Building Relationships and Families Among PLHIV in Low-and Middle-Income Countries: Overcoming Stigma and Leveraging Recent Advances

Abstract

People living with human immunodeficiency virus (PLHIV) face significant challenges, particularly stigma, which impacts their ability to build and maintain family or seek relationships. This is especially prevalent in low-and middle-income countries (LMICs), where awareness is limited. Stigma leads to societal rejection, internalized shame, and emotional distress, affecting both single and married PLHIV. Singles experience rejection, loneliness, and fear of disclosure, while sero-discordant couples face transmission fears, conception issues, and emotional strain. Even sero-concordant couples, despite sharing the same human immunodeficiency virus (HIV) status, struggle with stigma and conception challenges. This narrative review examines the effects of stigma on relationships and building families among PLHIV using a literature search across major electronic databases. It also highlights advancements such as online dating platforms, highly active antiretroviral therapy, preexposure prophylaxis, and assisted reproductive technologies, which help mitigate transmission risks and improve relationship dynamics. Overall, addressing HIV-related stigma through public education campaigns, psychosocial interventions, and policy-level interventions, as well as capitalizing on recent advances, is essential to improving relationship formation, intimacy, and quality of life among PLHIV.

Keywords

people living with HIV relationships family stigma recent advances

Introduction

Human immunodeficiency virus (HIV) continues to be one of the most significant global health challenges, impacting millions of people across the world.¹ Since the initial reports of acquired immunodeficiency syndrome (AIDS) cases in the United States in 1981, 84 million people have contracted HIV, and over 40 million have died from AIDS or related diseases.² The epidemic has far-reaching consequences, not only for individuals’ health but also for their families, communities, and economic development. The overwhelming majority of those affected by HIV live in low-and middle-income countries (LMICs), with 20.8 million (53% of global cases) residing in eastern and southern Africa.^2,3 In western and central Africa, there are 4.8 million (13%), in Asia and the Pacific, 6.5 million (15%), and in Western and Central Europe and North America, 2.3 million (5%).²

The stigma surrounding HIV infection remains one of the most significant challenges faced by people living with HIV (PLHIV), especially in LMICs, where there is a persistent lack of awareness and understanding of the disease.^4,5 In many regions, HIV is associated with moral judgments, discrimination, and fear of contagion, leading to the marginalization of PLHIV.⁶ This stigma manifests in various forms, from societal rejection to internalized shame, affecting both individuals and their relationships. Stigma and discrimination still hinder testing, starting, and staying on treatment.⁷ The challenges are further magnified when it comes to relationships, with many PLHIV struggling to navigate both romantic partnerships and the desire for family life amidst a backdrop of stigma.⁸ Stigma and discrimination, together with other social inequalities and exclusion, remain significant indirect obstacles in the fight to eliminate AIDS.⁷ A survey across 55 countries revealed that around 60% of people hold discriminatory views toward PLHIV, a rate nearly six times higher than the global target set for 2025.² In 11 of these countries, over 75% of respondents expressed discriminatory attitudes.² The prevalence of self-stigma, feeling ashamed of being HIV-positive, is also widespread in many countries. Data from Stigma Index surveys conducted between 2018 and 2021 in 20 of the total 21 countries showed that the percentage of individuals living with HIV who reported self-stigma exceeded the 10% target for 2025.² In nine of these 21 countries, more than half of those surveyed admitted to feeling ashamed of their HIV status.²

In both single and married statuses, PLHIV face a complex set of hurdles. Single individuals often experience rejection, loneliness, and isolation.⁹ Married couples, especially those in sero-discordant relationships (where one partner is HIV-positive and the other is HIV-negative), face a distinct set of challenges, including fears of transmitting HIV to the HIV-negative partner, planning conception, and managing the psychological and emotional toll of disclosure and intimacy.¹⁰ Similarly, couples in sero-concordant relationships (where both partners are HIV-positive) also face their own difficulties, including societal stigma and conception concerns, not to mention the fact that they can still reinfect themselves, which may compromise the effectiveness of treatment and worsen disease outcomes.^11-13

This narrative review examines the challenges faced by PLHIV, primarily in the context of stigmatization, interpersonal relationships, and the formation of families, alongside recent advances that help mitigate transmission risks and improve overall relationships.

