From Awareness, to
action plan, to program implementation.
REGIONAL CONFERENCE ON STRATEGIES FOR
COMBATING THE SPREAD OF
Epidemiology of HIV/AIDS in the
West African Region
By Dr. Aderemi Desalu
I have been asked to discuss the epidemiology of HIV/AIDS in
the sub-region under the following topics:
1. The epidemiology of HIV/AIDS and types
2. Factors driving the epidemic
3. HIV/AIDS surveillance
These will be addressed in the context of Sub-Saharan Africa
with focus on the West African sub-region, and in particular,
Epidemiology refers to the study of the distribution of
disease in human population against the background of their
total environment. It includes a study of the patterns of
disease as well as a search for the determinants of diseases.
As regards the distribution of disease, three major questions
are usually asked:
1. What is the distribution in terms of persons? - Who?
2. What is the distribution in terms of place? - Where?
3. What is the distribution in terms of time? - When?
The first case of HIV/AIDS discovered in Nigeria was in Lagos
in 1986. The individual was a Ghanaian prostitute practicing in
the Ivory Coast. The finding was interpreted to mean that the
infection was already in the country. The very low prevalence
rates recorded in other parts of the country at the time was
also an indication that we were at the beginning of the epidemic
and that we had an opportunity to avoid the havoc the disease
had caused in other countries we seem not to have taken prompt
appropriate action as was done in Senegal, which was at the time
in a similar position to Nigeria. Due to Senegal's prompt and
appropriate action, it now has a prevalence rate of below 3%.
The likelihood of adults in SSA to be infected is ten times
greater than for an adult in North America and twenty times
greater than an adult in Western Europe.
The West African sub region is in Sub-Saharan Africa.
Today 22.5 million persons living with HIV are in Sub-Saharan
representing 80% of the world's total amount; an alarming
Within the West African sub-region (and I will explain later
on) the prevalence rate ranges from between 2% and 8%, with the
exception of Cote d'Ivoire and Togo which range between 8% and
32%. Senegal on the other hand, as mentioned earlier, is below
None of these percentages are acceptable and we must all,
very seriously, join hands to bring under control this grave
threat to your sub region, to our children, to our future.
The prevalence rate in Nigeria going by the HIV Sentinel
Survey, 1999 is 5.4%, as mentioned earlier this was not always
the case. We have seen a steady rise, as most of our sister
nations in the West African region.
Nigerian statistics tell is that in:
1992 - The prevalence rate was 1.8%
1994 - The prevalence rate was 3.8%
1996 - The prevalence rate was 4.5%
1999 - The prevalence rate was 5.4%
Fortunately now we have a very serious and committed response
by the government with the most important multi-sectoral
approach. One hopes that all parts of this jigsaw fit together
and at the right time in order to bring about the outcome we are
all working so hard to achieve.
Adult prevalence rates for West African sub-region indicate
that in 1982 no country in our sub region had over 0.5%
prevalence. Indeed the statistics tell us the whole West African
sub-region was between 0% and 0.5%.
In 1987 we had begun to see a few countries with a prevalence
of 0.5% to 2.0%. These were Ghana, Sierra Leone and Senegal.
A few had also in 1987 a prevalence rate of 2.0% to 8.0%.
These were Togo and Burkina Faso.
In 1992, the picture was looking significantly worse. The
adult prevalence rates were:
0.5% to 2.0% for: Nigeria
2.0% to 8.0% for: Ghana
With the range of 8% to 16% being seen in the Cote d'Ivoire.
By 1997 we were all between 2% to 8% with the exception of
Togo which joined Cote d'Ivoire in the 8% to 16% adult
prevalence rate group and rising.
Some of the indicators for geographic areas of affinity in
Sub-Saharan Africa, which includes the West African sub-region
1. Year of HIV spread 1977-1978
2. Year of first AIDS case diagnosed 1985
3. Availability of data High in the sub-region
As regards major modes of transmission, transmission in the
· Blood/Blood products Medium./Low
· Homosexuality Low
· I.D.U. Low
· Heterosexuality High
Urban/Rural ratio - 3.6-1
Male/Female ratio - 1-1.3
As we all know, HIV is transmitted from one person to the
· Unprotected sexual intercourse 80%
· Blood/Blood products 10%
· M.T.C.T./Needles/sharps, etc. 10%
The groups of people most at risk cut across the West African
sub-region and include:
· Commercial Sex Workers - Statistics show that the rate of
HIV infections among this group is very high
- 55% in Abidjan, Cote d'Ivoire
- 34.2% in Nigeria (1996)
· STD patients - In Nigeria, going by the 1996 average, a
prevalence rate of 15.1% was seen in these groups. There is
scientific evidence that a person with untreated STDs is up to
6-10 times more likely to pass or acquire HIV during sex.
· M.T.C.T.(Vertical transmission from mother to child) - The
child of any HIV positive mother has a 30-40% chance of being
infected. Going by the national average in Nigeria, 4.5% of
antenatal cases were found to be HIV positive. Higher figures
are seen in Burundi - 20%; in Abidjan the figure is between
10-15%; in South Africa, 11-18% are seen.
Around 90% of children who become infected under 15 years of
age acquire the virus form their HIV infected mothers, whether
before or during breast-feeding. As women of childbearing age
themselves become infected in ever-greater numbers, a trend
reflecting their own vulnerability to HIV, the number of babies
infected through mother to child transmission rises
Since the beginning of the HIV/AIDS epidemic in the late 70s
and early 80s, the WHO and UNAIDS estimate that more than 5
million children under the age of 15 years have been infected.
In 1998 alone, 1400 children died of AIDS daily and an even
larger number become newly infected with every passing day.
At the end of 1998, it was estimated that 1.2 million
children under 15 years of age were living with the virus, and
well over 90% of these children live in developing countries
If our children, our future, continue to be born with a death
sentence on their heads, because ladies and gentlemen that is
what it is, we have no future.
· Long distance lorry drivers, migrant workers and drifting
across ECOWAS borders in search of greener pastures is another
risk group that cuts across the whole of the West African
sub-region. Let us hope that the newly introduced ECOWAS
passports do not make an already difficult task even more so.
· The youth, between ages 15 and 24 years are the most
affected age group. In Nigeria, the youths between the ages of
20 and 24 have an HIV prevalence rate of almost 10%.
· The military and paramilitary forces throughout our region
are a high-risk group. Recent test results in Nigeria of
soldiers returning from duties in Sierra Leone and Liberia show
a high percentage of HIV positive results.
Ladies and Gentlemen, the simple truth is we are all at risk.
This scourge touches every one of us and will in one way or
another knock on our personal doors. The time to act is now;
later may be too late.
The types of HIV we have are Type 1, Type 2, and Type 1-2.
In Nigeria, HIV-1 was the predominant virus found, accounting
for 89% of all the infections. HIV-2 accounted for 4% while HIV
1-2 accounted for 7%.
UNAIDS statistics tell us that HIV-1 is the dominant type
worldwide, and HIV-2 is found principally in Africa.
There are at least 10 different genetic subtypes of HIV-1,
but their biological and epidemiological significance is unclear
at the present time.
Both HIV-1 and HIV-2 are transmitted in the same ways, but
while this sis the case HIV-2 appears to be less easily
transmitted than HIV-1. The progression from HIV-2 infection to
AIDS appears to be slower than in the case of HIV-1. AIDS seems
clinically identical whether it results from HIV-1 or HIV-2.
It is expected that the vast majority of HIV infected
individuals will eventually develop AIDS although no long-term
cohort studies have been completed. Progression from initial HIV
infection to onset on AIDS might be more rapid in developing
countries. We need not be reminded that we are in our
sub-region, third world developing countries. Having briefly
discussed the first topic, I will now move on to discuss the
factors driving the epidemic in our sub-region.
I need to quickly point out that though I will be
concentrating on factors driving the epidemic, it does not mean
that we have no factors that could help us slow down the
epidemic that may be discussed at another time.
Man's total environment includes all living and nonliving
elements in his surroundings. It consists basically of 3 major
I will discuss the social component a bit further. This
represents the part of the environment that is entirely manmade.
In essence it represents the situation of man as a member of
society, his family group, his village, or urban community. His
culture including beliefs and attitudes, the organization of
society, politics and government, laws and the judicial system,
the educational system, transport and communications and social
services including health services.
Many of our societies in our sub-region are still held
tightly in the vicious cycle of:
Having mentioned the above, I
will now proceed to look at the very many factors that drive the
HIV/AIDS epidemic in our sub-region.
1. Poverty of our people, which I believe is mainly a
function of poor leadership, political instability and
destruction of institutions among many others. Poverty is also
inclusive of poverty of education, social sciences,
infrastructure, hope and a future.
2. Lack of safe sexual behavior. From the detailed work
already done by NACA one can list the following factors within
and accounting for this main factor:
a) Continued denial of the existence of AIDS
b) Educational limitations, such as
- limited information in local languages
- absence/limitation of sexual education in schools
- general low enrollment of children in schools
- low girl attendance
c) Cultural limitations to S.S.B. These include
- negative cultural factors
- the youth cannot speak about sexuality with parents publicly
- male sex behavior dominance
d) Contributory social behavior to the lack of S.S.B.
