In Nigeria, the intersecting crises of HIV and child marriage are threatening the futures of millions of young people, as well as the country’s progress toward ambitious global health and human rights targets. Recent revelations from leading health experts and advocates paint a sobering picture: despite years of intervention, Nigerian youth are slipping through the cracks of HIV prevention and treatment programs, while deeply rooted cultural practices like child marriage continue to put girls at risk of abuse, disease, and early death.
On August 27, 2025, Dr. Agatha David, director of Research and Consultant Paediatrician at the Nigerian Institute of Medical Research (NIMR), sounded the alarm at a press conference in Lagos. According to NIMR data, HIV testing rates among Nigerian youth have plummeted below 25 percent, with fewer than 23 percent of adolescents and young adults aged 15 to 24 having reported HIV testing in the past year. This is a far cry from the UNAIDS 95-95-95 targets, which call for 95 percent of people living with HIV to know their status, 95 percent of those diagnosed to receive antiretroviral therapy (ART), and 95 percent of those on treatment to achieve viral suppression by 2030.
“If they are not tested, we don’t know who’s positive,” Dr. David explained, highlighting a critical weak link in Nigeria’s HIV response. The consequences are dire: among those adolescents and young adults living with HIV, viral suppression rates lag below 80 percent—well behind the 92 percent success rate achieved in NIMR’s own programs, but not reflective of the national picture. Non-adherence to medication is fueled by a toxic mix of stigma, lack of family support, and the exploratory nature of youth, which often includes high-risk sexual behaviors. In a recent NIMR study, 20 percent of adolescents reported sexual debut before age 15, with inconsistent condom use and transactional sex further fueling transmission.
“If they are not virally suppressed, they can transmit the virus, continuing the chain,” Dr. David warned. The implications are not just medical—they’re social, economic, and generational. Nigeria, home to an estimated 2 million people living with HIV, is at risk of missing both the UNAIDS 2030 targets and the United Nations’ Sustainable Development Goal 3, which aims to end the AIDS epidemic.
But the challenges don’t end with HIV. In southeastern Nigeria, another crisis persists: the ancient custom of “money marriage,” in which young girls—sometimes as young as three—are sold into marriage, often to much older men, for sums as low as 18,000 naira (about $12 USD) or even for gifts like bottles of Coca-Cola. Thirty years ago, pastor Richards Akonam encountered this practice firsthand when he met 11-year-old Esther, married to an 86-year-old man. Over the years, Akonam has witnessed countless cases of girls being traded to settle debts or evade taxes, with devastating consequences for their health and autonomy.
“He sold her to settle his debts,” Akonam said of one father who sold his daughter Grace to a 36-year-old man for 30,000 naira (around $220 USD at the time). According to UNICEF, as of 2024, Nigeria had over 24 million child brides—the third highest number in the world. Around one in six Nigerian girls are married before age 15, despite the 2003 Child Rights Act, which prohibits marriage under 18. Legal loopholes and weak enforcement continue to undermine protections, with a subsection of Nigeria’s Constitution stating that any woman “who is married shall be deemed to be of full age.”
“The law is not being enforced,” said Izuchukwu Nwagbara, a Lagos-based lawyer, in an interview with CT. Many communities define childhood as ending before 18, and economic hardship only exacerbates the problem. In 2022, Nigeria’s National Bureau of Statistics reported that 40 percent of the country’s 216 million citizens were living below the poverty line. The “money wife” system entrenches cycles of abuse and exploitation, with girls sometimes forced to have sex with other men to generate income for their “husbands.” If a “money wife” dies childless, her family is required to provide another girl as a replacement, perpetuating the cycle.
The consequences are deadly. Save the Children International estimates that over 22,000 girls die annually from pregnancy and childbirth linked to child marriage, with nearly half these deaths occurring in West and Central Africa. One study found that “money marriage” increases the risks of psychological, physical, and sexual abuse. “Some of the husbands have the idea that if your wife misbehaves, you can flog her,” said Ignatius Ubetu, a pastor in northern Kano State who works to convince families of the value of girls’ education.
Efforts to combat these intertwined crises have met both progress and resistance. On the HIV front, NIMR has pioneered several innovative interventions, including Nigeria’s first adolescent-friendly HIV clinic in 2009 and outreach programs for children living with HIV in orphanages. To improve adherence, NIMR tested bidirectional SMS reminders—where youth confirm medication intake—and peer navigation programs, pairing virally suppressed adolescents with those struggling to stay on treatment. These interventions have shown promise, but scaling them nationally has proven difficult due to funding shortfalls.
“The government relies on donor agencies for ART drugs,” Dr. David explained. While the U.S. government continues to fund lifesaving ART, other critical interventions—like resistance testing, pre-exposure prophylaxis (PrEP), and routine monitoring tests—are not covered. “The Trump administration is a wake-up call, not just for Nigeria, but for many African countries. Because if you are depending on somebody to give you food, and the person is not obligated to give you food, they could decide that I have given you enough food, you should have been able to cultivate some food by now,” she noted. As a result, patients often pay out-of-pocket for essential tests, and Dr. David has called for local manufacturing of antiretrovirals to reduce dependency on foreign donors, citing India as a model.
Mental health, too, is a significant barrier to effective HIV care. NIMR studies have found that over 20 percent of HIV-positive adolescents experience depression and suicidal ideation, often triggered by stigma or family rejection. In one heartbreaking case, a nine-year-old boy attempted suicide after being expelled from his home because of his HIV status. NIMR is now planning a study to integrate mental health counseling into routine HIV care, collaborating with neuropsychiatric hospitals to address this urgent need. “Mental health issues are real, and we are not trained to handle them at scale,” Dr. David admitted.
The fight against child marriage has also seen both setbacks and glimmers of hope. In May 2024, a planned mass wedding of 100 girls in Niger State sparked national controversy and legal challenges, with critics fearing that some girls might be underaged or coerced into marriage for financial reasons. While the then women affairs minister, Uju Kennedy-Ohanenye, filed a court order to halt the weddings, she later clarified, “I did not intend to stop the marriage but to ensure the girls are of marriageable age and were not being forced into it.” Lois Auta, a legislative advocate in Abuja, lamented, “The former minister could not save the girls. I think you’re just wasting your time trying to stop a practice which they don’t see as an evil.”
Yet, grassroots efforts persist. Pastor Akonam, who founded the RichGrace Foundation with his wife in 2013, has helped more than 200 girls escape abusive early marriages and pursue education. Sometimes, the foundation pays back the debts owed to the girls’ “husbands”; other times, the girls simply flee. “I couldn’t turn my back on them,” Akonam said. Education and community outreach remain the most promising tools for change, even in the face of cultural resistance and personal danger. Akonam himself has narrowly escaped lynching while helping girls escape forced marriages.
As Nigeria stands at a crossroads, the stakes could hardly be higher. Without urgent, coordinated action to boost HIV testing, adherence, and holistic care—and to enforce laws against child marriage while shifting cultural attitudes—the country risks failing an entire generation. “We have the research. Now we need to translate it into practice,” Dr. David urged. The futures of millions of Nigerian children and youth depend on it.
