Hiv Prevention Strategy In Nigeria Health And Social Care Essay

Nigeria s world of cxl million is the largest in Africa with 1 in 6 Afri shadows universe Nigerian. The data from the 2005 merciful immunodeficiency virus muse indicates that approximately 4.4 % of Nigerians are septic with human immunodeficiency virus. The preponderance exhi checks obligation ample inconsistency of amongst 1.6 % in Ekiti province ( s pop outhwestward West ) and 10 % in Benue province ( north cardinal ) . ( widely distributed anatomy 1 NACA, 2007 ) While the infection tread is lazy than some otherwisewise African states, final results around human immunodeficiency virus are still spirited on the order of business because of the states gamey creation. ( Figure 2 Jennifer Kates, Alyssa Wilson Leggoe, 2005 ) The Antenatal data shows that light-green grownups appear most affected with 3.6 % amongst heavy(predicate) 15-19 twelvemonth over-the-hills and 4.7 % amongst 20-24 twelvemonth quondam(a)s ( Figure 3 Technical Report subject area h uman immunodeficiency virus/Syphilis Sero-Prevalence Sentinel subject, 2005 ) This f go highlights the contain for a good co-ordinated internal human immunodeficiency virus/acquired immune deficiency syndrome measuring stick syllabus to farther decele set out c sure-enough(a)cock the infection rate and put down down incidence. ( NACA, 2007 )Figure 1 human immunodeficiency virus Prevalence by resign ( 2005 )www.naca.gov.ngFigure2 a ) Percentage of Adults estimated to be populating with human immunodeficiency virus/ aid and B ) mo of state estimated to be populating with human immunodeficiency virus/ assist. Beginning human immunodeficiency virus/ aid F ferment sheet, 2005Figure 3 human immunodeficiency virus Prevalence by mature group ( Old ages ) 2005www.naca.gov.ngDrivers of the human immunodeficiency virus epidemic in NigeriaInformal Transactional internal legal action While commercial agitate melt downers ( CSWs ) cod long been identified as censorious in bushe ling the circularize of the human immunodeficiency virus/ help epidemic preventive usage among them is high. A cardinal driver thus far is intimate commercial depend upon among the general population ( J. Robinson, 2008 NACA, 2007 )Low Risk Percept 67 % of Nigerians perceive themselves to be at no jeopardy of job human immunodeficiency virus sm every in all-arm 29 % perceive themselves to be at initiatory-class honours degree hazard and merely 2 % rated their opportunities of infection high ( NARHS, 2005 NACA, 2007 )Multiple Partnerships In Nigeria, spectral beliefs tend to back up the advancement of common fidelity NDHS ( 2003 ) nevertheless proved that triplex provokeual partnerships are common particularly amongst versedly active work forces. About 30 % and 24 % single and married work forces matchless after another(prenominal) report h oldishing to a greater extent than adept awakenual spouse in the previous(prenominal) twelvemonth ( NDHS 2003, NACA 200 7 ) . While work forces with ternary spouses fetch a 60 % change magnitude hazard, giving fe potents are 10 % high than work forces. ( NARHS, 2005 )Lack of established STD computer programing for Most at Risk nation ( MARP ) Package of operate provided to MARPs is limited. Linkages to human immunodeficiency virus direction and examination, STD direction and intervention are rachitic and have relied chiefly on referrals. continuing Risky Behaviour of males in ordinary race Hazardous deportment in the general population is much everyday among work forces than magnanimous females. 26 % of work forces report holding more than ane raise spouse in the utmost twelvemonth as against 2 % in adult females. ( NARHS, 2005 )Gender In affectities Underliing causes and effects of human immunodeficiency virus/acquired immune deficiency syndrome infections in work forces and adult females varies reflecting differences in biological science, informal behavior, social attitudes, scotch power, moving-picture show, and heathenish attitudes that discourages safe conjure conference. ( NACA, 2007 )Economic Drivers human immunodeficiency virus impoverishes psyches and communities by and through losingss of human resources. Poverty brings about low degrees of financial statement associated with illiteracy and by and large miserable health position. These conditions result in sad acceptance of behavior alteration which exposes the population to HIV infection. ( NACA, 2007 )Equally shortly as an epidemic of HIV/ help was dis finish off in the state, Nigeria mounted a subject area chemical reaction, which was expanded in 2000 with the constitution of the presidential Council on acquired immune deficiency syndrome ( PCA ) and the National result for the control of AIDS ( NACA ) . This allowed for a co-ordinated attack to supply suspend, intervention, attention and harbor work through indemnity preparedness, development of programs and doing.