- Indifference to HIV/AIDS by people
e) Lack of S.S.B. as concerns the use of condoms are due in part
- lack of appropriate information on use/benefits
- non-acceptance of condoms
- low availability of condoms
- cost of the condom - condoms should be free and of good
3. The epidemic is also driven by inadequate STD prevention,
diagnosis and management. In this regard the following are
a) The prevention, diagnosis and management of STDs are not
sufficiently integrated into P.H.C.
b) Lack of information about where to go for diagnosis
c) Lack of information about STDs among the population
d) Fear of stigmatization
e) Non/poor availability of laboratory facilities for diagnosis
f) Competition with alternative medical practitioners
g) Insufficient number of health workers
h) Poor availability of drugs
i) Poor management of information system in STDs
j) Poor management of staff
k) Financial cost
4. Stigmatization of HIV/AIDS is also a major driving force
of the epidemic
5. Blood safety inadequacies. These are contributed to in part
a) Lack of national policy and implementation of
b) No national blood transfusion services
c) Inadequate number of trained personnel
d) Lack of voluntary non-remunerative blood donor system
e) Non-sustainable supply of consumables and reagents
f) High cost of processing blood for transfusion
g) Lack of blood substitute and components
h) Poor political and financial commitment
6. Inadequate targeting of youth is another epidemic-driving
force and this is caused by many factors, some of which are:
a) Lack of integration of necessary information into school
b) Many youth are not in school
c) Negative attitude of parents to sexual education
d) Poor role models
e) Lack of youth friendly health services and counseling
f) Declining moral standards
g) Paucity of channel of information targeted at youth
h) Poor recreational facilities for the youth
i) Non-implementation of the laws and rights of children/youth
j) Increasing unemployment
k) Lack of social welfare package
l) Inadequate funding of youth-related STD/HIV/AIDS programs
7. Another major driving force of the epidemic is the
inadequate care and support, and this in turn is brought about
by the following factors:
a) Not enough facilities for V.C.T.
b) High cost of diagnosis and inadequate diagnostic facilities
c) Inadequate number of social workers
d) Inadequate guidelines on counseling
e) Inadequate home-based care structures and support
f) Inadequate supply and high cost of drugs
8. The medical, social and related factors driving the
a) Ignorance of both the health care workers and the patients
b) Poor health-seeking behavior
c) Inadequate and misdistribution of health facilities
d) Poor infection control
e) Poor access to A.R.V. drugs and drugs for opportunistic
f) Inadequate number of trained counselors at all levels
g) Inadequate psycho-social help
h) Lack of confidentiality
i) Poor referral systems and lack of continuum of care
j) Competition with spiritual healers
k) Religious and cultural barriers
9. Epidemic driving factors related to human rights and
justice, which I will take Professor Soyinka's permission to
list. Some of them include:
a) Non-sensitization of legal staff to HIV/AIDS
b) Non-formulation of new laws and abundance of existing laws as
it relates to HIV/AIDS
c) Lack of information to PLWHAs regarding their rights
d) Not enough political drive
e) Strong religious and traditional laws which may be contrary
f) Protection of prisoners and people in detention
10. Other factors which drive the epidemic in our sub-region
a) A lack of focus on women's needs
b) Lack of research and facilities for research
c) Ineffective management of skills
e) Lack of the bottom up approach and involvement of and
capacity building of grass root organizations and structures
f) Maximally effective IEC
g) Proper monitoring and evaluation of programs and adequate
h) Lack of multisectorality
i) And finally, lack of funds. The best-laid plans may collapse
without appropriate funding. This factor needs to be
The third and final topic which I will be addressing is
HIV/AIDS surveillance. Accurate HIV/AIDS surveillance is a
beacon for action against the epidemic, and the need for quality
surveillance cannot be overstated, in order to map the epidemic,
region-by-region and country-by-country.
Surveillance succinctly means monitoring the trend of a
disease, in this case HIV/AIDS surveillance is to monitor the
trend of HIV/AIDS over a period of time as it affects the risk
groups, the age ranges, the prevalence, is the epidemic getting
better or worse, the gender disparities, etc.
Tracking the HIV/AIDS trend can serve as an early warning
system, allowing countries to anticipate and counteract new
waves of infection, and at the same time it focuses world
attention on the epidemic and its dramatic impact in many
For surveillance to be effective, the system and structure to
be used need to be well conceived and workable. This will lead
to accurate and relevant data being collected, as it relates to
the various markers and groups decided on.
The data that is then collected needs to be professionally
analyzed to give us an accurate up to date situation of the
By monitoring the situation of the disease, we are then in a
better position to plan our various meaningful interventions, in
order to better control the spread of HIV, and to. As mentioned
earlier, anticipate and counteract changes in the epidemic.
HIV/AIDS surveillance has been carried out in the countries
of our sub-region, hence the availability of he statistics
mentioned earlier. For example, we know that between 1982 and
now the sub-region has gone from 0 - 0.5% to 16% in some
Surveillance has told us that a country like Senegal is
achieving a lot more in the control of HIV/AIDS than the Cote
d'Ivoire or Sierra Leone.
It has raised questions.
It has made us explore further why this is so.
It has given us answers as to why this is so, and now it now
puts us in a better position to effectively tackle the HIV/AIDS
scourge. A task we cannot and must not fail in.
I thank you all very much for listening and wish us all a
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HIV/AIDS Prevention Strategies for West African Region
By Dr. Tony Elioke
In spite of developments in drug therapy for people living
with HIV/AIDS (PLWHA) and vaccine against HIV, prevention of HIV
infection still remains the priority objective for HIV/AIDS
control globally, more so in developing and underdeveloped
regions, like West Africa. It will be quite some time before
currently in use HIV anti-retroviral drugs become readily
available, accessible and affordable generally, in the countries
of West Africa. And within the interval, HIV/AIDS will have
caused so much devastation of the socio-economic systems of the
countries that little may be redeemable. The cost of managing an
AIDS epidemic is enormous and so it makes every economic sense
to apply the scarce resources of the West African countries to
prevention of HIV infection in the populations against the
option of paying more attention to drug management of AIDS
cases. Past and present experiences with syphilis and gonorrhea
teach us that not all epidemics can be controlled effectively
through and emphasized strategy of chemotherapy.
Prevention Strategies that have worked and those that have
Strategies for HIV prevention have developed along the line
of transmission. In Africa, the sexual role of HIV transmission
has remained overwhelmingly predominant; it is the same for West
Africa. Thus, Nigeria's Medium Term Plan II (1993-1997)
emphasized the strategy of prevention of sexual transmission,
with such interventions as:
· Promotion of safer sexual behavior
· Early diagnosis and proper management of STD
Another strategy is the prevention of HIV transmission
through blood and blood products, with:
· Promotion of appropriate use of blood and blood products
· Safe blood for transfusion, etc.
Prevention of peri-natal transmission is a third strategy.
All these strategies have largely worked where the
interventions have been appropriately packaged and delivered.
Unfortunately, in the mid-80s to mid-90s, interventions were
largely packaged from the experts' perspective above and
literary imposed on target sub-populations. (Many interventions
did not even target populations.) The none involvement of the
beneficiary population made projects alien, failed to utilize
the vast potentials of the sub-population, could not be
integrated into existing programmed of the groups and therefore
could not be sustained. Many projects did not have proper
evaluation as they had no base line and so success or failure
could not be objectively stated.
· Political commitment at leadership level has remained very
vital and much has gone into advocacy in the sub-region but
political commitment is only beginning to be secured in many
West African countries. Only a few have addressed the Agenda for
Action of the African Heads of State and Government of 1991/92/
· The strategy of preventing sexual transmission through the
adoption of safer sexual behaviours is an uphill task in
practice. Most activists believe that providing information
regularly to people would make them adopt safer behaviours as
prescribed, confronted with deadly scourge like AIDS. That has
not worked. Condom promotion and condom use appear to be
succeeding more, in practical terms, than the doctrine of
abstinence and fidelity. The controversy over the age of entry
into sexuality education has worked negatively against
postponement of age at first sex for young people.
· Power of negotiation of safer sex by woman is still elusive
and because most of sexual encounters outside marriage have
strong element of sexual exchange in the sub-region, he who pays
the piper dictates the tune and men want to get full
satisfaction for the material favours to their sex partners.
· Behavioural Sentinel Surveillance just beginning in the
sub-region, will give better insight into the successes and
failures in sexual behaviour interventions.
· With prevention through appropriate use of blood, those
countries with Blood Transfusion Services have achieved almost
complete safe blood transfusion. But in countries where private
laboratories, using commercial blood donors, provide most of the
blood banking services, transmission through blood, especially
in children, remains largely uncontrolled. Further, consistent
use of sterile instruments and disposable syringes and needles
is yet to be achieved in some of the West African countries,
especially where 'quacks' abound in the health service
provision. Pre-marital HIV testing for intending couples is
being practiced in some of the countries to reduce the incidence
of peri-natal transmission and ante-natal clinic attenders are
being routinely screened for HIV in some services. HIV positive
mothers are not encouraged to breastfeed. Anti-retroviral
therapy to block vertical transmission is largely for studies.
Again, evaluation of the impact of this strategy is not common.
Role of Parents and Schoolteachers in HIV/AIDS Prevention.
· Parents and teachers have enormous roles to play in
HIV/AIDS prevention. Particularly among young people. AIDS and
sexuality education is vital for this prevention and at the age
when this education will be most effective and fruitful, the
young persons are totally under the control and guide of parents
and teachers. Unfortunately, communication between children,
adolescents and youths, on the one hand, and their parents and
teachers on the other hand, is often poor in this part of the
world. Culture and tradition is largely responsible. Further, on
sexuality issues, parents and teachers are not equipped with the
knowledge and skill to effectively educate the young ones.
· Communication between spouses on sexuality is equally poor,
making prevention of HIV infection among couples poor.
Extra-marital relationship is high in most communities
encouraged by some cultural practices and many clients of female
sex workers are parents who thus sustain the "importation" of
HIV into families.
· Polygamy aids this
D. Role of Religious and Community Leaders in HIV/AIDS
· Religious and Community Leaders wield a lot of influence
over vast majority of the people. They can be invaluable assets
to HIV/AIDS prevention, if properly mobilized, sensitized and
have capacity built. But they can be equally very obtrusive if
their professional biases are allowed to hold sway. Many are
also highly conservative and resist changes. Religious
organizations often have reliable operational structures and
services that can readily integrate HIV prevention and control
strategies. Their leaders are highly regarded, looked up to as
representing God and exercise largely unquestioned powers with
· It is similar with Community leaders.
· They are equally good at mobilizing resources and
implementing programmes successfully, with cost effectiveness.
· They can accomplish the informational aspect of AIDS
education but may often have problem with the methods of
behaviour change know to produce better results.
· Over the years of the AIDS
fight in the sub-region, AIDS activists have been on a running
battle with religious leaders over the issue of condom promotion
for HIV prevention.
E. Prevention of Mother-to-Baby Transmission
As mentioned earlier, the ideal for this strategy is to have
all couples intending to make babies HIV-free. This free state
is easier to achieve at entry into marital relationship,
excluding extra-marital motherhood. Intra-marital HIV testing
will hardly ever become popular in this part.
