Essay: Assessing HIV/AIDS Survival in Nigerian Population

Contextual Project
Concept
A. Education has made survival and assessment of HIV/AIDS in Nigeria possible. Sex education has helped in preventing HIV/AIDS in Nigeria and increasing the participation of community leaders in the planning and implementation of HIV/AIDS programmes. In 2009, 23% of schools were provided life-skills based HIV education while 25% of men and women between the ages of 15 and 24 identified ways to prevent sexual transmission of HIV in 2010.
 HIV and AIDS education initiatives focuses on married girls as they are less likely to have access to health information than unmarried girls. Knowledge about HIV prevention is less among girls aged 15-19 compared to boys and many girls than boys are engaging in sexual activity before the age of 15 years. Education on the use of condom is one of the most effective strategies for combating the spread of HIV/AIDS. Because people believes that educating youths about condoms promotes early sexual initiation, a study was conducted in Nigeria in 2013 to know if people aged should be taught about using a condom to avoid HIV infection, 35% of women and 44% of men supported teaching young people aged about condoms for HIV prevention. Support for educating youth on the use of condoms for HIV prevention is higher in urban than in rural areas. Among women, support of condom education for youth is highest in the South East while among men, it is highest in the South South.
B. The use of condom is contributing towards people surviving the mayhem of HIV/AIDS in Nigeria. The use of condom is one of the most effective ways of people protecting themselves from HIV but restrictions on condom promotion in Nigeria have hampered efforts to promote this form of HIV prevention. In the year 2001, a radio announcement was suspended by the Advertising Practitioners Council of Nigeria (APCON) for promoting messages proposing that it is appropriate to engage in premarital sex as long as a condom is used. In 2006 APCON also started enforcing stricter regulations on condom advertisements that encourages indecency.
The National Strategic Plan of 2010-2012, Nigeria set the target of having 80% of sexually active men and women using condoms consistently and correctly with non-regular partners with the aim that by 2015 there will be a positive change in attitude towards use of condom and almost half i.e. 42% of HIV infections could occur among people considered to be having low-risk sex that is those cohabiting or married partnerships. Over 2 billion male condoms and 886,979 female condoms were distributed both by National Youth Service Corps (NYSC), NGOs and the Federal Ministry of Health in the year 2010.
 According to 2013 National Demographic Health Survey (NDHS), 50% of unmarried women and those who never had sex along with 53% of those who are currently married are least likely to know that using condoms and restricting sexual intercourse to one HIV/AIDS ¬negative partner decreases the risk of HIV transmission. 75% of women who are yet to be married but have had sexual intercourse are most likely to know that using condoms and restricting sexual intercourse to one HIV-negative partner reduces the risk of HIV transmission. HIV prevention awareness is lowest among men who are unmarried and have never had sexual intercourse and highest among men who have never been married but have had sexual intercourse. People in urban areas are more knowledgeable about HIV prevention methods than their counterparts in rural areas. HIV prevention methods knowledge increases with increasing education and wealth.
C. Media campaigns and public awareness of HIV/AIDS is on the increase and also raising hope for people that thought that life is over once infected with HIV/AIDS. This has aided the survival of victims by giving them new hope that with the use of combination antiretroviral therapy (cART), life existence continues. Nigeria is large and diverse in culture, religion, environment, politics, economy etc. comprising people of different backgrounds and media campaigns becomes an avenue of raising awareness of HIV thereby reaching many people in different regions. Radio campaigns organized by the Society for Family Health have greatly been successful in increasing peoples’ knowledge and changing their behavior about HIV/AIDS. A radio broadcast captioned “Future Dreams” in the year 2001 was ran in many Nigerian languages in over 42 radio channels. It centers on encouraging consistent use of condom, increasing knowledge and skills for condom in single men and women between the age of 18 and 34. After 2001 media campaign on HIV/AIDS, another one was launched in 2005 with the aim of raising more public awareness of HIV/AIDS to the masses. The campaign took advantage of the increase in owners of handsets and sent text messages with information about HIV/AIDS to millions of Nigerians. These media campaigns have enlightened a good number of Nigerians on how HIV/AIDS could be prevented and if infected that all hope is not lost.
