Hiv Prevention Strategy In Nigeria Health And Social Care Essay

Nigeria s world of 140 million is the openhandedst in Africa with 1 in 6 Afri advises being Nigerian. The information from the 2005 mankind immunodeficiency virus ascertain indicates that approximately 4.4 % of Nigerians be infected with human immunodeficiency virus. The prevalence exhibits land broad disparity of between 1.6 % in Ekiti province ( south West ) and 10 % in Benue province ( north primaeval ) . ( haoma 1 NACA, 2007 ) While the infection rate is slower than some different African states, secretes about human immunodeficiency virus are yet high on the docket because of the states high people. ( Figure 2 Jennifer Kates, Alyssa Wilson Leggoe, 2005 ) The Antenatal information shows that youthful grownups appear most affected with 3.6 % amongst pregnant 15-19 year dodderings and 4.7 % amongst 20-24 year olds ( Figure 3 Technical Report field of weigh HIV/Syphilis Sero-Prevalence Sentinel Survey, 2005 ) This f telephone number highlights the demand for a g ood co-ordinated issue HIV/ back up bar plan to farther decelerate down the infection rate and fill in down incidence. ( NACA, 2007 )Figure 1 HIV Prevalence by accede ( 2005 )www.naca.gov.ngFigure2 a ) Percentage of Adults estimated to be populating with HIV/ assist and B ) Number of People estimated to be populating with HIV/ back up. Beginning HIV/AIDS Fact sheet, 2005Figure 3 HIV Prevalence by Age group ( Old ages ) 2005www.naca.gov.ngDrivers of the HIV Epidemic in NigeriaInformal Transactional Sexual bodily function While commercial-grade sex workers ( CSWs ) have long been identified as critical in impacting the spread of the HIV/AIDS epidemic galosh employment among them is high. A cardinal driver nevertheless is informal commercial sex among the general population ( J. Robinson, 2008 NACA, 2007 )Low Risk Percept 67 % of Nigerians perceive themselves to be at no hazard of undertaking HIV while 29 % perceive themselves to be at low hazard and merely 2 % rated their oppo rtunities of infection high ( NARHS, 2005 NACA, 2007 ) double Partnerships In Nigeria, spiritual beliefs tend to back up the publicity of common fidelity NDHS ( 2003 ) nevertheless proved that multiple cozy partnerships are common particularly amongst versedly active work forces. About 30 % and 24 % single and married work forces severally inform holding more than one sexual spouse in the past twelvemonth ( NDHS 2003, NACA 2007 ) . While work forces with multiple spouses have a 60 % increased hazard, adult females are 10 % higher(prenominal) than work forces. ( NARHS, 2005 )Lack of established STD Programming for Most at Risk Population ( MARP ) Package of service provided to MARPs is limited. Linkages to HIV guidance and testing, STD direction and intervention are weak and have relied chiefly on referrals.Continuing Risky Behaviour of males in General Population Hazardous way in the general population is more prevailing among work forces than adult females. 26 % of work for ces report holding more than one sex spouse in the last twelvemonth as against 2 % in adult females. ( NARHS, 2005 )Gender Inequalities Underliing causes and effects of HIV/AIDS infections in work forces and adult females varies reflecting differences in biological science, sexual behavior, societal attitudes, economic power, exposure, and cultural attitudes that discourages safe sex dialogue. ( NACA, 2007 )Economic Drivers HIV impoverishes individuals and communities through losingss of human resources. Poverty brings about low storeys of focal point associated with illiteracy and by and large hapless closelyness position. These conditions result in hapless acceptance of behavior alteration which exposes the population to HIV infection. ( NACA, 2007 )Equally shortly as an epidemic of HIV/AIDS was noticed in the state, Nigeria mounted a national response, which was expanded in 2000 with the constitution of the Presidential Council on AIDS ( PCA ) and the field Agency for the f ind of AIDS ( NACA ) . This allowed for a co-ordinated attempt to leave bar, intervention, attention and relief services through polity preparation, development of programs and exe disasterion.NACA s authorization provinces that -A A1.A A A Coordinate and prolong protagonism by all sectors and at all degrees for HIV/AIDS/STD expanded responses in Nigeria.A2.A A A Develop the mystify for collaborationism and last from all stakeholders for a multi-sector and multi-disciplinary response to HIV/AIDS in Nigeria.3.A A A Develop and resign to the PCA, all programs on HIV/AIDS in Nigeria for constitution determinations.4.A A A Develop and joint a strategic program for an Expanded National Response to HIV/AIDS in Nigeria.A5.A A A Coordinate, proctor and time the exe cut of meation of the Strategic National Plan for the control of HIV/AIDS/STDs in Nigeria and all other canonic policies.A6.A A A Coordinate and ease the mobilisation of resources for an effectual and sustainable resp onse to HIV/AIDS/STDs in Nigeria.A7.A A A Undertake any other responsibilities