Method

This article is a narrative review that provides comprehensive existing evidence on the relationship experiences of PLHIV, with particular emphasis on stigma, relationship dynamics, and the influence of recent biomedical and social advancements.

Literature Review and Search Strategy

A literature search was conducted across major electronic databases, including PubMed/MEDLINE, Scopus, Web of Science, PsycINFO, and Google Scholar. The search covered literature published between 2010 and 2025 using combinations of relevant keywords as follows “HIV,” “people living with HIV,” “relationships,” “marriage,” “disclosure,” “stigma,” “sero-discordant couples,” “sero-concordant couples,” “assisted reproductive technologies,” “dating platforms,” and “developing countries” or “LMICs.” Boolean operators were applied to refine and combine searches. Additional relevant studies were identified through manual screening of reference lists of key articles and authoritative reports from international organizations such as the WHO.

Inclusion Criteria

Articles were included if they:

Examined relationship experiences, stigma, disclosure, intimacy, or conception among PLHIV.

Focused on data from low-and middle-income countries.

Addressed biomedical and technological developments relevant to HIV relationships (eg, highly active antiretroviral therapy (HAART), preexposure prophylaxis (PrEP), assisted reproductive technologies, or social media platforms).

Exclusion Criteria

Studies were excluded if they were not relevant to relationship dynamics or stigma among PLHIV or lacked sufficient contextual relevance (Figure 1).

Figure 1.

Conceptual framework illustrating factors that influence building families and relationships among PLHIV.

Conceptual Framework

Building Relationships and Families Among PLHIV

In the context of this review, “building relationships” refers to the ability of single PLHIV to initiate and sustain intimate partnerships with confidence, openly express romantic interest, and engage in relationship formation without fear of rejection, discrimination, or stigma related to their HIV status. In contrast, “building families” refers to the maintenance of harmonious partnerships within established relationships among PLHIV, characterized by emotional intimacy and mutual support, with minimal barriers to conception and reduced fears of HIV transmission to partners or children.

This section discusses three key areas: challenges faced by single individuals in initiating relationships, and challenges faced by the two main types of families, sero-discordant and sero-concordant partnerships. Based on the definitions provided, the challenges discussed primarily relate to HIV-related stigma, fears of transmission, and barriers to conception. This article focused mainly on heterosexual relationships. Given the broad psychosocial themes, stigma, and recent advances addressed in this review, expanding the scope to include LGBTQ+ would substantially increase the length and complexity of the manuscript. The broader nature of the LGBTQ+ relationships warrants a separate study in the future.

Single PLHIV

At the individual level, HIV-related stigma remains a substantial barrier to forming relationships. Studies indicate that a significant proportion of PLHIV have experienced some form of stigma or discrimination, even after achieving an undetectable viral load.¹⁴ Some studies reported the prevalence of loneliness from as low as 16.5% to 64%, with variations resulting from other socio-demographic factors such as employment, age, and so on.^9,15,16 Stigma can manifest as verbal abuse, social exclusion, or discriminatory attitudes, which can deter individuals from seeking relationships.¹⁷ Many HIV-positive individuals experience significant anxiety about disclosing their status to potential partners due to the fear of rejection.¹⁸ This fear is often rooted in societal misconceptions about HIV transmission and the stigma associated with the virus. The decision of when and how to disclose one's HIV status can be a daunting and emotionally taxing process. HIV can affect one's self-esteem and mental health, complicating the pursuit of new relationships.¹⁹ For individuals who belong to multiple marginalized groups, such as women, LGBTQ+ persons, or those from specific ethnic backgrounds, the challenges are compounded. These individuals may face intersecting forms of stigma, including sexism, homophobia, and racism, which can further isolate them and limit their opportunities to form relationships. Collectively, these factors create a cumulative psychosocial burden that precedes partnership formation and limits relationship opportunities even in the era of effective antiretroviral therapy.

