HIV/AIDS stands as a persistent and severe health condition with widespread implications for global public health. ^1,2 recognized by the World Health Organization (WHO) as a worldwide public health emergency, HIV continues to pose significant challenges, marking over three decades since its emergence. This pandemic has inflicted devastating consequences, claiming the lives of millions globally and causing severe harm to countless others. The virus has affected over 75 million people since its onset .¹ In the year 2022 alone, 39 million individuals were living with HIV, and 1.3 million succumbed to AIDS-related causes worldwide. ¹

The impact of HIV/AIDS remains particularly pronounced in the Sub-Saharan region which continues to bear the brunt of the global HIV/AIDS burden, representing two-thirds of the total cases worldwide.³ HIV which stands for human immunodeficiency virus leads to the disease AIDS (acquired immuno- deficiency syndrome), if left untreated.⁴ Presently, there are 25 million adults and children living with the virus in this region, constituting nearly 70% of the global figure. The statistics reveal an alarming scenario with approximately 1.9 million new HIV infections and 1.2 million AIDS-related deaths reported in Sub-Saharan Africa ⁵. Nigeria, within this context, shoulders a significant portion of the epidemic, hosting an estimated 3.2 million individuals living with HIV, positioning the country among those with the highest HIV burden globally, second only to South Africa. In 2005, the international community embraced the goal of universal access to HIV prevention, treatment, care and support by 2010.^6,7 National HIV/AIDS programs must fortify their health systems and remove any obstacles to treatment and preventive initiatives in order to meet this objective. Nigeria has implemented several measures to stop the spread of disease.⁸ People living with HIV/AIDS (PLWHAs) who have taken an HIV test and are on antiretroviral therapy (ART) have increased significantly as a result of international initiatives like the US Presidential Emergency Plan for AIDS Relief (PEPFAR) program. ⁹ In addition, there are many more antenatal women with HIV positivity who have received ART to prevent mother to child transmission of HIV.¹⁰ The challenges many of these global and national programs face in a multi-diverse socio-cultural society like Nigeria are the problems of stigma and discrimination(S&D).^11–14 The issues of S&D described by Jonathan Man ¹⁵ as the third phase of the HIV pandemic poses a serious threat to prevention and treatment. Therefore, for Nigeria to achieve her national policy on HIV/AIDS, aimed at controlling the spread of the infection and its impact, the issue of S&D needs to be addressed.^8,16 Significant research and knowledge on HIV related S&D in many ethnic and cultural settings that constitute Nigeria, are important tool in understanding this “hidden factors” that are impediments to effective prevention and treatment. Incorporating these findings into national prevention strategies will go a long way in reducing the transmission of the virus in the population.¹⁷

In 2017, the demand for Anti-Retroviral Therapy (ART) in Nigeria was 1.9 million, with over 52% of those affected receiving treatment. The South-South region had the highest HIV prevalence at 3.1%, while Lagos state recorded 1.4%. Global efforts to curb HIV have significantly reduced infection rates, especially in developed countries, by extending the lives of those infected. Though no cure exists, Highly Active Anti-Retroviral Therapy (HAART) has transformed HIV from a terminal illness to a manageable chronic condition. ^22–24

Over the past decade, Nigeria has witnessed notable advancements in curbing the HIV/AIDS epidemic.^25,26 The 2019 National AIDS and Reproductive Health Survey (NARHS) demonstrated a substantial reduction in the national HIV prevalence, decreasing from a peak of 5.8% in 2001 to 3.1%.²⁷ This accomplishment is largely attributed to impactful interventions such as Behavior Change Programs, HIV care and support initiatives, Prevention of Mother to Child Transmission (PMTCT), and the implementation of Highly Active Anti-Retroviral Therapy (HAART).¹⁹ HAART treatment primarily aims to reduce the viral load to undetectable levels, fostering immune reconstitution and notable clinical improvement. Additionally, HAART has proven effective in preventing opportunistic infections.^28–30 Successful outcomes in the management of HIV/AIDS hinge significantly on adherence to HAART, as underscored by studies such as Shah (2007) and Giri et al. (2013).

