CHAPTER ONE 1.0 INTRODUCTION

HIV/AIDS is a pandemic disease that causes high mortality rate. The disease was first identified among group of homosexuals in 1981 in the United States of America. The first virus that cause the disease was first named Human Immune Virus (HIV) and the words AIDS is a group of clinical features manifested in clients with advanced HIV infection which are usually opportunistic infections of immune system by weakening he entire organs and destroying the body’s ability to fight infections.

Problems of the patient with HIV/AIDs are the rejection and isolation by the community. Many of these patients die with social, psychological economic problem.

Rather than psychological problems, what is more worry some is the negative attitudes of people towards the infected ones. This leads patients to have low self-esteem thereby developing social stigma and their condition will become worst and the resultant effect will be death.

HIV I the abbreviation for Human Immune Deficiency Virus, which causes the disease called AIDS (Acquired Immune Deficiency Syndrome) this disease destroys the body’s immune system thereby making it prone to and unable to fight other infections that come to attack it . Presently, no vaccine is identified as preventing the infection of HI V/AIDS and there is no complete cure for the disease (UNICEF 2003).

HIV AND AIDS IN NIGERIA

Nigeria (2013)

3.2 million People living with HIV

3.2% Adult JIIV prevalence

220,000 New HIV Infections

201,000 AIDs- related death

21% Adults on antiretroviral treatment (source: UNAIDS Report 2014).

Of all people living with HIV globally, 9% of them live in Nigeria. Although HIV prevalence among adults is remarkably low (3.2%) compared to other sub-saharan African countries such as South African (19.1%) and Zambia (12.5%), the size of Nigeria’s population means that there were 3.2 million people living with HIV in 2013.

Nigeria, together with South Africa and Uganda, account for almost half of all annual new HIV infection in sub-saharan Africa. This is despite achieving a 35% reduction in new infections between 2005 and 2013.

Approximately 210,000 people died from AIDs- related illnesses in Nigeria in 2013. which is 14% of the global total since 2005, there has been no reduction in the number of the fact of the annual deaths, indicative of the fact that only 20% of people living with HIV in Nigeria are accessing antiretroviral treatment (ART) unprotected heterosexual sex accounts for about 80% of new HIV infections in Nigeria, with the majority of remaining HIV infections among key affected populations.

Annual number of AIDS–related deaths in Nigeria. 1990-20 13.

1990 – 30,000

1995 – 60,000

2000 – 90,000

2005 – 120,000

2010 – 150,000

(Source: UNAIDs estimates 2013)

KEY AFFECTED OPULATIONS AND HIB IN NIGERIA

Sex workers, men who have sex with men and people who inject drugs make up only 1% of the Nigerian population, yet account for around 23% of new HIV infections.

In response to this, the Nigerian National HIV/AIDS strategic plan (NSP) 201 02() 1 5 calls for enhanced behaviour change comrnt4nicition for key affected populations. To deliver this, peer education system is being scaled- up, alongside social media messaging that aims to reach those populations who tend not to prevent themselves for HIV services.

SEX WORKERS AND HIV IN NIGERIA

Half of all HIV infections in Nigeria among key populations are found in sex workers, their partners and their clients. This is not found surprising considering the fact that only 18% of sex workers were thought to have received HIV prevention information in 2014 19% of male sex workers and 25% of female sex worker in Nigeria are living with HIV. This is eight times higher than there general population.

The 2012 National HIV/AIDs and reproductive health survey found HIV prevalence to be even higher among female brothel based sex workers, at 27.4%. And the reasons for this high HIV prevalence including that many sex workers under-estimated their risk of HIV and so didn’t use necessary prevention method. Others believed that their faith would have also been found to not use condoms when they have sex in their partners, despite 88% using condoms with their most recent clients only key.

