and revealed the following results, which are far from reality:

Statement	Percentage of Nigerians who believe in it
Only sinners are infected.	29.7
Eating on the same plate can cause transmission.	24.7
Only transmits through a handshake	29.7
Transmits by touching the urine, and faeces, of AIDS patients.	24.0
Hugging or touching an HIV patient can cause transmission.	28.0
HIV is curable.	19.9
Praying daily saves people from HIV.	20.3
Worshipping the ancestors can save them from being infected with HIV	27.0

Table 1 – Percentage of Nigerians having misconceptions related to HIV

The above table depicts the thinking of the rural population who are less educated and the sample size is also very small – i.e,. 296. Thus, to identify the situation in-depth, a larger sample is required which must also comprise the point of view of the urban population.

While the world is accepting same-sex relationships, this concept is taboo in Nigeria. It is because same-sex relationships are not supported by the culture as well as the society. Yet, same-sex relationships are one of the most critical components that are causing the increasing HIV infections in Nigeria. Eluwa et al. (2019) undertook an integrated biological and behavioural surveillance survey in which the data was collected using a precoded questionnaire. The results regarded the MSM (men who have sexual relationships with other men) as 20% responsible for the spread of the disease. In contrast, this relationship is not accepted by society and the attitude of the people towards MSM is extremely hostile and discriminatory. As a consequence, these people shy away from medication and treatments. These statistics are revealing that the same-sex concept is against the social and cultural traditions as well as beliefs of the Nigerian people due to which the people having same-sex relationships are neglected by the society – despite being in such a large number.

Additionally, the gender discrimination ratio is high in Nigeria as women face sexual abuse, forced and early marriages – putting them at a greater risk of HIV infection. Odimegwu et al. (2018) are in agreement with the previously mentioned statement. The authors designed a study in which the discrimination that Nigerian female AIDS patients (from multiple ethnicities) face was analysed. The analysis was undertaken by evaluating the national representative data which was extracted from the results of the Nigerian Demographic and Health Survey 2013. The results indicated that females of almost all ethnicities do not express themselves and acquire medication as there is a high level of stigma prevailing in society. The authors also made a shocking revelation that increased awareness levels and education is still not impactful in reducing stigma which shows how strongly the social evil has grasped the roots of the society. However, education has slightly changed the thinking of diverse ethnicities as they do not misunderstand the modes of transmission of the disease but failed in reducing the fear of healthcare acquisition of the patients.

4.5 The religious perspective on discrimination

Nigeria is home to multiple ethnicities as well as religions, with Islam alongside Christianity being the most followed among the people of the region. In both of these religions, extramarital, transactional, and other illegal sexual activities are considered not pious or impure and punishable; this information is very important because religion plays an instrumental role in the sexuality of people. Somefun (2019) builds on this fact, as the author has developed a relationship between religion and the sexuality of the youth of Nigeria. The author carried out a cross-sectional study that particularly examined the religiosity and the perceptions of AIDS patients in young Nigerian minds. The research findings revealed that 68% of the youth of Nigeria have not engaged in any sexual activities, which is an evident indicator of the religiosity of the region as it indicates that the people are very God-fearing. As the sample size of this study was large – i.e. 2399 – followed by a wider time frame of observation – i.e. February 2018 till March 2018 – the results are acknowledged as credible. As both religions strongly condemn the types of sexual activities mentioned above, AIDS patients are considered transgressors because the main reason for the spread of this disease is illicit sexual activities or having multiple partners. So the patients with AIDS or HIV are deemed transgressors of the religion, due to which they are massively disliked by the Nigerian community.

Muoghalu and Jedege (2013) shed light on this fact by explaining that the people suffering from this infection are said to have received punishment from God because these people forbade God’s commands, due to which their immorality was punished. These authors are agreeing to this statement with full validation as they have conducted a quantitative and qualitative analysis by means of questionnaires and in-depth interviews of the adult population of Nigeria. The religious impact of the stigma is so intense that a large proportion of the Nigerian population believes that only sinners are infected with the virus and that praying daily or worshipping their ancestors would save them from getting this disease. Ndibuagu, Okafor, and Omotowo (2017) agree with this statement as they conducted 296 questionnaires which were then analysed by interviewers. Thus, the high rate of religious practises and beliefs among the Nigerian people is closely associated with the discrimination against AIDS patients, as it is viewed as disobedience to the order of God.

