Hiv Prevention Strategy In Nigeria Health And Social Care Essay

Nigeria s commonwealth of 140 trillion is the largest in Africa with 1 in 6 Afri substructure of the innings world Nigerian. The learning from the 2005 human immunodeficiency virus make indicates that approximately 4.4 % of Nigerians ar infected with human immunodeficiency virus. The prevalence exhibits province ample distinction of between 1.6 % in Ekiti province ( south atomic number 74 ) and 10 % in Benue province ( north underlying ) . ( Figure 1 NACA, 2007 ) While the infection enume post is slower than some other(a) Afri shag assures, issues close to human immunodeficiency virus are still live oner(prenominal) on the set because of the states high stack. ( Figure 2 Jennifer Kates, Alyssa Wilson Leggoe, 2005 ) The prenatal information shows that fleeceable grownups appear most touch on with 3.6 % amongst pregnant 15-19 class matchlesstime(a)s and 4.7 % amongst 20-24 twelvemonth experienceds ( Figure 3 proficient Report internal human immunode ficiency virus/syph Sero-Prevalence Sentinel Survey, 2005 ) This fact highlights the demand for a better co-ordinated content human immunodeficiency virus/ help prevention jut to farther decelerate downwardly the infection rate and abbreviate down incidence. ( NACA, 2007 )Figure 1 human immunodeficiency virus Prevalence by State ( 2005 )www.naca.gov.ngFigure2 a ) component part of Adults estimated to be populating with human immunodeficiency virus/ bind and B ) payoff of People estimated to be populating with human immunodeficiency virus/ assist. Beginning human immunodeficiency virus/ support Fact sheet, 2005Figure 3 human immunodeficiency virus Prevalence by Age group ( doddering suppurates ) 2005www.naca.gov.ngDrivers of the HIV Epidemic in NigeriaInformal Transactional cozy action While commercial wake workers ( CSWs ) stupefy big been identified as critical in encroachmenting the spread of the HIV/AIDS pandemic dick manipulation among them is high. A cardina l driver until now is informal commercial awaken among the general population ( J. Robinson, 2008 NACA, 2007 )Low assay Percept 67 % of Nigerians discern themselves to be at no post of labor HIV while 29 % perceive themselves to be at low risk of infection and merely 2 % rated their opportunities of infection high ( NARHS, 2005 NACA, 2007 )Multiple Partnerships In Nigeria, weird beliefs tend to back up the promotional material of vernacular fidelity NDHS ( 2003 ) nevertheless proved that fivefold inner partnerships are common particularly amongst devolve onu everyy fighting(a) work forces. About 30 % and 24 % star and married work forces sever onlyy revealed attribute much than one intimate fellow in the past twelvemonth ( NDHS 2003, NACA 2007 ) . While work forces with multiple spouses entertain a 60 % augmentd hazard, freehanded fe antherals are 10 % higher than work forces. ( NARHS, 2005 ) lose of established STD Programming for Most at Risk Population ( M ARP ) Package of service provided to MARPs is limited. Linkages to HIV way and interrogatory, STD direction and intervention are weak and direct relied chiefly on referrals.Continuing Risky port of males in General Population Hazardous look in the general population is more everyday among work forces than adult females. 26 % of work forces report holding more than one evoke spouse in the last twelvemonth as against 2 % in adult females. ( NARHS, 2005 )Gender In ableities Underliing causes and effects of HIV/AIDS infections in work forces and adult females varies reflecting differences in biological science, evokeual behavior, societal attitudes, economic power, exposure, and ethnic attitudes that discourages safe hinge on conference. ( NACA, 2007 )Economic Drivers HIV impoverishes someones and communities with losingss of human resources. Poverty brings about low degrees of statement associated with illiteracy and by and large abject health position. These condit ions result in hapless acceptance of behavior vicissitude which exposes the population to HIV infection. ( NACA, 2007 )Equally currently as an epidemic of HIV/AIDS was sight in the state, Nigeria mounted a national solution, which was spread out in 2000 with the constitution of the presidential Council on AIDS ( PCA ) and the theme Agency for the control of AIDS ( NACA ) . This allowed for a co-ordinated attempt to supply parapet, intervention, attention and nutriment service finished polity preparation, development of programs and death penalty.NACA s allowance provinces that -A A1.A A A Coordinate and draw out 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 support 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 indemnity roles.4.A A A Develop and joint a strategic program for an Expanded National result to HIV/AIDS in Nigeria.A5.A A A Coordinate, proctor and appraise the execution of the Strategic 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 Action ( 2005-2009 ) provides a strong and comprehensive model for ward off attempts including a balanced ABC attack. In this model, in- inculcate new(a) souls were label as a ground level population group. internal activity precept is a major percentage of band and one of the tools in minimal tamp required for HIV forfend. Political issues environing it include shield to arouse nurture and heartfelt-for-nothing earthly concernity by Faith Based Organizations ( FBO ) , Religious leaders and other stakeholdersInadequate accomplishments on gum elastic routine and dialogueMisconception about trip out cultivation and low creditAvailability, approachability and affordabilityLack of insurance environing intimate way in secondary educateings ( NACA, 2007 )A survey through with(p) in Nigeria analyzing the raiseual behavior of secondary civilize striplings showed that the average age at first confabulation 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 organise sexual management way of have be instituted for all prepares get downing at an earliest age. ( A.T. Owolabi, A.A. Onayade et Al, 2005 )Other surveies have examined how instructors feel about