 The 2013 National Demographic Health Survey shows that 97% awareness about HIV/AIDS is nearly widespread among urban women and men while 89% and 93% awareness among rural women and men respectively is slightly lower. 99% of women and men in the South East was seen having the highest level of HIV/AIDS awareness while 84% of women in the North Central and 88% in the North East zones shows the lowest awareness. There is an increase in the percentage of women and men age 15-49 who have heard of HIV/AIDS since 2008 and the increase in awareness is ascribed to the serious HIV/AIDS prevention programmes ran through nongovernmental organizations.
D. Prevention of mother-to-child transmission (PMTCT) of HIV has shown an improvement in HIV/AIDS survival in Nigeria. A small number of people in Nigeria about 18% of pregnant women with HIV/AIDS access antiretroviral therapy to get their children protected and as a result of this, Nigeria has accomplished a small decrease in new infections among children since 2009 leaving an estimated number of 69,400 children infected with HIV/AIDS in 2011. This brought a rise in the total number of children living with HIV in the country to 440,000.
Mother-to-Child transmission of HIV/AIDS is common among pregnant women. Improvements was recorded in the uptake of HIV/AIDS testing, counselling and access to the most effective antiretroviral regimens among pregnant women.
 Small number of pregnant women about 8.4% received single-dose nevirapine for PMTCT in 2011 compared with 24.5% in 2010 while more pregnant women, 33.2% received effective antiretroviral treatment for PMTCT in 2011 compared with 25.2% in 2010.
2008 National Demographic Health Survey (NDHS) reveals that there is an improvement in prevention of mother-to-child treatment where 65% of women and 62% of men in Nigeria are knowledgeable that HIV can be transmitted through mother to child and also 52% of women and 53% of men were aware that the risk of mother-to-child transmission can be lessened if the mother takes special drugs during pregnancy. Over half of women in the South East i.e. 54%, 52% in the South South and 51% in the North Central are well-informed about PMTCT while 29% men in the South West are least likely to be aware of PMTCT.
E. The most-at-risk group is the population that are at higher risk of being infected and affected by HIVAIDS. These population are usually vulnerable due to social and institutional rejection and discrimination. The most-at-risk groups have high prevalence of HIV/AIDS in Nigeria and considering their condition, they should be placed at the center of HIV prevention programmes but HIV/AIDS prevention messages are not sufficiently reaching them.
 Laws prohibiting the activities of men who have sex with men (MSM) is a major barrier to this group in accessing HIV/AIDS prevention services and programmes. Same-sex relations in Nigeria are criminalized with 14 years imprisonment and in the year 2014 a new law was passed to further criminalize the lesbian, gay, bisexual, and transgender (LGBT) people. The law states that people who participate in gay associations or publically show same-sex affection will be imprisoned for 10 years while those that support gay associations face the same conviction and this law has limited access for the lesbian, gay, bisexual, and transgender (LGBT) community to HIV services.
F. Men who have sex with men (MSM) in Nigeria are considered to have a high and increasing risk of becoming infected with HIV/AIDS. 24% of men who have sex with men were reached with HIV prevention programmes in 2011 regardless of the need for improvements in HIV knowledge and awareness among the group than in 2009 that 58% were reached.
 The use of condom has much remained unchanged since 2007 with only half of the men reportedly using condom. Preventing advancement of HIV/AIDS transmission, men who have sex with men should know their HIV status but it is unfortunate that HIV testing among this group is low and declining with only a quarter testing for HIV. The HIV/AIDS prevalence among this group was reported as high as 17% in 2011 from 14% it was in 2009. It was only half of the men that used condom the last time they had anal sex with a male counterpart in 2011.
G. Sex work or transactional sex which contributed in endangering the lives of people infected with HIV has taken a new look by minimizing the death rate with the regular use of condom. Transactional sex is a process of exchanging money, kindness or gifts for sexual intercourse. Male and female sex workers who receive money for sex are considered at risk of HIV/AIDS infection. This risk is reduced through the consistent use of condoms correctly. Lots of Nigerian sex workers are not being reached by HIV/AIDS prevention programmes and also do not have the knowledge about how to protect themselves from HIV/AIDS and other sexually transmitted diseases (STDs).