The reported adherence rates to ART medication among people living with HIV (PLHIV) in Nigeria vary from 44–98%.^11,31,32 Factors shown to be associated with good adherence include text message as reminders, patient selected treatment partners, use of pill box, age and gender. On the other hand, psychiatric morbidity negatively had adverse impacts on adherence.¹¹ Despite this efforts, HIV/AIDS stigma continue to re-emerge as a formidable threat, particularly among many Nigerians who lack awareness of the realities surrounding HIV and AIDS, leading to avoidance and stigmatization of individuals affected by the virus due to misconceptions about its transmission. This misguided belief suggests that one can contract the virus through association or close contact with an infected person.³³ S&D as described by various sources, represent social barriers that significantly impact the life experiences of individuals. The stigma associated with HIV and AIDS tends to marginalize people within their communities, adversely affecting the overall quality of life for PLHIV. Stigma is often synonymous with social disgrace. Research indicates that individuals reporting high levels of stigma are more than four times likely to experience limited access to healthcare. Moreover, HIV and AIDS-related stigma can give rise to discrimination, such as restrictions on travel, healthcare facility usage, employment opportunities, and social interactions for PLHIV.^{13,34, 60}

Although there have been few studies as regard stigma and discrimination against individuals living with HIV/AIDS,^35–58 it remains prevalent, impacting their access to care and quality of life. This research aims to comprehensively explore the knowledge, prevalence, types and determinants of stigma and discrimination among people accessing Anti-retroviral Therapy (ART) in Ikeja, Lagos State, Nigeria.

This research aims to fill a gap in the literature by exploring the relationship between stigma, discrimination, and factors affecting access to anti-retroviral therapy (ART) for people living with HIV/AIDS (PLWHA) in Ikeja, Lagos State, Nigeria. The geographical scope is limited to Ikeja, a prominent urban area, allowing for an in-depth exploration within a defined locale. It seeks to provide practical insights for the local healthcare sector, identifying cultural, socioeconomic, and healthcare-related influences that impact PLWHA's well-being. The findings could guide policymakers and healthcare professionals in developing inclusive interventions to reduce stigma and improve healthcare practices. Additionally, the study aims to empower both PLWHA and the wider community by increasing public understanding and contributing to global efforts against HIV-related discrimination.

This study that was conducted in Lagos State in January 2024, focused on Ikeja, a major economic and healthcare hub. Despite being the smallest state by landmass, Lagos had a population of 12.7 million in 2019, with Ikeja being home to over 470,200 people.^{35, 61} Overcrowding, rural-urban migration, and low-income earners characterize the state. Ikeja’s diverse urban-suburban population and its healthcare infrastructure, including several busy Anti-Retroviral Therapy (ART) clinics, provide an ideal backdrop to examine stigma and discrimination among people living with HIV/AIDS (PLWHA). The study aims to highlight the socio-economic and healthcare challenges affecting access to ART services in this region.

A crosssectional hospitalbased study conducted at the Antiretroviral Therapy Centre (ATC) was employed. Among all adult clients on ART regimen, accessing treatment at any HAART clinic in Ikeja, Lagos state.

A sample size of 400 was selected using the fischer formula. A simple random sampling technique was used. Out of seven known ART centers, three hospitals were selected using simple random sampling. The names of all seven centers were written on separate slips of paper, placed in a container, and three slips were drawn randomly to select Lagos State University Teaching Hospital Ikeja, 661 Nigerian Air Force Hospital Ikeja, and Primary Health Centre Ogba. For patient selection, a list of all PLWHAs undergoing ART at these hospitals was obtained using a random number generator, 400 patients were chosen from these lists to participate in the study, ensuring an unbiased and representative sample.

