Education + Advocacy = Change

Click a topic below for an index of articles:

New-Material

Alternative-Treatments

Financial or Socio-Economic Issues

Forum

Health Insurance

Hepatitis

HIV/AIDS

Home

Institutional Issues

International Reports

Legal Concerns

Math Models or Methods to Predict Trends

Medical Issues

Occupational Concerns

Our Board

Religion and infectious diseases

State Governments

Stigma or Discrimination Issues

 

If you would like to submit an article to this website, email us at info@heart-intl.net for a review of this paper

any words all words
Results per page:

“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

    


Situation Analysis Report on STD/HIV/AIDS in Nigeria
http://www.nigeria-aids.org /    

Acknowledgement

The present Situation Analysis for STD/HIV/AIDS is the result of the work of many individuals and teams working under the leadership of the Hon. Minister of Health, the chairmanship of Prof. G.C Onyemelukwe who led the Team setup by NASCP and the Chairmanship of NACA.

We would like to commend the political commitment of President Olusegun Obasanjo, who is constantly lobbying for actions to be undertaken in the field of STD/HIV/AIDS for Nigeria, and who isclosely following the preparation of the Strategic Plan that will bring an expanded national response to the fight against the epidemic in the country.

We would like to thank the Hon. Minister of Health for his determination in sharing the Strategic Plan vision with his collaborators, and particularly in making multisectorality a reality.The situation analysis is the picture of what is happening in all the various fields and sectors involved in the alleviation of the HIV/AIDS epidemic in Nigeria, and not only in the health sector alone.

Our thanks also go to the Honorable Ministers of Information, Employment, Labor and Productivity, Culture and Tourism, Planning, Women and Youth, Education, Finance, Internal Affairs Agriculture and Sports, PLWHA, Governors of all the states, Commissioners of Health in all states, Chairmen of local governments, NGOs,
We would like to thank in particular the teams who have been working, sometimes under difficult situations, at States and local government levels to gather

The support at field levels are greatly appreciated, and our thanks go to all the persons whoaccepted to help, we unfortunately cannot enumerate all of them.

We also appreciate the contribution of DFID, WHO, UNICEF,USAID staff, who supported the various teams and also UNAIDS for their support of the revision of the situation analysis.
The situation analysis here presented will be widely distributed in order to obtain comments from all developmental partners at state, zonal, national and international levels. We therefore thank all those who will read this situation analysis

Prof. Ibironke Akinsete
NACA Chairman


Executive Summary

The situation analysis shows that STD/HIV/AIDS has unfortunately not been sufficiently addressed in the past decade. This is due to:

  • Unstable political situation in the country.
  • Lack of political will, commitment and involvement
  • Competing priorities in other areas.
  • lack of multisectoral approach as major interventions so far are in the area of healthcare delivery.
  • Centralization of the program, with little involvement of States and local governments.
  • Despite excellent intentions, programs are donor driven and often not sufficiently coordinated. Mostly “project oriented “ activities with little program approach Major donors had frozen their assistance for long periods of time
  • UN theme group had little impact during the period under review.
  • little recognition and lack of support for the work done by NGOs and CBOs
  • weaknesses in general planning and programming
  • absence of financial support for STD/HIV/AIDS activities in other sectors except for a minimal budget from the Ministry of Health
  • Weaknesses in management issues and management systems, including Information system management and poor data on the epidemic but also weaknesses in planning, programming, procurement, finance.
  • Insufficient nation wide awareness reflected by weak advocacy and information programs towards general populations and specific at risk groups: youth, women.
  • Persons living with AIDS were reluctant to actively participate in prevention and control activities.
  • The legal system has not been sufficiently adapted to the evolution of the situation, and the ethic committee on HIV/AIDS is not functional.

As a result of all these factors the situation analysis demonstrates that actions in the field of advocacy, information and awareness development have been scanty, and this has led the population to feel that STD/HIV/AIDS is not a major problem concerning them.In addition, AIDS is still regarded as a health problem and therefore is not sufficiently focused on behavioral change communication targeted at all Nigerians which would result in health seeking behaviors leading to early testing, and early treatment.

The available data, which is mostly based on sentinel surveys of adult pregnant women, shows that the sero prevalence rate for adult women is 5,4% as compared to 1.8% in 1992.