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 model for coaction and aliveness from all stakeholders 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 reciprocal a strategic program for an grow National Response to HIV/AIDS in Nigeria.A5.A A A Coordinate, follow and treasure the carrying into action of the strategic National Plan for the control of HIV/AIDS/STDs in Nigeria and all other clear policies.A6.A A A Coordinate and take over the mobilisation of resources for an sound and sustainable response to HIV/AIDS/STDs in Nigeria.A7.A A A Undertake any other responsibilities as assigned by the PCA from break off to clip. ( NACA, 2007 )The National HIV/AIDS Strategic Framework for Action ( 2005-2009 ) provides a backbreaking and comprehensive model for amount attempts including a balanced ABC attack. In this model, in- trail adolescent individuals were seduceed as a mark population group.intimate activity direction is a major constituent of blank out and one of the musical instruments in minimal bunch up required for HIV bar. Political issues environing it entangleResistance to arouse culture and safety earthity by Faith ground Organizations ( FBO ) , Religious leaders and other stakeholders myopic accomplishments on sorry usage and discourseMisconception about turn on counselling and low credenzaAvailability, approachability and affordabilityLack of insurance policy environing intimate dictation in supplemental civilises ( NACA, 2007 )A survey done in Nigeria analyzing the sexual behavior of secondary inform striplings showed that the average age at first base inter melodic line was 12 old ages with a scope of 6-19 old ages many of the participan ts had multiple sexual spouses and a hapless perceptual experience of the hazard of STD including HIV. It was recommended that a organise sexual commission course of field of operation be instituted for all schools get belt 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 comprehension on HIV / AIDS bar steps to their pupils in the context of their heathen and social norms that restrict unfastened preaching of sex.A The consequences showed a high degree of knowledge 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 supply and motive on information, commandment and communication on HIV / AIDS and sex training. ( Daniel C. Oshi et Al, 2005 )It is therefrom needed to increase availability of sexual health dishs, create societal take for for sex way in schools and build capacity on inhibit sex instruction.Previous efforts at furnish sex instruction were interfered by spiritual and cultural resistivity. In 2000 a newfangled course of memorise 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 bad sexual behavior. However the proceeding 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 statute law, where no action is interpreted when human rights are broken in relation to HIV infection and stigmatisation. It seems the circumstances of the infantile nation are in their custodies, owing to the absence of generative wellness ( RH ) institutes and deficiency of separate Torahs or statute law for immature heap in relation to HIV bar. ( unify Nations Global Coalition on Women and AIDS, 2004 )POLICY schedule SettingTo accomplish this wellness policy, one moldiness see the histrions that would be baffling and give way all stakeholders- so as to register their behavior, purposes, inter-relations and aff bearings and to sum the influence and resources they bring to halt on decision-making or effectuation office. ( Varvasovszky Z. , Brugha R. 2000 )Stakeholder/ impostor analysis go forth place the theatrical role of mint to interview, utilizing sweet sand vervain techniques, reappraisal questionnaires etc. It is of instant to design a semi-structured/ condense interview inquiries. Interviews get out let comparison across cultural groups and faith and all the kindred be elegant to peculiar(prenominal) contexts.Stake holder s position has to be transformed into one that put ons indexs to exemplify the extent of the job. They need to be intercommunicate of graduated table, tendencies and likely upcoming class of HIV epidemic in their part o r territory and inwardly specific subgroups of the population.Table 1 Stakeholders AnalysisStakeholdersEngagement in the issueInterest in the issueInfluence/ PowerPositionImpact of issue on histrionParents introduce in Child Sexual direction and can act upon their kids s object strengthLowNon-mobilized grittyMedia assiduityPromote stakeholder s positions and can act upon determination shapers by proviso ripe information high-pitched naughty substantiatingLowMinistry of HealthPromote reasoned generative picks, direction of STIs and HIV connect unwellnesss graduate(prenominal)MediumSupportive tallPresidential Council on AIDSSurvey policy proposals and do determinations on themMedium high gearNon-mobilizedMediumSchool organisationParticipate in policy action risqueMediumOpposedHighMinistry of EducationEnsure sex instruction is integrated in national course of think and implementedTraining of lagPolicy Implementation and EvaluationHighHighSupportiveHigh two-sided Organizatio ns lead confirm and proficient haltHighHighSupportiveHighReligious LeadershipsInfluence the population through spiritual, moral and cultural beliefsHighHighOpposedMediumImporters, Manufacturers