2.0INTRODUCTION HIV/AIDs has been ranked among the common disease of all times that is threatening us with the extinction of youths and adults. It is not only terrorizing the entire generation but also kills and leaves millions of orphans for the oldest grandparent to carter for.
2.1HIV/AIDS IN NIGERIA
According to USAID brief (2004), Nigerian epidemic is characterized by one of the most rapidly increasing rates of new HIV/AIDS cases in West Africa. Adult HIV prevalence increased from 1.8% in 1991 to 5.
8% in 2001. This infection rate, although lower than that of neighboring African countries should be considered in the context of Nigeria’s relatively among population of approximately 117 million, the joint United Nations programme on HIV/AIDS (UNAIDS) by the end of 2001. HIV prevalence among women attending continental clinic in 1999 rose from less 1% to 21%. Among sex workers in Lagos. HIV prevalence rose from 2% in 1988-89 to 12% in 1990-91 by 1995-96 up to 70% of sex workers tested positive.
USAID Brief (2004) further elaborates that current projections show an increase in the number of new AIDS cases from 250,000 in 2000 to 360,000 by 2006.
As a result of the epidemic the crude death rate in Nigeria was about 20% higher in 2000 than in 1990. In 2001 alone 170,000 adults and children died of AIDS at the end of 2001, UNAIDS estimated that 1 million children orphaned by AIDS were living in Nigeria.
USAID Brief (2004) further added that several factors have contributed to the rapid of HIV in Nigeria. These include sexual networking practices such as polygamy, a high prevalence of untreated sexually, transmitted infection (STI’S), low condom, poverty, low literacy, poor health status, low status of women stigmatizing, and denial of HIV infection risk among vulnerable, groups.
Nigeria is a complex mixture of diverse ethnic groups, language, cultures, religious and regional groupings all of which are major challenge for HIV prevention programmes.
Several countries in Africa with previously low infected numbers are now experiencing serious epidemic. It is spreading like wild fire millions of people in rural areas in some African countries have not heard of HIV/AIDS and a very high percentage of our sexually potent population between the dangerously ignorant about it (Nuhu 2002).
Laura (2002) opined that HIV/AIDS as potentially global biological holocaust which is yet to attract the full sustained through a recent research concluded that most people still doubt the true existence of HIV/AIDS virus. Others claim that God has already destined the ways of every one’s death, epidemic which has already almost affected the larger population of the expected leaders of tomorrow and not only do they make up the population of the work force, but they also represent the strength of the nation and her hope for the next generation has young men and women buried daily resulting from untimely death, caused by the lethal virus. Because many people obey their sexual urges so easily and indulge in per-or, extra-marital relationships. While young boys and girls indulge in experimental sex to test their state of maturity.
Gilberto (2003) mentions that nearly all Nigeria, trado-medical herbal doctors are claiming to have cure of HIV/AIDS pictures of sexual transmitted disease and the victims are often displayed to public claiming that the untreated STDs are the causes of AIDs virus. Although many important questions about the disease cannot yet be answered but certain facts demand very clear course of action by governments. Medical supports is very necessary but medical support itself will not stop the continuous spread of the epidemic. The federal and state government must take some public health measures immediately. Either by identifying and isolating carriers unity is assured that they are no longer capable of transmitting the virus or provisions of diagnostic and treatment center for the victims or correct the lack of adequate public sanitation, improve levels of nutrition’s and the recognition of the spread of AIDS and the individual abstinence from reckless indulgence within the communities as the only solution to the courage.
Gilberto (2003) further opined that recognized AIDS victims who are treated nastily and viewed as living corps, the are usually rejected by friends and sometimes denied by relatives and out rightly deprived of their means of livelihood must be discouraged, as this certain to cause serious obstacles or discouragement in their efforts to fight the virus already eating deep into their immune systems. It is pertinent for individuals parents, guardians and NGO’s to rise up and face the challenges of the murderous intentions of AIDs virus and not the victims or else, HIV/AIDS virus victims would continue to go into hiding for fear of not being treated as outcast and thereafter deliberately spreading it to innocent people before their own time.