The situation analysis shows that:

  • There are indeed some weaknesses in the data as presented.It is mostly based on the sero prevalence of pregnant women. Infected women tend to have a lower chance of becoming pregnant, and therefore do not automatically frequent antenatal clinics where the surveys are taking place. Little data is available concerning youth, and pediatric HIV infection rate. Few other sero prevalence studies are available in other groups e.g. male adults with the exception of scanty data on the military and prisons.
  • Information concerning incidence rates is extremely scarce.  The voluntary screening centers are still very few in the country, and besides the private sector, which is widely developed in Nigeria, does not share its data with the Public sector.
  • The association of STDs with HIV has not been sufficiently addressed throughout the period, and STD control (early detection, and early treatment) has been neglected as an essential part of the response to fight HIV.(Data on STD is scanty).
  • A substantial amount of planning has been undertaken, but what often fails is that these plans have not been implemented in most cases.Examples are numerous: for years Nigeria has worked on Blood safety guidelines, including how to ensure a National Blood Transfusion service, how to screen the blood to be transfused for HIV, Syphilis, and Hepatitis B, but while plans exist for the past years they still have not been implemented. Other examples can be cited: guidelines are available in almost all fields, but they are often not distributed or else the training of staff to utilize them is not undertaken.

The situation analysis has identified these fundamental weaknesses: 

  • All linkages to health have been unsuccessful because there is a weak primary health care system. It shows that it has hindered even actions in the field of voluntary testing: Why tell a person that he is sero positive if the PHC back up cannot provide the essential support.
  • Past actions in the MTP l and ll have been project and action oriented instead of program oriented. The links between all these projects and actions were not evident.
  • Financial allocations have never been sufficient to support MTP I and MTP II
  • Past actions have lacked coordination – Most partners do what they want where they want, and this includes NGOS, CBOs and International organizations, the Private sector, etc. Past actions have lacked adequate monitoring and evaluation. Little is known about where one is starting from and of course it is difficult in such conditions to measure the results of any activities.
  • Much has been done, but with little impact as there have been insufficient efforts to share information, network and document information.
  • The medical field is far more advanced in reporting what is going on (although as mentioned above there are still lots of weaknesses) than the other sectors.  In particular the social, economic and cultural sectors are not sufficiently involved. There is lack of behavioral, cultural and economic impact studies. Information about youth, women, labor force, the informal sectors, children in and out of schools, women and men working in the informal sector, are lacking.
  • NGOs and CBOs work has not been sufficiently documented. This is one of the gaps that will have to be addressed.
  • States and local government are not sufficiently aware of what is going on in their territories in terms of STD/HIV/AIDS alleviation, and they are not sufficiently sensitized to the importance of undertaking multisectoral approaches to fight the epidemic.

Besides this long list of obstacles, many opportunities have been detected at multisectoral levels. The analysis of the response will demonstrate if these opportunities have been sufficiently taken into account. Some of these are:

  • The recent commitment at the highest level and shared vision by government leaders under the new expanded National response initiative.
  • The Government’s determination to support a Multisectoral approach
  • The Government’s determination to involve a new Multisectoral Presidential Committee on AIDS (PCA)
  • The Government’s determination to support a new Multisectoral committee on AIDS (NACA) and to make sure that they have the personnel, the space and the financial support to execute the program.
  • The Government’s efforts to establish a National response through the Strategic Plan.
  • The willingness of the Ministries and political bodies (Senate, House of Representatives) the organized Private sector, NGOs, PLWAs to join and collaborate with NACA.
  • Several reforms in the various sectors to make STD/HIV/AIDS a priority (Education, Health, Women and Youth, Sports, Labor, Finance, Planning, Defense, etc.)
  • Poverty alleviation programs
  • Beginning of Strategic Social Sectors Policies
  • Community response and involvement triggered by the work of NGOs and CBOs. And various peer group associations e.g. youth clubs, artists joining hands, media – net, Journalist against AIDS
  • Social marketing of condoms
  • Information services are reaching more and more communities, and they are adapting the information to their needs, including utilization of local languages (Increasing media response)
  • There is an increasing consciousness among International organizations including donors are becoming more and more conscious that an integrated approach and more coordination is necessary to help the Government, States and Local government develop their national response.

The exercise has demonstrated that Nigeria is now in a position to analyze its past programs with a real desire not to destroy what has been done so far, but to positively criticize it. This is in order to find solutions to the various problems that have been encountered and to utilize all opportunities that have been developed during the period under review. The realities have not been hidden, and that in itself is an immense step forward.