· Having children to survive a man, in this sub-region, is so
vital that the pre-occupation of many young men who tested HIV
positive is often how to get a child, preferably male, to
survive them. They, therefore, rush marriage and gamble for an
HIV negative child, often with success, but at great risk to
their spouse. Use of anti-retrovirals to protect a baby from an
infected mother may even encourage this practice. Artificial
insemination with donor sperm is a healthy option.
· Many of the pregnant women testing HIV positive at ANC
never have their spouses tested.
· Uncontrolled vertical transmission will raise both infant
mortality and AIDS orphans.
F. Role of the Mass Media in HIV/AIDS Prevention.
· Raising public awareness and providing accurate information
on which people can act is most vital in HIV prevention.
· The fastest way to reach large populations is through the
mass media, especially the electronic media, in West African
Region. Most surveys in Nigeria give this indication. The
electronic media can use diverse methods, which appeal to
diverse sub-populations most and target populations with air
· A good number of the populations hold mass media
information as credible. The programmers need proper training
and orientation for this role.
G. Ensuring the Safety of Blood Supply.
· There must exist a national policy on blood supply. (e.g.
· Such policy must be religiously implemented across the country
· For this to happen in a country like Nigeria, there must exist
effective supervision of the operators of any system that is in
· Donor selection must be practiced to compliment donor
screening for HIV.
· HIV testing kits must be in regular supply, especially to all
blood supply facilities. Interrupted supply of kits and
therefore screening of blood is unacceptable.
· Commercially supplied blood must be re-screened in the health
facility before transfusion.
· Blood screening should include for the routine pathogens, like
HIV is still spreading in the various countries of West
Africa, at varied rates, but through common modes the most
important of which is heterosexual.
Unsafe blood transfusion is still going on in some of the
countries and puts many children at risk.
· Prevention still remains the cornerstone of the fight
against the HIV/AIDS epidemic and strategies for prevention have
evolved in line with international guidelines, namely for
sexual, blood and blood products and vertical transmissions.
· The multi-sectoral approach, involving all stakeholders and
service providers, particularly parents, teachers, political,
religious and community leaders, is most effective.
· Realistic methods and interventions based more on what works
that what is ideal are to be preferred for achieving the goal.
· Practical political commitment of the leaders is a sine qua
non for efforts to yield the desired results.
· The window of hope is West African Sub-region is gradually
closing and actions must be hastened.
· With joint realistic efforts, we can and should be able to
have a hold on the prevention of further HIV transmission in
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ROLES OF RELIGIOUS LEADERS, NEWS MEDIA PRACTITIONERS AND
PARENTS IN COMBATING HIV/AIDS IN WEST AFRICA.
A PAPER PRESENTATION AT THE FDA REGIONAL CONFERENCE ON
STRATEGIES FOR COMBATING THE SPREAD OF HIV/AIDS IN WEST AFRICA
HELD AT ABUJA
JUNE 5-8, 2000.
NIGERIA YOUTH AIDS PROGRAMME
9, ADEBOLA STREET, SURULERE, LAGOS
01-5455268, email: firstname.lastname@example.org
The HIV/AIDS Pandemic has remained a major reproductive
health problem all over the world with catastrophic effects in
many countries, especially the developing countries. In Nigeria,
according to the statistics released by the Ministry of Health
between 1987 and April 1999.
Over the years various efforts have been made by the
international, national and local organization in related fields
to fight the spread of HIV/AIDS by increasing awareness on its
modes of transmission and prevention but the number of infected
persons have been on a steady increase especially among the
youth. This can be attributed to the fact that pre-marital
sexual activities are a common, but disturbing phenomenon in the
The whole issue of HIV/AIDS prevention is viewed viz. a viz.
the health, cultural, economic, religious and social dimensions
and this is applicable to the entire sub-region. With the
increase in the number of those affected with the AIDS virus in
Africa on a daily basis, there is an urgent need for us to look
inwards to identify better strategies that can most effectively
address the problem of HIV/AIDS. HIV/AIDS Prevention Programmes
in Africa are prone to a lot of problems which affect the
receptivity and sustainability of the programmes.
Issues such as cultural diversity and belief in harmful
traditional practices have direct impact on the health of
members of the communities where they are practiced. Such
practices include: female genital mutilation, wife inheritance,
tribal marking, polygamy and early marriage. These practices do
not make room for promotion of positive health seeking behavior
among community members. For instance in a culture that permits
wife inheritance, the transmission of HIV through this process
is quite common. Polygamous settings also make it conducive for
the transmission of STIs from one person to the other.
Religion has a great influence in the behavior and code of
ethics of those practicing it. Over the ages, it has been used
to contribute to human development by structuring the lives of
men and women along particular codes. Also, over time,
traditional practices have intermixed with religion and has led
to difficulty in separating one from the other. Some aspects of
religion have failed to ensure continuity with the changing
environment or reflect the significant changes that the
lifestyles of people are undergoing and have undergone. Issues
bordering on condom use, sexuality, family planning and care and
support of persons living with HIV/AIDS are often considered
controversial subjects. However, it is important that we
identify the aspects of religion that are likely to affect the
health of its followers and at the same time promote those that
affect health positively. The common ground in HIV/AIDS
prevention is abstinence and mutual fidelity between couples.
This should be fostered by religious leaders.
Socio-economic problems faced by a majority of Africans have
led to the weakening of our codes of ethics.
As a result, practices which were hitherto taboos are being
condoned because of the economic benefits they afford the people
involved. The perception of the maleness and femaleness has
direct implications for behavior and health. For instance a girl
that is under the illusion that she is meant to submit to the
opposite sex would naturally find it difficult to say no to sex
or even negotiate for safer sex practice. On the other hand, a
boy may feel obliged to go any length to demonstrate his
virility even at the risk of contracting STIs.
From the foregoing therefore, the leaders of the society are
the influential tools that can be used to positively redirect
the downward trend in the AIDS pandemic in the sub-region. At
home, parents should begin to internalize in their children
positive values and behavior that will reduce the risk of
contracting AIDS. Positive health seeking behavior must start
fro the home to become deeply rooted in our communities.
In view of frightening trends on its spread, there is an
urgent need for effective responses to the HIV/AIDS pandemic by
seeking ways of curbing its spread.
Most HIV/AIDS prevention strategies in the region now involve
community empowerment which can be simply described as the
provision of necessary skill, information, and education to
community people, to enable them to function effectively in
their various localities and take control of their lives and
make decisions for themselves. This empowerment could be
economic, social or political for HIV/AIDS prevention.
Community empowerment could be measured by the use of
policymakers, i.e. community and religious leaders, parents and
news media practitioners, as health educators. Peer education
approach is now being used extensively in HIV/AIDS/STI
intervention programmes in various countries including Senegal,
Egypt, Colombia, Sierra Leone, USA and Jamaica because of its
advantages which include cost effectiveness, effective influence
on behavioral changes, and its snowballing effect. Peers usually
feel more comfortable to discuss their health concerns with
ROLES OF POLICY MAKERS IN COMBATING THE SPREAD IF HIV/AIDS
Roles of Religious Leaders
Religion is one of the most important social institutions
with pervasive effects on various aspects of people's lives,
attitude and behavior. The importance of religion in
understanding the behavior of individuals, groups and
communities can be illustrated with Email Durkheim's (1991:47)
definition of religion as:
A unified system of belief and practices relative to sacred
things, that is to say things set apart and forbidden - beliefs
and practices which into one single moral community… all those
who adhere to them.
There are three main religions in Africa - Christianity,
Islam and traditional religion. This definition indicates that
religion is a set of beliefs and practices that are shared by a
group of people. One inference that can be made from this is
that religion affects not only the group's behaviors, but also
The religious institutions have been identified as important
agencies for the dissemination of information. The importance of
religious groups as effective educational and enlightenment
agencies can be attributed to their sacred, dogmatic and awe
inspiring powers. Many believers hold information of religion on
reproductive health behavior and sexuality of young people in
particular and the society in general, especially in terms of
sexual morality, fidelity and chastity before marriage. Since
the religious institutions have this advantage, coupled with the
fact that they often command a captive audience, they could be
effective tools in combating the spread of HIV/AIDS in the
Also, in the care and support of Person infected and affected
with HIV/AIDS, religious leaders and the institutions are able
to provide the necessary spiritual and emotional support which
would enable individuals and families cope with the question of
life, death and ill health. The effectiveness in carrying out
this role is largely dependent on the level of awareness of the
Roles of Parents and Community Leaders
These two groups of people play fundamental roles in
combating HIV/AIDS because African societies are changing even
with the opening up to the world is still seen and interpreted
according to our culture, as such individuals are firstly part
of their societies before they are part of their world. With
this, the parents and community leaders who head the family
which is the primary social group in Africa, and who
traditionally performs important socialization functions often
do not recognize sex education for children/wards as part of
their duties, or when they do, they often shy away from
discussing the issues with their children/wards, for the fear of
encouraging them to have sex.
Furthermore, sexual and reproductive health matters are
regarded in Africa especially in many homes as very private and
sensitive issues, which should not be discussed even between
parents and their children, community leaders and their
community, teachers and students. This lack of knowledge usually
leads many young people to engage in sex, ignorant of the
consequences of their behavior and end up being blamed, chided
or abandoned to their fate when they get into trouble.
So it is the role of parents and community leaders to make
the home and environment the first place for HIV/AIDS education
and information as "Charity they say begins from home". The
family should consciously care and support their members who are
faced with the consequences of the HIV/AIDS pandemic rather than
rejecting and stigmatizing them.
Having established the point that the role of parents in
HIV/AIDS Prevention cannot be overemphasized. The next question
would be, how can parents communicate with their children/wards?
Parents need to communicate to their wards using four basic
skills that are being suggested; they are interaction, inquiry,
directive influence, and strategic influence.
Interaction: involves openness, accessibility, friendliness
and being approachable and sympathetic to each other.
