Health-System Determinants of Gender Disparities in HIV Infection Among Adolescent Girls and Young Women in Sokoto, North-Western Nigeria: Policy and Service Delivery Implications

Abstract

Background: Adolescent girls and young women remain disproportionately affected by HIV in sub-Saharan Africa. In north-western Nigeria, lower overall HIV prevalence does not eliminate concentrated vulnerability created by gender inequality, early marriage, limited education, economic dependence, low sexual autonomy, HIV-related stigma, and barriers to confidential health services. This review examines how biological and socio-cultural risks are intensified or mitigated by health-system design in Sokoto State. Methods: An expanded narrative review was undertaken using the submitted conference abstract as the conceptual foundation. Targeted searches of PubMed and authoritative reports from UNAIDS, the World Health Organization, the National Agency for the Control of AIDS, UNFPA, and the World Bank were conducted for evidence available up to July 2026. The literature was organised using social-ecological and health-systems perspectives, with emphasis on service accessibility, acceptability, referral, confidentiality, workforce capacity, commodities, data, and the meaningful engagement of adolescent girls and young women. Results: Gender disparities in HIV vulnerability arise from interacting biological, interpersonal, economic, socio-cultural, and health system determinants. Biological susceptibility and sexually transmitted infections operate within relationships shaped by age disparate partnerships, early marriage, limited condom negotiation, and economic dependence. Health-system barriers include fear of stigma and disclosure, judgemental provider attitudes, insufficient privacy, restrictive service hours, weak referral pathways, fragmented HIV and sexual and reproductive health services, inadequate commodities, and limited youth participation. Nigeria has developed relevant strategies, including the National HIV and AIDS Strategic Plan and the Generation Negative strategy. Programmes such as the Adolescent Girls Initiative for Learning and Empowerment can address educational and economic determinants, while Operation Triple Zero offers a youth-engagement model for adolescents living with HIV. However, coverage, institutionalisation, local coordination, and evaluation remain uneven. Evidence supports combination approaches that integrate youth-friendly services, HIV testing and self-testing, pre-exposure prophylaxis choice, condoms, sexually transmitted infection care, gender-based violence response, peer navigation, education, and social protection. Conclusion: Reducing HIV disparities among adolescent girls and young women in Sokoto requires more than risk communication. It requires a gender-responsive health system that protects confidentiality, brings services closer to young people, connects clinics with schools and communities, strengthens referrals and commodity security, and gives adolescent girls and young women meaningful roles in programme design and accountability. Education and economic empowerment should be treated as core HIV prevention interventions rather than peripheral social activities.