 In the year 2011, few sex workers about 26% were approached with HIV/AIDS prevention messages more than 80% reached in 2009. As consistent condom use has been seen to be high among sex workers with their clients, many fails to use condoms consistently during sex with their partners. The increase in HIV/AIDS prevention messages to male sex workers is of importance as condom use with clients is much low among the group especially to female sex workers. As at 2011, a quarter of sex workers were living with HIV/AIDS and almost all sex workers about 89% were reported using condom with their most recent client. From the 2013 National Demographic Health Survey (NDHS), it was seen that condom use by men who paid for sexual intercourse is highest among the of age 20-24 with 77% higher than those who have never been married having 70% while those living in urban areas is 75% high. The percentage of men that reported using condom the last time they paid for sex increases with increasing wealth.
H. HIV testing in Nigeria to those that were able to access the services is yielding a positive result for the survival of the infected and uninfected people. Few Nigerians knows their HIV/AIDS status and this has become a problem placing people at risk of becoming infected considering the fact that not everyone knows his or her HIV status and increases the risk of onward transmission to sexual partners. Those that are willing to get tested for HIV usually have to travel long distances to access the service as there is lack of HIV testing and counselling facilities mostly in the rural areas. 1357 HIV testing and counselling facilities nationwide were available in 2011 and only 12% of women and men aged 15-49 were able to receive an HIV test and get the results. In Nigeria, HIV testing and counselling of pregnant women is central to the prevention of mother-to-child transmission but this HIV testing among sex workers has increased but still remains low with 42% receiving HIV test and the results within the last 1 year in 2011. Understanding of HIV testing is poor between men who have sex with men (MSM) leaving small number receiving a test in previous years. Few injecting drug users (IDUs) knows their HIV status and in 2011 only one in five reported to have received a test. It was reported that health care facilities offering HIV testing in Nigeria do not follow international standards about confidentiality and ethics. In study carried out, more than half of people living with HIV reported that they did not know they were being tested for the virus while about one in seven health care professionals acknowledged to never receiving informed consent for HIV tests. Legislation that criminalizes the activities of the most-at-risk individuals subjecting them to the risk of discrimination and arrest has hindered them from accessing HIV/AIDS testing services.
 The knowledge of HIV status through HIV testing is essential in assisting people in making vital decisions in undertaking safer sex practices to minimize their risk of contracting or transmitting HIV/AIDS. The knowledge of their HIV status permits HIV positive individuals in taking actions in protecting their sexual partners and access treatment services. Giving the 2008 NDHS, 60% of women and 71% of men knows where to go and get an HIV test. The idea of knowing where to get HIV testing is highest among sexually active women and men who have never been married with 83% and 86% respectively and also among urban women and men with 7% and 81% respectively. This increase in knowledge of knowing where to get tested was made possible with increasing education and wealth. By means of marital status, never-married women and men who have not yet started sexual activity were the least likely to know where to get an HIV test. It was discovered that the men and women knowledge of knowing where to get tested for HIV is lowest in the North Western Nigeria. 14% of urban women are more likely than 7% of rural women to have been tested for HIV. Nationwide, the percentage of women who had been tested for HIV was highest in Cross River with 33% high and lowest in Kebbi with 1% low.
I. The HIV/AIDS treatment and care in Nigeria is not adequate enough to take care of 3.4 million Nigerians infected with the disease. Survival of patients with Human immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) has improved with the use of antiretroviral therapy irrespective of the fact that HIV/AIDS is a major public health concern and among the causes of death in Nigeria and many parts of the world. Survival of patients living with the Acquired Immune Deficiency Syndrome has increased with highly active antiretroviral therapy (HAART) which is currently called combination antiretroviral therapy (cART). In Nigeria, the average of 54% of AIDS patients has survived 63 months between 1982 and 1996. Although cART has brought longer survival to HIV-infected patients. But despite increase and survival experienced with the use of cART, resources required to provide adequate treatment and care for those living with HIV/AIDS in Nigeria is significantly lacking. In a study conducted in Nigeria among healthcare providers, it was found that many healthcare providers had not received sufficient training on HIV prevention and treatment while several of the health facilities had a shortage of medications, equipment and materials.
 The 2005 to 2009 National HIV/AIDS Strategic Framework set out to provide ARVs to 80% of adults and children with advanced HIV infection and to 80% of HIV-positive pregnant women by 2010 was not achieved, only 31% of people who demanded treatment for advanced HIV infection received it in 2009 and as a result of the slow rate in the treatment process, the goals were extended from 2010 to 2015 in the revised framework. As at 2011, only few number of people in need of treatment received it. Out of 1.4 million adults that needs treatment, only 432,285 adults received the treatment. On the other hand, the number of children who needed treatment has increased since 2009 to 280,000 with an addition of 36,716 children receiving treatment.