Inquiry: involves listening, asking questions, clarifying
received information and conceptualizing possible solutions of
Directive influence: involves pulling together various
opinions and ideas into a plan, providing specific
recommendations, setting standards, fulfilling and eliciting
promises, challenging poor performance, commendation of good
performance, setting priorities and guides for implementing
Strategic influence: involves getting things done. This is
achieved through stimulating others behavior by honestly showing
feelings, motives, and concern, convincing others, shaping their
behavior through constructive criticisms and providing a
favorable atmosphere and support to achieve results.
Roles of News Media Practitioners:
This group plays an information role by bringing to light
information relevant in HIV/AIDS prevention because the media
reaches wide ranges of people with information, entertainment,
This groups is also equipped with materials to do justice to
media blitz required in HIV/AIDS campaign prevention
It is worthy of note that a group of media practitioners in
Nigeria has set up a network of media people working in the
areas of HIV/AIDS prevention campaign (Medianet). This group is
mandated to cover any workshop, conference, and forums relating
to HIV/AIDS within and outside Nigeria. The media is also a role
model, by shaping attitudes, setting trends, setting agenda for
public debates and discussions as a result of their programming
which may be controversial, like the recent discussion on
vaccine for cure of HIV/AIDS by Dr. Jeremiah Abalaka. The
assistance of the media on such topical issues also increases
the public awareness.
1. Level of communication and counseling services provided in
religious institutions should be improved. More information
should be provided for youth about causes and consequences of
various types of RH problems as well as preventative measures.
This can be done by integrating Reproductive Health, HIV/AIDS
and sexuality information in the activities and programmes of
religious institutions. There is urgent need to break the
culture of silence on the discussion of the above issues within
the religious institutions, integrate HIV/AIDS counseling in
already existing counseling services in churches and mosques.
2. Organise training programmes for ministers, parents and
youth workers in order to enhance their capacity to cope with
need for counseling on RH, HIV/AIDS, etc. It is only when
parents, religious and community leaders are well informed about
the HIV/AIDS issues that they can at their level, combat the
3. Beyond the lip service, concrete avenues should be
provided for members also to discuss RH, emotional issues with
trained counselors in religious institutions without inhibition
or fear of moral reproach or lack of confidentiality.
4. There is a need for more enlightenment programmes for both
young people and adults. This will help to reduce the
misconception and prejudices that both parties have which may
inhibit discussion on HIV/AIDS. For adults, this will also help
to increase their knowledge and build their capacity to
responding effectively and appropriately to the RH information
needs of their wards and the wider community. Advocacy for the
inclusion of RH and HIV/AIDS education should be in the
curriculum of trainee pastors.
5. More media programmes should be organized including the
government on RH and HIV/AIDS for young people, children and
adults. Information material creating awareness on HIV/AIDS
should be highly simplified and translated into local dialects
and circulated to the rural areas.
6. There should be stakeholder needs assessment and
stakeholder participation in the design, plan of programmes,
development policies and implementation of programmes addressing
the HIV/AIDS pandemic.
7. When a thorough needs assessment is done, target specific
curricula should be developed to meet specific training needs of
all groups/religious leaders, community leaders, media
practitioners and parents.
8. Encouraging Intergenerational Communication (Parent-child
communication) on sexuality and Reproductive health at the home
level, community, religious environment and schools have been
identified as a viable strategy n HIV/AIDS prevention.
9. There should be a systematic plan for education of all the
various categories of people being discussed. For instance, in
addressing parents, they should be categorized (uneducated and
educated) including the community leaders.
1. Durkheim, Emile (1915): The Elementary Forms of the
Religious Life; (trans.) J.W. Swain; London; Allen and Unwin.
2. Nigeria Youth AIDS Programme: Religion and Reproductive
Health Behavior of Youth. Monograph Series No. 2 April 2000, pp
3. Makinwa, Adebusoye, Pauline K. (1919): Adolescent
Reproductive Behavior in Nigeria: A study of five cities Ibadan:
Nigeria Institute of Social and Economic Research (NISER)
Monograph Series, No. 3, 1991.
4. O'Dea, Thomas F. (1966): The Sociology of Religion: New
Jersey: Prentice Hall, Inc.
5. Feyisetan Bamikale and Pebley, Anne R. (1989): Premarital
Sexuality in Urban Nigeria in Studies of Family Planning.
Monograph Series Vol. 20, No. 6, Nov./Dec., 1989; pp. 343-354.
6. Nigeria Youth AIDS Programme: Intergenerational Communication
and Reproductive Behavior of Youth. Monograph Series No. 3,
April 2000; pp. 5, 27.
7. Nigeria Youth AIDS Programme: Community Empowerment and
Reproductive Behavior of Young People. No. 4, April 2000; pp. 3,
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BY MR. MOHAMMED FAROUK AUWALU
(1). The various regulatory bodies should wake up to their
responsibilities and checkmate the various claims of cure in the
(2). Health professionals should be adequately sensitized on
the issues that have to do with HIV/AIDS.
(3). I will like to appeal on behalf of PLWHA to the FDA to
help in providing us with a computer to be hooked to the
internet, so as to have most current information on the latest
drugs and other activities. It will also enhance Networking.
(4). PLWHA should stop seeking help where there is none. They
should seek information instead.
(5). I urge the relevant authorities to make the ART
available to the affected people if possible today.
(6). PLWHA should be involved in all decision making in
matters that involves HIV/AIDS at the highest level.
(7). Donors agencies should start focusing attention on how
to subsidize ART drugs.
(8). I recommend that there should be a sensitization
workshop for journalist so as to assist them to report the
issues of HIV/AIDS better.
(9). Am also appealing to media managers to discourage
situation whereby PLWHAs are the basis of jokes by comedians,
cartoonists and other media practitioners.
I will want to end here and say God bless you all Amen.
Back to top
INTEGRATING HIV/AIDS CONTROL INTO PRIMARY HEALTH CARE
*Dr. M.M. Ogbalu: Executive
*Dr. C.O. Akpala: Director, Manpower Dev. & Training
*Dr. C.C. Ibeh: Deputy Director, Executive Director's Office
*Dr. A. Ikpeazu: Assistant Director & Special Assistant to the
Dr. G. Okafor: Snr Lecturer, College of Medicine, Enugu
*ADDRESS: National Primary
Health Care Development Agency, Abuja
A paper presented at the Regional Conference on HIV/AIDS in
West Africa, at the Sheraton Hotels Abuja, June 5-8, 2000
INTEGRATING HIV/AIDS CONTROL INTO PRIMARY HEALTH CARE
At the end of 1998, more than 33 million people in the world
were living with HIV infection, almost half of whom were women
in their reproductive years. HIV related diseases may account
for 75% of annual deaths in the 15-60 age group within the next
15-20 years. (1)
Majority of HIV infected persons are found in the developing
world while approximately 90% of all infected children are found
in Africa alone. (2)
In Nigeria, the skepticism with which both policy makers and
the general populace had regarded the issue of the level of
prevalence of the disease in the past is gradually giving away
to the realities of a situation where majority of medical
impatient beds in our hospitals are today occupied by patients
with AIDS related infections. Available statistics show that the
country currently has a national HIV prevalence of 5.4% while
4.3 million persons are projected to be infected by the year
2003. (3) At the current rate of transmission, the outlook is
Although epidemiologically, three main routes of transmission
of the infection have been documented i.e. sexual intercourse,
maternal-fetal and blood and blood products, available evidence
shows that in Nigeria, most infections are acquired through
unprotected sexual intercourse.
In the absence of an effective cure or vaccine for the
disease, primary prevention through Information, Education and
Communication (IEC) remains the most viable strategy towards
reducing the incidence of new infections. The objective of IEC
should be to produce a change in risk behavior. Although the IEC
should be targeted at the entire population, emphasis would be
placed on those with high risk of infection such as youths.
For control measures to have any meaningful impact on the
populace, they need to be brought down to the grassroots level
in villages and wards and especially in rural areas where more
than 70% of Nigerians reside. Primary preventative measures in
the rural areas poses enormous challenges to health workers as a
result of the relatively high level of illiteracy, poverty and
ignorance. This is further complicated by the relatively long
incubation period of HIV which blurs the relationship between
the individuals lifestyle and infection.
PHC AND HEALTH DEVELOPMENT IN NIGERIA
Since the concept of PHC was defined and given international
recognition in the Alma-Ata more than two decades ago, it has
become the main focus for the promotion of health all over the
world. PHC is the level of health care closest to communities
and the individual and therefore the first point of contact
between health workers and the population. In Nigeria PHC is
constitutionally the responsibility of LGAs. A National Health
Policy was launched in 1988 and in which PHC forms the basis for
its implementation. The health policy therefore recognizes that
the adoption of strategies based on the principles and goals of
PHC is necessary to ensure health for all Nigerians. These
principles include the following. :
a. Universal accessibility of services to provide adequate
coverage on the basis of need.
b. Community involvement and self reliance.
c. Intersectoral action for health
d. Appropriate technology and cost effectiveness in relation to
the available resources.
INTEGRATING HIV CONTROL INTO PHC
The major problem facing HIV/AIDS control in Nigeria and most
developing countries is a lack of proper coordination of
activities at the grassroots level. Most of the activities had
been run as vertical programs parallel to the formal health
services. The arguments on the merits and demerits of vertical
programs have been overflogged and will not be repeated here.
Suffice it to say however, that this has constituted one of the
major obstacles to an effective and coordinated approach to
HIV/AIDS control in Nigeria. There is not doubt therefore that
the answer lies in a full integration of HIV control into PHC.
The National Primary Health Care Development Agency (NPHCDA)
has the necessary structure on ground in all the 774 Local
Government Areas and down to ward and village levels to ensure
that control activities are carried down to the grassroots and
covering the entire country. The mandate of the agency involved
the supervision, monitoring and evaluation of the implementation
of PHC at all levels of government in Nigeria. To effectively
fulfill this role, the agency has six Zonal offices
corresponding to the geopolitical zones in the country. The
Zonal offices are headed by experienced Community physicians as
Zonal coordinators and most of whom have been involved in
HIV/AIDS control programs at community level. The NPHCDA also
has as part of its staff, three zonal technical officers in each
state of the federation. These are experienced community health
officers with MCH background whose function involves the
supervision of PHC workers in all the LGAs within the assigned
state. In each LGA there is also a PHC coordinator who is a
Community Health Officer with MCH background and responsible for
the day-to-day implementation of PHC in the LGA. Assistant PHC
coordinators coordinate PHC activities at district levels while
Village Health Workers deliver PHC down to the household level.