4.6 The role of media and communication

Media is the main form of communication between authoritative entities and the public which makes it responsible for the management of a public perception and point of view. This shows that the media has an integral role in shaping the Nigerian public’s perspective of HIV patients. Aghaei et al. (2023) studied this topic in detail by performing a systematic review and meta-analysis of articles published related to AIDS patients and their portrayal in media. The finding of the systemic review indicated that policymakers use mass media as the biggest tool to change the stigmatised thinking and condemnation of AIDS patients. However, the research outcomes of the meta-analysis were quite the contrary as they revealed that mass media has a moderate level of impact on stigma reduction in society.

Odimegwu et al.’s (2018) data analysis indicated the impact of radio programmes on the fear of stigma in Nigerian women. The study compared the perspectives of ethnicities of women ‘namely Igbo, Yoruba, Hausa and Fulani. The findings had unravelled that Igbo and Yoruba-based women were less fearful of the HIV-related stigma when they heard more radio programmes about this. On the other hand, the females belonging to Hausa and Fulani became more afraid of experiencing stigma and discrimination after hearing the radio programmes. Likewise, these findings reveal a very critical concept: the way Nigerian people consume media and other forms of communication determines their attitudes towards AIDS patients. Odimegwu et al. (2018) regarded the education and English literacy level to be the main cause of this disparity. The females of Hausa and Fulani were less educated and did not understand English well which might have resulted in their lack of understanding of the awareness messages on radio. Hence, the media of Nigeria became unsuccessful in destigmatising the society due to the education and language literacy differences of the people.

The abovementioned study elaborates that media has been a tool used for destigmatisation by the relevant authorities. Also, the National Agency for the Control of AIDS (NACA) directed the media to report the challenges and obstacles faced by the AIDS patient particularly due to the stigmatization of the disease in the society (Simon, 2023). Simon (2023) that the media reporting coordinated with HIV and its stigmatisation was not working previously. It is because it did not have the human touch to it due to which the media channels are now having on-air conversations with the people who are living with this disease so that the misconceptions and religious issues related to the disease could be ended. The social as well as religious leaders are also being contacted by media professionals so that they all can come together and convince the audience to put an end to the stigma. Hence, this section has highlighted the continued efforts of the media and communication authorities of Nigeria in ending the stigmatisation of HIV/AIDS.

Odimegwu, Adedini, and Ononokpono’s (2013) cross-sectional random study has also critically evaluated some of the workable suggestions to reduce the AIDS stigma in society. The finding reveals that the most practical way to improve the public’s perception of the AIDS patient is to develop a messaging or communication strategy so that highly relevant and impactful messages are shown in the media. The scholars also mentioned that healthcare centres, institutions, public places, and community halls could be used as the primary locations for the display of such messages. Using this policy would lessen the hatred for the infection and the people’s intense reactions towards the patients.

4.7 The political and legal take

Odimegwu Akinyemi and Alabi’s (2017) review also elaborated on the legal setting that backup the healthcare access of the AIDS patient. The researchers described that the legal frameworks and checks in the country are weak which become the main obstacle in the implementation of a Human rights-based approach while treating the AIDS patient in the region. To secure Nigerians from AIDS. the legislation has banned same-sex engagement or marriages in Nigeria under the Same-sex Marriage Prohibition Act (2014). Schwartz et al. (2015) carried out a critical analysis of the prospective data of a well-established Nigerian clinic which is renowned in the same-sex community. The scholars compared the data before and after the implementation of this legislation; the results elaborated the stigmas of the society as the fear of discrimination is extremely high in the MSM community especially. They feared a strong societal and cultural backlash. As an aftermath of this, the number of visits of the AIDs patient declined. This was represented by the reduction in the follow-ups and amount of patients showing up for their ART. Thus, the study has made it certain that the access of the major portion of HIV patients has declined after the introduction of this law.