The situation analysis as conducted provides an excellent basis to map out what has been done so far and to spell out what were the difficulties and the opportunities in key sectors. It is essential to conduct the next step which is the analysis of the response which will show why it has not worked, or why it has worked in order to decide on what to prioritize in terms of efforts. What is working can be retained while strengthening what was not working so well, and also have the courage to drop all activities, which have hopelessly shown their failure to respond.

Introduction

Nigeria with a population of about 120Million people represents about 1/5 of the total African population. The result of the recently concluded November 1999 Sentinel Survey indicated that 5.4% of the adult population, which represents 50% of, total population are already infected with HIV. This means that 2.6 Million adults are living with the HIV (SOURCE, See Bibliography).

Nigerians in policy and academia in the early eighties denied the presence of HIV infection in Nigeria, which probably delayed the country from quickly, and appropriately reacting to the surging wave of the epidemic as was done in many other African countries. The first case of AIDS was reported in Nigeria 1986. Since then the trend has been on the increase as shown on fig 1-5.

The most severe impact has been on adults in their sexually active and economically reproductive years that is (15 – 45 years of age).

In certain areas like Enugu State, the mean HIV prevalence had increased from 2.3% in 1995 to 16.8% by 1999, an increase of more than 700%. Similarly eight other areas in the country had HIV prevalence rates greater than 10 percent.

The socio-economic impact of this epidemic on the Nigerian society has not been documented but it is becoming apparent that the already fragile health care delivery system is being overloaded. There are also more reported cases of monoparental families and orphans. Furthermore the Nigerian population continues to increase at an alarming rate of 2.83% or more. Hence, the projected impact will have disastrous consequence on the population of Nigeria and ultimately of Africa and the world. Despite all these, the Nigerian populace still continues to deny the existence of the disease.

HIV/AIDS/STD control program structures exist in the states and LGA but are confined to the Health sector alone. Although, many other partners have been involved (NGO, CBO, Religious organizations, Bilateral and multilateral organization), co-ordination of these efforts were weak and the program were very much donor driven and project oriented.

Objective of the Situation Analysis 

The overall objective of this situation analysis conducted in Nigeria was to understand the background factors that will help developmental partners, government (National, State and LGA and Communities) identify the most important areas for action to be developed in the strategic plan and budgeted plans of action. The specific objectives were as follows:

  • Identify who is vulnerable to STD/HIV/AIDS and why.
  • Identify the most serious obstacles that affected the implementation of STD/HIV/AIDS control and prevention activities in the country.
  • Identify the most promising opportunities for expanding the response of Nigeria to the epidemic.  
  

Scope 

The scope of the situation analysis was to have a total picture of what has been done so far in the whole country, which involved developmental partners in this exercise. It also involved obtaining data and documentation of STD/HIV/AIDS on-going activities over the period. Research 

Methods and Approaches

Methodology 
Nigeria has 36 states and FCT with 774 LGA and communication systems are difficult. Also because the budget to support the strategic plan formulation was limited, the following methodology was chosen: 

  • Advocacy meetings with Federal ministers, governors, commissioners, heads of hospitals, traditional / religious leaders and professionals associations. 
  • Focus group discussions with youths, NGO, CBO and the organized private sector.
  • Questionnaires (quantitative and qualitative) to the general public, sex workers, hoteliers, laboratory scientist, heads of hospital, religious, traditional leaders and traditional healers, and NGO.

The multisectoral and multidisciplinary committee which carried out the situation analysis under the direction of NASCP, were representative of the following institutions:

  • States ministries of health
  • Federal ministries (Health, education, labor, defense, information, youth, women, sports) planning commission, National population commission.
  • The academia: universities, research institutions, and tertiary hospitals.
  • DFID, UNICEF, WHO, USAIDS
  • Organized private sector.
  • PLWHA
  • NGOs, CBOs

The situation analysis was originally planned to commence in January 1988. However due to various problems including non-availability of funds, it did not start until January 2000. The exercise was conducted over a period of 8 weeks.  

Due to the short period for this exercise gaps have been identified and will be addressed in the strategic planning exercise and will be effected in the strategic planning activities.