Health development committed at Local Government, District
and Village levels are also in place to assess the community
health needs, manage the services as well as ensure community
The NPHCDA has just concluded PHC project formulation
workshops in all the 774 LGAs in the country. This is a prelude
to the development of a comprehensive PHC plan that will guide
the implementation of PHC in the entire country. The agency
provided technical assistance to the PHC coordinators and their
assistants which enabled them to draw up PHC workplans tailored
specifically to tackle identified health problems peculiar to
the LGAs. Having identified HIV/AIDS as a problem in all the
LGAs in the country, the workplans in each of the LGAs contains
a number of programs aimed at tackling the HIV infection at the
LGA level. To ensure that the LGAs are able to implement the
various interventions on HIV/AIDS control, the NPHCDA will
provide the necessary training for primary health care workers
in all LGAs. The training will be in the form of continuing
education programs for PHC workers. This will involve periodic
training workshops for the PHC workers to bring them up to date
on new concepts in PHC and HIV/AIDS control. In addition the
curriculum for institutions responsible for training of health
workers will be reviewed to incorporate current concepts on
HIV/AIDS prevention and control. Primary Health Care workers
already in this field, ranging from Community Health Officers
down to Village health workers would be imparted with the
necessary knowledge and skills required for effective HIV
control as well as be trained to understand their expected
roles. The various health development committed at LGA, District
and Village levels are also not left out in the training
After the training, the health workers will be expected to
carry out the following interventions under the framework of
1. IEC (Information, Education and Communication) This is the
main strategy for he control of HIV/AIDS. All PHC workers are
health educators and will be actively involved in this exercise
as part of integrated health care delivery at the health centers
as well as during outreach programs and home visits. They will
however need to be supported with health education material in
the form of posters and leaflets, all of which should be
tailored to the local conditions in terms of culture, language
and level of education. This in turn means that the materials
should be produced locally.
2. Counseling The workers will provide pre- and
post-screening counseling especially for those that are HIV
positive. This will also be directed at people living with
HIV/AIDS including their families.
3. Health Information System/ Surveillance As part of PHC
implementation in the entire country, and efficient and accurate
record and data collection system has been put in place to
provide the information which forms the basis for the National
Health Information system. The data covers information from the
most peripheral clinics and outreach centers to comprehensive
health centers in each LGA. The data will be very useful for
monitoring trends in HIV infection and mortality.
4. Treatment of Common Ailments All PHC workers have been
trained to treat common infections and disorders using their
standing orders. Most of the opportunistic infections associated
with AIDS are covered in the standing orders and modalities for
referral of more complicated cases clearly spelt out. The Bamako
Initiative component of PHC has been recently strengthened all
over the country to ensure that there is regular drug supply
within the PHC system. Primary Health Care workers will also
accept referrals from hospitals for patients who will need
5. Home Based Care and Support Health workers will also
deliver home based care and support to people living with
HIV/AIDS as well as their family members.
The National Primary Health Care Development Agency has the
necessary structures and network to ensure that HIV/AIDS control
activities reach local communities in the entire country. This
we believe is the most cost effective approach to tackling the
HIV/AIDS scourge in Nigeria. This will ensure sustainability in
1. UNAIDS/WHO. HIV in Pregnancy: A Review. Geneva,
WHO/CHS/RHR/99.15 UNAIDS/99.35E. 1999
2. Global Program on AIDS. WHO/MCH/GPA/90.2. Geneva, World
Health Organization. 1990.
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HIV and AIDS
Care and Support
Presented at plenary session
during the regional conference on HIV and AIDS West in African
region, held at hotel Sheraton, Abuja, Nigeria, organised by
Foundation for democracy in Africa, Washington.DC
Dr. Megh Raj
Catholic diocese of Makurdi
"……..AIDS kills those on whom
society relies to grow crops, work in the mines, factories, run
the schools, and hospitals and govern countries. It creates new
pockets of poverty when parents and breadwinners die and
children leave school earlier to support the remaining
President Nelson Mandela
The AIDS epidemic in Nigeria, largely invisible and insidious
as it began, is now visible in, what should have been the
unlikely sites, that is, rural communities in the country. The
years of dissemination of HIV are now surfacing, as evidenced by
the ever-increasing number of HIV/AIDS related admissions in our
health settings and deaths in the communities. Yet, AIDS is
supposed to be more evident in towns and cities, where HIV
testing and hospitalization are more available, and where the
epidemic is more fueled by over crowding, commercial sex
industry, cultural and corporate diversity.
The dramatic improvements in clinical outcomes of recent drug
therapies in the world have led to the hopes of HIV infection
becoming life-long manageable condition. In resource-constrained
settings, however where the very basic necessities for human
existence like clean water is almost miracle, this remains an
Even when these therapies
become accessible, they will leave a lot of unattended problems,
problems like lost human dignity, financial hardships and
violated rights. So, the tremendous need for multidimensional
care will still remain a challenge.
Care for the People Living with HIV AIDS:
Every human person would like, not only to live in dignity,
but also to die in dignity…Caring for people with and HIV, may
not be easy, but is very crucial for the remaining period of
PLHA's life. Caring can be emotionally demanding, involving and
yet can be gratifying.
The over all objective of care for a person with HIV is to:
· restore the self esteem and dignity
· recognise the and sustain the self-potential
· and … to help restoring relationships
While the clinical objectives are:
Effective management and prevention of common symptoms and,
Enhancing the immune system and postponing progression to AIDS.
So, the nature and extent of care depends on their needs;
physical, psychological and social.
The expressed and observed needs of PLWHAs are great and
include; physical needs, access to basic drugs, need for
psychosocial and religious support, financial assistance,
consideration of their families, household help, and empathy
from health staff.
As a consequence, the HIV/AIDS epidemic demands development
of innovative, yet realistic care approaches involving many
sectors, such as clinical, nursing, social welfare groups. That
care must be based on continuum, encompassing effective
preventive and pastoral work in the families and community.
Models Of Care:
Realization by the health care institutions of the futility
of trying to manage all AIDS patients in the hospitals, and
expansion of NGOs which in addition to their HIV awareness and
prevention services, response to the wider care needs of PLWHA
and their families, led to the development of two different care
models. They are:
a) Hospital Based, hospital, b) Hospital initiated home care
model, and c) Community rooted initiative.
There are other care models now focus on links between
various initiatives they are;
a) Church based, b) NGO based, and c) PLHA support network care
Advantages and shortcomings of various care models:
Model Types Advantages ShortcomingsNo single care model can be
'ideal'. A 'perfect' initiative needs to be designed depending
on the local situation and the needs.
Final objective in care is to provide wholistic home based- care
Home - Care
Home - Care means any form of care given to sick people in
their own homes. It can mean the things people might do to take
care of themselves or care given to them by the family or health
care worker. The care includes physical, psychological and
Rationale for Home - Care
· Good basic care can be given successfully at home.
· People who are very sick or dying would often rather stay
at home, especially when they know they can not be cured in the
· Sick people are comforted by being in their own homes and
communities, with family and friends around.
· Home care can mean that hospitals will be less crowded, so
that doctors, nurses and other hospital staff can give better
care to those who really need to be in the hospital.
(e.g. St.Thomas' Hospital in Ihugh is a 200 beds facility,
and serves a catchment area with population of around 250,000.
With current HIV sero-prevalence of about 5.4%, 1000 people are
likely to get infected every year. If all require admissions for
a duration of 2 weeks, this implies 2 to 5 patients a day will
be admitted with HIV related problems, and they will occupy
about 40 beds a year. We already have an overwhelming number of
other chronic and terminally ill patients)
· It is usually less expensive for families to care for some
one at home, for example they will not have to pay for the
hospital bill and transportation to and from the hospital.
· If a sick person is looked after at home, family members
can meet their other responsibilities more easily. This can be
difficult if they have to stay at the hospital, or have to
travel frequently to help and take food to the sick person.
· Sometimes hospital care is simply not possible.
Care at home can be provided by those who are personally
committed to care and may involve any body, besides, doctors,
nurses, volunteer health workers, social workers, religious
leaders, family members friends and others. It does not require
to be a specialist, but only basic knowledge and skills. Both
can be acquired from health workers. Home based care for PLHAs
is not exclusive for rural areas or patients. It can also be
provided for people living in urban areas.
Components of Home - Care:
Comprehensive wholistic care involves; teaching, physical
care, psychological care - counselling,
pastoral - spiritual care and social support.
Physical care: Involves looking after physical needs and
providing comfort for the sick person. It also includes
identification of common symptoms, their possible causes, what
to do at home and when they must seek help.
Counselling, spiritual and pastoral Care:
Counselling. Naturally, any patient who is suffering from a
disease with no possible cure, but only stigmatization, will
develop psychological problems because of his own perceptions of
the disease and society's attitudes as well. Counselling enables
a client /patient to open up and share his/her emotions, fears,
guilt, anxiety as well as more practical issues about the
future, survival and planning one's future.
For various reasons, any one who is considering having an HIV
test for any reason should receive pre- and post test
counselling. Post and follow-up counselling facilitate sharing
the result with the family members, and eases provision of care.
How ever, post counselling is not complete until the client has
made plans to meet the challenges of living with HIV infection.
Counseling helps to find a balance between confidentiality and
revealing his/her serostatus to a few significant people in
Counselling will ensure the integration of prevention and
care, and it does well when incorporated into home care.
Spiritual and Pastoral Care. Many people with terminal
illness such as AIDS find spiritual support a source of comfort
and strength, besides helping them cope with feelings of guilt
The spiritual care depends upon patient's religion and faith.
Most people with HIV say they need God the most, and religious
isolation on the basis of their former life style is not only
moralistic but will also seriously affect the patient's morale
Pastoral care can be given not only by a religious leader,
but any body who is committed to give loving help to another
Gender, social, economic inequity makes some people
vulnerable HIV infection, and drives them further to the point
Social security is part of enhancing self -potential, to
improve and enhance option minimize social impact unfortunately,
many countries including Nigeria do not provide such security,
but social support can be possible.
