CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

HIV care has changed greatly over the past two decades. Understanding of the virus has grown, effective antiretroviral medicines have been developed, and people who start treatment early and take it consistently can now live long and healthy lives. Modern HIV care therefore rests on patient autonomy and on making the best use of the different skills of health care professionals, working as a team. A team approach works well only if every provider, including the pharmacist, has adequate knowledge of HIV and a positive attitude towards people living with the virus.

HIV remains a major public health problem. According to UNAIDS (2026), 41.0 million people were living with HIV worldwide in 2025 and 1.2 million people acquired the infection that year. About 88% of people living with HIV knew their status and 78% were accessing treatment, which means that about 5.0 million people were living with HIV without knowing it (UNAIDS, 2026). The burden falls heavily on sub-Saharan Africa. Nigeria is among the countries with the largest HIV epidemics in the region, although the 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) showed prevalence among adults aged 15 to 64 years to be lower than earlier estimates, at 1.4% (Federal Ministry of Health [FMoH], 2019). Prevalence varies widely between states and is highest in the South-South zone. Rivers State is among the three states with the highest prevalence, at 3.6% among adults aged 15 to 64 years, behind only Akwa Ibom and Benue (FMoH, 2019).

Because most people living with HIV need lifelong antiretroviral therapy, they must collect their medicines regularly. Community pharmacists are among the most accessible health professionals and are well placed to support people with chronic conditions such as HIV (Ajagu et al., 2017). The World Health Organization (WHO) has recommended that the role of community pharmacists be expanded to increase access to HIV services, and it has encouraged decentralising HIV care from hospitals to community settings (Ajagu et al., 2017). Pharmacy visits offer opportunities for counselling, adherence support, referral and, increasingly, testing and prevention services beyond the traditional dispensing role. A 2025 survey of community pharmacies in Nigeria found that almost all of them were willing to provide HIV pre-exposure prophylaxis (PrEP) if given training, supplies and support (University at Buffalo, 2025).

However, willingness is not the same as readiness. The evidence shows that pharmacists’ knowledge and attitudes differ from place to place. In a survey of community pharmacies in Pune, India, researchers found stigmatising attitudes and low levels of knowledge alongside a high willingness to take part in HIV management (Gupta et al., 2010). In a survey of 205 community pharmacists in South-East Nigeria, overall knowledge of HIV was high (70.41%), but the mean attitude score towards HIV services was only about 57%, only 23.4% of pharmacists stocked HIV test kits and 31.7% stocked antiretroviral medicines, and perceived skills for HIV services were low (mean 39.26%), even though pharmacists were highly ready to offer such services (87.32%) (Ajagu et al., 2017). Most of the pharmacists could not correctly describe the WHO clinical staging of HIV (Ajagu et al., 2017). These findings suggest that pharmacists’ knowledge, attitude and skills must be assessed locally before roles are expanded.

In Rivers State, Nigeria, community pharmacies are widely distributed and could play a valuable supporting role in HIV management and care. Before any such role is planned, however, the pharmacists’ own level of knowledge and attitude must be known. This study therefore evaluates HIV-related attitudes of community pharmacists in Rivers State and assesses their basic knowledge of HIV, in order to judge their ability to serve as HIV educators.

1.2 Statement of the Problem

The knowledge and attitude of community pharmacists towards patients living with HIV in Rivers State, Nigeria, are not well documented. The question is influenced by several factors: the nature of the disease, accepted models of HIV care, international and local evidence on pharmacists’ knowledge and attitudes and their influence on outcomes, and the capacity of Nigerian community pharmacists to deliver HIV care given the realities of pharmacy practice in the country (Ajagu et al., 2017). Studies of community pharmacists elsewhere in Nigeria show high willingness but limited stocking of test kits and antiretrovirals and low perceived skills (Ajagu et al., 2017), and evidence specific to Rivers State, one of the states with the highest HIV prevalence (FMoH, 2019), appears limited.