Other limitations were insufficient time for training of all participants including members of the committee as well as poor utilization of guidelines. (UNAIDS Strategic Plan Guidelines)

Detailed Methodology

The various approaches included:

  • Formation of field teams.
  • Development and production of 15 sets of questionnaires for different target populations (Laboratory, Policy makers, Healthcare workers, General public, PLWHA, Traditional healers and Leaders, CSW, Hoteliers, Prisoners, NGOs, CBO SAPCs).
  • Training was minimally carried out for the field workers while the team leader carried out supervision. No pre-testing of the questionnaires were done as a result of the short time frame for the fieldwork.
  • Memoranda were invited from the general public through newspaper advertisement (New Nigeria and the Punch Newspapers); NTA and Federal Radio Coperation of Nigeria. Invitation letters were also delivered to The President of Nigeria Labor Congress and its 15 unions, including Health workers and NECA
  • One day visit per state
  • Random sampling of target population.
  • During the field visits data was collected through the following means: Direct administration of Questionnaires, Observation equipment, IEC materials, inferences drawn from Advocacy meetings with the Governors, community and Traditional Leaders; Moderation of FGD, in-depth interviews. Team members served as interviewers, reporters, moderators and key players in advocacy meetings. Where applicable tape recorders were used by the groups to record discussions.
  • Direct assessment of laboratory equipment, kit stock, equipment, personnel etc was also done to gather information. 
  • The Staff of the secretariat of the AIDS Control Program were also used to assist in the data gathering process in each of the states. Evaluation process in the states involved situation and response analysis, which include the structure at the state and local Government, secondary and tertiary institutions and other facilities.
  • Team group were created to undergo situation analysis – the states level and LGA (See annex for constitution of the team).

Data Entry and Analysis

Quantitative and qualitative data were obtained. A team composed of an Epidemiologist and a Computer Analyst was constituted to analyze data obtained from questionnaires and the focus group discussions. The data was managed using MS Access and MS Excel. The results of the analysis were disseminated amongst the members of the Central Evaluation team and modified in line with the comment of the teams. A report was produced in limited quantity for the perusal of the Minister of health. Further work is being done in order to present this result for wider distribution locally and internationally.

Analysis of the situation in key areas 
A decision was made to collect information in the following key areas: 

  • Safe sexual behavior
  • STD management
  • Blood safety
  • STD/HIV/AIDS prevention in young people
  • STD/HIV/AIDS prevention in women
  • Care and support at Federal, state and community level
  • Labor force
  • Sexuality education
  • Psycho social help and counseling support
  • Human rights and ethics
  • Research

In addition some cross cutting issues were studied e.g.

  • Management
  • IEC
  • Monitoring and evaluation
  • Partnerships
  • Funding
  • Multisectoriality
  • Community involvement

Needs: Safe Sexual Behavior

Obstacles

Opportunities

  • Continued Denial of the existence of AIDS.

Education

  • Limited information in local languages
  • Limited information on STD/HIV/AIDS
  • Limited use of local channels of communications
  • Absence/limitation of sexual education in schools
  • General low enrolment of children at primary level and even higher in secondary and tertiary schools.
  • Girls attendance in school still low
  • Ignorance and illiteracy
  • Poor media interest and development

Culture

  • Negative cultural factors
  • Influence of religious factors
  • Youth cannot speak about sexual behavior with parents, teachers and they cannot publicly mention the subject
  • Myths and misconceptions and very strong beliefs of cures about STDs in general
  • Male sex behavior dominance
  • Sex freedom and acceptability of sexual behaviors such as multiplicity of partners, early sex, early marriages, child marriages, wife inheritance when widowed, etc.  Youngsters have sex early resulting in many teenage pregnancies.
  • Social sexual networking

Social behaviour

  • Indifference shown to STD/HIV/AIDS by population in general and youths in particular 
  • Lack of perception of risks especially among youths.  
  • Prostitution  
  • Poverty / affluence attraction to sex  
  • Social pressures and peer examples  
  • Crime  
  • Lack of data on Homosexuality.  

Condom  

  • Lack of counseling and VCTs  
  • Non acceptance of condom  
  • No female condom  
  • Low availability of condom  
  • Poor quality of Condom  
  • Cost of condom.

Education

  • Curriculum for integrating STD/HIV/AIDS developed (1998) but not yet implemented   
  • Plan to bring sexuality education into schools. But not yet put in place   
  • Availability of communication channels at local levels   
  • Efforts to raise attendance especially of girls in primary schools.   
  • Media involvement   
  • National video counseling board – multisectoral   
  • Advocacy targeted at government at all  levels.   
  • Sporting events   
  • Private T.V Stations  

Social behavior   

  • Poverty alleviation program   
  • Involvement of NGO’s CBO’s and Religious organizations.

Condom   

  • Social marketing of condoms  

Political Commitment

  • Political commitment at the highest level.