Structured questionnaires was administered to individuals accessing ART in Ikeja to gather quantitative data on their experiences of stigma, discrimination, and related factors. These instruments include validated scales or items measuring stigma levels, discrimination experiences, and healthcare access barriers. The sociodemographic details of the participants was recorded using a pretested questionnaire schedule. Social stigma related to HIV was assessed using the Berger HIV Stigma Scale. During the process of patient interaction, queries/questions regarding HIV/AIDS/ART was clarified and solved. Any additional openended responses of the subjects was noted, without further probing.

The Berger Stigma Scale measures HIV-related stigma across four domains: Personalized Stigma, Disclosure Concerns, Negative Self Image, and Public Attitudes, totaling 40 items. Scores range from 40 to 160, with higher scores indicating greater stigma.^62,63 The scale has strong reliability (coefficients 0.90–0.96) and takes 15–25 minutes to complete. Knowledge of HIV was assessed through a separate scoring system, with scores over 60% classified as good knowledge. Ethical clearance was obtained from the Lagos state university teaching hospital Health Research and Ethics Committee with the Ref.No LREC/06/10/2499, and informed consent was obtained from participants. Participants were informed of their right to withdraw from the study at any time without penalty. Research assistants were trained to ensure confidentiality, and no personal identifiers were included in the data to prevent stigma.

Data was analyzed using STATA version 11.0, with statistical tests like Chi-squared, t-statistic, and logistic regression. A p-value of < 0.05 was considered significant. Univariate analysis presented frequencies, percentages, means, and standard deviations. Knowledge scores were graded, and associations between stigma, discrimination, and ART accessibility were tested using Chi-square and logistic regression, with significance set at p < 0.05.

A total of 409 questionnaires were given out and 400 returned indicating a 98% response rate. Univariate analysis is expressed as frequency tables, mean and standard deviation while bivariate and multivariate was presented in tables.

The first section of the finding’s presentation covered the respondents' demographic and socioeconomic details.

From Table 1, more than a quarter of respondents were in the 20-29years (26.3%), 30-39years (27.5%), and 40-49years (26.7%) with a mean of 39 ± 11. Gender distribution shows a near-equal split with 50.3% female and 49.7% male. As regards the level of education, more than two thirds of participants (73.5%) have completed university education, with 2.0% having no formal education. The average monthly income of the participants varies; smaller proportion earn between ₦50,000 and ₦100,000 (17.7%), while the bulk earn between ₦100,000 and ₦500,000 (29.7%). The monthly average income is roughly ₦301,568 ± ₦318,389.

Concerning HIV status disclosure, more than one third of participants (46.3%) have declared their status, compared to over half (53.75%) who have not. For partners' HIV status more than one third (42.75%) of the participants reported having an HIV-positive spouse. With a mean of 5.3 ± 5 years, the participants' length of time on ART reveals more than half of participants (52.7%) have been on therapy for less than five years.

Table 2: Among the respondents, 89.7% were aware of what stigma related to HIV/AIDS means, indicating high awareness levels. However, only 46.7% knew about support services available to address stigma and discrimination faced by PLWHAs. Additionally, 58.0% had received information regarding discrimination against PLWHAs, and 46.0% had participated in educational programs related to HIV/AIDS stigma and discrimination. Furthermore, 79.3% were aware that reducing stigma could improve healthcare access for PLWHAs. Despite high awareness, more than half (60.0%) of respondents had poor knowledge overall.

From Table 3 above, more than a third of participants (38.7%) reported being treated differently by healthcare providers due to their HIV status. Negative attitudes or behaviors from family or friends were encountered by 41.5% of participants, 48.7% felt ashamed or judged because of their HIV status, and 48.0% believed there is widespread discrimination against PLWHAs in Ikeja. Personal experiences of verbal abuse or insults related to HIV status were reported by less than a third (31.7%) of respondents.

The prevalence of stigma and discrimination was generally low, with more than two third (79.7%) of respondents classified as experiencing low prevalence. This classification was based on scoring and grouping responses into low and high prevalence categories.

