Obinna examines the interplay of HIV stigma and social tensions in his home country of Nigeria, illustrating how effective health communication may help spur queer liberation.

Content Warning: This article discusses homophobia.

Health education and communication is an area of enormous opportunity in Nigeria. Despite being a great African nation—both in terms of population and gross economic product—this wealth and resource isn’t allocated to building comprehensive, accessible, and high-quality healthcare systems in Nigeria. 

The Nigerian healthcare system suffers from both low human resource and weak communication strategies, which have specific impact on the health and wellbeing of more marginalised communities. Although varsities and training centres churn out graduates in the health sector every year, there seems to be a greater yearning for greener pastures by these graduates. According to Business Day, 50% of Nigerian youths want to leave the country, and student visas seem to be the easiest way to do so. These high exodus rates of highly qualified professionals are depleting the Nigerian health sector.

Additionally, the EAS Journal of Humanities and Cultural Studies pinpointed that the healthcare communication strategies in Nigeria aren’t widespread in the terms of their actions. They highlighted that effective communication like mass media can be used as an easier strategy for health education and communication, especially to reach rural communities who are more likely to lack access and information on biomedical care.

This exodus of national human resources and the lack of culturally specific communication strategies impacts sexual and reproductive health and education. As a secondary school student, I witnessed boys segregated during extra curricular activities and girls confined in a closed building to be educated on female health issues between the age of ten to eighteen. There was no mention of health education in the school curriculum, except as a form of extracurricular activities organised by Non-Governmental Organisations (NGOs). 

Despite the silence around all aspects of health, and specifically reproductive and sexual wellbeing, this didn’t restrict me from hearing and understanding sexual health issues concerning human immunodeficiency virus (HIV) from the world. Of all sexually transmitted diseases (STDs), HIV is most known due to its devastating deadliness and stigmatising social response to the virus as it emerged in the 1980s. Despite much medical progress, and significant social change, many of these changes haven’t been incorporated by health officials in Nigeria to assist with deeper social awareness and sensitization. 

AIDS was first identified in Nigeria in 1985. The causative agent, HIV, hadn’t been discovered until 1983, which led to the observation that HIV can cause AIDS. Growing up in the 2000s and 2010s as a Nigerian child and teenager, I was still unaware that there had been therapy for the virus known as antiretroviral therapy or ART. For many Nigerians, the growing availability and use of the internet during these years increased access to health information, and escalated discussions around healthcare. The internet helped citizens become better educated without waiting for government resources. On discovering my sexuality and coming into being fully aware, the internet became my source of information. 

However, the internet isn’t an accessible resource to all. It’s possible to become overwhelmed with articles online, and reading peer-published articles involves patience and often some academic knowledge. Additionally, the literacy rate in Nigeria as of 2021 is estimated at 77.62%, compared to 99% in a developed country like the United Kingdom. 

Despite accessibility barriers, the internet remains to this day a key source of information for young LGBTQI+ Nigerians looking to understand their sexuality and care for their sexual health needs in a deeply stigmatising social environment. Due to the anti-same-sex marital law that was implemented in 2014, Nigerian queer people have lived deeper in the closet to survive. The anti-queer law has brought more awareness to queer people and this has subjected LGBTQI+ Nigerians to abuse. It has led queer people to educate in the secret, so as not to be lynched. There are different websites like Kitodiaries and outlets like PrideTV on Instagram, Whatsapp, and Facebook where queer people are given a heads-up on how to stay safe in the country. One way these networks support each other is by compiling lists of incidents, often of people masquerading as queer people, to abuse or report members of the queer community. 

 I spoke to Tessy*, a Nigerian cis lesbian who spends a lot of her time on Twitter fighting misogyny by countering misogynists on issues that affect both cis and trans women. She spoke on how she has been able to navigate her sexuality through this online space. In Nigeria, the taboo surrounding sexual education prevents parents from teaching their children about sexuality, leaving them to fend for themselves. In 1999, the Nigerian government proposed the introduction of sex education in schools but this development has stalled, and is now up to the discretion of schools and parents willing to spend enough money on private institutions. Tessy believes that sexual communication and education and all it encompasses is very important in our growth. Through self-education, she has learned to be disciplined and intentional in her sex life, which has helped to keep her protected from STDs. 