MEN WHO HAVE SEX WITH MEN (MSM) AND HOV IN NIGERIA

The 2012 National HIV/AIDs and reproductive health survey also found out that 17% of men which have sex with men MSM) are living with HIV in Nigeria. They are the only key affected population; they actually experienced a rise in HIV between 2007 prevalence and 2010, now accounting for 10% of all new HIV infections in the country.

2014 saw the signing into law of a bill that increased the punishment for homosexuality to 14 years in jail, despite same-sex activities already being illegal and worthy of a jail sentence. Homophobia discourages many MSM from testing for HIV. Indeed, only 17% of MSM were reached with HIV prevention programming in 2010.

PEOPLE WHO INJCT DRGS (PWID) AND HIV IN NIGERIA

It is thought that 9% of new HIV infections in Nigeria are among people who inject drugs (PWID) and yet there are no HIV prevention programmes that target this population. In 2010, only 19.4% of PWID knew their HIV status, so the reported HIV prevalence among this effected population of 4.2% is likely to be much higher. Reducing HIV infections among this population is reliant on Nigeria implementing harm reduction services that are not currently available, such as needle syringe programmes and opioid substitution therapy.

YOUNG PEOPLE AND HIV IN NIGERIA

National data suggests that 1.3% of young women (15-24 years old) are living with HIV and 0.7% of young men. Only 24% of young people in 2002 could currently identify ways to prevent. Sexually transmission of HIV, and reject common myths. Early sexual debut is common in Nigeria, which begins at less than 15 years old 15% of Nigeria’s youths. This is one factor that increases HIV vulnerability among young people, alongside very low HIV testing rates -only 17% of young people know their HIV status. However, this is higher than the testing rate among adults.

CHILDREN AND THOSE ORPHANED BY AIDS IN NIGERIA

400,000 children in Nigeria are living with HIV. HIV also has an indirect impact on children I Nigeria whereby they become the caregivers for parents who are living with HIV. Most often this responsibility lies with girls rather than boys. This reflects the imbalance in schooling between the two genders in Nigeria, with girls missing out on HIV education that could teach how to protect themselves from infection. It is though that 2 million children in Nigeria are currency orphaned by AIDs with many caring for siblings along or being looked after by grandparents.

HIV PREVENTION PROGRAMMES IN NIGERIA PREVENTION OF MOTHER-TO-CHILD TRANMISSION OF HIV

Of the 190,000 pregnant women living with HIV in 2013, only 27% of them received antiretroviral treatment to prevent the transmission of HIV to their child. Only 19% of these women are still taking their mediation when breastfeeding, emphasizing lack of drug supply and lack of knowledge of the transmission routes of HIV. 22% of all new child HIV infections globally during 2013 were in Nigeria (51,000) with only a 19% decline in child HIV infections since 2009, it is clear that Nigeria is not progressing fast enough with its PMTCT programme. Infact, it is the second worst performing global plan priority country after Chad.

Only 12% of children who are born HIV-positive are then receiving treatment to control their HIV infection.

Improvements in the uptake of HIV testing and counseling, and scaling up access to the most effective antiretroviral regimes among pregnant women are essential targets Nigeria must meet if they are to half the rising members of children born with HIV. More PMTCT sites are being set up around the country, so it is hoped that the dramatic rise between 2012 (1,410) and 2013 (5,622) will lead to more promising PMTCT statistics in the near future.

In early 2015. The telecommunication company Etisalat started rolling out SMS messages to its subscribers about PMTCT and where people could seek HIV services. It is hoped that large-scale communications like this will encourage women to come forward for testing to prevent their babies for being born with HIV.

PREVENTING TB AMONG PEOPLE WITH HIV

Nigeria is one of the ten countries worldwide that together make up 80% of all people living with HTV who also have TB. (National Survey 2012) The risk of developing TB infection declines dramatically if a person living with HIV is on antiretroviral treatment.

In Nigeria, 88% of people diagnosed with TB are also living with HIV. However, the low uptake of HIV treatment in Nigeria could explain why so many people are developing TB, and why the country is not on track to meet the 2015 target of halving TB prevalence since 1990.