Insight Into the Sero-Discordant Family

At the interpersonal level, building families among PLHIV is shaped by the interaction between stigmas, perceived transmission risk, and reproductive aspirations. Sero-discordance refers to a situation in a relationship where one partner is HIV-positive, and the other is HIV-negative.²⁰ This condition places the HIV-negative partner at risk and is marked by emotional, social, and health-related challenges. In the context of LMICs, where awareness and access to healthcare may be limited, sero-discordant couples face heightened risks.²¹ For instance, HIV sero-discordant couples are estimated to account for up to 60% of new HIV infections in sub-Saharan Africa.²² For the HIV-negative partner, the emotional burden can be significant. The psychological toll includes constant worry about contracting HIV, and both partners suffer from navigating the complexities of disclosure and trust.^23,24 Despite medical advancements, such as the U = U principle (undetectable = untransmittable), which offers reassurance that HIV-negative partners are not at risk if the HIV-positive partner's viral load is undetectable, the anxiety, stigma, lack of awareness, and limited resources remain a greater barrier.^25,26 Psychosocial factors such as trust issues, blame, the side effects of HAART, which may lead to decreased libido, affecting intimacy and sexual health, could all add to unstable relationships.²⁷ Social isolation is another significant challenge, as sero-discordant couples face exclusion from family and community support due to the stigma surrounding their relationship.

Additionally, sero-discordant couples seeking to have children face several obstacles, both psychological and medical. Parents always have a fear of transmitting the virus to their child. Additionally, the HIV-negative and HIV-positive partners may be concerned about their ability to father or bear children without contracting or passing the virus, respectively.²⁸

Insight Into the Sero-Concordant Family

Sero-concordance occurs when both partners in a relationship are HIV-positive. While it may appear that these partners are not at risk of HIV infection, this may not be totally true. These couples need to adopt preventive measures comparable to those recommended for sero-discordant couples, as evidence suggests lower engagement with HIV care in this group. For example, in a large cohort study conducted across four high-HIV-prevalence Sub-Saharan African countries, sero-discordant index partners demonstrated higher levels of care engagement than sero-concordant partners. At enrollment, 80.6% of sero-discordant partners were receiving HAART, compared with 47.5% of sero-concordant partners, while viral suppression (<1000 copies/mL) was achieved by 77.1% versus 44.3%, respectively.²⁹ Maintaining the virus load at an undetectable level among both partners is essential in preventing them from reinfecting each other (superinfection). While the clinical significance of superinfection remains variable, reinfection with a different HIV strain has the potential to complicate treatment, including through the emergence of drug resistance, which may compromise the effectiveness of HAART and adversely affect disease outcomes.^12,13

Additionally, sero-concordant couples are not immune to stigmatization. They may face external judgment and internalized discrimination, especially in cultures where HIV is viewed with prejudice.³⁰ Even though both partners are HIV-positive, they are still subjected to negative societal perceptions of their health and relationship. The stigma of HIV as a “dirty” disease persists, exacerbating the emotional burden of living with the virus.³¹

Furthermore, for couples who are both living with HIV, fertility issues are often compounded by the virus and its treatments. HIV medications can have side effects that affect fertility, and couples may fear transmitting the virus to their child.³² This fear is exacerbated by limited access to assisted reproductive technologies and persistent stigma surrounding conception among PLHIV, with published data indicating that fewer than 1.5% of the population in sub-Saharan Africa have access to assisted conception services.³³ Psychologically, sero-concordant couples may experience self-blame or blame each other for their HIV status or infertility.³⁰ These feelings of guilt can complicate relationship dynamics and may influence decisions about marriage, family planning, and sexual health.

Changing Dynamics With Recent Advances

Recent advances in HIV prevention, treatment, and reproductive health have changed how people perceive risk. These advances provide safer conception options and facilitate access to romantic relationships among PLHIV. Advances in biomedicine, such as HAART, pre- and post-exposure prophylaxis, and assisted reproductive technology, have markedly reduced transmission risk and improved long-term health outcomes.³⁴ Simultaneously, digital innovations such as online dating platforms and telemedicine have transformed how relationships are initiated and how HIV prevention, counseling, and care are accessed.³⁵ Collectively, these developments are redefining how relationships and families are built.