go throughing their noesis on HIV / AIDS bar steps to their pupils in the context of their cultural and societal norms that restric t unshackled treatment of sex.A The consequences showed a high degree of lore about HIV / AIDS bar among teachers.A Nevertheless, instructors do non go through on this experience 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 hence necessary to increase handiness of sexual health services, create societal support for sex instruction in directs and build capability on appropriate sex instruction.Previous efforts at supplying sex instruction were interfered by apparitional and cultural resistance. In 2000 a new course of sphere was introduced for comprehensive sex instruction for 10-18 twelvemonth olds which concentrated on bettering pupil s re recognition and attitudes to sexual wellness and cut downing unstable sexual behavior. However the execution of the undertaking was a entire failure and has si nce been abandoned. ( Avert, 2010 )In a state where issues such as confidentiality around HIV proving is non overfly by statute law, where no action is taken when human rights are broken in copulation to HIV infection and mugtisation. It seems the destiny of the gullible tidy sum are in their custodies, owing to the absence of fat wellness ( RH ) institutes and deficiency of separate Torahs or statute law for immature people in intercourse to HIV bar. ( unify Nations Global alinement on Women and AIDS, 2004 )POLICY AGENDA SettingTo accomplish this wellness indemnity, one must see the histrions that would be have-to doe with and psychoanalyze all stakeholders- so as to understand their behavior, purposes, inter-relations and participations and to sum the influence and resources they bring to bear on decision-making or execution operation. ( Varvasovszky Z. , Brugha R. 2000 )Stakeholder/ Actor analysis lead identify the type of people to interview, utilizing sweet san d vervain techniques, reappraisal questionnaires etc. It is of seconding to plan a semi- unified/ condense interview inquiries. Interviews give let likeness across cultural groups and faith and yet be sensitive to specific contexts.Stake holder s position has to be transformed into one that utilizes indexs to lay out the extent of the job. They need to be informed of have table, tendencies and likely future class of HIV epidemic in their part or territory and at heart specific subgroups of the population. elude 1 Stakeholders AnalysisStakeholders use in the issueInterest in the issueInfluence/ PowerPositionImpact of issue on histrionParentsParticipate in electric razor Sexual development and can act upon their kids s determinationMediumLowNon-mobilized nobleMedia exertion fight stakeholder s positions and can act upon determination shapers by supplying dependable information noble higher(prenominal) corroboratoryLowMinistry of wellnessPromote healthy generative picks, di rection of STIs and HIV cerebrate unwellnesss risqueMedium victualsive juicyPresidential Council on AIDSSurvey indemnity proposals and do determinations on themMediumHighNon-mobilizedMedium teach AdministrationParticipate in policy executionHighMediumOpposedHighMinistry of EducationEnsure sex instruction is integrated in national course of study and implemented prep of staff policy Implementation and EvaluationHighHighSupportiveHighBilateral Organizations let support and technological supportHighHighSupportiveHighReligious LeadershipsInfluence the population through spiritual, moral and cultural beliefsHighHighOpposedMediumImporters, Manufacturers and Sellers of the merchandise e.g. rubbers, text editions countenance low-cost and high case merchandiseEngagement in disseminationHighLowSupportiveHighNACADevelop and present to PCA all programs on HIV/AIDS in Nigeria for policy determinationsHighHighSupportiveHighDocumentary/ national analysis would be undertaken to place the co me in of eubstance between the present policies in the state. It would anyways cover how far policy shapers draw on investigate findings in addresss during policy preparation and execution phases. The information beginnings would include seek semipublications and studies, statute law, administrative/ executive director ordinances or sites, reimbursement agreements, guidelines and advice, meeting studies and proceedingss, policy statements, addresss, and articles.An economic rank allow be considered to measure and construe the honour of this wellness intercession. This go out mensurate the results in financial footings every bit profound as in wellness units. For this policy a cost specialty analysis ( CEA ) will be more good in ordination to besiege the quandary of puting financial value on human lives. It will equivalence the value of resources spent on the intercession to the measure of wellness gained as a consequence. ( David Wonderling et Al, 2005 )A complete apprehension of consistence of old policies with research findings, the grade of influence of research on policy lay scene, preparation and execution would be needed to vouch 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. star sign s theoretical account of docket puting claims that the specialness of this movement 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 sex macrocosm 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 th e usage of media, raising consciousness and march on rubber usage, affecting FBOs in policy execution.thither is besides no cause that sex instruction or rubber handiness in coachs will increase promiscuousness or cut down the age of first sexual intercourse of in school infantile soul, hence this policy has no potency for inauspicious consequence. This policy s acceptableness mightiness be of concern, as on that point 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 uncalled-for gestations and the complications from illegal abortions, thereby cut downing matriarchal(p) mortality. Previous work in Nigeria has shown that equal instruction works in HIV bar and this is briefly being use to advance abstention and be faithful intercession plans.Kingdom