as assigned by the PCA from clip to clip. ( NACA, 2007 )The National HIV/AIDS Strategic Framework for Action ( 2005-2009 ) provides a strong and comprehensive model for bar attempts including a balanced ABC combat. In this model, in-school new-fangled persons were marked as a mark population group.Sexual activity statement is a major constituent of bar and one of the tools in minimal great deal required for HIV bar. Political issues environing it includeResistance to arouse instruction and arctic publicity by Faith Based Organizations ( FBO ) , Religious leaders and other stakeholdersInadequate accomplishments on rubber usage and dialogueMisconception about sex instruction and low credenceAvailability, handiness and affordabilityLack of insurance policy environing sexual instruction in secondary schools ( NACA, 2007 )A survey done in Nigeria analyzing the sexual behavior of secondary school stri plings showed that the average age at first intercourse was 12 old ages with a scope of 6-19 old ages many of the participants had multiple sexual spouses and a hapless perceptual experience of the hazard of STD including HIV. It was recommended that a structured sexual instruction course of charter be instituted for all schools get pour down at an early age. ( A.T. Owolabi, A.A. Onayade et Al, 2005 )Other surveies have examined how instructors feel about go throughing their cognition on HIV / AIDS bar steps to their pupils in the mount of their cultural and societal norms that restrict unfastened treatment of sex.A The consequences showed a high degree of cognition about HIV / AIDS bar among teachers.A Nevertheless, instructors do non go through on this cognition because of cultural and societal taboos.A In add-on, instructors do non have proper preparation and motive on information, instruction and communicating on HIV / AIDS and sex instruction. ( Daniel C. Oshi et Al, 2005 ) It is consequently inevitable to increase handiness of sexual wellness services, create societal support for sex instruction in schools and build capacity on prehend sex instruction.Previous efforts at supplying sex instruction were interfered by spiritual and cultural resistance. In 2000 a new course of study was introduced for comprehensive sex instruction for 10-18 twelvemonth olds which concentrated on bettering pupil s cognition and attitudes to sexual wellness and cut downing hazardous sexual behavior. However the executing of the undertaking was a entire failure and has since been abandoned. ( Avert, 2010 )In a state where issues such as confidentiality or so HIV proving is non covered by statute law, where no action is taken when human rights are broken in relation to HIV infection and stigmatisation. It seems the extremity of the immature people are in their custodies, owing to the absence of generative wellness ( RH ) institutes and deficiency of separate Torahs or s tatute law for immature people in relation to HIV bar. ( United Nations Global Coalition on Women and AIDS, 2004 )POLICY AGENDA SettingTo accomplish this wellness policy, one must see the histrions that would be involved and analyze all stakeholders- so as to understand their behavior, purposes, inter-relations and involvements and to measure the influence and resources they bring to bear on decision-making or deed procedure. ( Varvasovszky Z. , Brugha R. 2000 )Stakeholder/ Actor abridgment leave behind steer the symbol of people to interview, utilizing sweet sand verbena techniques, reappraisal questionn bearinges etc. It is of import to plan a semi-structured/ condense interview inquiries. Interviews volition let comparison across cultural groups and faith and yet be sensitive to specific con textual matters.Stake holder s position has to be alter into one that enforces indexs to exemplify the extent of the job. They need to be informed of graduated table, tendencies and likely future class of HIV epidemic in their part or territory and within specific subgroups of the population.Table 1 Stakeholders AnalysisStakeholdersEngagement in the issueInterest in the issueInfluence/ PowerPositionImpact of issue on histrionParentsParticipate in Child Sexual Education and can act upon their kids s determinationMediumLowNon-mobilizedHighMedia IndustryPromote stakeholder s positions and can act upon determination shapers by supplying adept informationHighHighsupportiveLowMinistry of HealthPromote healthy generative picks, direction of STIs and HIV related unwellnesssHighMediumSupportiveHighPresidential Council on AIDSSurvey policy proposals and do determinations on themMediumHighNon-mobilizedMediumSchool AdministrationParticipate in policy ExecutionHighMediumOpposedHighMinistry of EducationEnsure sex instruction is integrated in national course of study and implementedTraining of staffPolicy Implementation and EvaluationHighHighSupportiveHighBilateral Organizat ionsProvide support and proficient supportHighHighSupportiveHighReligious LeadershipsInfluence the population through spiritual, moral and cultural beliefsHighHighOpposedMediumImporters, Manufacturers