Biomedical Advancement

Since its emergence in the early 1980s, HIV/AIDS has been a significant global public health concern.³⁶ Extremely high mortality rates and a lack of scientific knowledge during the early stages of the epidemic stoked widespread stigma and fear. An important turning point was the development of HAART, which turned HIV from a fatal disease into a manageable chronic condition.³⁷ HAART has proven to be effective in reducing transmission risk.³⁸ By the end of 2024, an estimated 40.8 million (ranging from 37.0 to 45.6 million) people were living with HIV, with 77% receiving antiretroviral therapy and 73% achieving suppressed viral loads.^39,40 Since 2010, the number of new HIV infections has decreased by 40%, down from 2.2 million.⁴¹

PrEP is now readily available to be offered to HIV-negative individuals in sero-discordant relationships before the HIV-positive partner achieves viral suppression with HAART.⁴² When the HIV-positive partner is on HAART, and the HIV-negative partner adheres to PrEP, the risk of HIV transmission drops to ∼0.5%.⁴³ For partners not on PrEP and where the viral load of the HIV-positive partner is uncertain, prescription of post-exposure prophylaxis (PEP) is recommended to be started as early as possible, ideally within the first 2 h, but not beyond 72 h after exposure.^44,45

Assisted reproductive technology is also a key advancement in the care of PLHIV. The safest option for an HIV-negative female to conceive with an HIV-positive male is to use sperm from an HIV-negative donor.⁴⁶ Otherwise, clinicians may recommend sperm preparation techniques, such as sperm washing, which ensures the sperm is HIV-negative, and then subsequent insemination.⁴⁷ Sperm washing combined with intra-uterine insemination or in vitro fertilization offers the lowest risk of HIV transmission.⁴⁸ However, it is costly and is not always accessible in low-resource settings. When the male partner has maintained an undetectable viral load and the female partner uses PrEP, natural conception is possible through planned intercourse during the ovulation period.⁴³ Additionally, the WHO and UNAIDS recommend incorporating male circumcision into standardized HIV-1 prevention programs. Safe male circumcision (SMC) has been shown to reduce the risk of HIV acquisition by ∼60%.⁴⁵ On the other hand, for an HIV-positive female and an HIV-negative male, self-insemination prevents HIV transmission to her HIV-negative partner by avoiding exposure to vaginal fluids.⁴⁹ Alternatively, if the female has maintained an undetectable viral load for an extended period, the HIV-negative male partner may use PrEP as a preventive measure during attempts at natural conception.⁴³ The Centers for Disease Control and Prevention recommends that the HIV-negative partner undergo HIV testing every three months while the couple attempts conception through unprotected intercourse.

Amid recent advances in HIV care, one of the most pressing questions in HIV research is when an effective vaccine will be available. Despite decades of rigorous research, an effective HIV vaccine has not yet been developed, with the virus's extensive genetic variability and rapid mutation rate among major obstacles.⁵⁰ However, recent advancements in vaccine research, especially the use of novel platforms such as mRNA and viral vectors, have shown encouraging potential in inducing immune responses. An RV144 HIV vaccine candidate, which is a heterologous prime-boost regimen using a canarypox vector (ALVAC) and gp120 protein, demonstrated a modest 31.2% reduction in HIV acquisition risk in a clinical trial.⁵¹ Additionally, immune-based therapies, such as the use of broadly neutralizing antibodies (bNAbs), are being explored for both prevention and treatment, offering promising new approaches to HIV control.^52,53

These advancements combined help mitigate the perceived risks of HIV transmission, leading to improved relationship dynamics and reducing some of the stigma and difficulties faced by PLHIV.

Digital Advancement

Social media has emerged as a key tool for HIV-positive individuals, particularly those who are single, to connect with others and reduce feelings of isolation.^54,55 There are several online dating platforms nowadays that offer a space for individuals to share experiences, find support, and connect with potential partners who understand the challenges of living with HIV.^56,57 Some of the already existing dating platforms also incorporate HIV-related features such as HIV status disclosure, PrEP usage, and undetectable viral load indicators.⁵⁸ This allows PLHIV to transparently share their health status and reduces the anxiety associated with disclosure. This development makes dating apps vital tools to help users identify compatible partners who share similar health statuses or prevention strategies. The integration of HIV-related features into dating apps could also contribute to normalizing HIV status discussions.^58,59 As more users engage with these features, it helps diminish stigma and discrimination, creating a more inclusive environment for PLHIV seeking relationships. Additionally, one study found that such a feature promotes HIV self-testing among users of the platforms by up to 70%.⁶⁰

While dating apps and websites for HIV-positive individuals provide an opportunity for connection, they also present challenges. The main issues include honesty, trust, transparency of HIV status, and the fear of rejection.⁶¹ Ethical concerns around privacy and disclosure are significant in the context of online dating for PLHIV.^61,62 The platforms must ensure confidentiality and offer safeguards against discrimination. The need for clear guidelines around privacy and data protection is paramount for individuals engaging in relationships while managing their HIV status.