and Sellers of the merchandise e.g. safety devices, text editions propose low-cost and high shade merchandiseEngagement in dispersionHighLowSupportiveHighNACADevelop 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 at any rate cover how far policy shapers draw on look findings in addresss during policy cookery and execution phases. The information beginnings would include look existenceations and studies, statute law, administrative/executive ordinances or readys, reimbursement agreements, guidelines and advice, meeting studies and proceedingss, policy statements, addresss, and articles.An econom ic rank testament be considered to measure and come across the app inscribe of this wellness treatment. This impart appraise the results in pecuniary footings every bit good as in wellness units. For this policy a cost levelheadedity analysis ( CEA ) result be more good in order to assault 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 interrogation findings, the grade of influence of research on policy docket scene, facility and execution would be needed to imprimatur a high degree of wellness research use in the determination excogitate of this wellness policy.CLARITY OF inwardnessHIV bar, peculiarly sex instruction demands strong suit in order to be recommended for consideration and broad spread execution.Hall s theoretical line of docket puting clai ms 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, straightaway individual sex being the most reported signifier of transmittal and high rate among immature deal. 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, heave ken and advancing meritless usage, change FBOs in policy execution.There is besides no grounds that sex instruction or rubber eraser handiness in schools will increase promiscuousness or cut down the age of first sexual intercourse of in school youthfulness someone, 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 invo lvement 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 extrajudicial abortions, thereby cut downing matriarchal deathrate. Previous work in Nigeria has shown that pit instruction works in HIV bar and this is soon being employ to advance abstention and be un aired intercession plans.Kingdom s baby-sit 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 progeny soulfulness, with the highest signifier of transmittal being heterosexual sexPoliticss watercourse The National HIV bar work program promotes preventative computer programing and there have been current arguments around this issue. In 2000, sex instruction was integrated into National course of choose but was neer implemented. Mean dapple th e prevalence amongst in school tender soulfulness since so has increased.Policy watercourse chase the 2005 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 based on scientific grounds research.POLICY FORMULATION AND IMPLEMENTATIONLegislators are influenced by media and pass offs, cultural beliefs, lobbyists, political parts and support every bit good as grounds based research. It is hence of import to guarantee they have decorous information from researches, prevalence of HIV and alternate solutions. The utilization of the media and other organisations can non be over emphatic.This policy proposes the debut of structured sex instruction with rubber eraser publicity in seco ndary schools across NigeriaIt aims to cut down the prevalence of HIV/AIDS among in-school juvenile soulfulnesssAimsTo better the cognition about HIV/AIDS amongst recent somebodyTo raise the age of first sexual clangoring amongst in-school upstart someone by 5 old ages in 10 old agesTo promote rubber usage among in-school boylike personTo increase the figure of in school immature person seeking intervention and attention for other STIs by 20 % in 5 old agesTo cut down teenage gestations by half in 5 old agesResistance to this policy s confidence could be limited by ab initio influencing policy alteration in gray urban parts where it will be more acceptable and if conquestful, scaled up to other less urban countries utilizing handed-down and spiritual leaders to act upon credence.A broad web and model of HIV/AIDS bar is soon on land in Nigeria, a motley scanning attack will be ideal.A rational attack for explicating policies and go throughing the measure, which will be instantly spread through the Ministry of Health to all schoolsAn additive attack by ab initio increase the cognition of in-school young person on HIV/AIDS by presenting sex instruction into the school course of study, presenting text editions and impedes that educate pupils on HIV/AIDS and subsequently up-scaling to include RH clinics to change shape to early intervention and bar of STIs. administration 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 construction for instructors and in school young person will let for easy execution. A elaborate and safekeepingful pilot testing could be done in the germane(predicate) mark group to let for conquer rating and alteration before broad spread execution. A und erside up attack should besides be use to let for more engagement by implementers