In addition, the satisfaction of the patients with the healthcare service being provided to them must be analysed, as it shows the quality of services offered by the healthcare sector and also highlights areas for improvement. Ahmed et al. (2023) identify the AIDS patients’ satisfaction with the facility at the federal medical centre of Nigeria. Results of the cross-sectional survey of 351 respondents indicated that the patients were highly satisfied with the healthcare staff, and their professionalism indicated that they are well-trained. The authors also regarded the governments’ and NGOs’ interest in improving the healthcare facilities for AIDS patients in the region as evidenced by the improvement in the behaviour of the healthcare staff.

Odimegwu, Adedini, and Ononokpono’s (2013) study has also highlighted the increasing attention of political and government authorities towards the destigmatisation of AIDS patients. It is because this issue is one of the most pressing challenges faced by the public healthcare administration currently. The scholars also have mentioned the increasing political involvement of the situation as VCT services are being provided to patients, but the number of infected individuals acquiring these services is extremely low. The authors have regarded the prevailing stigma in society as the main reason for the patient’s reluctance to use healthcare facilities. In the same manner, the excess of the AIDS patient at the high-quality medical facility is not a simple construct because there are many complexities involved in the patients’ acquisition of the facility. For example, it must be made sure that the administration of the healthcare sector is being properly monitored, the budgets are ample to meet the finances, the judiciary is in support of the policies, and the legislation is in support of the policies (Columbia University, 2021). These factors make certain the formulation of a national health policy that would make sure that AIDS patients could access treatment easily. In addition to this, the political leadership of Nigeria has expressed its willingness to take immediate action to put an end to the AIDS epidemic by the year 2030. For this reason, the heads of government and senior officials of Nigeria participated in a political declaration at the United Nations, where these leaders pledged to take immediate as well as transformative steps to stop the spread of AIDS in the country (United Nations, 2021).

4.8 The Healthcare industry and its workers

Schwartz et al.’s (2015) prospective data analysis also mentioned that the Same-sex Marriage Prohibition Act of 2014 resulted in a drastic change in the behaviour of healthcare providers towards the MSM and LGBT community. It is because sharing their sexual preferences resulted in the suppression of the MSM community by healthcare professionals. The discrimination faced by healthcare providers is one of the major reasons for patients’ hesitation to pursue their medication or treatments. Building on this point, Ehiri et al. (2019) undertook a cross-sectional survey in which behaviours and attitude toward the prevention of mother-to-child transmission (PMTCT) service providers – in Lagos, Nigeria – was evaluated. The results were contrary to the previously based argument – i.e. the health care providers were not hostile towards the patients. Ehiri et al. (2019) mention that only 4% of the workers heard their colleagues talking badly regarding the patient or notice that the quality of care provided to the patient was not up to the mark. 15% of the workers did not even care about the stigmatisation or discrimination because they were so occupied with their work duties. 86% of the workers supported the patients in their decision of having a baby regardless of their disease. 94% did not test patience without consent as 86% of the participles were aware that discrimination or unfair treatment would cause them big trouble.

Aransiola et al.’s (2014) qualitative study also described the attitude of the healthcare workers towards the patients as negative because the workers also fear being excluded from society in case, they get infected with the disease while treating the patients. This revelation demonstrates that even healthcare workers are afraid of being the victim of social exclusion, due to which they tend to discriminate against or portray cold behaviour with patients. Besides death, being eliminated from society is the biggest fear that results in unintentional marginalisation or discrimination by healthcare workers. However, this research only describes the attitudes of a small proportion of patients and a very small number of healthcare workers. The perspective of workers in different cities, and the hierarchy of medical institutions must be considered but it is out of the scope of this study.

4.9 Intervention for Destigmatisation

Further, the Government of Nigeria has realised that self-reliance is the key to improving the infrastructure of their healthcare sector, due to which they have increased domestic financing for the treatment of HIV and AIDS in order to meet the surging number of patients in the country (Beizu, Ihekanandu, and Ilika, 2022). As a response to this measure, the private sector is being strengthened in order to provide state-of-the-art healthcare services to AIDS patients; this process was at its peak between 2026 and 2020 (US AID, 2022). SFI played a pivotal role in this regard, as technical support was provided to the relevant authority so that the financial management of the state could be improved (US AID, 2022). This shows that Nigeria is making every effort to make sure its alignment with high-quality and world-class healthcare standards. On the other hand, the outcomes of these efforts are not visible enough which highlights the need for a detailed investigation.

