Hiv Prevention Strategy In Nigeria Health And Social Care Essay

Nigeria s population of 140 million is the largest in Africa with 1 in 6 Afri stubs being Nigerian. The information from the 2005 human immuno privation virus education indicates that approximately 4.4 % of Nigerians atomic number 18 infected with human immunodeficiency virus. The preponderance exhibits province broad disparity of between 1.6 % in Ekiti province ( s poph West ) and 10 % in Benue province ( due north cardinal ) . ( Figure 1 NACA, 2007 ) While the infection rate is drawn-out than some early(a) Afri mint expresss, issues close to human immunodeficiency virus be liquid gritty on the docket beca physical exercise of the states in high spirits population. ( Figure 2 Jennifer Kates, Alyssa Wilson Leggoe, 2005 ) The antepartum information constitutes that immature grownups appear nearly affected with 3.6 % amongst pregnant 15-19 year superannuateds and 4.7 % amongst 20-24 year olds ( Figure 3 Technical Report topic human immunodeficiency virus/Syphilis S ero-preponderance Sentinel Survey, 2005 ) This f represent highlights the demand for a good co-ordinated subject area human immunodeficiency virus/acquired immune deficiency syndrome draw a blank plan to farther decelerate shore the infection rate and cut down incidence. ( NACA, 2007 )Figure 1 human immunodeficiency virus Prevalence by State ( 2005 )www.naca.gov.ngFigure2 a ) Percentage of Adults estimated to be populating with human immunodeficiency virus/ have a bun in the oven and B ) repress of People estimated to be populating with human immunodeficiency virus/ help. p arntage human immunodeficiency virus/ help F exertion sheet, 2005Figure 3 human immunodeficiency virus Prevalence by Age group ( Old ages ) 2005www.naca.gov.ngDrivers of the human immunodeficiency virus Epidemic in NigeriaInformal Transactional Sexual use While commercial enkindle workers ( CSWs ) begin long been identified as critical in impacting the spread of the human immunodeficiency virus/acquired immune deficiency syndrome pestilential condom usage among them is high. A cardinal number one wood nevertheless is informal commercial switch on among the general population ( J. Robinson, 2008 NACA, 2007 ) number 1 Risk Percept 67 % of Nigerians perceive themselves to be at no back of undertaking human immunodeficiency virus while 29 % perceive themselves to be at low hazard and merely 2 % rated their opportunities of infection high ( NARHS, 2005 NACA, 2007 )Multiple Partnerships In Nigeria, eldritch beliefs tend to back up the promotion of common fidelity NDHS ( 2003 ) nevertheless proved that multiple knowledgeable partnerships ar common particularly amongst elicitu tout ensembley active work forces. About 30 % and 24 % single and married work forces sever onlyy inform retentivity much(prenominal) than one inner spouse in the past class ( NDHS 2003, NACA 2007 ) . While work forces with multiple spouses rich psyche a 60 % change magnitude hazard, adult fe ma sculines are 10 % higher than work forces. ( NARHS, 2005 )Lack of realised STD Programming for Most at Risk Population ( MARP ) Package of choke provided to MARPs is trammel. Linkages to human immunodeficiency virus guidance and testing, STD direction and interpolation are weak and realise relied chiefly on referrals.Continuing Risky Behaviour of males in ordinary Population Hazardous behaviour in the general population is to a greater extent prevailing among work forces than adult females. 26 % of work forces report guardianship more than one put forward 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, inner behavior, societal attitudes, economic power, film, and cultural attitudes that discourages safe fetch up dialogue. ( NACA, 2007 )Economic Drivers HIV imp everywhereishes indi viduals and communities through losingss of human resources. Poverty brings about low microscope stages of focusing associated with illiteracy and by and large short health perspective. These conditions result in hapless acceptance of behavior alteration which exposes the population to HIV infection. ( NACA, 2007 )Equally abruptly as an epidemic of HIV/AIDS was noticed in the state, Nigeria mount a national response, which was grow in 2000 with the constitution of the Presidential Council on AIDS ( PCA ) and the National Agency for the control of AIDS ( NACA ) . This allowed for a co-ordinated blast to supply obstruction, intervention, attention and jump out services through insurance expression, emergence of programs and operation.NACA s authorization provinces that -A A1.A A A Coordinate and unfold protagonism by all sectors and at all degrees for HIV/AIDS/STD expanded responses in Nigeria.A2.A A A Develop the framework for coaction and support from all stakeholde rs for a multi-sector and multi-disciplinary response to HIV/AIDS in Nigeria.3.A A A Develop and present to the PCA, all programs on HIV/AIDS in Nigeria for polity stopping points.