Mapping Strategies for Preventing HIV in Nigeria

By Dirk Hoffman

Obinna Ekwunife, PhD, assistant professor of medicine in the Division of Population Health, and colleagues published “Expanding HIV Prevention: Exploring Community Pharmacists’ Willingness to Provide PrEP in Nigeria” in October in the journal AIDS and Behavior.

The study aimed to understand whether community pharmacists in Nigeria would be willing to provide HIV pre-exposure prophylaxis (PrEP), a medication that prevents HIV before exposure, and what support they would need to do so.

To answer these questions, the research team surveyed licensed community pharmacists in two major cities, Lagos and Abuja, using an online and in-person questionnaire.

They also mapped the locations of pharmacies and compared them with places where individuals most at risk for HIV (such as sex-worker hot spots) live or work. This helped determine whether pharmacies were better positioned than hospitals to reach people who could benefit most from PrEP.

PrEP uptake in Nigeria remains low because of stigma, limited clinic access, and shortages of trained providers.

Ekwunife says several forms of stigma hamper PrEP uptake in Nigeria.

“Many people fear being labeled as HIV-positive simply for seeking PrEP. Sex workers, gay and bisexual men, and transgender people often face discrimination, including from health care workers,” he says. “And conversations around sexual health are often considered taboo, making individuals reluctant to seek prevention services in public hospitals that offer HIV services.”

Ekwunife notes these stigmas may make pharmacies, where people routinely visit and feel anonymous, an appealing alternative for PrEP delivery.

The mapping analysis also found that 82 to 94% of sex-worker hot spots were closer to a pharmacy than to a hospital, meaning pharmacies are physically closer to many people who need PrEP most.

“Pharmacies are also open longer hours, are more discreet, and are located in both urban and peri-urban communities,” Ekwunife says. “This makes them ideal access points for prevention services.”

Several system-level barriers also restrict PrEP access in Nigeria, Ekwunife notes.

These include an insufficient number of HIV-specialized clinics relative to population need, restricted clinic hours and a shortage of trained PrEP providers, particularly in busy hospitals.

“Pharmacies are far more numerous and widely distributed, offering a way to expand reach,” Ekwunife asserts.

Interestingly, the study found that 99.6% of community pharmacies surveyed expressed a willingness to deliver PrEP.

“The universal complete willingness was striking, even higher than what studies in the U.S. and Canada have found,” Ekwunife says. “This finding is very encouraging. It shows that Nigerian pharmacists see themselves as key partners in HIV prevention and are open to expanding their role if given the right training, supplies and support.”

“Their readiness suggests that scaling up pharmacy-based PrEP could significantly strengthen HIV prevention efforts in the country.”

Ekwunife says the study ultimately offers several practical insights for informing strategies for implementing pharmacy-based PrEP in Nigeria:

• training of community pharmacists and other pharmacy providers is essential, especially on PrEP guidelines, HIV testing, counseling, and stigma reduction
• pharmacies need logistical support, such as access to HIV rapid test kits and PrEP supply chains
• private consulting rooms are available in almost all surveyed pharmacies, making confidential counseling feasible
• collaboration with nurses and HIV clinicians can strengthen service quality

Tyler Nauta, a biomedical sciences undergraduate student at the Jacobs School, is a co-author on the study.

Nauta participated through the UB Research and Creative Activities for Undergraduate Students Program, a competitive, SUNY-funded initiative that supports undergraduates in faculty-mentored research.

Under Ekwunife’s mentorship, Nauta contributed substantially to the project, particularly in spatial analysis and data management, which are core components of the study’s mapping findings. Nauta also participated in manuscript preparation.

The study’s first author, Theodora C. Omenoba, is a licensed pharmacist who served as the study coordinator for the project in Nigeria. She is affiliated with Bloom Public Health, the implementing partner responsible for on-the-ground project execution of Pharm PrEP Nigeria Study (a project funded by a 2024 developmental grant from the University of Washington/Fred Hutch Center for AIDS Re­search, an NIH-funded program under award number AI027757).

The study’s other Nigerian co-authors represent a collaborative team across key public health and pharmacy institutions, including Bloom Public Health, the Association of Community Pharmacists of Nigeria, and Pan-Atlantic University, Lagos. Their combined expertise in pharmacy practice, implementation science, and community health helped support data collection, stakeholder engagement, and contextual interpretation of the findings, Ekwunife says.