The aforementioned information depicts that there are many endeavours being introduced in order to eradicate this lethal disease from Nigeria. However, the effectiveness of these measures is called into question. It is because Odimegwu, Akinyemi, and Alabi (2017) carried out a secondary data analysis which depicted that the multiple reforms in Nigeria are ineffective. After all, their planning, implications and monitoring are not done properly. The authors carried out a secondary data analysis of high-quality resources (qualitative as well as quantitative) and the research gap indicated the flaws in the planning, implementation and monitoring of the political frameworks. The scholars explained that the policies are not in alignment with societal attitudes and behaviours which causes their lack of application. The authors also highlighted that the stigma level of society must be accurately measured to relate the practices to societal standards. Also, these reforms could not succeed until a proper assessment system is established to track the growth.

4.10 The Role of the social system in destigmatisation

Another critical factor that determines the acquisition of healthcare facilities by the patients, followed by the dignity of their behaviour towards them, is the type of area in which they are living, i.e., rural or urban. Odimegwu, Akinyemi, and Alabi (2017) have proven that the awareness and education levels of the urban areas in Nigeria are high, due to which the stigma ratio in these areas is low. The scholars also described that stigmatising behaviour followed by massive discrimination against the AIDS patient is a characteristic of a rural area because poverty, a low level of education, and a lack of awareness of the symptoms and treatment of the disease are features pertinent to the rural areas of Nigeria.

Aransiola et al. (2014) carried out a qualitative study of the patient data of an ART clinic in Osum State, Nigeria. The main objective of this research was to find out how the administration works at the personal as well as societal levels to deal with the increasing stigma in society. 15 patients and 3 workers were analysed, and the results indicated that the patients belong to a very diverse range of ethnicities, and the extent of stigma and discrimination that the patients had gone through was very large. This led to the deterioration of the psychological health of the patient as well. The continuous cross-cutting themes described the negative impact of the previously mentioned social and economic influences on the mental health of the patients. On the other hand, it was all done unintentionally because the patients were given selective food parcel switches to show that support was being provided to them by the health authority. The negative effects on their mental and physical health have been due to the marginalisation and discrimination that they had faced, intentionally from society or the healthcare administration. The social efforts – e.g. special food parcels – failed as the stigma took over the patients’ experiences.

Odimegwu, Adedini, and Ononokpono (2013) performed a cross-sectional random study of the residents of Nigeria that collated the data of the Yoruba ethnicity residing in the Osuna State of Nigeria along with the Igno ethnicity located in Imo State. This mixed-methods study took into consideration both quantitative as well as qualitative data, and a multivariate logistic regression model was employed to identify the association between the variables of interest. The main objective of this endeavour was to identify the impact of the HIV stigma on the patient’s utilisation of the counselling services provided, followed by the testing facility in these areas. The outcome of this study demonstrated a negative relationship between the attitudes of the public and those of people infected with HIV or AIDS. The markers on the stigma index indicated the extent of utilisation of the voluntary counselling and testing (better known as VCT) services provided to the patients. This is explained by the negative relationship between the increase in negative emotions or feelings of the patients and their likelihood to make use of the VCT services. This research has uncovered that the efforts laid down by the national authorities and the social system of the country cannot be successful because AIDS has become a pandemic in the region and its stigma is even considered to be a bigger epidemic.

4.11 The role of education and awareness in stigmatisation

In the previous section, the low levels of awareness of the disease among the Nigerian people were outlined. In contrast, this section denotes the intensity of the problem. Table 1 shows the misconceptions that a significant percentage of the population has, which show that the health education efforts laid down by the sector are ineffective and require upgrading because the low awareness level of the Nigerian people is criminalising patients who might unintentionally get infected with the disease. Otokpa, Lawoyin, and Asuzu’s (2013) research findings support this argument as they linked the low literacy rate with increased stigma. The authors distributed semi-structured questionnaires in which mothers with secondary education showed high awareness levels of HIV/AIDS as compared to the uneducated ones who solely regarded HIV infection as an outcome of past mistakes. This demonstrates that misdeeds are the prime source of disease transmission that uneducated Nigerians could think of.

In addition, Agu et al.’s (2020) study also highlighted the lack of integration of HIV awareness in school-level education as many of these children do not have a basic understanding of HIV/AIDS. The authors presented a thematic analysis which highlighted the need for a plan of action which particularly targets the children’s curriculum so that a major proportion of Nigerian adolescents is saved from getting victims of this disease.