Social support to PLHA can be demanding and often is
difficult in the prevailing economy, social structure and
society's (non) response. The needs of PLHA and their families
are constantly changing.
They will need;
a). To be educated about the services and options available to
b). To save access to the available facilities,
c). To understand the potential violation of their rights,
d). Legal help, and
e). Material assistance such as food, clothing, medicines and
supports for surviving
There are no welfare offices or NGOs that have relevant
Programme towards assisting the patients.
Useful alternatives like;
a) Vocation guidance and training for PLHAs and families,
small scale income generating ideas and interventions can be
provided by volunteer groups.
b) Community based services including day care centres,
community farming to assist in food production, and also for
social integration of PLHA.
c) PLHA support groups run by and for PLHAs and other
affected people for mutual
support have proved to be successful in countries like Uganda,
Tanzania, Malawi, Zambia, Zimbabwe and others.
These activities may not be immediately practical in Nigeria
due to present level of awareness and lack of political will.
* PLHAs may stand the risk of disclosure of their HIV status
and be ostracized, and may be reluctant to seek help. This
stresses the need for counselling, sensitization of the
communities and enhance the African traditional spirit of
AIDS care, support, and counselling are becoming increasingly
important issues in Nigeria.
They are most effective when based on continuum of care, and
home- based-care needs to be viewed as part of that care to PLHA
and not as an isolated parallel initiative.
Half-way houses, day-care centres hospice care especially in
the cities, and other possibilities should be explored as
appropriate in different settings.
Because of the obvious reasons,
the home-care -gap is widening in areas where home care services
are expanding. Lack of AIDS care standards and protocols and
skepticism among the health workers and community members, of
the effectiveness of care must be broken. A concerted effort
will be required. To facilitate this and coordinate services, a
network including all those involved in such activities, though
difficult, will be essential.
Role of a person living with HIV, in providing care for
others living with HIV:
Human beings are generally are very strange in a sense, that
don't like to be alone in certain circumstances. Specially, when
placed in crisis, they look for others in the similar situation.
Probably to derive some strength in a sense of companion ship.
Its natural to look for others suffering from the same
situational crisis, same with people with HIV, does certainly
NOT mean they others to get infected as well. NO.
It's often observed in our counselling sessions for persons
with HIV, their expression and inclination to meet other persons
Based on that expressed desire, we designed our counselling
sessions to offer introduction and friendship with other HIV
Besides, there are some gray areas in counselling. Not often
discussed, never the less are experienced.
That gray area is a subtle psychological advantage has over
his client, unethical maybe, but natural especially when
counselling is smart mind game, entails skillfully helping the
clients to examine viable alternatives and options. Two people
faced with similar situations tend to help each other better
than when in situation where both are different planes of
crisis. Here HIV serostatus is decimator.
With this idea we started introducing then positive clients
to each other (with obtained consent)
Later we developed the concept of training PLHA in counselling
skills and pastoral care.
It is quiet evident with psychological well being and
disposition, that persons living with HIV have a tremendous role
to play in helping other PLHA with cope with HIV infection.
It further nurture the self potential in the clients, restore
dignity and makes them happy for being able to help others.
Vadeikya and Adikpo are two sleepy towns, 500kms away from
Abuja in Benue state.
There has been overwhelming demand on the home care team to
look after them and the volunteers were not enough and they ran
a risk of developing burnt syndrome. The clients were living in
far places, making frequent and scheduled visits impossible,
because of inadequate transport and hostile weathers.
So, the idea of bringing them together on planned days was
discussed with the clients..
Response was great. The result is to two AIDS self support
groups initiated and nurtured by the missionary sisters in
Mwuese is one such person from that support group.
She has been living with HIV for 5 years. She is a trained
counsellor and pastoral care workers helping others with HIV and
offering them hope and reason to live.
Later they were in trained in workshop in examining income
generation options…they were taught vocation skills
Commonly used drugs to treat the symptoms in people with
Drugs for infections (Antibiotics): (Avoid Sulfa's and any
drugs that is not understood)
Medicines for fever: Aspirin, Paracetamol
Medicines for diarrhea Acute: ORS, antibiotics. Persistent:
adsorbents, antimotility agents
Medicines for skin conditions General: calamine lotion
Bacterial infections: GV gentian violet,
potassium permanganate, hydrogen peroxide.
Yeast infections: gentian violet, ketoconazole, nystatin,
clotrimazole, potassium permanganate
Medicines for nutritional problems Vitamin and mineral
Medicines for nausea and vomiting Anti-emetics
Medicines for pain Aspirin, Paracetamol, narcotic pain
Medicines for tuberculosis Streptomycin, Isoniazide,
ethambutol, rifampicin, pyrizinamide
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HOME-BASED CARE AND SUPPORT FOR PEOPLE LIVING WITH HIV/AIDS
USING TRADITIONAL HERBAL MEDICINE
TONY ELUJOBA1,4, LOLA IRINOYE 2 AND YEMI FAKANDE3
DEPARTMENT OF PHAMACOGNOSY1 AND DEPARTMENT OF NURSING2,OBAFEMI
AWOLOWO UNIVERSITY, ILE-IFE. STATE HOSPITAL, ILESA3. NIGERIA
As Africans, traditional medicine has been and is still our
socio-cultural heritage for the care of the sick from time
immemorial. Members of the African community, surrounded by
different species of medicinal plants and curative herbs,
practised and are still practising a lot of self-medication
using those herbs. Strategies for home-based care and support
for the People Living HIV/AIDS (PLWHA) can be derived from this
ancestral heritage at very little costs and energy. The major
objective of such a design is to reduce the treatments of the
various opportunistic diseases to a home-based or
community-based or better still, self-based care programmes,
utilising the various advantages that can be derived from herbal
medicines over any known anti-retroviral drugs in current use.
Such an endeavour if successful, would reduce the stress on the
hospital resources. Examples of such medicinal plants, matching
individual opportunistic diseases, are presented together with
suggestive indices for measuring their success. Practical
application and demonstration of this protocol on the
Living-Hope Care and Support Group, a charitable,
non-governmental organisation of PLWHA in Osun state, is hereby
presented to include the development of some pharmaceutically
formulated herbal medicines used for the treatment of
opportunistic diseases in those PLWHA, while recognising all
issues of ethics and human rights.
4Address For Correspondence: Professor Tony Elujoba,
Department of Pharmacognosy, Faculty of Pharmacy, Obafemi
Awolowo University, Ile-Ife, Nigeria.
Presented at the FDA Regional
Conference on Strategies for Combating the Spread of HIV/AIDS in
West Africa at Abuja, Nigeria, June 5-8, 2000.
Traditional medicine is defined
by the World Health Organisation (WHO,1978) to mean the totality
of all knowledge and practices, whether explicable or not, used
in diagnosis, prevention and elimination of physical, mental or
social diseases, handed down from generation to generation
either verbally or in writing. It is said to include all such
medicines and practices that have been used for several hundreds
of years and are still being used without any observed or
recorded adverse effects. Though, we are well aware and familiar
with the existing controversy on traditional medicine as well as
the various limitations of its practice in Nigeria and perhaps
in other countries of the West African sub-region, this paper
will only address the positive relevance of the exploitation of
herbal medicines for home-based care and support for the People
living With HIV/AIDS and will consciously avoid controversial
statements on traditional medicine.
STATEMENTS OF FACTS
HIV/AIDS is currently an incurable disease by western drugs
and there is little or no definite protocol for effective
management of the opportunistic diseases in most hospitals in
several countries of the West Africa sub-region. Traditional
medicine can be said to be a controversial issue among medical
scientists of all makes and forms, probably due to the fact
that, little is known about its potentials in the care of the
sick. However, traditional medicine has been used and continues
to be sought openly or blindly by the People Living With
HIV/AIDS under the alternative therapy everywhere in the world
and more often than not, it is in the desperate bid to search
It is often one of the major
sub-themes for discussion any time there is World AIDS
Conference. The quest for cure and management of HIV/AIDS in the
forests of Africa has since advanced in the East African
countries e.g. Kenya, Tanzania and Uganda as well as in
Cameroon, the eastern neighbour to Nigeria. This has led to
various spurious claims and counter claims while traditional
medical practitioners continue to proclaim proficiency in
HIV/AIDS management with no evidence yet of effectiveness. The
Chinese and the Indians have spent and are still spending large
resources in the search for cure of HIV/AIDS among the
Traditional Chinese Medicine (TCM) and Ayurveda, respectively.
Neither the Chinese nor Indian medicines had yet produced the
most needed cure. Thousands of basic and applied scientists all
over the world continue to have sleepless nights in their
laboratories looking for cure, and no one can say who of the
sleepless scientists would find it? Could the magic drug for
effective management or total cure of HIV/AIDS, not come from
the African bush? It is general belief by the African
traditional medical practitioners that no disease exists in
Africa without an effective remedy somewhere among the trees and
shrubs of Africa. Will a cure for HIV/AIDS come soon or later?
Are we expecting such cure in the same way that the clinical
answer came to the world on syphilis, gonorrhoea, smallpox and
hepatitis? Or, will a cure never come like for many other
chronic ailments such as hypertension, diabetes, asthma which
never got permanent curative management up till today?
ADVANTAGES OF HERBAL MEDICINE IN HIV/AIDS MANAGEMENT
The raw materials for the preparation and formulation of
herbal medicines are readily available within the community and
in the home. Most of the common, O.T.C medicinal herbs are found
naturally in many residential surroundings growing either wildly
or as cultivated plants. Even in rare cases when they have to be
acquired from herb dealers for self-medication, it is invariably
cheap and affordable. Hence the resulting final herbal medicinal
products become low-cost and easy to purchase. Accessibility
remains a very valuable merit of herbal medicine, the
practitioner being resident within the same community and he is
known by every community dweller to be capable of helping in
health and disease state.