  

Needs: STD MANAGEMENT

Obstacles

Opportunities

Early Detection

  • Not sufficiently integrated into PHC 
  • Lack of information about where to go for diagnosis Lack of information about 
  • STDs among population 
  • Fear of Stigmatization 
  • Lack of confidentiality at health services level Inadequate facilities at all levels of diagnosis 
  • Cost of investigation 
  • Non/poor availability of laboratory facilities for diagnosis 
  • Lack of relevant skills for laboratory detection 
  • Competition with alternative medical practitioners 
  • Insufficient number of Health workers 
  • Poorly distributed personnel Vulnerability of women 
  • Unavailability of data systems and poor management information system. 
  • Absence of information on private sector 
  • Lack of youth friendly services 
  • Paucity of relevant drugs 
  • Private sector may not follow norms and guidelines 
  • Difficulties in the application of syndromic guidelines 

Early Treatment

  • Cost of care Self medication 
  • Poor availability of drugs 
  • Competition with quacks 
  • Use of street/expired/fake drugs 
  • Non compliance with treatment and self medication Poor availability of treatment guidelines 
  • Poor distribution of available guidelines 
  • Lack of appropriate skills for treatment Inaccessibility to PHC facilities in some areas 
  • STD treatment assigned to special clinics Ineffective procurement of drugs 
  • No information on cost/practices of private sector 
  • Stigmatization 
  • Cultural beliefs 
  • Poor management of staff 
  • High turnover of trained staff 
  • Poverty (Staff and Clients) 

Epidemiology and Prevalence

  • Poor Management Information System on STD 
  • Institutional diagnosis and management systems of STIs are not available 
  • Information sharing between Public and Private sectors non-existent.

Counseling and information

  • Paucity of counseling service/personnel at all levels 
  • Poor utilization of condoms and counseling facilities 
  • Limited number of trained counselors at all levels 
  • Poor patronage of available facility 
  • Limited use of available counseling services due to stigmatization.
  • Routine syphilis test for ANC
  • Available, recently reviewed guidelines on Syndromic management
  • Ongoing strategic plan on STD/HIV/AIDS
  • Renewed strength for PHC
  • Renewed strength for NHMIS
  • Availability of NGOs, CBOs and religious organization
  • Media favourable to HIV/STD problems
  • Existing essential drug list
  • Cost recovery system through drug revolving fund. Helping to lower the cost
  • Existing curricula in training institutions.
  • Early manifestation in Men leading to search for help.
  • National Health Plan



Needs : Blood Safety

Obstacles

Opportunities

  • National policy not yet implemented   
  • No legislation to back up policy   
  • No national blood transfusion services   
  • Uncoordinated services at state level   
  • Uncoordinated/ unsupervised private/ public laboratories   
  • No application of norms by blood bank   
  • Inadequate number of trained personnel   
  • Lack of supervision at all level   
  • No standard operating procedure   
  • Lack of information and education on risks to public 
  • Cultural and religious factors that impede blood Alternative Treatments.   
  • Lack of voluntary non remunerated blood donor system   
  • Non sustainable supply of consumables and reagents   
  • High cost of processing blood for transfusion   
  • Lack of blood substitute.   
  • Lack of blood components   
  • Lack of facilities to prepare blood components.   
  • No standardized pricing system   
  • Poor storage facility (Cold chain)   
  • Poor packaging   
  • Short expiry dates – reagents   
  • Too many unnecessary transfusions prescribed (Anaemia - very common in women and children, Malaria, Sickle Cell)   
  • Poor political and financial commitment
  • Availability of private laboratory (When coordinated/supervised)
  • Known prevalence of HIV due to transfusion
  • Edict in Lagos state against blood transfusion not screened
  • Availability of private blood banks
  • Existing institution/curriculum for training
  • Interest of donor (DFID, WB, WHO, EU)
  • NGO “blood for life” in Lagos
  • Availability of documents – workshop carried out e.g. appropriate use of blood.
  • Year 2000 WHO day theme – Safe Blood
  • Autotransfusion
  • Lagos and Oyo states have semblance of state level transfusion services.