and Sellers of the swop e.g. rubbers, text editionsProvide low-cost and high pure tone merchandiseEngagement in distributionHighLowSupportiveHighNACADevelop and present to PCA all programs on HIV/AIDS in Nigeria for policy determinationsHighHighSupportiveHighDocumentary/ Content analysis would be undertaken to place the grade of consistence between the present policies in the state. It would besides cover how far policy shapers draw on research findings in addresss during policy preparation and execution phases. The information beginnings would include research publications and studies, statute law, administrative/executive ordinances or orders, reimbursement agreements, guidelines and advice, meeting studies and proceedingss, policy statements, addresss, and articles.An economic rat ing will be considered to measure and construe the value of this wellness intercession. This will mensurate the results in pecuniary footings every bit good as in wellness units. For this policy a cost effectivity analysis ( CEA ) will be more good in order to besiege the quandary of puting pecuniary value on human lives. It will compare the value of resources spent on the intercession to the measure of wellness gained as a consequence. ( David Wonderling et Al, 2005 )A thorough apprehension of consistence of old policies with research findings, the grade of influence of research on policy docket scene, preparation and execution would be needed to guarantee a high degree of wellness research use in the determination devising of this wellness policy.CLARITY OF MESSAGEHIV bar, peculiarly sex instruction demands strong ground in order to be recommended for consideration and broad spread execution.Hall s theoretical account of docket puting claims that the strength of this grounds depe nds on the issue s Legitimacy, Feasibility and Support. ( Kent Buse, 2005 )The issue at manus is legitimate as the HIV epidemic continues to harry the state, heterosexual sex being the most reported signifier of transmittal and high rate among immature people. It is executable since the policy will be implemented logistically through already bing systems, cost and resources will hence be reduced. Support can be generated through act uponing the population with the usage of media, raising consciousness and advancing rubber usage, affecting FBOs in policy execution.There is besides no grounds that sex instruction or rubber handiness in schools will increase promiscuousness or cut down the age of first sexual intercourse of in school recent person, hence this policy has no potency for inauspicious consequence. This policy s acceptableness might be of concern, as there will be resistance from spiritual leaders and other involvement groups. This policy besides has other societal and wel lness benefits, as the usage of rubbers will besides cut down other STIs, cut down unwanted gestations and the complications from illegal abortions, thereby cut downing maternal mortality. Previous work in Nigeria has shown that equal instruction works in HIV bar and this is soon being used to move on abstention and be faithful intercession plans.Kingdom s Model proposes that there are 3 watercourses of policy procedure and they need to cross for policies to be considered. ( Kent Buse, 2005 )Problem watercourse High prevalence of HIV among in school fresh person, with the highest signifier of transmittal being heterosexual sexPoliticss watercourse The National HIV bar work program promotes condom computer programing and there have been ongoing arguments around this issue. In 2000, sex instruction was integrated into National course of study but was neer implemented. Meanwhile the prevalence amongst in school issue person since so has increased.Policy watercourse Following the 20 05 National HIV/Syphilis Sero prevalence lookout study for pregnant adult females go toing Ante-natal clinics in Nigeria. NACA has mounted more response to HIV bar. More support for HIV bar is being provided by bilateral organisations and NACA has become unfastened to execution of policies through FBOs and CSOs. Interventions are now being chosen and funded ground on scientific grounds research.POLICY FORMULATION AND IMPLEMENTATIONLegislators are influenced by media and runs, cultural beliefs, lobbyists, political parts and support every bit good as grounds establish research. It is hence of import to guarantee they have adequate information from researches, prevalence of HIV and alternate solutions. The function of the media and other organisations can non be over emphatic.This policy proposes the debut of structured sex instruction with condom publicity in secondary schools across NigeriaIt aims to cut down the prevalence of HIV/AIDS among in-school young personsAimsTo better the cognition about HIV/AIDS amongst young personTo raise the age of first sexual brush amongst in-school young person by 5 old ages in 10 old agesTo promote rubber usage among in-school young personTo increase the figure of in school young person seeking intervention and attention for