Telemedicine and other digital health interventions have become valuable in HIV care by improving access, engagement, and psychosocial support.^35,63 Evidence from randomized trials and metaanalyses indicates that e-health and telemedicine interventions are linked to better antiretroviral drug adherence, with one metaanalysis reporting an 18% higher likelihood of adherence compared with standard care.⁶⁴ Digital interventions have also demonstrated benefits in addressing HIV-related stigma, especially facility-based stigma, when the healthcare staff or clinic itself is the stigmatizing agent.³⁵ For example, a metaanalysis of randomized controlled trials involving over 1075 PLHIV revealed a modest but significant reduction in perceived stigma and a concurrent improvement in quality of life.⁶⁵ Additionally, digital prescriptions and home-based delivery of PrEP have expanded access to HIV prevention, improved privacy, and reduced stigma.⁶³ Beyond clinical outcomes, technology-based approaches, such as online support groups, text messaging, and videoconferencing, have demonstrated potential in increasing access to psychosocial and mental health services.⁶⁶ This is crucial because the prevalence of anxiety and depression among PLHIV is high. However, due to limits in physical examination, continuity of patient–provider relationships, and diagnostic depth, telemedicine cannot completely replace in-person care (Table 1).

Table 1.

Different Challenges Faced by PLHIV and Remedies Based on Their Relationship Status.

Relationships	Main Challenges	Helpful Interventions
Single	Disclosure anxiety Fear of rejection Isolation and loneliness Stigmatization Other psychological problems^14-17	HAART Social media dating platforms Telemedicine and e-health platforms Public education and awareness Support network and expert counselling^35,37,38,54
Sero-discordance Male-positive	Fear of infection by the other partners Difficulty with conception Stigmatization Other psychological problems^21,23,24,28	HAART PrEP for the HIV-negative partner SMC HIV-negative sperm donor Public education and awareness Support network and expert counselling Assisted reproductive technology Telemedicine and e-health platforms^{35,37,43,48,67}
Sero-discordance Female-positive	Fear of infection by the other partners Difficulty with conception Stigmatization Other psychological problems^21,23,24,28	HAART PrEP for the HIV-negative partner Assisted reproductive technology Public education and awareness Support network and expert counselling Telemedicine and e-health platforms^35,37,38,43
Sero-concordance	Superinfection Difficulty with conception, for example, fear of vertical transmission Stigmatization Poor adoption of preventions Other psychological problems^13,29,30,32	HAART Public education and awareness Support network and expert counselling Telemedicine and e-health platforms^35,37,38

Abbreviations: HAART, highly active anti-retroviral therapy; PrEP, preexposure prophylaxis; HIV, human immunodeficiency virus; SMC, safe male circumcision.

Recommendations for Addressing Stigma and Enhancing Relationship Dynamics

Public Education and Awareness Campaigns

Public education campaigns are essential in combating HIV-related stigma, especially in LMICs where misinformation is rampant. These campaigns should focus on the effectiveness of modern treatments like HAART and PrEP, the importance of safe sexual practices, psycho-social support, and the reduction of stigma for PLHIV. Evidence suggests a strong inverse relationship between educational attainment and HIV-related stigmatization. In a multicountry analysis examining the association between education and HIV stigma, countries with the highest proportions of individuals without formal education and awareness such as Niger (70.6%), Mali (70.3%), Guinea (60.5%), Sierra Leone (51.1%), Liberia (32.0%), Togo (29.3%), Ghana (21.0%), and the Democratic Republic of Congo (13.5%), exhibited consistently high stigma indices (>40%) and vice versa for countries with higher number of literates.⁶⁸

Social and Support Networks

Peer support groups led by trained PLHIV are encouraged by WHO and the US President's Emergency Plan for AIDS Relief (PEPFAR) to meet the unique needs of PLHIV and their partners.^69,70 Support from family, friends, and community organizations is vital in helping PLHIV to cope with stigma. The impact of support group interventions on important outcomes, including lower mortality and morbidity, higher retention in care, enhanced confidence and self-esteem, improved coping skills, perceived reduction in stigma, and improved quality of life, was largely positive, according to 90% of the reviewed articles in a systematic review that assessed the impact of support groups.⁷⁰