 
Needs: Youth

Obstacles

Opportunities

  • Inadequate and non implementation of policy on integration of STD/HIV/AIDS into school curriculum  
  • Many children and youth not in schools  
  • Inadequate sensitization of policy makers and implementors  
  • Inadequate funding of youths – related 
  • STD/HIV/AIDS programs  
  • Negative attitude of parents to sex and sexuality issues  
  • Religious organizations attitude towards sexuality education  
  • Inequality of opportunity for education between boys and girls  
  • Poor role models of adults in society  
  • Early marriage for girls  
  • Poor perception of risks of STD/HIV/AIDS  
  • Negative peer pressure  
  • Influence of pornographic materials  
  • Non implementation of censorship policy (videos, films)  
  • Lack of youth friendly health care services – counseling facilities  
  • Economic factors – desire to get rich quick Increasing drop out rates in school  
  • Poverty Sexual harassment/abuse in school  
  • Hawking  
  • Increasing prevalence of street children and area boys  
  • Declining moral standards Increasing moral decadence  
  • Easy access of youth to alcohol, drugs, bars, nightclubs, etc.  
  • Decreasing parental supervision of youths  
  • Poor recreational facilities for youths  
  • Non implementation of laws and rights of children/youths  
  • Increasing unemployment  
  • Lack of social welfare package  
  • Increasing indiscipline in the society 
  • Misplaced priorities  
  • Paucity of channel of information targeted at youths  
  • Increasing IV and non-IV drug use among youths.
  • Sexuality education policy  
  • Poverty alleviation program 
  • Creation of jobs 
  • Availability of laws to protect children 
  • Introduction of UBE (Universal Basic Education)   
  • Existing institution
  • Availability of religious and traditional institutions   
  • Family life education in schools
  • Existence of youth clubs and associations
  • Availability of youth friendly club and societies.

 

  


Needs: Care and Support

Obstacles

Opportunities

EARLY DIAGNOSIS

  • No facility for VCT 
  • Expensive cost of diagnoses Inadequate facility for diagnosis  
  • Poor health sector beheviour for prevention and diagnosis  
  • Paucity of reagents and consumables  
  • High cost of screening  
  • Poor quality control of testing  
  • Donor apathy in  care and support  
  • Care and support not linked to prevention  

COUNSELLING  

  • Inadequate facilities for pre/post test counseling  
  • Inadequate skills of health care providers  
  • Inadequate number of social workers.  
  • Paucity of trained counselor at all levels  
  • Poor selection of trainees  
  • Inadequate peer counselors  
  • Inadequate counseling by people living with HIV/AIDS  
  • Intimidating procedure of the counseling service  
  • Lack of hospital policy  
  • Lack of motivation for trained counselors Inadequate guidelines on counseling  

PATIENT MANAGEMENT  

  • Inadequate facilities at all level.
  • Inadequate trained personnel 
  • Inadequate supply of drugs  
  • High cost of care and support  
  • Stigmatization  
  • Confidentiality not observed and human rights.  
  • Poor referral system at all levels  
  • Lack of logistic for follow-up and continuum of care  
  • Limited funding for home care  
  • Ineffective monitoring and evaluation  
  • Competition with alternative medical practitioners and spiritual homes  
  • Poor reporting system  
  • Poor distribution of existing guidelines  
  • High turnover of trained counselors.  
  • High cost of care and support  
  • Inadequate mobilization of community to support people with HIV/AIDS  
  • Inadequate skills for social workers  
  • Poverty to sustain treatment and appointment.  
  • Increasing prevalence of TB  
  • Increasing number of AIDS orphans  
  • High cost of antiretroviral drugs (ARVD)  
  • Unavailability of ARVD  
  • Non -  control of sale and prescription of ARVD  
  • Lack of training in the usage of ARVD  
  • Lack of monitoring of medical and paramedical  
  • Lack of laboratory monitoring of those on ARVD  
  • Pressure from pharmaceutical companies to sell drugs.
  • Extended family system 
  • Existing training institution for care and support   
  • Existing community based organization, NGOs   
  • Existing manuals (Counseling, home care and case management)   
  • Media involvement.   
  • Political commitment and advocacy efforts   
  • Ongoing strategic planning   
  • The PHC structure (Multi-sect oral involvement)  
  •  Existing health facilities   
  • Association of PLWHA   
  • Interest of donor agencies, DFID, USAID, WHO, Pathfinder   
  • Existing  professional organizations   
  • Poverty alleviation program   
  • Pool of available trained counselors   
  • Increasing community awareness.   
  • TB/Leprosy program   
  • Report of the orphan survey.   
  • ARV on the essential drug list.