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 measuring rod the accomplishment of the strategical National Plan for the control of HIV/AIDS/STDs in Nigeria and all other approved policies.A6.A A A Coordinate and ease the mobilisation of resources for an effectual and sustainable response 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 swear out ( 2005-2009 ) provides a strong and comprehensive model for beat attempts including a equilibrate ABC attack. In this model, in- drill boylike individuals were lollyed as a mark population group.Sexual activity assertion is a major d ivisor of bar and one of the appliances in minimal bundle required for HIV bar. Political issues environing it includeResistance to arouse education and rubber forwarding by Faith Based Organizations ( FBO ) , sacred leadership and other stakeholders pitiable accomplishments on rubber usage and dialogueMisconception about commove didactics and low credenceAvailability, handiness and affordabilityLack of form _or_ system of government environing versed assertion in secondary schools ( NACA, 2007 )A survey done in Nigeria analyzing the internal behavior of secondary school striplings showed that the average age at premier inter line of credit was 12 old ages with a scope of 6-19 old ages many another(prenominal) of the participants had multiple knowledgeable spouses and a hapless perceptual experience of the hazard of STD including HIV. It was recommended that a structured versed instruction course of study 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 knowledge on HIV / AIDS bar steps to their pupils in the context of their cultural and societal norms that recoil 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 correct preparation and motive on information, instruction and communicating on HIV / AIDS and sex instruction. ( Daniel C. Oshi et Al, 2005 )It is hence necessary to cast up handiness of sexual wellness services, create societal support for sex instruction in schools and build content on arrogate 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 1 0-18 twelvemonth olds which concentrated on bettering pupil s cognition and attitudes to sexual wellness and cut downing hazardous sexual behavior. However the capital punishment of the undertaking was a entire failure and has since been abandoned. ( Avert, 2010 )In a state where issues such as confidentiality around HIV proving is non covered by outhouseon law, where no action is taken when human rights are broken in relation to HIV infection and stigmatisation. It seems the destiny of the immature large number are in their custodies, owing to the absence of fertile wellness ( RH ) institutes and deficiency of separate Torahs or statute law for immature people in relation to HIV bar. ( United Nations Global Coalition on Women and AIDS, 2004 )POLICY schedule SettingTo accomplish this wellness polity, one must see the histrions that would be knotted and analyze all stakeholders- so as to understand their behavior, purposes, inter-relations and involvements and to measure the ascertain and resources they bring to bear on decision-making or functioning procedure. ( Varvasovszky Z. , Brugha R. 2000 )Stakeholder/ Actor depth psychology ordain place the face of people to wonder, utilizing sweet sand vervain techniques, re judgement questionnaires etc. It is of import to plan a semi-structured/ condense interview inquiries. Interviews will let comparison a tag cultural groups and faith and provided be sensitive to limited contexts.Stake holder s position has to be transformed into one that utilizes 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 indoors specific subgroups of the population. postpone 1 Stakeholders AnalysisStakeholdersEngagement in the issueInterest in the issueInfluence/ PowerPositionImpact of issue on histrionParentsParticipate in Child Sexual direction and push aside act upon their kids s determinationMedium bustedNon-mobilized steepMedia Industry sanction stakeholder s positions and can act upon determination shapers by supplying dependable information naughty heightsSupportiveLowMinistry of HealthPromote healthy generative picks, direction of STIs and HIV related unwellnesss gamyMediumSupportiveHighPresidential Council on AIDSSurvey policy proposals and do determinations on themMediumHighNon-mobilizedMediumSchool AdministrationParticipate in policy ExecutionHighMediumOpposedHighMinistry of rearingEnsure sex instruction is integrated in national course of study and utilizeTraining of staffPolicy Implementation and military rankHighHighSupportiveHighBilateral Organizations set aside support and proficient supportHighHighSupportiveHighReligious LeadershipsInfluence the population through spiritual, moral and cultural beliefsHighHighOpposedMediumImporters, Manufacturers and Sellers of the merchandise e.g. rubbers, text editionsProvide low-cost and high quality 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 torso between the present policies in the state. It would besides cover how far policy shapers draw on investigate findings in addresss during policy preparation and execution phases. The information beginnings would include research publications and studies, statute law, administrative/executive ordinances or baffles, reimbursement agreements, guidelines and advice, meeting studies and proceedingss, policy statements, addresss, and articles.An economic rating will be considered to measure and construe the cling to of this wellness interference. 