The data reveals significant relationships between stigma subscales in the study. There is a moderate positive correlation between personalized stigma and negative self-image at 0.5838, indicating that higher levels of personalized stigma are associated with more negative self-perceptions. A strong positive correlation of 0.8012 exists between personalized stigma and public attitude, suggesting that personal stigma is closely linked to perceptions of societal attitudes. Disclosure concerns show a weak positive correlation with personalized stigma at 0.0296, and a weak positive correlation with negative self-image at 0.1195. The strongest correlation is between personalized stigma and public attitude. Meanwhile, public attitude and negative self-image have a moderate positive correlation of 0.4698, while disclosure concerns and public attitude show a weak correlation of 0.0554.

The partner's HIV status was found to be a significant variable in the stigmatization analysis. With p = 0.017 and χ² = 8.12, there was clear statistical significance. This implies that a person's ability to avoid stigmatization is significantly influenced by the HIV status of their partners.

Additionally, there was an association between respondents' average monthly income and stigmatization (χ² = 290.74, p < 0.001, indicating that socioeconomic position is a key factor influencing stigmatization.

However, a number of factors had no statistically significant association with stigmatization. The χ² = 3.33 and the p = 0.504 for age did not indicate an association.

The following factors did not significantly differ (p > 0.050): gender, marital status, ethnicity, religion, educational status, disclosure of HIV status, occupation, place of residence, and duration on ART.

The average monthly income has an association with discrimination among the factors analyzed. With p < 0.001 and χ² = 33.06 there was clear statistical significance. This implies that people's experiences of discrimination are significantly influenced by their financial levels.

The presence of HIV in a partner was also significantly associated with discrimination (χ² = 18.80, p < 0.001). This suggested that a person's ability to avoid discrimination is significantly influenced by their partner's HIV status. Another variable that showed statistical significance in relation to discrimination was status disclosure (χ² = 4.63, p = 0.031). This suggests that a person's chance of facing discrimination is greatly impacted by whether they disclose their HIV status.

It was also found that discrimination was associated with occupation (χ² = 13.8243, p = 0.008) indicating that occupational status has an effect on experiences of discrimination.

However, several factors (including age, marital status, religion, ethnicity, educational attainment, place of residence, and duration on ART) did not show statistically significant differences from one another when it came to discrimination (p value > 0.05).

Table 4.9 highlights several statistically significant variables associated with stigmatization. Individuals aged 20–29 years have a significantly higher likelihood of experiencing stigmatization with an odds ratio (OR) of 50.41 (95% CI: 1.66–1529.63, P = 0.024), and those aged 30–39 years have an OR of 44.82 (95% CI: 1.61–1249.63, P = 0.025). Ethnicity also plays a role, as Hausa individuals are less likely to experience stigmatization with an OR of 0.10 (95% CI: 0.02–0.62, P = 0.013). Those living outside Lagos State have an increased likelihood of stigmatization, with an OR of 4.75 (95% CI: 1.09–20.81, P = 0.039). Disclosure of HIV status significantly affects stigmatization, with disclosed individuals having an OR of 4.37 (95% CI: 1.41–13.57, P = 0.011). Additionally, individuals with an average monthly income of ₦50,000-₦100,000 are significantly less likely to experience stigmatization, with an OR of 0.03 (95% CI: 0.008–0.11, P < 0.001).

Table 4.10 highlights several statistically significant variables associated with discrimination. Males are less likely to experience discrimination with an odds ratio (OR) of 0.33 (95% CI: 0.14–0.79, P = 0.013). Occupation as an artificer significantly increases the likelihood of discrimination, with an OR of 11.28 (95% CI: 2.18–58.31, P = 0.004). Residing outside Ikeja is associated with a decreased likelihood of discrimination, with an OR of 0.35 (95% CI: 0.13–0.90, P = 0.030). Having a partner with a negative HIV status significantly reduces the odds of discrimination, with an OR of 0.11 (95% CI: 0.03–0.44, P = 0.002). Finally, an average monthly income of over 500,000 also significantly lowers the likelihood of experiencing discrimination, with an OR of 0.13 (95% CI: 0.03–0.49, P = 0.003).