s dumbfound proposes that there are 3 waterways of policy surgical proce dure and they need to cross for policies to be considered. ( Kent Buse, 2005 )Problem watercourse High prevalence of HIV among in school juvenile mortal, with the highest signifier of transmittal being heterosexual sexPoliticss watercourse The National HIV bar work program promotes condom scheduling 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 untested soul since so has increased.Policy watercourse Following the 2005 National HIV/ lues venerea 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 AN D IMPLEMENTATIONLegislators are influenced by media and posts, cultural beliefs, lobbyists, semipolitical separate and support every bit good as grounds based research. It is hence of spell out 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 adolescent somebodysAimsTo better the cognition about HIV/AIDS amongst preadolescent personTo raise the age of first sexual drag amongst in-school young person by 5 old ages in 10 old agesTo promote rubber usage among in-school young personTo increase the practice of in school young person pursuance 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 southern urban parts where it will be more acceptable and if winnerful, lepidote up to other less urban countries utilizing traditionalistic and spiritual leaders to act upon doctrine.A broad web and model of HIV/AIDS bar is soon on land in Nigeria, a assorted scanning 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. shaping of in-school HIV nines and groups will supply a meeting place for pupils to aerate their positions on abstention, sexual exposure a nd bar patterns and eventually condom handiness and distribution.Cost will be reduced by utilizing bing resources and adult male power. add-ond cognition of HIV/AIDS in the population with capacity building for instructors and in school young person will let for late execution. A boom and careful pilot testing could be done in the relevant mark group to let for appropriate rating and alteration before broad spread execution. A buttocks up attack should besides be used to let for more engagement by implementers and regular 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 whitethorn differ well from one other and intercessions may be implemented in polar ways by different people. Specific intercessions may be interactive or even antagonistic and yet most programmes will unite some(prenominal) intercession schemes, doing rating of the effects of specific intercessions or constituents in spite of appearance the programme bundle hard or impossible to extricate. ( UNAIDS, 2008 )In measurement the effectivity of the policy, elaborate grounds on the existent procedure of rescue 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 ) deliver the goods appropriate information to immature people and grounds of betterments in their resulting cognition supply 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 skill s-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 manner/INDICATORSStaffMonitoring and rating preparation for plan directors and implementers training of school nurses and instructorsTraining of spouses and stakeholders on young person and HIVMedia preparation on Sexual activity instruction and caoutchouc publicityCapacity edifice for implementers diverseness in supplier behavior in relation to school young personChange in supplier behavior in relation to describing systems remedyment in administrative and describing systemsExperimental surveies tour of instructors and school nurses trained in supplying sexual instruction and wellness services to school young person snatch 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 normCondom usage as a societal normBehavioural surveillance studyCondom handiness and handinessSti gmatization around sex instruction and rubber usageNumber of jangles aerate on sex instruction and rubber usage among school young personEducation labor 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 person purify school young persons consciousness on HIV/AIDSImprove rubber negociating accomplishments among school young personImprove rubber usage among school young person cut STI incidenceReduce HIV morbidity and mortalityReduce teenage 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 of rubber distributedNo of school young pers on who used rubbers in their last sexual brushFacilitiesHandiness of friendly tender service Centres for school young person within and outside the schoolBuild effectual gene linkage/referral systems for STI direction in communitiesEstablish regional offices through the Ministry of Education to supervise disposal and M & A EIncrease entrance to RH servicesPromote dealingss among assorted organisations involvedAllow lenient monitoring and rating of executionSchool young person will be able to entree RH services without stigmatisationProvide utilizable information on execution procedure and successBehavioural surveillance studyNo of young person accessing RH services before and after(prenominal) intercessionNo of RH services functional 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 co gnition 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, corporation and spiritual groups and parents on HIV/AIDS cognitionSkills and services confederation mobilisation for HIV sensitization 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 mannerRebrand rubber usage as a constructive 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 instructionAdvocacy/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 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 legal 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 modify them do informed determinations refering their sexual wellness.Surveies done have shown adequate grounds that sexual instruction attachment 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 selfsame(prenominal) 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 fibrous 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 better brighter hereafter, free from HIV/AIDS.