In 2012, Nigeria conducted its first ever national survey to determine the procedure of TB infection throughout the country.

There is a greater commitment to improve TB case detection, improve access to treatment, roll out with use of new technologies to test for TB and engage all health care providers in TB care as a result.

Multi-drugs resistant TB (MDR-TB) is becoming an increasing problem, caused when treatment increasing problem, caused when treatment is started and not completed or taken incorrectly. Only 16% of TB cases in 2013 were diagnosed and treated or successfully, Nigeria is experiencing a similar problem rolling out TB treatment as it is for HIV treatment.

In 2012, a MDR-TB treatment centre was opened in Lagos Nigeria with modern technology, specialized health care professionals, and the second-line drugs that are needed to treat MJJR-TB.

It was financed domestically, and it is hoped that this increased level of expertise and drug stocks within the country will help keep the number of TB cases under control and provide better care for those living with TB and HIV.

GOVERNMENT COMMITMENT TO HIV IN NIGERIA

As well as the National Strategic Plan (NSP) on HIV and AIDs 2010-2015, the country also initiated a presidential comprehensive response plan (PCRP) in 2013 as Nigeria was missing national targets in its HIV response. There are a number of priority interventions outlined in the PCRP, with particular focus on finding the response and ensuring that targeted interventions are in place. It aims to prevent 105,000 HIV infections during its two year duration.

In early 2015, former president Jonathan signed a new anti discrimination bill into law which secured the rights of people living with HIV, protecting HIV positive employees from unfair dismissal positive and from mandatory HIV testing.

BARRIERS TO HIV PREVENTION IN NIGERIA

1. LEGAL BARRIERS

One of the major barriers to accessing HIV prevention programmes for MSM are laws that prohibit their activities. For example, same sex relations in Nigeria are criminalized with l4years imprisonment.

This is not only limiting access for HIV prevention programme for this community but causing nationwide stigma and discrimination against people based on their sexual orientation.

1. SOCIAL BARRIER

Gender inequality is embedded in Nigerian society and culture. Although women do have the rights to land, the patriarchal society dictates that their rights are weaker than men’s, the result is a high fertility rate of six children per woman, due to the pressure on her to give birth to boy who can inherit and to give more likely to have more children, not to use children not to use own land. If a woman has a girl child first, she is more likely to more children not use contraceptives, have shot periods between pregnancies, and be subjected to polygamy. Each of these factors increases a woman’s vulnerability to HIV 1.6 million Women are living with HIV in Nigeria UNAIDS 2013. (NAIDS 2013).

1. STRUCTURAL BARRIES

A simple lack of centres that deliver HIV services (testing Centre PMTCT center, and treatment center) presents problems for the Nigerian population. PMTCT coverage and center that provide infant diagnosis remain extremely low and result many new HIV infections each year, HIV transmission via products is minimal in Nigeria, enhanced effort could almost eliminate this risk, although there are guidelines for certain practice the lack of universal precautions and failure to record blood safety information in all circumstances mean HIV transmission via blood products remain risk for patents and health care workers.

1. ECONOMIC BARRIERS

Nigeria’s funding of its HIV response remains challenging, but the PCRP launched in 2013 has committed to bridging the gap in funding by providing more domestic resources. It is hoped this will mobilize the response to HIV dramatically, as in 2012 only 21.4% was dramatically financed.

HIV TESTING AND COUNSELLING (HTC) IN NIGERIA

The National HIV & AIDS and reproductive health survey of 2012 found very low uptake of HIV testing in Nigeria-just 23% of males 29% of females had tested in the year. Less than 70% of these people had received their results. Since then a huge number of new HTC centres have been built, bringing the total from 2,391in 2012, to 7,075 in 2013. As a result, a 50% rise in the number of people tested was seen in those two years. Couples testing and provider initiated testing and counseling has been recommended throughout the country, but uptake at HTC center is slow.