This study assessed the level of knowledge and HIV-related stigma and discrimination faced by people living with HIV/AIDS in Ikeja local government, Lagos state. The report reveals that majority (89.75%) of participants are aware of the stigma associated with HIV/AIDS, 60% possess only a limited understanding of the issue. This aligns with previous studies showing that although awareness is high, detailed comprehension of stigma and active involvement in educational programs remain low. The high rate of stigma and discrimination against people living with HIV/AIDS (PLWHAs) in Ikeja highlights the complex interactions between institutional operations, cultural norms, and societal views. ^{61, 62, 64, 65}

A significant portion of participants reported experiencing stigma in healthcare settings, which reflects ongoing challenges faced by PLWHAs in accessing healthcare services.^{66, 67} These findings are consistent with prior research, indicating that negative attitudes from healthcare providers discourage PLWHAs from seeking medical attention, worsening their healthcare outcomes. ^57,68–70 Discrimination is also widespread in the workplace and educational institutions⁷¹, which echoes research demonstrating how HIV stigma infiltrates multiple areas of life, affecting the opportunities and well-being of PLWHAs.^73,74

Media portrayals were also cited as contributors to HIV stigma, reinforcing negative stereotypes and societal prejudices. This underscores the role of public perception in perpetuating stigma. Religious and cultural beliefs were identified by many respondents as significant factors influencing attitudes toward PLWHAs. These cultural stigmas pose serious barriers to acceptance and support, further isolating PLWHAs from social and community activities. This social isolation is a recurring theme in HIV stigma studies, as it exacerbates the emotional and psychological toll on affected individuals. ^74–78

Economic factors were also identified as contributors to stigma. Many participants believed that poverty worsens the stigma associated with HIV, a viewpoint supported by research indicating that PLWHAs with lower socioeconomic status are more vulnerable to discrimination. The report highlights the potential of educational initiatives to reduce stigma, with respondents recognizing that increased awareness and understanding can foster more accepting attitudes and behaviors toward PLWHAs. This reinforces previous findings showing that educational efforts can challenge stereotypes and improve public perceptions.^74–79

The study’s findings align with broader research on HIV-related stigma and discrimination, emphasizing the importance of continuous efforts in community support, legislative reform, and education to address these issues. The regularity of stigma and discrimination reported by participants reflects the broader dynamics of HIV-related stigma. Family, friends, and healthcare providers were common sources of stigma, which can lead to feelings of guilt, rejection, and condemnation among PLWHAs. These experiences have a significant impact on their quality of life and mental health, underscoring the critical need to address stigma in HIV/AIDS care. ^80,81

Interestingly, the study found a lower prevalence of overt discrimination and verbal abuse, which contrasts with some literature suggesting these forms of discrimination are more widespread. This discrepancy may stem from cultural differences in how stigma is perceived and expressed, as well as potential improvements in Ikeja’s efforts to reduce stigma. However, the mixed views on stigma indicate the complexity of HIV-related discrimination, highlighting the need for ongoing research and locally tailored solutions.⁸³

The report provides valuable insights into the different dimensions of stigma faced by PLWHAs, as shown by the stigma subscales in Tables 4.5 and 4.6. These subscales—Personalized Stigma, Disclosure Concerns, Negative Self-Image, and Public Attitude—offer a comprehensive understanding of the stigma phenomenon and its impact on PLWHAs in Ikeja. This subscale measures internalized stigma, also known as self-stigma, which is the experience of feeling guilty, ashamed, or having a bad self-image due to one's HIV status. Studies on self-stigma in HIV-positive communities in Abeokuta, Nigeria; Tamil Nadu, India, confirms the idea that women may internalize negative societal attitudes more thoroughly than men, as seen by the somewhat higher ratings among females ^36,59,85.