Needs: Women

Obstacles

Opportunities

  • Social/Religious status of women
  • Poor access to information and treatment
  • Poor economic power
  • Cultural bias against women
  • Religious bias against women
  • No empowerment – economically, socially, politically
  • No reproductive rights
  • Physiological factors
  • Early marriage
  • Inability to negotiate safe sex
  • Poor education
  • High level of illiteracy of women especially in the northern states
  • Violence – rape abuse of women
  • Migration
  • Rural to urban areas
  • Poor legislation on women’s rights
  • Prostitution
  • No female condom
  • Religious/Social upheavals
  • Poor decision making power in sexual matters
  • Polygamy
  • Wife inheritance and wife sharing
  • Widowhood and inheritance rights
  • Non implementation of laws that apply to women
  • Poor/inadequate reproductive health issues
  • Poor distribution of NGOs especially to rural areas
  • Multiparity and large families
  • Lack of confidence in self and other women
  • Lack of channel of information
  • Women have little time for leisure and information
  • Women community organization
  • Women targeted programmes
  • Ministry of women affairs
  • Religious organizations 
  • NGOs, CBOs, Donors Agencies dealing with reproductive issues
  • More and more gender issues up-coming
  • Head of NACA, Minister of state of Health, Transport
  • Adult education Program
  • Female functional literacy program
  • Educated children
  • Plan to start Social marketing of female condom.


Needs: Labor

Obstacles

Opportunities

INFORMAL SECTOR

  • More than 50% of labor force in the informal sector – no social safety nets for illness and disability
  • Mobility of the informal sector
  • Poor organizational structure Inadequate provision for prevention of STD/HIV/AIDS among staff and workers
  • Poor reporting system
  • Migration of workers
  • Inadequate remuneration
  • Poor education
  • Poor health seeking behavior 

FORMAL SECTOR

  • Managers not sufficiently informed about STD/HIV/AIDS to help in prevention for their staff and workers
  • Little response from management
  • Lack of commitment of management towards STD/HIV/AIDS prevention and control
  • Inadequate welfare package for those with STD/HIV/AIDS
  • Little or no funds committed to STD/HIV/AIDS prevention and control
  • No reporting system to the central data on incidence and prevention rates   
  • Inadequate and sustained  information on STD/HIV/AIDS within the companies
  • Breach of confidentiality of HIV status
  • Mandatory pre-employment screening for HIV
  • Poor implementation of international, national laws on employment and labor
  • Breach of  human rights of HIV positive staff
  • Inadequate provision for care and support
  • Unions not utilized for prevention of HIV
  • Lack of policy on HIV/AIDS/STD in most organizations   
  • Frequent duty travel away from home which exposes them to risk
  • Disposable cash predisposes to leisure activities – alcohol, multiple sexual partners, drugs, casual sex, etc.
  • Poor enforcement of occupational safety and health regulations.
  • Existence of Unions and Associations
  • Training department within organizations
  • Existence of health structures
  • Availability of funds
  • Organizational structure within the sectors
  • Potential to produce STD/HIV/AIDS education materials
  • Existing international and national laws, codes, ordinances
  • Existing social clubs within organizations  
  • Networking among organizations and companies


Needs: Sexual Education

Obstacles

Opportunities

  • Sex not discussed openly in families and with adults
  • Sexual issues are taboos
  • Sex education not well addressed in school curricula
  • Sex education materials insufficiently produced
  • Sex education materials not widely distributed
  • Resistance of parents to introduction of sexuality education
  • Lack of skills of teachers/parents for sexual education
  • Resistance from religious leaders – Islam/Christianity/Traditionalist
  • Low level of sexuality education among school children at all levels
  • Inappropriate peer education on sexuality

CONCEPTION OF EDUCATION (Production, distribution, Dissemination and evaluation)
CONCEPTION

  • Insufficient number of trained personnel at conception level
  • Insufficient material in local languages –  funds for translation of materials in local languages
  • Insufficient trained IEC personnel at all levels  Insufficient training of staff
  • Lack of equipment, inadequate facilities for production of IEC materials
  • Inadequate  information sharing between different sectors
  • No supervision and regulation of quality and relevance of materials produced
  • Insufficient facilities to evaluate conception programs
  • Not all the sectors are covered in the conception
  • No supervision and regulation of quality and relevance of materials produced  

IEC PRODUCTION  
(Lack of Production Facilities)  

  • Inadequate funds for production of materials Inadequate quantity of materials produced due to lack of funds  

DISTRIBUTION

  • Difficulties with distribution of materials to states and LGAs due to inadequate funds, poor communication and networks
  • Poor logistics
  • Poor organization of distribution at all levels
  • No evaluation of distribution patterns at all levels  

DISSEMINATION  

  • Insufficient trained IEC personnel at all levels  
  • Inadequate funding  
  • Inadequate facilities for dissemination.  
  • Poor logistics at all levels  