2.2HIV/AIDS: A DEVELOPMENT ISSUE Macintyre Kate Lisanne and Steven (2003) are of the view that; HIV/AIDS was initially conceived of as a health issue, and was separated from the general development context – it was a problem to be dealt clearly by health professionals. It is now clearly that the HIV epidemic is clearly associated with and exacerbated by the wider challenging to development poverty, food and childhood insecurity and gender inequality. The systemic effects of the disease are inarguable. A holistic approach to programming is needed in order to address the effects of the pandemic, particularly on marginalized communities.
Macintyre, Kate, Lisanne and Steven (2003) further said that: if individuals are unaware of the methods of transmission and the mechanism to reduce vulnerability to HIV/AIDS infection rates increase. Lack of access to health care the need to generate income which sometime results in engaging in unsafe commercial sex – as well as inability to negotiate power relation with respect to sexual practice also contributed to the rise of infections.
According to Sussan (2002) the HIV/AIDS pandemics is closely linked to the availability of basic services, such as health care and education, and to economic infrastructure such as the capacity or lack of sufficient income through traditional or modern mean, including agriculture and education and to the empowerment of women and girls.
2.2.1POLITICS AND ECONOMY
Muyidan (2004), claimed that; external debt and structural adjustment policies imposed by the IMF and World Bank often have negative impacts on developing countries due to the need to reduce state spending, manage inflation and reform their economies. This leads to a reduction in provision of basic social services, such as education, health care and rural extension services, leaving poor people, particularly epidemic. And individuals are significantly more unalterable if they are unaware of the methods of transmission or the mechanisms to reduce contraction of HIV. Poor health services result in a lack of treatment for sexually transmission, and ultimately lack of treatment for AIDS related illness. The constriction of basic social services as a response to structural adjustment, policies have serious implications for communities vulnerable to HIV infection.
According to Sussan (2000) globalization can impact on developing countries competitiveness in the international marked. Demands to remove trade barriers and lift tariffs can seriously affect prices for primary produce. And impact on the livelihood of students who may depend on the sale of surplus production for their family’s survival income insecurity may encourage labour migration in search of income alternative coping strategies such as prostitution and other activities which can further the spread of infection.
According to Ogunyombo (2003) labour migration is often a response to the effects of poor infrastructure in rural areas. Lack of secure livelihoods encourages the migration of family members (predominantly to urban centers) in search for paid work. Generally, mate family member migrate and are then vulnerable, to related social issues such as multiple sexual partners or engaging prostitutes, increasing their chances HIV infection and, ultimately, increasing the risk that they will transmit the disease to their wives, who have remained in the rural community.
2.2.3SOCIAL AND CULTURAL ISSUE
Nasir (2002) asserts that, gender inequality leaves women and girl particular vulnerable to HIV infection due to unequal power relations between men and women. It is exceedingly difficult for woman or girls to negotiate safe sex with resisting mate on both physical and cultural levels. Their husbands of adultery, further exacerbating their vulnerability to physical or economics abuse, often suspect women who propose the use of condoms. The traditional distribution of labour means that women’s works burden will increase as they are required to care for sick family members as well as continue to work in the fields, carrying cater and search for cooking fuel.
Khadijat (2003) is in the view that inheritance rights differ with geography, but women are often landless and without assets should their husbands died. This lacks of security could invoke other coping strategies such as prostitution, increasing their vulnerability to and transmission of HIV infection. Frequently, widows are married by their husband’s brother or fired to consolidate the compound the destruction to the brother or friend and ultimately his other wives.
Rothethenberg (2004) opined that: in both the developing world and industrialized countries, those who are marginalized are most vulnerable to HIV infection, the impact of AIDS on their livelihood and families is severe poverty is not restricted to developing counties; it is a global problem, experienced in both urban and rural communities of the industrialized world. Similar issues, such as lack of access to basic social services including education and health care and issues of income insecurity discrimination and feelings of powerless, are faced by all options, may turn to high risk coping mechanisms. Programmes aimed at securing the livelihood of marginalized communities in industrialized countries will also prove beneficial in struggle against HIV/AIDS.
2.2.5The RURAL/URBAN ISSUE
HIV/AIDS was initially considered and urban issue; transmission was at its highest rates of infection equaling those at the urban centers. Transmission rate are exacerbated when rural-urban linkages are strengthened through improved transport; road system, schools trade and marketing centers, and the migration of family members to worm (Ogunyombo).