It is recalled that a traditional healer is defined by the
World health organisation as a person who is recognised by the
community in which he lives to be capable of providing
healthcare delivery system using plant, animal and mineral
substances as well as such other means. He is readily
approachable and trusted to provide holistic management of
diseases afflicting his people in the community. He is normally
trusted and put in confidence with inherent assurance that the
treatment prescribed would be effective. The herbal remedies
prescribed are happily acceptable to the members of the
community since most of the remedies are culture-based and
socio-culturally compatible. Some of the remedies are culturally
peculiar and identified with specific families within the
community and children in such homes grow with the knowledge of
Privacy and confidentiality are parameters of ethics and
human rights in HIV/AIDS which have defied all solutions in the
orthodox medical setting. An HIV-positive patient has to be in
contact with several hospital departments e.g. haematology, STD
clinic, nursing departments, pharmacy department, medical
records etc and in a short while, every hospital worker is fed
with the information on the sero-positive status of the patient.
On the other hand, in the traditional medical setting, the only
person that knows about the sero-status of the patient may be
the traditional healer himself. Secrets are better confined in
this circumstance and this may further strengthen the reason why
HIV/AIDS patients would prefer traditional medicine. This
health-seeking behaviour is encouraged by the mentality that a
possible cure with less risk of toxicity could come their way
either by design or serendipitiously.
Although, none of the several
cure-claims has been proved beyond any reasonable, scientific
doubt, whether in Nigeria or anywhere in the world, we make bold
to say also that none of the vital advantages enumerated above
can be used to describe any currently available anti-retroviral
drugs. None of them whether singly or as combination medication
is affordable, readily acceptable, accessible or
culture-compatible. The circumstances, which usually have faced
several unethical options and which eventually lead to the
prescription of anti-retroviral drugs, cannot guarantee privacy
or confidentiality among the various health care providers in
STRATEGIES FOR ANTI-HIV HERBAL SCREENING FOR HOME-BASED CARE
In the absence of cure for
HIV/AIDS, it is our opinion that research in Africa should find,
among the thousands of plant species, such herbs that can be
used for the management of the individual opportunistic
infections, so that the infected people can live a relatively
more comfortable life and perhaps with longer life expectancy.
There are many previous studies in the sub-region reporting the
ethnobotanical and ethnopharmacological wealth of our forests
which could be used to select plants for the following
opportunistic diseases: respiratory disturbances (cough), mouth
thrush, gastro-intestinal discomfort, dermatological affections,
fevers and urinary tract infections. Documentations abound in
the literatures on West African plants, their medicinal uses and
properties that would suggest anti-opportunistic activities e.g.
anti-viral, anti-microbial, anti-tussive, anti-spasmodic,
anti-inflammatory, anti-pyretic, analgesic, anti-U.T.I.,
anti-skin rashes and anti-cancer (e.g. Kaposi's Sarcoma). Such
plants, if effective, would be used to manage the diarrhoea,
lower the viral load, reduce persistent fevers, eliminate pains,
remove skin rashes, cure the tuberculosis and coughs, as well as
challenge any other STD infection. Some examples of such plant
species extracted from literature that can be examined as
anti-opportunistic medicinal herbs are presented in Table 1.
SOME HERBS WITH ANTI-HIV INDICATORS
Garcinia kola Heckel (Clusiaceae) Anti-viral/Antimicrobial
Aristolochia ringens Vahl (Aristolochiaceae)
Ocimum gratissimum Linn (Lamiaceae) Antidiarrhoeal/anti-rashes
Alstonia boonei DeWild. (Apocynaceae) Antipyretic/Antimalarial
Cassia podocarpa Guil.et Perr. (Caesalpinoideae)
Zanthoxylum zanthoxyloides Waterm. (Rutaceae)
Heliotropium indicum Linn (Boraginaceae) Anti -
The management success indices
when using such herbal treatments can be postulated to include
increased body weight, physical resolution of signs and
symptoms, reduced frequency of diarrhoea, reduced incidence of
fatigue and depression, lack of gastro-intestinal disturbances,
reduced frequency of skin rashes, absence of respiratory
infections and reduced medical visits for hospitalization.
LIVING-HOPE CARE AND SUPPORT OUTFIT
This is a non-governmental, non-political, non-profit making
but charitable, model of community-based, home-based
incorporating self-care programme for the care and support of
the People Living With HIV/AIDS. It is situated at Ilesa in Osun
State of Nigeria, representing an outfit of the African AIDS
Research Network (AARN, Nigeria Chapter) at Obafemi Awolowo
University, Ile-Ife, Nigeria. The main objectives of the
Living-Hope Care, as contained in its constitution are as
(a). Provision of comprehensive support for those infected
with HIV and the affected, acceptable within the social context
of community in which they live,
(b). Collaboration with governmental and non-governmental
organisations in a bid to provide comprehensive care for the
People Living With HIV/AIDS along a continuum.
(c). Dissemination of relevant knowledge with the aim of
achieving changes in the attitude of the communities around and
outside the state towards giving support for the infected and
In the recent past, the PLWHA have readily participated in
awareness education programmes even at State Assembly levels
with excellent success. With a total of over 120 PLWHA on the
register and close to 30-40% attending the fortnight
clinical/counselling meetings at a time, a purely
community-based, home and self-care setting is practised using
mainly locally-available, low-cost materials including common
herbal medicines. The whole exercise of keeping them together in
such a community and compartmentalized manner, ensuring constant
counseling on safe sexual behaviour, has proved effective as an
additional control strategy in the state. The set-up is also
seen as a potential research laboratory taking cognizance of
strict compliance to all ethical and human right issues
involved. The official careers, most of whom are university
workers and registered members of the African AIDS Research
Network, with multi-disciplinary expertise, include Pharmacists,
Clinicians, STD Nurses, Laboratory Scientists, Community Nurses
and Dental Surgeons.
The Network has since developed
some herbal preparations, pharmaceutically modified to improve
quality, safety and efficacy for cough, mouth thrush, diarrhea,
fever and skin rashes. The Table 2 shows the various
preparations under each of the opportunistic diseases.
HOME-BASED CARE HERBAL PREPARATIONS FOR DIFFERENT
HERBAL/DRUG PRESCRIPTION ROUTE OF ADMINISTRATION
1. COUGH Bitter Kola in Honey(Bitakolin Syrup) Oral
2. MOUTHTHRUSH Bridelia mouthwashCashew Nut ChewingStick Oral
3. DIARRHOEA Ocimum infusionGuava infusionMormodica infusion
4. SKIN RASHES Aloe vera gelCassia alata concentrate Topical
5. LOSS OFAPETITE VitaminsFruit meals Oral
6. GENERALWEAKNESS Rest/HaematinicsFruit meals Oral
7. FEVER Antipyretic analgesicsHerbal anti-malarials Oral
8. U. T. I. Antibiotic Oral/Parenteral
One of the preparations (Ocimum
gratissimum) for management of opportunistic diarrhea, was
investigated scientifically and has led to a fairly formulated
emulsion which is expected to be more active than the currently
used Ocimum gratissimum infusion, when all safety assessments
had been undertaken and is found to be safe for human
consumption. This also serves as a typical example of drug
discovery from traditional medicine and the results have since
been accepted for publication in a learned international journal
We, in the African AIDS
Research Network (Nigeria Chapter), believe that traditional
medicine has a role to play in the effective institution of
home-based care for HIV/AIDS in the sub-region of West Africa
even if the services are limited to the treatment of
opportunistic diseases using locally-available, low-cost
materials. The present non-availability of cure for HIV/AIDS
ought to be a great challenge to every medical and basic
scientist in the sub-region. This should then lead us to
persuading our governments to invest in drug research on the
medicinal plant flora of the sub-region as an additional
way-forward in our fight against HIV/AIDS pandemic. Let us
congesture that the answer can be found in our forests,
therefore pursuing the challenges with adequate scientific
procedures, compliance to fundamental scientific guidelines and
protocols as well as to unchallengeable ethical obligations. Our
success in providing the sub-region (in particular) and the
whole world (in general) with local medications that would
effectively address the individual opportunistic diseases and
probably with lower viral load, would have reduced the stress on
hospital resources, increasing the life expectancy of PLWHA,
thereby reducing the menace of HIV scourge to a more, manageable
chronic disease as well as standing the chances of serendipitous
discovery for the cure of HIV/AIDS in the sub-region!
The authors wish to thank the African AIDS Research Network
(Nigeria Chapter) for encouragement and for individual members'
financial contributions towards this cause and greater gratitude
goes to the Foundation for Democracy in Africa (FDA) for the
opportunity given to one of us (Professor Tony Elujoba) to
attend this conference.
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SOCIO-ECONOMIC IMPACT OF HIV/AIDS
IN THE AFRICAN SUB-REGION
PASTOR (MRS) PAT U. EKOH
A SYMPOSIUM PAPER PRESENTED AT THE FOUNDATION OF DEMOCRACY WEST
AFRIC REGIONAL CONFERENCE ON HIV/AIDS,
ABUJA, FCT, NIGERIA
JUNE 7, 2000
IMPACT SYMPOSIUM 4
SOCIO-ECONOMIC IMPACT IN THE SUB-REGION
PRESENTER: PASTOR (MRS) PAT. UGONMA EKOH
STATE OF THE ART
Since the Conference opened on Monday, Epidemiological survey
issue of HIV/AIDS prevalence has been extensively discussed and
to cap it up, Dr. Desalu gave a very comprehensive data on the
State of the Art and this presentation will not want to
duplicate this aspect. However, some epidemiological information
that has to do with the economic impact of HIV/AIDS pandemic in
the sub-region will be worth mentioning.
Some sero-prevalence survey in Africa has shown that Zambia
has nearly four-fold increase in AIDS - related deaths of
employees under 45 years between 1989-1992, Ugandan in the
1990's had the loss of potential productive years of workers
between 20-49 triple by 12% from 1989 according to WHO report on
AIDS. Abidjan, Cote d'Ivoire moved from 1% in 1986 - 10% in
1991. As we have heard, Nigeria has about 2.6 million adults
between 15-49 years infected with HIV/AIDS.
With these facts before us, we do not need any one to tell us
again that those who society depend on to score a plus are being
snatched away from the society. 90% HIV/AIDS victims are among
adults in prime working years. Assessing the socio-economic
impact of the pandemic is important because a knowledge of this,
widely circulated and disseminated to every sector of the
society will remove the habit of most nations in the sub-region
trying to bury their heads in the sand oblivious of the
impending doom awaiting the Generation Next. We should not be
like a rock in the midst of a lake that does not know the sun's
hotness that is scourging the land.