other STIs by 20 % in 5 old agesTo cut down teenage gestations by fractional in 5 old agesResistance to this policy s credence could be limited by ab initio influencing policy alteration in gray urban parts where it will be more acceptable and if successful, scaled up to other less urban countries utilizing traditional and spiritual leaders to act upon credence.A broad web and model of HIV/AIDS bar is soon on land in Nigeria, a assorted scanning labialise will be ideal.A rational attack for explicating policies and go throughing the measure, which will be instantly diffused through the Ministry of Health to all schoolsAn incremental attack by ab initio increasing the cognition of in-school young perso n on HIV/AIDS by presenting sex instruction into the school course of study, presenting text editions and stuffs that educate pupils on HIV/AIDS and subsequently up-scaling to include RH clinics to turn to early intervention and bar of STIs. Formation of in-school HIV nines and groups will supply a forum for pupils to aerate their positions on abstention, sexual exposure and bar patterns and eventually condom handiness and distribution.Cost will be reduced by utilizing bing resources and adult male power. Increased cognition of HIV/AIDS in the population with capacity edifice for instructors and in school young person will let for easy execution. A elaborate and careful pilot testing could be done in the relevant mark group to let for abstract rating and alteration before broad spread execution. A underside up attack should besides be used to let for more contest by implementers and uninterrupted rating and redefining of aims or schemes.EvaluationHIV bar intercessions are complex. There are legion intercessions and schemes to take from. The content and quality of intercessions may differ well from one another and intercessions may be implemented in different ways by different people. Specific intercessions may be interactive or even counter and yet most programmes will unite several intercession schemes, doing rating of the effects of specific intercessions or constituents within the programme bundle hard or impossible to extricate. ( UNAIDS, 2008 )In measuring the effectivity of the policy, elaborate grounds on the existent procedure of bringing of the intercession that establishes the extent and quality of bringing will be gathered. Facility audit is besides of import to supply information on adequateness of substructure, equipment, proficient and operational guidelines.The success of the policy execution will besides be evaluated utilizing the five key United Nations General Assembly Special Session ( UNGASS ) ends. ( WHO Technical study series, 2006 )Pro vide appropriate information to immature people and grounds of betterments in their resulting cognitionProvide appropriate accomplishments developing to immature people and grounds of their ability to show these accomplishments, and utilize these accomplishments to diminish their hazard of going infectedSupply appropriate skills-based preparation, equipment and supplies to implementers and grounds of this ensuing in increased bringing of effectual, high quality wellness services to immature people.Provide grounds of reduced exposure of HIV among immature people, such as alterations in the attitudes and behaviors of immature peopleProvide grounds of a decrease in HIV prevalence among immature people that can be attributed to the intercessionDonabedian s model for measuring health care conceptualizes Inputs, crop and Outcome . ( Kent Buse et Al, 2005 )Table 2 Policy Implementation and EvaluationUndertaking IMPLEMENTATIONUndertaking EVALUATIONINPUT/RESOURCESACTIVITIES/INTERVENTION S ERVICEEnd productOUTCOME/IMPACTMEASUREMENT METHOD/INDICATORSStaffMonitoring and rating preparation for plan directors and implementersTraining of school nurses and instructorsTraining of spouses and stakeholders on young person and HIVMedia preparation on Sexual activity instruction and Condom publicityCapacity edifice for implementersChange in provider behavior in relation to school young personChange in supplier behavior in relation to describing systemsImprovement in administrative and describing systemsExperimental surveiesNumber of instructors and school nurses develop in supplying sexual instruction and wellness services to school young personNumber of stakeholders trained on HIV and the young personQuality appraisal of describing systemsMedia supportAwareness creative activity for rubber publicity to interrupt barriersCommission and air jangles on the impact of sex instruction on school young person.Media run aiming socio cultural issues disaggregated by age, sex and locatio n.Media run on inter-generational sexharmonisation of stuff development, distribution and usageIncrease consciousness on sex instruction and rubber rebrandingSexual activity instruction and sex literacy as a societal normCondom usage as a societal normBehavioural surveillance studyCondom handiness and handinessstigmatisation around sex instruction and rubber usageNumber of