Ogunyombo (2003) further explained that, rarely is farming mechanized in developing countries – communities depend on the availability of local labour for their survival. Household security in rural areas is therefore particularly vulnerable to the effects of HIV/AIDS especially with respect to the supply of labour.
2.3ALTERNATIVES FOR AIDS IN NIGERIA
Nigeria is the most heavily populated in Sub-Saharan African, and HIV/AIDS are a huge public health issue. In Nigeria, orthodox management of HIV and AIDS is in line with the standard practice worldwide. Most of the anti-HIV drugs like the reverse transcriptase inhibitors and the protease inhibitors are largely available. Most Nigerian’s are so poor and the anti-HIV drugs so expensive that the drug might as well be non-existent (Chibuzo, 2002).
2.3.1ANY NEED FOR ALTERNATIVE
According to Michael (2004) given the problem of cost, a great need exists for an alternative approach to solving the HIV and AIDs problem. In Nigeria, society, expects individuals to be healthy, willing and able to work. People with HIV and AID cannot fulfill this demand. In Nigeria, we have no effective social security service for the welfare of people who cannot help themselves, so people explore alternative solutions.
Michael (2004) further explained that: people with AIDS carry a huge social stigma in Nigeria. Few people will not shake hands with someone who they know is HIV infected. This maintains financial impoverishment because after they lose their jobs it is hard to get another. In Nigeria. They all boast feats perceived as unattainable by orthodox medicine they are the long available savior’s for Nigeria helpless citizens who are infected with HIV.
2.3.2SPIRITUAL HOMES AND CHURCHES
Chibuzo (2002) assert that; ever since Nigeria’s orthodox medial community designated. HIV and AIDS is incurable, thousands of people who besieged spiritual home and churches in search of miraculous healing. Many Nigerians believes that HIV/AIDS have a spiritual dimension and that the illness could be caused in an individual as a result of attack by evil supernatural forces. Because of this, some people feel most appropriate place for the treatment of HIV and AIDS is spiritual and Churches. A couple of positive result have purportedly emerges from some of these spiritual homes. Some patients with faith have supposedly had their AIDS cured and their HIV status changed. Some patients have gone television to buttress these claims and some of them brandish result of laboratory tests conducted before and after the miracles healing. This continues to generate deep controversy in Nigeria; social circle as an ever-increasing number of continue to search for solution.
2.3.3AFRICAN TRADITIONAL HEALERS African herbs traditional healers still attend a number of medical problems in rural areas of Nigeria. Their attendance to HIV and AIDS cases is also due to the link that has been established by the lay public between HIV and evil spirit (Tommy 2004).
Tommy (2004) Further explained that, they make use of undisclosed herbs concoctions and charms alongside ritual – worships and animal sacrifice to heal their patients. Patients sometimes report an improvement in their symptoms but because there is little or no documentation, the claims of cure symptoms relief are not substantiated.
According to Chibuzo (2002) Nigerians also use the service of homoeopaths – self proclaimed doctors with little or no medical training. These homoeopaths claim extensive and sometimes exhaustive knowledge of all human disease and always emphasized that all ailments have a definitive cure. They are unique in that they appear to practice a hybrid of orthodox Pseudo-orthodox, traditional and spiritual medicine some prescriptions include common substance with believed but as yet unconfirmed medical value such as garlic, aloevera, and mistletoe to quite bizarre ones like urine therapy.
Chibuzo (2002) further buttress that: the attraction is the measure of hope they instill in psyche of the patient. To the person with AIDS he or she has offered a definitive cure where the orthodox doctor has offered little more than palliative treatment.
By far the most controversial of all the alternative options for managing HIV and AIDS is what we refer to as the Pseudo-orthodox option. This is as a result of its peculiar feature, namely that of an orthodox practitioner with an unorthodox approach to health care delivery and scientific innovations (Tommy 2004).