4.12 Theoretical Framework

The social identity theory implies this research as the categorisation of people has been done based on different social categories – such as genders, ethnicities, rural or urban population and education levels (Ellemers, 2019). Owing to the high level of stigma prevailing in society, the patients categorised themselves as vulnerable to discrimination due to which they prefer not to connect with others or have social life. The main reason for this isolation is outgroup discrimination which is because of the misconceptions and lack of awareness in society.

In the same manner, the intersectionality theory is well-suited for the study because this theoretical framework explains the distinctive experience of the different social identities that results in privileges are discriminatory behaviour directed towards them (Kelly et al., 2019). The HIV patients in Nigeria belong to diverse social identities – for example, ethnicity or gender. This results in the unique experiences that each social identity goes through. The females in Nigeria are a prime example of the oppression and discrimination that happens in the region – e.g., sexual abuse with this social identity. Conversely, this framework not only discusses discrimination but also highlights the privileges of specific social identities (Kelly et al., 2019). The reduced stigma in the female population of Igbo and Yoruba due to their English literacy as well as higher education denotes the privilege that these women have as they are not afraid of getting victim to the stigma compared to the less educated females of Hausa and Fulani.

4.13 Chapter Summary

This chapter explained the social and cultural evils that prevent HIV patients in Nigeria from accessing treatment. Nigerians oppose HIV patients because they believe that they have engaged in illicit sexual activity, which is against their religion, culture, and social norms. They also have major misconceptions related to the transmission of the disease. These reasons result in the condemnation of AIDS patients, which is so influential that the efforts of the government and media fail to destigmatise society.

Chapter Five

Discussion and Conclusion

5.1 Introduction of the Chapter

This chapter concludes the gist of this research. The discussion section has encapsulated the takeaways of the study and linked them with the research questions. Not only are the main challenges faced by HIV patients in accessing healthcare services in Nigeria justified in the study, but also actionable recommendations for policy, practice, and research are elaborated to overcome the mentioned issues. The constraints followed by the strengths of this study, are also mentioned in this section. This provides future researchers with considerations to follow while replicating the studies.

5.2 Summary of findings and their linkage to research questions

In this study, the social and cultural contexts of Nigerian society with reference to community perception and conduct towards AIDS patients have been extensively studied. All of these backdrops have been evaluated by specifically catering to the requirements of the research questions that have been determined in Chapter 1. The first research question is to identify the challenges and impediments that prevent Nigerian HIV patients from accessing quality healthcare. In Chapter 4, several relationship themes were formed that comprehensively explain the social and cultural barriers to the acquisition of healthcare facilities for HIV patients. The study has answered the question by referring to the universal stigma in society pertaining to HIV patients. Nigerian people have multiple misconceptions related to the spread of the disease, as they believe the sharing of the patients’ things would get them infected with it.

In addition, the religiosity level of the society is extremely high, as Islam and Christianity are practised there. Both of these religions disapprove of illicit sexual activities. The people of Nigeria relate the spread of HIV to having sexual intimacy with multiple partners. Due to this, they regard AIDS patients as sinners and worthy of God’s punishment – i.e., HIV. Moreover, same-sex relationships are disliked by the Nigerian community and these people think of them as taboo; same-sex relationships are a major cause of the spread of this disease in the region. Then society does not accept the previously indicated construct. Hence, not only the people but the health care administrators as well as workers also exhibit discriminatory behaviour towards AIDS patients.

On the other hand, most victims of stigma and discrimination are female, which also discards the societal norm that having illegal sexual affairs results in the transmission of the disease, as forced early marriages and sexual assault of females are extremely high in Nigeria. This also contributes to the large ratio of female AIDS patients in the region. All of these factors also refer to the fact that the education and awareness levels of the Nigerian people are so low that they still follow a stigmatised approach. Another social evil that arises due to the lack of literacy and awareness among the Nigerian people is the ineffectiveness of the efforts and initiatives implemented by the government and the media platforms. Besides introducing several measures, such as radio programmes, having one-on-one conversations with HIV patients and spreading awareness messages across all platforms, the media has been unsuccessful in eliminating the stigma. It clearly shows how deeply it has held the roots of society.