EVALUATION

  • Irregular evaluation of materials and activities due to lack of funds
  • Inadequate personnel
  • Poor logistics
  • Poor communication network 

CONDOMS 

  • Religious opposition
  • Cultural opposition
  • Parental opposition
  • Unavailability of female condom
  • Poor decision making power of  women in reproductive health issues
  • Poor standard of condoms
  • Gross ignorance about use of condoms 
  • Inefficient social marketing
  • Perceived reduction of sexual pleasure 
  • Low acceptance of condom usage
  • Quality control assurance of condom is low 
  • No faith in condom
  • Condoms perceived as a method of family planning.
  • Cost of condom – poor affordability 
  • Inaccessibility of condom in rural areas 
  • Lack of co-ordination and procurement of condoms
  • Tariffs on condoms
  • Inadequate information on condom utilization 
  • Absence of local production of condom.
  • Introduction of Sexuality education in schools
  • Existing information on HIV/AIDS/STI for IEC teams
  • Lack of production capacity within private sectors
  • Existence of marketing distribution networks
  • Existence of one condom quality assurance lab in Lagos.


Needs: Psychosocial Help and Counseling Support

Obstacles

Opportunities

MEDICAL

  • Ignorance (Health Care and clients)       
  • Inadequate number of trained personnel       
  • Poor health seeking beheviour       
  • Inadequate and misdistribution of health facilities       
  • Inadequate protective devices for health workers       
  • Poor infection control      
  • Lack of infection control policies in various institutions       
  • Fear and stigma of healthcare workers       
  • No continuum of care       
  • Inadequate facilities for diagnosis of  opportunistic infections
  • Inadequate drugs for treatment of opportunistic infections       
  • Poor access to ARV drugs for opportunistic infections       
  • High cost of drugs       
  • No monitoring facilities for disease markers.  

PSYCHOSOCIAL HELP AND COUNSELLING SUPPORT   

  • Inadequate number of trained counselors at all levels   
  • Counselors not part of curriculum in training institution   
  • No organized training institution for HIV/AIDS/STD counseling
  • Inadequate number of guidelines for counseling   
  • No monitoring/evaluation of counseling that is going on.   
  • No networking between trained personals   
  • Inadequate psychosocial help   
  • Lack of sustainability (Inadequate funding for psychosocial support)   
  • Poor referral systems   
  • Poor logistics for follow up   
  • Stigmatization. 
  • Lack of confidentiality   
  • Poor continuing education facilities   
  • Competition with spiritual healers   
  • Competition with traditional healers   
  • Negative medical effects.  

SOCIAL  

  • Religious barriers  
  • Cultural practices  
  • Fear of the unknown Ignorance  
  • Poverty  
  • Access to information, diagnostic and treatment facility  
  • Gender inequality

PSYCHOSOCIAL HELP AND COUNSELLING SUPPORT   

  • Existing health facilities   
  • Existing NGOs, CBOs, religious organizations involvement   
  • Existing commitment   
  • Existing guidelines   
  • Existing association of PLWHAs  

MEDICAL   

  • Existing medical facilities   
  • Existing NGOs, CBOs etc   
  • Existing health facilities   
  • Existing NGOs, CBOs, religious organizations involvement   
  • Existing commitment   
  • Existing guidelines   
  • Existing association of PLWHAs   
  • Private medical practitioners   
  • Pharmaceutical companies

SOCIAL

  • Existing health facilities   
  • Existing NGOs, CBOs, religious organizations involvement   
  • Existing commitment   
  • Existing guidelines   
  • Existing association of PLWHAs   
  • Poverty alleviation program


Needs:   Human Rights and Ethics

Obstacles

Opportunities

  • Legal department staff not sensitized enough on the importance of HIV/AIDS 
  • Conservatism
  • Laws are not following all new issues related to the HIV/AIDS epidemic and the profound changes that may have an impact on society as a whole
  • Non compliance with existing laws
  • Poor monitoring and implementation of existing laws
  • Gaps in existing laws on rights
  • Non enforcement of laws
  • Poor involvement of the legal profession on HIV/AIDS/STI issues
  • Poor circulation of documents
  • Populations are not sufficiently aware about existing laws on HIV/AIDS
  • Poor institutional backup at state and LGAs
  • Not enough political drive
  • Traditional/Religious laws do not address HIV/AIDS 
  • Strong Traditional/Religious laws which may be contrary to HIV/AIDS
  • Stigmatization
  • Ignorance
  • Prisons not protected enough
  • Existing laws
  • Existing human rights organizations