Modifications in Therapeutic Approaches

Therapeutic interventions, such as individual counseling or couples therapy, can help alleviate the psychological strain of living with HIV. These therapies should aim to address issues like self-esteem, depression, relationship dynamics, and coping with the stigma of HIV, promoting healthier relationships among sero-positive individuals. Another recommendable approach is incorporating telemedicine, digital prescriptions, and home-based drug delivery into the routine care of PLHIV. This would provide easier access to HIV prevention services, enhance privacy, and reduce stigma.^35,63 Even though internet availability is increasing in LMICs, with 85% of teenagers owning a cell phone by the age of 14, several barriers still limit the establishment of telemedicine in LMICs.^71,72

Advocacy for Policy Change

Policy reforms are needed to protect the rights of PLHIV, most importantly regarding laws, marriage, family planning, and access to reproductive health services. Governments must work to ensure that these individuals can have fulfilling relationships and families without facing discrimination or fear of transmission. UNAIDS is now calling on countries to adopt bold new targets to remove social and legal barriers in order to allow enabling environment for HIV services. One key goal is to ensure that fewer than 10% of countries maintain punitive laws and HIV criminalization.⁷³ HIV criminalization refers to the unfair use of criminal laws against people living with HIV based solely on their HIV status.⁷⁴ This may occur through HIV-specific laws or through general criminal laws. In 2020 alone, the HIV Justice Network reported at least 90 unjust HIV criminalization cases across 25 countries.⁷⁴

The Role of International Organizations

Global organizations such as the WHO and UNAIDS play a crucial role in reducing stigma and improving the quality of life for sero-positive individuals. These organizations should continue to advocate for the rights of PLHIV, provide resources, and support local efforts to combat stigma. For example, the Centers for Disease Control and Prevention has supported research on HIV-related stigma among PLHIV to better understand its effects on testing, treatment adherence, retention in care, and viral suppression. The evidence generated has informed the development of stigma-reduction interventions, provider training, and community-based programs.⁷⁵ At the global level, the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination was established in 2018 following a call to action by the NGO Delegation to the UNAIDS Program Coordinating Board. The initiative promotes coordinated, country-led efforts to eliminate stigma and discrimination in healthcare, legal systems, workplaces, and communities.⁷⁶

Limitations of the Study

This narrative review did not employ systematic review methods and included studies of variable designs and strength of evidence. The study explores only some forms of heterosexual relationships, with a lack of focus on other forms of homosexual relationships, which are even more predisposed to intersected stigma and risk of HIV transmission. The study also could not provide details on several forms of stigma experienced by PLHIV, as well as other psychological traumas that are highly associated. Additionally, despite HIV being a pandemic disease, the review focused on findings from LMICs.

Conclusion

This review demonstrates that relationship formation and family building among PLHIV in LMICs are shaped by intersecting biomedical, psychosocial, and contextual factors. Single individuals face disclosure anxiety and isolation, whereas sero-discordant and sero-concordant couples encounter transmission fears, conception concerns, and social exclusion. The study shows how recent advances, such as HAART, PrEP, safer conception strategies, and digital health innovations, could help PLHIV in navigating relationships, building families, reducing stigma, and improving overall well-being. Key research gaps include the need for longitudinal studies to measure how biomedical and digital innovations translate into sustained improvements in relationship stability and stigma reduction. Finally, implementation research is needed to determine how recommendations on stigma-reduction interventions can be effectively integrated into routine HIV care systems in LMICs.

Footnotes

Acknowledgments

The authors extend their sincere gratitude to the faculty members at Chulalongkorn University and Gombe State University for their academic support during the preparation of this review. We also acknowledge the researchers whose work provided the foundation for this manuscript.

ORCID iD

Safiyanu Adamu Maikifi

Ethical Considerations

Ethical approval was not required for this narrative review as it did not involve human participants, human data, or human tissue. Therefore, ethics committee approval and informed consent were not required.

Consent to Participate

Not applicable.

Consent to Publication

Not applicable.

Author Contributions

Abubakar Sunusi Ishak conceived the idea for the manuscript. Auwal Rabiu Auwal, Abubakar Sunusi Ishak, and Safiyanu Adamu Maikifi contributed to the manuscript concept and preparation of both the initial and final drafts. All authors were involved in drafting, modifying, and reviewing the manuscript and gave their final approval for submission.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

No new data were created or analyzed in this study. Data sharing is not applicable to this article.

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