Also, as a major part of the Nigerian population is not educated, they often misunderstand the awareness messages that are usually broadcasted in English, which often creates misconceptions related to the disease. This is because many Nigerians cannot understand English. Likewise, the government and healthcare sector of Nigeria is streamlining their efforts to ensure alignment between the United Nations healthcare guidelines and their health facilities from the previous decade. Still, these endeavours do not make a visible impact. In contrast, this study has revealed that many healthcare institutions in Nigeria (such as Federal Medical Centre) have well-equipped and professional staff who are not hostile towards their patients. It was also discovered that many institutions are providing top-notch quality treatment and most of the staff members were supportive of the AIDS patients. The inquisition has answered that the staff members are very fearful of the consequences of their actions due to the high involvement of government and NGOs in this matter. However, in multiple instances, it was also analysed that transgender people or people belonging to the MSM and LGBT community were discriminated by the healthcare industry and Nigerian community, which shows a contrast to the previously indicated viewpoint. The lack of education and the stigmatisation of same-sex relationships were the main culprits for this discrimination. However, the negative role of the law prohibiting same-sex relationship (i.e. Same-sex Marriage Prohibition Act 2014) also forms the basis of this major hindrance of healthcare acquisition by HIV/AIDS patients in Nigeria.

The second research question was intended to figure out the significance of uncovering obstacles that prevent HIV patients in Nigeria from acquiring healthcare treatment. The study has exclusively answered this question by highlighting the massive population of Nigeria being infected with this lethal disease and the continuously increasing proportion of patients, which depicts the alarming situation. Thus, the government has directed its attention towards the reduction of AIDS, and this study also uncovered the causes of the failure of the political as well as the legislative measures taken to prevent the spread of this disease. The social identity theory was utilised to identify the current state of connection of HIV patients with other community members. The intersectionality theory was employed to analyse the unique experience of the HIV patients that directed the discrimination of the entire community towards them. The lack of education, awareness, and English literacy, and negatively associating religiosity with HIV patients are the primary reasons that have led to the prevalence of adverse experiences and discrimination against the audience under study.

5.3 Implications and recommendations for policy, practice and research

The third research question of the study referred to the key strategies to minimise the rising stigma in Nigerian society. In addition, the fourth question also aimed to highlight the recommendations that could be beneficial to the policymakers and the healthcare administration of Nigeria to make certain that their healthcare policies are eliminating HIV from its roots. The primary motive for undertaking this study was to highlight the flaws in the current policy implementation in Nigeria that are adding to the stigmatisation of society. The study has indicated that misconceptions are the major causes of the rising stigma in society. The above-explained issues show that special awareness programmes must be introduced by the government that would eradicate the baseless beliefs that are associated with the AIDS patient, which include the belief that this disease is only transmitted to homosexuals or that certain physical appearances denote the presence of this disease. Gender and sexuality discrimination (such as MSM) must be removed from society, as the early marriages of young girls are the biggest reasons for the transmission of HIV in Nigeria. MSM being the 20% responsible for the disease transmission also shows that the discrimination would be continued towards this proportion of the population; they would keep on shying away from the treatment. This would make their lives miserable and result in the failure of the social and health care systems that are striving to make positive changes in the lives of AIDS patients. The misconception that only God’s wrath causes AIDS infection must be eliminated, as this research has made it certain that everyone, even children, is at risk of getting infected with HIV in Nigeria.

5.3.1 For Policy

By complying with the ASPIRE framework by the United Nations, the policymakers of Nigeria must ensure that the health administration is not hostile towards patients based on their sexuality (OHCHR, 2023). This framework protects the rights of LGBT individuals to access health care. This would cause a major proportion of the HIV patients in Nigeria (i.e., the MSM community) to feel safe in accessing the health administration rather than preparing not to get treatments and feeling the judgement of the workers.

5.3.2 For Practice

The study has demonstrated that the only way to realise all of the earlier indicated recommendations is to effectively utilise the media and communication platforms in Nigeria. By taking into consideration English literacy as well as the education level of the areas where the awareness programmes will be broadcast, authorities can adapt their message according to the locality (its language) so that it is properly understood by the targeted audience. Another practical way to spread awareness is to utilise public properties, such as stadiums or halls, to spread awareness messages (Odimegwu, Adedini, and Ononokpono, 2013).