I am quite optimistic that the
government will react with speed, if the peace/stability/lives
of citizens are being threatened by war. Tanks and missiles will
be promptly rolled out to contain the force. It is time for all
stakeholders to respond with same speed as at during war
The impact of HIV/AIDS in this presentation will focus on
Family, Public Sector and the Society at large.
FAMILY - The impact of the disease on the family starts from
when a member is diagnosed HIV positive. There is a lot of
emotional stress, anger, distrust and casting of blames. It is a
trying moment and most people will rather keep mute than
disclose their HIV status to their spouse. There was this case
in Nigeria in 1999 where a 419 doctor - that is fake doctor,
played on a man who, kept visiting the hospital for an ailment
he couldn't understand. The fake doctor convinced him to do a
secret test which he conducted. After sometime, he came back
bringing a positive HIV report from a doctor in LUTH for him. He
promised managing the case also. Due to ignorance, the man gave
in. On weekly bases, he took money from this man and gave him
some injections. At a point the man in question couldn't pay
anymore after he had sold all his household properties. He then
decided to inform the wife, he was tested more properly but was
found negative. Imagine his stress, the finances, the estranged
relationship etc that he went through during this period in
An announcement of being HIV
positive can ruin happy marriage relationships. Apart from this,
members of the family will spend huge amount of family income in
managing the situation. The cost of management is sometimes more
than five times the workers salary. Before the worst happens,
poverty will have taken a greater toll on the family. When
eventually death strikes, both parents, children become orphans
and the extended family might not be able to cope. Child labour
will increase, and most of them become really vulnerable to
contacting the diseases from their male customers who entice or
even rape them. The children left behind who might not be able
to fend for themselves will add to the number of miscreants in
the society. The impact is much and we can go on and on without
PRIVATE AND PUBLIC SECTOR
HIV/AIDS is the greatest challenge facing African's business.
The pandemic threatens health and stability of the work force.
HIV/AIDS is seen to be claiming the best entrepreneurs, managers
and technical specialists. It increases the cost of doing
business apart from causing illness and death of employees. This
is so because when trained and experienced skilled workers are
affected and can no longer work due to ill health, the employer
will have to train new hands adding to the cost of training.
Employers are also going to be faced with the burden of health
care of affected staff, pay death benefits, pensions and other
The impact is also seen in
decreased productivity, as workers are absent, or away to take
care of sick relatives or attend burials. Also because the
majority of productive members of the society are sent out of
work by the pandemic, then fewer people will have the resources
to purchase goods. Let us try to quantify these impacts in
monetary terms. A typical company in Kenya was estimated to have
incurred an average annual loss of KSH 1.9 million to HIV in
1994, I am sure Nigerians situation will be higher than this, if
such research is also conducted.
IMPACT ON GOVERNMENT
The impact of the Epidemic on
government is also overwhelming. The disease is taking its toll
on the provision/delivery of effective health care. The hospital
beds are being taken over by a great number of patients
suffering from HIV related symptoms. The total cost of managing
one AIDS patient is put at $327.55 and $588.0 when this is
multiplied to accommodate the 2.6 million people already
infected, the nation will be spending between $851,630,000 -
$1,528,800,000. The total budget for health sector cannot take
care of this.
PROBLEMS AND LIMITATIONS
Knowing the impact of HIV/AIDS pandemic is the first step but
there are a number of factors that limit this knowledge being
properly translated into workable policies thereby making impact
assessment a bit difficult.
One, Epidemiological data -
Generating accurate epidemiological data is a bit difficult. For
instance there should be a sero-prevalence surveillance in the
work place, this will give accurate picture of this impact in
monetary terms to awaken employers and government from their
non-activity and make them to act promptly.
Second, there is a problem in monitoring and Evaluation.
There is a strong need to monitor and evaluate actions already
taken at different levels of intervention to ascertain their
strength and weakness so this can stand for a future frame-work
for further intervention. This is a strong area of problem,
there is limited funds for NGO's and the Government to do this.
If this is not done our progress will be very slow.
Thirdly - Testing is very expensive for government, employers
and individuals. This makes it a bit difficult for a vigorous
action and more positive response in this area. Also the fact
that there is no cure yet makes it difficult for individuals to
be motivated to go for test. When we do not have accurate
information on who is affected, the impact will not be fully
felt and controlling the spread will be difficult.
Lastly, the claim that there is
a cure for AIDS at a time, this claim has not been fully
ascertained will increase risk behaviour. People are made to
have false hope. The negative impact of this little result that
has been achieved in combating the pandemic will be serious.
RECOMMENDATIONS AND SUGGESTIONS
In order to reduce the impact of HIV/AIDS, I recommend that
Epidemiological data should not only be done to generate data
for statistical purposes, but this data should be converted to
people. We should do test that can identify the individuals,
follow-up on them through counseling and make arrangement for
their care and support. Generating data from the work place can
be done anonymously as is being done for ANC. Employers can make
genotype and blood group testing mandatory. The blood samples at
the same time could be use to test for HIV/AIDS.
Since the private sector is being affected in terms of
profitability and productivity, they should get involved in
funding, educating their staff and in support and care
programmes. They have been involved in funding Education and
Sports, they should also be encouraged to give towards combating
A good care and support package should be put in place for
PLWA. If there is a good welfare package that will include
housing, upkeep of victims and families, many more people will
come out to be tested and in the Nigerian set up, I am sure some
people who are not, will even want to claim to be so as to enjoy
the package on the ground.
Thank you and God bless.
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AIDS AND DEVELOPMENT:
THE SOCIO-ECONOMIC IMPLICATIONS OF THE HIV/AIDS EPIDEMIC IN
BY DR. A. ARKUTU
By some estimates, nearly 200 million people in SSA, slightly
more than one third of the entire population of the region, have
been directly affected by the HIV/AIDS epidemic. They include
the 12 million men, women and children who have already died of
AIDS, approximately 22 million currently living with HIV/AIDS
and their dependents. But what impact has the epidemic had on
the demography, health and economic and social development of
the countries of the region? What does the future portend and
what lessons can we in West Africa learn from the experience of
the nations to the East and South of the sub-continent?
The HIV virus is thought to have crossed from chimpanzees to
humans somewhere in the Democratic Republic of the Congo 50 or
60 years ago. The disease was first recognized in the United
States in the early '80s. By the late '80s and early '90s,
however, East Africa had become the epicenter of the spread of
HIV/AIDS in SSA with Uganda, Tanzania and Kenya the most
affected. In the mid to late '90s, concentration of the epidemic
shifted to Southern Africa, notably Zambia, Zimbabwe, Malawi and
more recently, Botswana, Namibia and South Africa. West Africa
has been relatively spared, with only Cote d'Ivoire, Benin,
Burkina Faso and Guinea-Bissau being classified as having a
generalized epidemic with more than five percent of the adult
Research on the socio-economic impact of the HIV/AIDS
epidemic began only in the early '90s. Most of the studies were
conducted by various multilateral as well as bilateral
organizations including UNDP, UNESCO, ILO, UNAIDS, The World
Bank, USAID in collaboration with national research institutions
and individuals. Naturally, to date, most studies have focused
on the Eastern and Southern African countries where the epidemic
was concentrated. The findings and lessons learnt from the
results of those studies are, however, relevant to West Africa
because apart from the severity of the epidemic, social,
cultural and economic conditions are remarkably similar. West
Africa has much to learn from the experience of her neighbors to
the east and south.
Cumulatively, 12 million people have died from AIDS since the
epidemic became established in SSA. Three times as many people
are currently living with HIV/AIDS and an estimated 4 million
Africans are newly infected each year. All these people, mostly
young adults and children, will die within the next 10 years or
so. HIV/AIDS will thus cause a significant rise in the Crude
Death rate in nearly all African countries where more than five
percent of the adult population is infected. Infant and child
mortality rates in severely affected countries will rise by 50
percent more than would have been the case without HIV/AIDS.
The World Bank, the US Bureau of the Census and the
Population Division of the United Nations have analyzed
demographic data using different methodological techniques and
assumptions in order to estimate the likely impact of HIV/AIDS
in countries most affected by the epidemic. There are
significant differences in their findings but there is general
agreement that many countries in SSA will experience net losses
in numerical terms due to HIV/AIDS. For example, Nigeria had an
estimated 1.1 million fewer people in 1997 than it would have
had without HIV/AIDS. Similarly, there were 900,000 fewer people
in South Africa and 1.6 million fewer people in Zimbabwe. The
Population Division of the U.N. in its 1999 report "The World at
Six Billion" revised its long-term population projections for
countries in SSA taking account of the status of the HIV
infection in each country. While severely affected countries
will suffer significant reductions in the size of their
population over the next two decades, no country is expected to
experience negative population growth as a direct result of the
epidemic. The impact of HIV/AIDS on fertility and population
growth rates, both of which remain high in SSA, will not be
great enough to produce the negative growth predicted and feared
by many international and African commentators.
Life Expectancy at Birth
Life Expectancy at Birth is a much more reliable measure of
the health status and well being of a population than GNP or
GDP. In the first twenty years following independence, African
countries made huge development efforts and invested heavily in
health, education and other social services in a determined
effort to raise the living standards of their people. As a
result of improvements in the availability of health services
including child immunizations, the control of communicable
diseases, improved nutrition and sanitation and education, life
expectancy increased by 15 to 20 years by the mid-'80s in most
countries. This represented one of the few concrete achievements
of the post-colonial era.
The HIV/AIDS epidemic has wiped out the hard won gains in
life expectancy and reversed the trend in several countries. Of
the eighteen countries in SSA classified as having a generalized
epidemic, all except Togo, have experienced declines in life
expectancy between 1990-1995. Life expectancy in Burkina Faso,
currently estimated at 46, is 11 years shorter than it would
have been without HIV/AIDS. The World Bank estimates that in
nine African countries with infection rates of more than 10
percent of the adult population, HIV/AIDS will erase 17 years
from the life expectancy meaning that instead of reaching 64
years, by 2010-2015 life expectancy will only be 47 years.
Examples include Zimbabwe, Botswana, Uganda and Cote d'Ivoire.