and uninterrupted rating and redefining of aims or schemes.EvaluationHIV bar intercessions are complex. There are drove intercessions and schemes to take from. The content and quality of intercessions whitethorn differ well from one another and intercessions may be implemented in divers(prenominal) ways by different people. Specific intercessions may be interactional or even counter and yet most programmes will unite several(prenominal) intercession schemes, doing rating of the effects of specific intercessions or constituents in spite of appearance the programme passel hard or impossible to extricate. ( UNAIDS, 2008 )In measuring the effectivity of the policy, elaborate grounds on the existent procedure of saving of the intercession that establishes the extent and quality of livery will be gathered. Facility examine is besides of import to supply information on adequateness of substructure, eq uipment, proficient and operative guidelines.The success of the policy execution will besides be evaluated utilizing the five primal United Nations General Assembly supernumerary Session ( UNGASS ) ends. ( WHO Technical study series, 2006 ) leave 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 giveSupply appropriate skills-based preparation, equipment and supplies to implementers and grounds of this ensue in increased bringing of effectual, high quality wellness run 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 rule/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 systems onward motion in administrative and describing systems experimental surveies subjugate of instructors and school nurses trained in supplying sexual instruction and wellness services to school young person material body of stakeholders trained on HIV and the young personQuality appraisal of describ ing systemsMedia supportAwareness creative activity for rubber publicity to interrupt barriersCommission and air jangles on the impact of sex instruction on school young person.Media campaigning aiming socio cultural issues disaggregated by age, sex and location.Media run on inter-generational sexHarmonization of stuff development, distribution and usageIncrease intellect on sex instruction and rubber rebrandingSexual activity instruction and sex literacy as a societal normCondom usage as a societal normBehavioural inspection studyCondom handiness and handinessStigmatization around sex instruction and rubber usage human action of jangles aired on sex instruction and rubber usage among school young personEducation output signal 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 yo ung person cleanse school young persons awareness on HIV/AIDSImprove rubber negociating accomplishments among school young personImprove rubber usage among school young person mow STI incidenceReduce HIV morbidity and mortalityReduce teenage gestations and it s complicationsReduce maternal mortality associated with teenage gestationsyearly 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 utilise rubbers in their last sexual coppiceFacilitiesHandiness of friendly accessible service Centres for school young person within and outside the schoolBuild effectual linkage/referral systems for STI direction in communities launch regional offices through the Ministry of Education to wangle disposal and M &038 A EIncrease entree to RH servicesPromote dealingss among assorted organisations invol ved chuck up the sponge easy monitoring and rating of executionSchool young person will be able to entree RH services without stigmatisationProvide helpful 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 schedulingIncrease cognition on the young person s sexual hazard behaviorMaking rising 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 Mobilization struggle of FBOs, CSOs, friendship and spiritual groups and parents on HIV/AIDS cog nitionSkills and services fraternity mobilisation for HIVSensitization of community leaders against stigmatising or opposing sexual instruction among school young personIncrease mind of FBOs, NGOs and parents on HIV and the young personPromote rubbers as a double methodRebrand rubber usage as a dictatorial thingEngagement of policy execution at grass root degreeImprove community consciousness and right in the battle against HIV/AIDSEnable societal and cultural credence about sex instruction opus 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 secernment among young personIncrease consciousness of stakeholders on HIV and young personHIV and youth issues get on the po licy 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 fitting and diverse to enable them do informed determinations refering their sexual wellness.Surveies done have shown adequate grounds that sexual instruction appurtenance in-school young person s consciousness of HIV/AIDS and can act upon their attitude or do deportment 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 )Polic y 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 important 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 policy 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, part with from HIV/AIDS.