As per recent facts for January 2023, social media use in Nigeria amounted to 31.6 million; WhatsApp, Facebook, YouTube, and Instagram were the top social media platforms used by these active social media members of the Nigerian community (Sasu, 2023). Therefore, by complying with Odimegwu, Adedini, and Ononokpono’s (2013) suggestion, social media could also be used by the government to display public service and awareness messages, as during the pandemic this medium was immensely utilised by the global healthcare administration to spread awareness messages and answer public concerns related to the COVID-19 pandemic (Murthy et al., 2020).

Enweani and Chinyere EKE (2019) comprehensively described the increasing usage of social media platforms by religious organisations in Nigeria, which also sparks the possibility of collaboration between the government and these organisations to eradicate the myths in society. One of the main reasons for the discrimination against AIDS patients in Nigeria is the high religious level of the people, which causes them to look at HIV patients as transgressors of God’s limits. Religious organisations could use their social media following to spread a positive message regarding the misconceptions in society and explain that anyone can be infected with HIV, not just sinners, and that the patients should be treated with integrity and respect.

5.3.2 For Research

This study comprises a qualitative analysis of the hindrances using 14 pieces of research/articles. These barriers could be further studied using a mixed-methods approach where quantitative data would also be taken using primary methodology so that comprehensive insights into the unique experiences of HIV patients could be studied in depth (Saunders, Lewis, and Thornhill, 2019).

5.4 Limitations and strength of research

5.4.1 Constraints

The data pertinent to the topic was available in large amounts, but only a few of the available articles critically analysed the major cause of the spread of the disease, followed by the stigmas related to it that negatively impact the lives of these patients. This shows the biggest limitation of the study. Subu et al. (2021) have highlighted that the people who experience stigma and discrimination do not openly talk about it and do not express their feelings fully, which shows that they involve studies that consider the point of view of HIV patients in Nigeria and are not fully representative of their situation. This represents the social stigma and reporting bias as discriminated people tend to not share their hurtful experiences with the public, which causes underreporting of the information. Therefore, there is a need to have one-on-one structured interviews with HIV patients – who are willing to share their experiences with full transparency. This would make sure that the available data is the actual determinant of HIV patients’ lives in Nigeria.

5.4.2 Strengths

This research has massive potential for impact as it has discovered the primary cause of the social evils prevailing in Nigerian society, which are disrupting the health care of HIV patients. This study presents structured recommendations to policymakers and the government with the actionable steps necessary to deal with the social issues at their core.

This impact is also extended to the humanitarian as a social ground because access to high-quality healthcare facilities is a human right. Therefore, this research has highlighted the disparity in the healthcare industry of Nigeria, which depicts the broader objectives of this research, i.e., to humanise HIV patients.

Moreover, the vulnerable communities in Nigeria, including female and LGBT communities, were intended to be empowered in this inquisition, as it has advocated for their basic healthcare requirements and rights.

5.5 Conclusion

In conclusion, this study has given an all-inclusive explanation of the stigmatisation of HIV patients in Nigerian society. The social and cultural traditions prevalent in society followed by religious beliefs of the Nigerian community result in the negative attitudes of people towards HIV patients. The study has explained that improper education and awareness levels of society are the two primary social evils that are not letting HIV patients acquire their basic right to quality healthcare access. In Nigeria, HIV patients have become a social identity that is always at risk of discrimination and unfair treatment by society and healthcare professionals. The stigma in society is unshakable to the extent that the efforts of the government, legal system, social system, education, media, and communication methods have failed significantly. The reason for this failure was the negligence of the prime causes of this unwavering stigma in society, which include the ineffective utilisation of media and communication tools to convey awareness messages. The target audience was not able to understand these messages due to language and literacy disparities. Also, inequality in the attitude of the healthcare workers was observed with the LGBT community, which prevented a large percentage of the infected Nigerian population from getting treatments. All of these recommendations were dealt with using actionable policies and suggestions. These recommendations are designed considering the latest trends in the Nigerian community, which maximises their effectiveness. The future researchers were also given ideas to extend this study, followed by the strengths and weaknesses of this inquisition, so that they could avoid the potential constraints and optimise the quality of their data representation.

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