J. HIV/AIDS funding in Nigeria is on the increase as the year goes by through the help of financial donors thereby enabling Nigeria in making significant progress towards financial sustainability. As at the year 2010, total available funding for HIV/AIDS was $497,817,471. In the same year, funding from international bodies was $370,927,328.
 In 2008, 7.6% of domestic HIV funding was from public sources $30,082,451 compared with 45.5% $125,139,584 in 2010. There was an increase in funding available for HIV prevention activities in 2010 while funding for HIV treatment and care decreased by 28.5% in the same year. Most of the Nigerian HIV/AIDS funding comes from development partners such as PEPFAR, Global Fund and World Bank. The World Bank loaned the sum of $90.3 million to Nigeria in 2002 to support the 5-year HIV/AIDS Programme Development Project and later in 2007, the same World Bank allocated an additional $50 million loan for the programme. Considering the success achieved in the programme, the World Bank further gave $225 million towards the HIV/AIDS Programme Development Project II ranging from 2009-2013. Through the President’s Emergency Plan for AIDS Relief (PEPFAR), the United States has given a huge amount of money to Nigeria including the US$488.6 million given to Nigeria in 2011 for HIV/AIDS prevention, treatment and care. The sum of $360,454,493 was approved by the Global Fund and US$275,586,635 was disbursed to Nigeria in 2012 to expand HIV/AIDS treatment, prevention and care programmes. These funding has been centered on spreading the HIV prevention, support and care to make it available and accessible in primary care facilities and at community levels and expand antiretroviral treatment access across secondary health facilities nationwide.
CRITICAL EVALUATION
The concept is essential and useful in monitoring and evaluating the assessment of HIV/AIDS survival in Nigeria as a monitoring and evaluation officer.
From the observation made and knowledge acquired from this course, the attention of the government of the federation will be drawn to enhance HIV/AIDS service delivery by providing adequate training to HIV/AIDS service providers comprising of public and private sector personnels, provision of comprehensive antiretroviral therapy and offering a good welfare package at every health facility on which HIV/AIDS services are offered.
The government will also be encouraged to a decisive action in increasing Antiretroviral therapy (ART) program management and financing by setting a priority based on availability of funds, financial sustainability and identifying numerous funding sources including international donors for the Antiretroviral Therapy (ART) program.
Ensures proper counseling, testing, patient monitoring, patient education on adherence and prevention of mother-to-child transmission.
Since public-private partnership is non-existent in Nigeria in the fight against HIV/AIDS, the concept will help in bringing both public and private sectors together for effective collaboration as majority of the private sectors who do not receive any form of support from the government will start receiving and lack of formal linkages between private and the public sectors on ART programs will be restored.
As a monitoring and evaluation officer, the concept will enable me in encouraging the federal government in strengthening the ART program in preparation for expansion by establishing additional facilities in every state, local government and communities that currently lacks a facility for easy accessibility of the services at the urban and rural areas.
Current Research Activities Related to the Concepts
Information rises the confidence level in any decision making process and that is why (Edewor, 2010) suggests that information is necessary for human development. (Nwafor-Orizu, 2003) describes dissemination of sources of information in Nigerian rural areas by stating that oral sources such as face-to-face interaction, television, radio, associations, traditional institutions and written sources such as magazines, newspapers etc. intends to simplify rural information transfer as a way of removing ignorance and fallacy.
The information and education campaign to prevent the spread of the disease should be followed with strength and proper care is to be given to the already afflicted people.
(Mooko and Aina, 2007) pronounce that each individual whether literate or illiterate requires information for kinds of issues necessary for his or her continued existence. They went on saying that as information users are complex, some information are homogenous like policy makers, professionals, students, researchers while others are heterogeneous such as artisans and rural inhabitants. (Ilo and Adeyemi, 2010) propose that information is the most effective available weapon for prevention and cure of HIV/AIDS.
(Cichocki 2010) maintains that the first action to be taken when attempting to find out one’s status is HIV testing and one should not depend on symptoms of HIV to conclude whether one is infected. Only that HIV/AIDS testing is a sure way of finding out. The earlier HIV/AIDS is diagnosed, the better the prognosis and the likelihood of a long and healthy life according to researches on HIV/AIDS.
