The scale of the challenge is considerable. Nigeria is home to roughly two million people living with HIV, the second-largest such population in the world. With the global target of ending HIV/AIDS set for 2030, the authors note that only a few years remain, and a single policy factor continues to compromise that timeline: the legal treatment of sex work as a criminal matter. Nigeria’s legal landscape is fragmented, with southern states punishing allied activities such as pimping and brothel-keeping, while northern states, applying versions of Sharia law, criminalise prostitution outright. This patchwork, the authors argue, creates an environment in which poor health outcomes and economic inefficiency flourish together.

The epidemiological logic of the critique is straightforward. Criminalisation drives sex work underground, where stigma and the persistent fear of arrest deter people from seeking HIV testing, prevention tools, and treatment. Studies cited in the commentary document that sex workers in Nigeria are frequently refused care by healthcare providers and routinely avoid health services out of fear of police encounters. This is despite the existence of the Nigerian HIV and AIDS (Anti-Discrimination) Act of 2014, which was intended to prohibit discrimination based on real or perceived HIV status. In practice, the authors observe, sex workers remain discriminated against by the very systems that are supposed to protect them, and enforcement activities themselves are associated with violence, extortion, and human rights abuses.

The numbers illustrate the consequences. A 2023 review of HIV trends in Nigeria reported a cumulative HIV prevalence of 10.8 percent among key populations in Kano State, dramatically higher than in the general population, with stigma and insufficient services identified as major barriers to care. Because criminalisation obstructs access to the very interventions that prevent and treat HIV, the commentary argues, it directly drives new infections and keeps the epidemic concentrated and expensive to manage. Treating advanced HIV disease, managing opportunistic infections, and funding long-term antiretroviral therapy and hospitalisations cost far more than preventive care would, meaning the current legal framework effectively forces Nigeria to spend more money for worse outcomes.

The fiscal dimension is central to the authors’ case. The Nigerian government and major international funders, including PEPFAR and the Global Fund, have invested heavily in HIV prevention programmes. Yet when one of the most vulnerable populations cannot safely access those programmes, the return on investment collapses. Police raids, detentions, and the cost of running detention facilities for arrested sex workers consume taxpayer money and law-enforcement capacity that the authors describe as counterproductive, straining an already overstretched judicial system. Decriminalisation, by contrast, would relieve pressure on the courts and police, freeing funds that could be redirected toward healthcare and reducing the sexual and gender-based violence documented during law-enforcement operations.

The commentary is careful to distinguish decriminalisation from legalisation, a distinction with significant practical implications for Nigeria. Legalisation typically involves formal state regulation through registration and licensing schemes, which can improve labour standards in theory but, in a politically conservative society, risks driving sex workers further underground if they are unwilling to identify themselves to authorities. Decriminalisation, as defined by the Global Network of Sex Work Projects, means the complete removal of criminal and administrative penalties against the sale and purchase of sex, advertising, solicitation, and third-party involvement, eliminating extraordinary policing and surveillance. International evidence, including a major global epidemiological review published in The Lancet, links decriminalisation to reduced HIV risk environments and increased uptake of services among sex workers, making it the more context-appropriate reform for Nigeria.

From a programmatic standpoint, decriminalisation would transform how prevention reaches the population that needs it most. The authors point to evidence that Nigerian sex workers are eager to engage with prevention: in one recent study, 95.9 percent obtained HIV testing when it was available, and 68 percent used pre-exposure prophylaxis, or PrEP, when it was accessible. Removing the threat of arrest would allow health authorities to systematically supply and track tools such as PrEP and condoms, and to establish regular testing within sex worker communities rather than relying on ad hoc, low-trust outreach. Instead of being treated as a public health liability, sex workers would be integrated into the healthcare system, with unhindered access to sexual and reproductive health programmes.

The economic argument extends beyond the health budget. The authors highlight an emerging contradiction in Nigerian policy: recent government proposals to tax all income, including earnings from sex work, sit awkwardly alongside laws that criminalise that same income. Decriminalisation would resolve this contradiction, bringing an active segment of the informal economy into the tax base and generating revenue that could be invested in public health programmes, including HIV prevention and sexual health clinics. Economic empowerment effects would follow, the authors argue, as sex workers gained the ability to demand fair pay and safer working conditions, spend less on bribes to law enforcement, negotiate condom use more effectively, refuse dangerous clients, and reduce their exposure to violence and abuse.

The commentary also addresses a common counterargument: that economic and educational exit programmes are a preferable empowerment strategy in conservative societies. The authors acknowledge that such programmes can help some women transition out of sex work, citing studies from Africa and Canada, but note that in criminalised environments their effectiveness is limited by legal precarity, violence, and stigma, and that the best results come from integrated, voluntary, rights-based support rather than stand-alone exit mandates. Decriminalisation, in their framing, is best understood as a structural harm-reduction reform that enhances the reach and effectiveness of every other intervention.

Ultimately, the authors present Nigeria with a clear choice. The country can continue along an expensive and futile path of criminalisation that feeds the epidemic it claims to fight, or it can adopt a realistic, health-centred policy of decriminalisation. They are explicit that decriminalising sex work should not be read as an endorsement of the profession but as an acknowledgement that containing HIV requires unimpeded access to prevention and care, unobstructed by law. Framed as an investment in public health, the reform promises lower infection rates, more efficient use of national and donor funds, and meaningful progress toward ending AIDS by 2030. From a health economics standpoint, the authors conclude, it is an investment Nigeria cannot afford to postpone.

Subject of Research: Health economics analysis of sex work decriminalisation and its impact on HIV prevalence in Nigeria

Article Title: Decriminalising sex work and the health economics impact on HIV prevalence in Nigeria

Article References: Decriminalising sex work and the health economics impact on HIV prevalence in Nigeria. (n.d.). https://doi.org/10.1007/s44155-026-00452-0

Image Credits: AI Generated

DOI: 10.1007/s44155-026-00452-0

Keywords: sex work decriminalisation, HIV prevalence, Nigeria, health economics, PrEP, HIV prevention, key populations, stigma, public health policy, harm reduction, PEPFAR, Global Fund