There has been a wide debate (especially from an article published by Greenspring School) on whether sex education should be taught in Nigerian schools. In Nigeria, 1.9 million are estimated to be living with HIV. The question that remains, however, is if sexual education becomes part of the curriculum, will it include lessons about LGBTQI+ identities? And, if it does, will it portray LGBTQI+ identities in a good light? There are many conservative social values driven by religious morals, with Christianity in southern Nigeria and Islam in the north. 

As a result of these remaining conservative social values, Tessy believes that health communication is also limited by shame and stigma. Sex is seen as a taboo, not to be discussed away from the marital bed. This has posed a serious problem in health communication issues. “I try to be open in my relationships concerning STDs and also avoid perpetuating stigma especially when it’s discussed by people around me due to less knowledge on better health language for the masses, in Nigeria.” 

It is also important to contextualise the stigma that pertains in Nigeria towards HIV as a product of the racist Western response to the virus that continues today. Despite the disease being brought to Nigeria by the West, the global communication around the disease have inaccurately depicted it as an African disease as much as a gay disease. As a result, many of us  queer Nigerians are meticulous about our health because we are seen to house STDs—especially HIV and AIDS—due to stigma from people in Western nations.

As a medical doctor currently in residence, Dr Francis Moses* had a lot to say about health communication. Being gay, he explains, has helped him better understand sexual health than his medical training and experience working as a doctor. Letting go of his prejudices and embracing his gay identity supported his ability to both accept the evidence-based teachings of science, and become a more empathetic and compassionate doctor. He tells a story of how the Nigerian medical world’s queerphobia makes them resistant to scientific evidence when it comes to LGBTQI+ people’s health and wellbeing. 

Due to stigma, shame, and the danger members of the Nigerian LGBTQI+ community face, many seek solace through physical and online spaces to make us feel connected. Francis learned that reading about sexuality and sexual health while he was exploring his own identity as a gay man in these spaces helped him become the man he is today. During our conversation, he stresses how those who have unprotected anal sex are at a higher rate of contracting sexually transmitted diseases, especially those who are at the receptive end. He got to know the information and complexity of viruses in his basic years as a medical student and over the years, he had learned more. His way of helping the younger LGBTQI+ population is through communication and advising them on basic precautions where necessary. There is always the chance of mistakes, but taking control of protecting our sexual health is much safer than hoping things work out in our favour. 

As a gay person living in Nigeria, I have had to cancel multiple meetups with those who wanted sex without protection. Earlier in my life, I learnt the necessary details on how to stay safe and it would become my failure to let this down to please someone else. I also acknowledged that there are ways to enjoy sex other than penetration, which has been my other method for when the other party does not want to take the necessary precautions. From my personal experience, I have learnt that sexual education helps me communicate my boundaries with my partner.

Ben*, a young gay man in his thirties, acknowledges the recklessness involved in the queer scene. Ben spoke about how he counters this by prioritising his health as well as his partner’s when he is in a relationship. Other than HIV and AIDS checks, he goes for checkups twice a year to certify himself free from other STDs like chlamydia, gonorrhoea, and human papillomavirus. Regular check ups are important, even when there are no symptoms, which can be an unfamiliar concept for many Nigerians. This isn’t just due to poor healthcare communication and education:  the high poverty rate in Nigeria means that medical attention is a low priority for an average Nigerian when there is only money for food.

There is a lot to be done on communication in Nigeria and it needs all hands to be on deck to be handled. Nigeria still has a long way to go in sexual health. We also can’t be certain if better health communication in Nigeria will equate to better healthcare for LGBTQI+ Nigerians. Until queer people have rights in Nigeria, our healthcare system remains restricted. 

Resources

Recently, a few LGBTQI+ NGOS have been established in Nigeria. These include the Bisi Alimi Foundation, The Initiatives for Equal Rights, and Improved Sexual Health and Rights Advocacy Initiatives. They offer online resources on how to stay safe and advocate for the well-being of queer people. They also have head offices (situated in Lagos) in which people can walk in to get the necessary advice and basic safety protections.

Consent

*Ben & Tessy offered consent to use their first name as no one will recognize them and also, they are not secretly in the closet. Francis Moses offered to use his middle name, “Francis” and another made-up name, “Moses.”