Certain risk behaviours have been linked to increased HIV infection rate such as life style related risk behavious like unprotected sex, multiple sexual partners etc. (Anochie and Eneh, 2001).
(Olaleye, 2003) postulates that lots of campaigns have been made by both government and non-governmental organizations to prevent the spread of HIV/AIDS infection. The measures taken comprises of condom use to avoid the infection from the unprotected sexual intercourse, abstinence from sex, blood screening meant for transfusion, maintenance of one sexual partner etc.
(Omoniyi and Tayo-Olajubu, 2006) stated that those diagnosed with HIV/AIDS may get a life-threatening diseases known as opportunistic infection that are caused by microbes such as viruses and bacteria that attacks humans. The HIV damages the immune system making an infected person vulnerable to all forms of diseases which may eventually breakdown the immune system.
HIV/AIDS is depriving both the rural and urban communities of fully-grown labor that would have added to increased farm labour, domestic activities such as child rearing, cooking and other valuable contributions to household livelihoods and sustainable development (Barnett and Whiteside, 2002). HIV/AIDS also makes agricultural production capacity invalid with a good number of AIDS deaths in the most productive age group of 15 – 49 years. This will affect the transfer of farm information from generation to generation (Drimic, 2002). Households are afflicted with AIDS, a multi-faceted loss of labour, capital and knowledge to the extent that loss of labour and knowledge affects communities where capital assets loss is redistributed within the rural economy (Baire, 1997). Increasing mortality among young farm workers had disturbed the spread of agricultural knowledge and land management skills from one generation to another (Irwin, 2003).
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Application of the concepts in the current Job
As a monitoring and evaluation officer, the concept will help me to:
1. Monitor and evaluate the rate and quality at which HIV/AIDS services are rendered
2. Organize sensitization campaign on how to avoid contacting HIV/AIDS
3. Encourage government to lessen some laws on same sex or gay marriage that is restricting the victims from freely accessing these services
4. Propose to government of the federation to enact laws that will stop the stigmatization of the HIV/AIDS patients
5. Ensures proper and timely funding of HIV/AIDS prevention, treatment and care programmes by the government and international donors
6. Enhance access of HCT to young boys and girls, females who have sex with women, men who have sex with men, pregnant women etc. through community-based approaches.
7. Ensures government put in place strategies to target populations especially most at risk persons (MARPs) and break the barrier of discrimination and unfriendly services hindering acceptance.
8. Organize training for leaders of rural dwellers so that the information and knowledge of HIV/AIDS will be taken to the nooks and crannies of this country
9. Organize and evaluate overall progress on achievement of results
10. Establish a well-defined effective system for assessing the HIV/AIDS programmes organized by government by reviewing the activities
11. Inspires stakeholders in ensuring that the objectives are met
12. Rally round support for public private partnership for effective service delivery on HIV/AIDS prevention, treatment and care
Usefulness of concept to the current world
The concept is useful in encouraging the government of the federation in improving access to HIV/AIDS care by providing antiretroviral therapy close to people’s residence since large number of people living with HIV/AIDS in Nigeria who need antiretroviral therapy are unable to access them because of the time and cost needed to travel to health centers in addition to an inadequate number of trained health professionals to provide treatment.
It is also useful for Nigerian government in maintaining and increasing the current funding and investment levels by ensuring that HIV testing and treatment gets to all Nigerians.
In view of the fact that stigma and discrimination are problems mostly faced by people living with HIV/AIDS in many countries including Nigeria, the concept is useful for government in making policies stopping discriminating people infected with HIV/AIDS.
It’s useful in establishing a well-organized, dependable and safe antiretroviral (ARV) drug distribution system by implementing a nationwide ARV distribution system that monitors ARV consumption and assures routine resupply of drugs.
Reducing patient out-of-pocket expenditure on laboratory tests is another usefulness of the concept where government re-evaluates monitoring protocols and establish subsidy programs for screening, confirmation and tests monitoring.
Considering the fact that survival of patients with acquired immune deficiency syndrome has improved with combination antiretroviral therapy, it is useful in inspiring family and community members of people living with HIV/AIDS in giving adequate care and support to them without discrimination. It is useful in disseminating information on multiple sexual partners and the practice of protected sex as a way of preventing sexually transmitted infections including of HIV/AIDS and monitoring intervention programmes to control the spread of the disease.