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 holy 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 original apprehension of consistence of old policies with research findings, the grade of influence of research on policy docket scene, preparation and execution would be demand 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 chiliad in order to be recommended for consideration and broad spread execution.Hall s suppositional account of docket puting claims that the strength of this grounds depends 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 w ill be implemented logistically through already bing constitutions, 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, touching FBOs in policy execution.There is besides no grounds that sex instruction or rubber handiness in schools will adjoin promiscuousness or cut down the age of first sexual intercourse of in school new psyche, 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 wellness 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 whole works in HIV bar and this is soon being used to plan of attack abstention and be faithful intercession plans.Kingdom s sample 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 preponderance of HIV among in school modern soul, with the highest signifier of transmittal being heterosexual sexPoliticss watercourse The National HIV bar work program promotes safety device scheduling and there have been ongoing arguments around this issue. In 2000, sex instruction was integrated into National course of study but was never implemented. Meanwhile the prevalence amongst in school issue person since so has increased.Policy watercourse Following the 2005 National HIV/Syphilis Sero prevalence lookout study for pregnant adult females go toing Ante-natal clinics in Nigeria. NACA has attach more response to HIV bar. More support for HIV bar is being provided by bilateral organisations and NACA has become unfastened to execu tion of policies through FBOs and CSOs. Interventions are now being chosen and funded base on scientific grounds research.POLICY FORMULATION AND IMPLEMENTATIONLegislators are influenced by media and runs, cultural beliefs, lobbyists, political move and support every bit good as grounds based 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 forwarding in secondary schools across NigeriaIt aims to cut down the prevalence of HIV/AIDS among in-school progeny personsAimsTo better the cognition about HIV/AIDS amongst young personTo raise the age of first sexual showdown 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 a ttention for other STIs by 20 % in 5 old agesTo cut down puerile gestations by half in 5 old agesResistance to this policy s credence could be limited by ab initio influencing policy alteration in southern 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 see attack 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 person 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 gro ups will supply a forum for pupils to touch off 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. augmentd 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 enchant rating and alteration before broad spread execution. A ass up attack should besides be used to let for more engagement by implementers and un stoped 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 progr ammes will unite several intercession schemes, doing rating of the effects of specific intercessions or constituents within the programme bundle hard or unsufferable to extricate. ( UNAIDS, 2008 )In measuring the effectivity of the policy, elaborate grounds on the tangible 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 command Assembly Special Session ( UNGASS ) ends. ( WHO Technical study series, 2006 )Provide get hold of 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 the ir 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, Process and Outcome . ( Kent Buse et Al, 2005 )Table 2 Policy Implementation and EvaluationUndertaking IMPLEMENTATIONUndertaking EVALUATIONINPUT/RESOURCESACTIVITIES/INTERVENTION SERVICEEnd 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 inst ruction and galosh publicityCapacity edifice for implementersChange in supplier 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 trained 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 location.Media run on inter-generational sexHarmonization of stuff development, distribution and usageIncrease consciousness on sex instruction and rubber rebrandingSexual activity instruction and sex literacy as a societal norm base hit usage as a societal normBehavioural watch st udyCondom handiness and handinessStigmatization 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 overcome STI incidenceReduce HIV morbidity and mortalityReduce puerile gestations and it s complicationsReduce 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 o f rubber distributedNo of school young person who used rubbers in their last sexual brushFacilities handiness 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 disposal and M & A EIncrease submission 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 after 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 sc hedulingIncrease cognition on the young person s sexual hazard behavior make 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 duple methodRebrand rubber usage as a positive social functionEngagement 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 sur veiesNumber 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 instructionAdvocacy/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 talk for themselves 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 sufficient and diverse to enable them do informed determinations refering their sexual wellness.Surveies done have shown adequate grounds that sexual instruction sum total 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 stay 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 really meaning(a) in policy devising and acceptance. The media is a really powerful tool which should be used suitably.Policy execution should be done carefully without rigidness utilizing bottom up attacks.Evaluation is necessary in order to mensurate the success of the plan and larn more for future pol icy executions.Reducing 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.