Perceptions of how the general public perceives and handles individuals living with HIV/AIDS are measured by this subscale. A strong conviction that the public has negative attitudes towards people living with HIV, which are a result of social prejudice and misinformation, is indicated by high scores on this subscale. Numerous studies support these conclusions, showing that stigma from the public still poses a serious obstacle to the quality of life for those living with HIV ^56,86,87.

The findings from the subscale analysis are logical and align with current research on HIV stigma. Personalized Stigma, Disclosure Concerns, Negative Self-Image, and Public Attitude are all critical dimensions that impact the lives of individuals with HIV. These dimensions help to pinpoint areas where interventions can be most effective, such as public education to reduce societal stigma and supportive services to help individuals cope with internalized stigma. The gender differences observed, though not always statistically significant, highlight the need for gender-sensitive approaches in addressing HIV-related stigma. These insights are invaluable for developing comprehensive strategies to combat stigma and improve the well-being of people living with HIV/AIDS ^88,89. The data showed that, in comparison to people under 20, those in the 20–29 and 30–39 age groups are substantially more likely to encounter stigma. This result is in line with the theory that widespread assumptions and misconceptions regarding the lifestyles of younger PLWHA contribute to their increased social stigma. Youth are sometimes unfairly condemned for imagined acts that may have contributed to their HIV status in many nations, including Nigeria. Cultural norms that stigmatize drug use and premarital sexual activity, both of which are frequently (and often incorrectly) linked to HIV transmission, may be the root cause of this age-related stigma ⁹⁰.

Additionally, younger PLWHA may lack the social support systems that older individuals might have, exacerbating their vulnerability to stigma. The absence of strong family or community support can leave younger individuals feeling isolated and more susceptible to negative societal attitudes. This pattern aligns with previous research indicating that younger people with HIV face more pronounced stigma, making targeted interventions for this age group crucial.

Gender emerged as a key influence in discrimination but not in Stigma. It was discovered that the likelihood of discrimination was far lower for men than for women. This demonstrates the relationship between gender-based discrimination and HIV-related stigma. HIV-positive women frequently bear a dual burden: they are discriminated against because of their gender identity and stigmatized for having the virus ^91,92.

Women may experience more severe societal repercussions and are frequently held responsible for HIV transmission within their families in many countries, including Nigeria. This social guilt can show up as a variety of discriminatory experiences, such as being neglected in medical settings or being shunned by the community. This research emphasizes how gender-sensitive strategies are necessary to combat HIV-related prejudice and make sure that women's particular needs are met.

Looking at different forms of stigmatization across gender distribution females living with HIV/AIDS in Ikeja experience slightly higher personalized stigma (mean score: 2.63) compared to males (2.29), though the difference is not statistically significant (P = 0.0946). This might be due to societal expectations placing more pressure on women. Disclosure concerns were nearly identical for both genders, suggesting a shared fear of stigma (P = 0.7391). Negative self-image scores were also similar, indicating internalized stigma affects both sexes equally (P = 0.1748). Public attitude scores were high across the board, reflecting widespread societal stigma (P = 0.4760). These rational conclusions are consistent with recent research showing that stigma associated to HIV affects men and women in a similar way, highlighting the widespread nature of stigma irrespective of gender ^93,94.

While marital status was not significantly associated with stigma or discrimination in this study, divorced individuals had higher, though not statistically significant, odds of experiencing both. This points to an intricate relationship in which other variables, such as social support and financial stability, interact with married status to predict stigma and discrimination rather than stigma or discrimination alone ^95–97. PLWHA who are divorced or alone may face more stigma and discrimination as a result of losing their spouse's support, which can be an important defense against negative societal perceptions. Furthermore, societal standards that stigmatize divorce or singlehood may make it harder for PLWHA to overcome these obstacles.

Religion and ethnicity were significant factors in stigma experiences. Those who identified as Hausa were much less likely than Yoruba people to face stigma. This might be explained by the different cultural perspectives that various ethnic groups have on HIV/AIDS. Communities that have more robust support networks within the community and less judgmental views towards disease, for instance, may create more conducive circumstances where stigma is less common.