Tommy (2004) further buttress an explanatory example as follows: in the late 1990, a Nigeria doctor Jeremiah Abalaka of the medicrest clinic Abuja announced in the Nigeria press that he has raised a lot of preventive and curative vaccine for HIV virus. This raised a lot of questions in Nigeria medical circles, the first was about the decision to announce this supposed scientific breakthrough in the pages of local newspapers in a country where medical burnals are published and medical congresses are held regularly. The second was for the proof and evidence that such a vaccine had actually been developed and that it worked. To the first question, Abalaka himself and a few of his apostles though that his ideas would be stolen if he decided to put it through this scientific method. In answer to the second question, the Nigerian government constituted a panel made up of respected medical experts under the dual auspices of the Nigeria medical association and the Nigeria Academy of science. Their mission was to verify Abalaka’s claims.
Although their report which did not favour Abalaka’s claims was submitted and partly published it has remained a source of controversy. Numerous claims in support of the Abalaka vaccine come from several source including the Nigerian Army and a couple of private health outfits. Recently, information in the Nigerian media about Abalaka’s vaccine has been scarce, although some unconfirmed report maintains he still administers. The vaccine at his clinic in Abuja. Tommy (2004).
Tommy (2004) further opined that; whether these alternative opinions are worthwhile and capable of helping is controversial but they will remain as long as difference exists on people’s understanding and perception of illness spiritually and medically. Although alternative treatments seem to be needed, current evidence does not appear to justify their existence.
At last Tommy (2004) opined that: the claims and counter claims are a calculated attempt to exploit dispensation, ignorance and fear.
2.3.6ALTERNATIVE CURE According to Aloosika (2003) AIDs virus has been described by scientists as a biological holocaust that posed depopulate this generations manpower, social and economic development. Nuclear scientists and medical personnel have been researching to discover vaccine for its permanent cure but with little or no success at all. According to 2003 year Book of science and the future.
The only meaningful achievement in drug science is out break was in 1987, when Aziduth Mdine (AZI), which was, said help slow the devastating reaction, and reproduction of HIV-virus in the body was discovered. It was also to be very effective but some patients could alternate with a compound called dideoxy-Cytidine (DDC) “the drug in conjunction with the former was said to be able to slow the multiplication and reaction of the virus in the body but can not mitigate it complete”.
According to Gallo (1987), the discovery of HIV as cited in 2003 year book of science and the future. “Anti HIV/AIDS drugs may create more problems than they solve” the permanent cure to HIV/AIDS virus presently, is death” as no one has ever been cured of incompletely in the history of its devastating existence (Michael 2004).
Further assert that, all those claiming permanent cure to AIDs should be held guilty of the worst false claim in medical history because, most victims treated by them did actually improve but later developed into more complex HIV/AIDS virus sickness, this happen six (6) to eight (8) months of discharge from treatment which are often at very exorbitant cost. Therefore, everyone must abstain from mall reckless illicit sexuality ask the best prevention which is better than cure”.
2.4INTERVENTIONS TO REDUCE HIV/AIDS STIGMA
2.5INTRODUCTION Stigma and discrimination relating to HIV/AIDS (AID stigma) undermines public health efforts to combat the epidemic (Malcolm 198, USAID 2003). AIDS stigma, negatively effects preventive behavior, care seeking behavior upon diagnosis, quality of care give to HIV positive patients, and perception and treatment of people leaving with HIV/AIDS (PLHA) by communities, families and partners (Gerbert 1991, Herek, 2000). One of the most surprising elements of AIDS stigma is to its ubiquitous nature even where the epidemic is widespread and affecting so many people, such as in Sub –Saharan Africa. Therefore, as many in the HIV/AIDS community note, decreasing AIDS stigma is a vital step in stemming the epidemic (Came on 2002; Malcolm 1998: USAIDS 2003). Given this situation, it is critical that intervention that effectively reduce AIDS stigma be identified and implemented.
2.4.2STIGMATIZATION OR DISCRIMINATION
The HIV/AIDs pandemic has evoked a wide range of reactions from individuals, communities and even nations; from sympathy and caring to silence, denial, fear and even violence stigma is an important factor in the type and magnitude of the reactions to this epidemic (Malcolm 1998). We know much less about the level and reasons for silence an denials than we know about violent, hostile, or isolationist reactions. Physical harm of PLHA has been documented in numerous reports from developing countries (USAID, 2004).
According to Ogunyombo (2003) probably one of the most publicized events occurred in a Urban township in 1998, when Gugu Dlamini, on AIDS activist, was killed by members of her isolated event, it highlight the potential consequences of AIDS stigma, level of involvement necessary to reduce stigma.