There are a number of reasons why more people are not testing for HIV in Nigeria. These include supply problems with testing kits and logistic issues getting further supplies. There is also a common belief that HTC centres are where HIV-positive people go to access care, rather than them being testing centres for those who don’t know their status.

ANTIRETRO VIRAL TREATMENT (ART) IN NIGERIA

Antiretroviral treatment (ART) provision in Nigeria is extremely low, with only 21% of adults living with HIV receiving treatment in 2013, and 12% of children. Only 19% of breastfeeding women who are living with HIV are taking ART.

Although the number of antiretroviral treatment (ART) centers increased between 2012 and 2013, it is still enough with only 820 enters the whole of Nigeria. It is not surprising that people living with HIV are struggling to access clinics where they can get treatment. ART administration is being decentralized from hospitals to primary health centres, and from doctors to nurses and community health workers, although there is still a huge demand for more healthcare professionals.

Certain weaknesses in the system exist, which mean people who receive a positive HIV diagnosis are not referred on to treatment, or not retained in treatment for very long. Even when ART can be accessed, drug supplies are known to run out and lead to stock outs.

THE FUTURE OF HIV IN NIGERIA

Nigeria has a very high number of people living with HIV despite relatively low HIV prevalence.

When reading the major statistics all together the situation is stark: 9% of all people living with HIV globally are in Nigeria, 14% of the global deaths from HIV-related illness are in Nigeria, only 20% of people living with HIV are on treatment, and only 27% of pregnant women are receiving treatment for PMTCT. (UNAIDS 2013).

Providing antiretroviral treatment for all people living with HIV doesn’t only benefit those already living with HIV, it also dramatically reduces the chance of onwards HIV transmission to others. In a country like Nigeria where there are so many people on treatment it is also hard to HIV epidemic, considerable commitment, funding and resources need to be mobilized to expand access to treatment as a prevention method.

Despite government commitment to the HIV response in many ways punitive laws such as the anti-homosexually bill damaged progress. They prevent key populations such as MSM seeking HIV services and make it extremely difficult to reach them with prevention messages. Engaging all members of the society and especially those who are most vulnerable to HIV, is a key to a unified and considered HIV response.

Finally, encouraging HIV testing among Nigerian population to ensure everyone knows his/her HIV status is key to any informed strategic plan. Without knowing the extent of how many people are living with HIV, it is hard to mitigate new infections and provide HIV treatment to all.

OBJECTIVE

The agency was established to achieve the following objectives:

1. To control and prevent the spread of HI V/AIDS in the state.
2. To support and provide effective management of people infected and affected by the disease.
3. To strengthen the capacity of all stake holders and ensure efficient utilization of resources in the fight against the disease.
4. To strengthen and standardize monitoring and evaluation system of HI V/AIDS in the state in accordance with the district health information system (DHIS) and Nigeria national response information management system (NNRIMS).

FUNCTIONS

Similarly the agency has the following functions

1. Plan and coordinate activities of the various strategic responses for HI V/AIDs
2. Monitor, control and prevent mother to child transmission of HI V/AIDs
3. Support research on HI V/AIDs
4. Mobilize resources (state, National and international) and fight against HI V/AIDs
5. Carry out effective mobilization and public awareness on HI V/AID

Treatment, care and support which was recently included as a component of the HIV/AIDS programme development agenda has been strengthened by the global fund and presidents emergency fund for AIDS relief (PEFAR) that came into assist and develop anti-retroviral centers in certain locations.

SERVICE DELIVERY POINTS

The agency has the following service delivery points spread across the state;

1. Anti-retroviral treatment (ART) comprehensive centers
2. Prevention of mother to child transmission (PMTVT)
3. HIV counseling and testing (HCT) sites

OTHER MYTHS ABOUT HIV MOSQUIOTOES, SORCERY & HIV

Witchcraft or occult initiation practices cannot cause anyone to have HIV unless they involve sex without condoms, drinking human blood, or other dangerous practices like making cut or scar marks on different people with the same unclean blade, If fraternity, sorority or society” initiations involves in any of these practices, then a participant could be exposed to HIV infection.