1.3 Objectives of the Study

The main objective of the study was to assess knowledge and attitude, and their association with demographic variables, towards patients living with HIV among community pharmacists in Rivers State, Nigeria. The specific objectives were to:

1. assess the knowledge and attitude of community pharmacists towards patients living with HIV in Rivers State;
2. identify demographic variables associated with differences in community pharmacists’ knowledge and attitude towards patients living with HIV; and
3. determine whether there is an association between the knowledge and the attitude of community pharmacists towards patients living with HIV in Rivers State.

1.4 Research Questions

The following research questions were considered:

1. What are the knowledge and attitude of community pharmacists towards patients living with HIV?
2. What is the association between the demographic variables of community pharmacists and their knowledge and attitude towards patients living with HIV?
3. What is the association between the level of knowledge of community pharmacists and their attitude towards patients living with HIV?

1.5 Significance of the Study

The results may inform public policy and help change the perceptions of patients and health care professionals about HIV care. Community pharmacies are accessible, open for long hours and in frequent contact with the public, including people who appear healthy, so they are well placed to contribute to disease management programmes and to the detection, education and referral of people at risk of HIV (Ajagu et al., 2017). Their usefulness depends on the readiness of the pharmacists themselves, and studies show that training and support are needed (Ajagu et al., 2017; University at Buffalo, 2025).

The findings will help policy makers to make informed, evidence-based decisions on pharmaceutical care for patients living with HIV in communities, including decisions about training and incentives. They will show the current state of HIV care in community pharmacies and, where necessary, help policy makers to strengthen the sensitisation of pharmacists. The patient is the ultimate beneficiary. The study will also:

1. provide data for people inside and outside the pharmacy profession about community pharmacists’ knowledge of HIV;
2. provide baseline information for judging what is working and what is not in community pharmacies in relation to HIV; and
3. help to assess whether community pharmacy services are meeting current health care needs and how they should be improved.

1.6 Limitations of the Study

The main limitations of the study were a relatively small sample size, a number of potential respondents who declined to take part, and strict ethical requirements, which also reduced the sample. In addition, respondents were given more than the standard 15 minutes prescribed for the validated tool so that they could complete the lengthy questionnaire.

1.7 Operational Definition of Terms

Community pharmacist: a pharmacist who works in a retail pharmacy.

General HIV test: the part of the questionnaire that examines participants’ general knowledge of HIV.

HIV: the human immunodeficiency virus, a virus that attacks the immune system, the body’s natural defence against illness. It destroys a type of white blood cell called the T-helper cell and makes copies of itself inside these cells.

Knowledge: a respondent’s understanding of HIV, its transmission, treatment and management, as measured by the study instrument.

Attitude: a respondent’s feelings, beliefs and readiness to act towards patients living with HIV and towards providing HIV services.

References

Ajagu, N., Anetoh, M. U., & Nduka, S. O. (2017). Expanding HIV/AIDS care service sites: A cross sectional survey of community pharmacists’ views in South-East, Nigeria. Journal of Pharmaceutical Policy and Practice, 10, 34. https://doi.org/10.1186/s40545-017-0122-x

Federal Ministry of Health (Nigeria). (2019). Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) 2018: National fact sheet. https://nigerianstat.gov.ng/nada/index.php/catalog/65/download/680

Gupta, A., Sane, S. S., Gurbani, A., Bollinger, R. C., Mehendale, S. M., & Godbole, S. V. (2010). Stigmatizing attitudes and low levels of knowledge but high willingness to participate in HIV management: A community-based survey of pharmacies in Pune, India. BMC Public Health, 10, 517. https://doi.org/10.1186/1471-2458-10-517

UNAIDS. (2026). Global HIV statistics: Fact sheet 2026. https://www.unaids.org/sites/default/files/2026-07/2026_UNAIDS_Global_HIV_Factsheet_en.pdf

University at Buffalo. (2025). Mapping strategies for preventing HIV in Nigeria [News article]. https://medicine.buffalo.edu/news_and_events/news/2025/11/ekwunife-hiv-prevention-nigeria-23704.html