Religion, although not significantly associated with stigma or discrimination in this study, still showed trends where individuals practicing Islam had higher odds of stigma. This finding suggests that religious beliefs and community practices might influence how HIV/AIDS is perceived and how individuals are treated. Previous studies have shown mixed results regarding the role of religion, indicating that it can either mitigate or exacerbate stigma depending on the religious context and its teachings about illness and morality ^76,77,98.

Higher educational attainment was significantly associated with lower odds of experiencing discrimination. This suggests that education can serve as a protective factor, possibly because educated individuals are better equipped to understand HIV/AIDS, advocate for their rights, and navigate healthcare systems. Education might also foster more progressive attitudes towards HIV, reducing the likelihood of discriminatory behavior from others.

This is consistent with the larger body of literature that emphasizes the value of education in empowering people and lowering stigma and discrimination associated with health issues. Additionally, those with higher levels of education might have easier access to social networks and resources that help lessen the negative effects of discrimination ^34,99.

Experiences of prejudice were strongly influenced by occupation, with artisans experiencing much greater odds than civil servants. This draws attention to the occupational vulnerabilities that some occupations have, especially those that are less stable and have a lower social status, which might make people more vulnerable to discrimination. Workplaces with pervasive prejudice toward HIV/AIDS or without policies protecting PLWHA can provide as fertile grounds for discrimination. This research highlights the significance of workplace interventions and regulations that safeguard the dignity and rights of PLWHA, guaranteeing equitable support for all occupational groups ^{71, 76, 100}.

Both stigma and discrimination were influenced by geographic location. Outside of Ikeja, people were more likely to face stigma than outside of Lagos State, where prejudice was less likely to occur. This regional discrepancy may result from differing HIV/AIDS knowledge, resources, and support networks in various areas. It's possible that urban regions like Ikeja have stronger support networks and healthcare infrastructures, which lessen discrimination. On the other hand, stigma associated with HIV/AIDS may be higher in rural or less urbanized areas due to stronger traditional beliefs and limited access to factual information ^{101, 102}.

The likelihood of facing stigma and discrimination was much decreased if one's partner's HIV status was unknown or negative. This implies that the social dynamics and support networks accessible to PLWHA can be impacted by the partner's status. Partners who do not know their status or who are HIV-negative may offer stronger support, lessening the negative effects of discrimination and stigma in society. The suffering of having been infected by a positive spouse may, despite the appearance of normalcy, intensify discrimination and stigma amongst Sero concordant couples ^104,105.

There was a strong association found between higher income and a decreased likelihood of discrimination and stigma. This emphasizes how stable economies provide protection against stigma and discrimination, since those with higher wages may have better access to healthcare, social services, and educational opportunities. In line with the larger body of research on the protective benefits of socioeconomic position, economic empowerment can give PLWHA the means to stand up for their rights, get better healthcare, and create supportive social networks ^106,107

The study concludes that stigma and prejudice against PLWHAs are still pervasive in Ikeja and have an impact on their general well-being, social inclusion, and access to healthcare. The difficulties that PLWHAs confront are mostly caused by socioeconomic issues, stigmas associated with culture and religion, and unfavorable attitudes from healthcare professionals. Even though stigma-related problems are becoming more widely recognized, there is still a significant need for improved education and focused treatments to deal with these problems. The results are consistent with previous research, which emphasizes the necessity for a multifaceted strategy to counteract stigma and discrimination connected to HIV.

List of abbreviation

AIDS Acquired immune deficiency syndrome

ART Anti-Retroviral Therapy

ATC Antiretroviral Therapy Centre

HAART Highly Active Anti-Retroviral Therapy

HIV Human immunodeficiency virus

NARHS National AIDS and Reproductive Health Survey

PEPFAR US President’s Emergency Plan for AIDS Relief

PLHIV People Living with HIV

PLWHA People Living With HIV/AIDS

PMTCT Prevention of Mother to Child Transmission