jangles aired on sex instruction and rubber usage among school young personEducationProduction and distribution of IEC MaterialsProduction of text editions integrated with cognition of STI and HIVDevelopment and version of course of study on sex instructionSexual instruction Sessionss in schoolsCondom dialogue accomplishments developing for school young personImprove school young persons consciousness on HIV/AIDSImprove rubber negociating accomplishments among school young personImprove rubber usage among school young person load STI incidenceReduce HIV morbidity and mortalityReduce teenage gestations and it s com plicationsReduce maternal mortality associated with teenage gestationsAnnual National HI/AIDS sero-prevalence lookouts study among in school young personPrevalence of STI and HIV among school young personNumber of teenage gestations and maternal deceases related to themNo of rubber distributedNo of school young person who used rubbers in their last sexual brushFacilitiesHandiness of friendly accessible service Centres for school young person within and outside the schoolBuild effectual linkage/referral systems for STI direction in communitiesEstablish regional offices through the Ministry of Education to supervise governance and M & A EIncrease entree to RH servicesPromote dealingss among assorted organisations involvedAllow easy monitoring and rating of executionSchool young person will be able to entree RH services without stigmatisationProvide utile information on execution procedure and successBehavioural surveillance studyNo of young person accessing RH services before and af ter intercessionNo of RH services available to youthNo of young person referred through linkage systemsResearchPopulation based study on Sexual activity instruction, rubber usage and publicity in school young personIncrease cognition base on sex instruction and rubber schedulingIncrease cognition on the young person s sexual hazard behaviorMaking future sex instruction programming policies based on grounds based scientific researchExperimental surveiesNumber of research proposals and surveies carried out on sex instruction, hazard behaviors, rubber scheduling and usage among school young personCommunity MobilizationBattle of FBOs, CSOs, community and spiritual groups and parents on HIV/AIDS cognitionSkills and services community mobilisation for HIVSensitization of community leaders against stigmatising or opposing sexual instruction among school young personIncrease consciousness of FBOs, NGOs and parents on HIV and the young personPromote rubbers as a double methodRebrand rubber u sage as a positive thingEngagement of policy execution at grass root degreeImprove community consciousness and integrity in the battle against HIV/AIDSEnable societal and cultural credence about sex instructionConstitution of young person groupsExperimental surveiesNumber of young person groups on HIV/AIDS advancing sex literacy and rubber usageNumber of community stakeholders involved in young person groupsNumber of outreach events advancing sex instruction advocacy/policyRecommending for policy reforms on socio-cultural and economic issues that promote HIV transmittal, stigma and favoritism among young personIncrease consciousness of stakeholders on HIV and young personHIV and youth issues get on the policy docketLaws on HIV and young person, stigma and favoritism enactedExperimental surveiesNature and type of issues incorporated into the National Youth policyNo of public hearings on the bill of exchange measure and Young person policyDecisionThe immature can non sing for themsel ves in doing lawful determinations that impact their ain lives. Their determinations are influenced by parents, the community, equal force per unit area, and their personal cognition. It is hence of import that the cognition they have is enough and diverse to enable them do informed determinations refering their sexual wellness.Surveies done have shown adequate grounds that sexual instruction addition in-school young person s consciousness of HIV/AIDS and can act upon their attitude or do behaviour alteration.Health system research findings in the Nigeria will stick by impotent unless translated into public wellness action through effectual public policy-making. ( Shamsuzzoha B Syed et al.,2008 )Policy docket scene, preparation, execution and rating are all necessary phases in achieving policy alteration. In world, they all happen at the same time and can be revisited and changed while the procedure is ongoing.Stakeholder s influence is real important in policy devising and accep tance. The media is a really powerful tool which should be used suitably.Policy execution should be done cautiously without rigidness utilizing bottom up attacks.Evaluation is necessary in order to mensurate the success of the plan and larn more for future policy executions. reduce HIV/AIDS prevalence amongst in-school young person goes a long manner in cut downing prevalence in the general population and promises a healthier brighter hereafter, free from HIV/AIDS.