Mosquitoes and other insects do not spread HIV. When insects bite they suck in a very small amount of blood from their bite victims. At the same time, the biting insects deposits a small amount of their saliva, not blood, into their victims skin, therefore mosquitoes and other insects do not spread HTV because saliva does not spread HIV.

In addition, scientists have proven that the HIV virus dies when it goes into mosquitoes and other insects. (NACA Q & A Hand Book 2012).

BODY FLUIDS

Urine, sweat, tears and stool cannot transmit HIV because there is very little or no HIV in any of these body products. There is no recorded case of any one getting the virus through sweat, saliva urine or stools. HIV is only passed through blood, sex fluids, (Semen and vaginal fluids) and breast milk.

If blood enters your body, through an opening like a cut while you are offering assistance, it would be possible for you to become infected with HIV. Therefore, it is best to handle accident victim who are bleeding with caution. Wear plastic gloves or some type of barrier such as plastic bags over your hands when aiding accident victims.

SHARING OBJECTS WITH OTHERS

It is true that HIV is not transmitted by saliva, but when you brush your teeth, sometimes you may cut your mouth or gums. If the blood of someone who has HIV gets on the toothbrush or chewing stick and then it gets into your mouth soon after, there is a chance (although very small) that you could become infected with HIV.

There are other reasons why it is not advisable to share toothbrushes and chewing sticks, such s contracting gum and tooth diseases. Sharing a drinking glass, cup, plate or food with a person who has HIV does not spread the virus. HIV is only spread from one person to another through blood, sex fluids or breast milk. It is therefore safe to share a glass, cup, plate or food with a person who has HIV. Living with, caring for, or touching a person who has HIV cannot give you the virus. Likewise sharing towels, sheets or clothing with an HIV positive person cannot infect you. Its only when you have unprotected sex, share needles, blades or handle the sores of a parson with AIDS that you are risked to having HIV infection, so also sharing toilets, sitting on a toilet that has been used by someone with HIV will not expose you to HIV because the virus cannot live exposed on a toilet seat.

1.1     AIMS AND OBJECTIVE

HIV/AIDS is devastating to humanity. Presently measures are being taken to counter its negative impact. The spread of HI V/AIDs has remained a source of global concern. This discussion programme is aimed at investigating the level of awareness and possible impact of HIV/AIDs based messages on Students of Ken Saro-Wiwa Polytechnic, Bori. Among its objectives are:

1. Educating the student on what HIV/AIDs is, its signs and symptoms, how it can be transmitted and mode of prevention.
2. Provide help line information service on HIV/AIDs.
3. Educate the students on the dangers of HIV/AIDs and the risk behaviours that lead to contracting the virus.

1.2     SIGNIFICANCE OF THE STUDY

This study is significant because it assist the state government investigation the level of HIV.AIDS awareness among the student in Ken Saro-Wiwa Polytechnic, Bori. level of HIV/AIDs, their level of risk perception influenced their behaviour against the spread of HIV/AIDS. It is also of benefit to non-governmental organizations (NGOs) and international agencies like UNICEF, USAID. DFID etc in planning their activities.

The study will benefit the State and a Local Government, people and student of Ken Saro-Wiwa Polytechnic, Bori. in social mobilization and communication strategies towards combating  HIV/AIDS. It will also add to the body of knowledge in the state.

So also the media who are agents of most campaigns also benefit from the study, as it helps points out and guide the media on problem areas found in campaign against     HIV/AIDs.

1.3     SCOPE/LIMITATION

This study covers only the students of Ken Saro-Wiwa Polytechnic, Bori.

1.4 OPERATIONAL DEFINITION OF KEY TERMS

Risk: A possible, usually negative outcome e.g A  Danger.

Perception: conscious understanding of something.

HIV: Human Immune Deficiency Virus