Nigeria 's population of 140 million is the largest in Africa with 1 in 6 Africans being Nigerian. The information from the 2005 HIV study indicates that approximately 4.4 % of Nigerians are infected with HIV. The prevalence exhibits province broad disparity of between 1.6 % in Ekiti province ( south West ) and 10 % in Benue province ( north cardinal ) . ( Figure 1 ; NACA, 2007 ) While the infection rate is slower than some other African states, issues about HIV are still high on the docket because of the states high population. ( Figure 2 ; Jennifer Kates, Alyssa Wilson Leggoe, 2005 ) The Antenatal information shows that immature grownups appear most affected with 3.6 % amongst pregnant 15-19 twelvemonth olds and 4.7 % amongst 20-24 twelvemonth olds ( Figure 3 ; Technical Report National HIV/Syphilis Sero-Prevalence Sentinel Survey, 2005 ) This fact highlights the demand for a good co-ordinated National HIV/AIDS bar plan to farther decelerate down the infection rate and cut down incidence. ( NACA, 2007 )
Figure 1: HIV Prevalence by State ( 2005 )
www.naca.gov.ng
Figure2 a ) Percentage of Adults estimated to be populating with HIV/AIDS and B ) Number of People estimated to be populating with HIV/AIDS. Beginning: HIV/AIDS Fact sheet, 2005
Figure 3: HIV Prevalence by Age group ( Old ages ) 2005
www.naca.gov.ng
Drivers of the HIV Epidemic in Nigeria
Informal Transactional Sexual activity: While commercial sex workers ( CSWs ) have long been identified as critical in impacting the spread of the HIV/AIDS epidemic rubber usage among them is high. A cardinal driver nevertheless is informal commercial sex among the general population ( J. Robinson, 2008 ; NACA, 2007 )
Low Risk Percept: 67 % of Nigerians perceive themselves to be at no hazard of undertaking HIV while 29 % perceive themselves to be at low hazard and merely 2 % rated their opportunities of infection high ( NARHS, 2005 ; NACA, 2007 )
Multiple Partnerships: In Nigeria, spiritual beliefs tend to back up the publicity of common fidelity ; NDHS ( 2003 ) nevertheless proved that multiple sexual partnerships are common particularly amongst sexually active work forces. About 30 % and 24 % single and married work forces severally reported holding more than one sexual spouse in the past twelvemonth ( NDHS 2003, NACA 2007 ) . While work forces with multiple spouses have a 60 % increased hazard, adult females are 10 % higher than work forces. ( NARHS, 2005 )
Lack of established STD Programming for Most at Risk Population ( MARP ) : Package of services provided to MARPs is limited. Linkages to HIV guidance and testing, STD direction and intervention are weak and have relied chiefly on referrals.
Continuing Risky Behaviour of males in General Population: Hazardous behavior in the general population is more prevailing among work forces than adult females. 26 % of work forces report holding more than one sex spouse in the last twelvemonth as against 2 % in adult females. ( NARHS, 2005 )
Gender Inequalities: Underliing causes and effects of HIV/AIDS infections in work forces and adult females varies reflecting differences in biological science, sexual behavior, societal attitudes, economic power, exposure, and cultural attitudes that discourages safe sex dialogue. ( NACA, 2007 )
Economic Drivers: HIV impoverishes persons and communities through losingss of human resources. Poverty brings about low degrees of instruction associated with illiteracy and by and large hapless wellness position. These conditions result in hapless acceptance of behavior alteration which exposes the population to HIV infection. ( NACA, 2007 )
Equally shortly as an epidemic of HIV/AIDS was noticed in the state, Nigeria mounted a national response, which was expanded in 2000 with the constitution of the Presidential Council on AIDS ( PCA ) and the National Agency for the control of AIDS ( NACA ) . This allowed for a co-ordinated attempt to supply bar, intervention, attention and support services through policy preparation, development of programs and execution.
NACA 's authorization provinces that: -A A
1.A A A Coordinate and prolong protagonism by all sectors and at all degrees for HIV/AIDS/STD expanded responses in Nigeria.A
2.A A A Develop the model for coaction and support from all stakeholders for a multi-sector and multi-disciplinary response to HIV/AIDS in Nigeria.
3.A A A Develop and present to the PCA, all programs on HIV/AIDS in Nigeria for policy determinations.
4.A A A Develop and joint a strategic program for an Expanded National Response to HIV/AIDS in Nigeria.A
5.A A A Coordinate, proctor and measure the execution of the Strategic National Plan for the control of HIV/AIDS/STDs in Nigeria and all other approved policies.A
6.A A A Coordinate and ease the mobilisation of resources for an effectual and sustainable response to HIV/AIDS/STDs in Nigeria.A
7.A A A Undertake any other responsibilities as assigned by the PCA from clip to clip. ( NACA, 2007 )
The National HIV/AIDS Strategic Framework for Action ( 2005-2009 ) provides a strong and comprehensive model for bar attempts including a balanced `` ABC '' attack. In this model, in-school young persons were marked as a mark population group.
Sexual activity instruction is a major constituent of bar and one of the tools in minimal bundle required for HIV bar. Political issues environing it include
Resistance to arouse instruction and rubber publicity by Faith Based Organizations ( FBO ) , Religious leaders and other stakeholders
Inadequate accomplishments on rubber usage and dialogue
Misconception about sex instruction and low credence
Availability, handiness and affordability
Lack of policy environing sexual instruction in secondary schools ( NACA, 2007 )
A survey done in Nigeria analyzing the sexual behavior of secondary school striplings showed that the average age at first intercourse was 12 old ages with a scope of 6-19 old ages ; many of the participants had multiple sexual spouses and a hapless perceptual experience of the hazard of STD including HIV. It was recommended that a structured sexual instruction course of study be instituted for all schools get downing at an early age. ( A.T. Owolabi, A.A. Onayade et Al, 2005 )
Other surveies have examined how instructors feel about go throughing their cognition on HIV / AIDS bar steps to their pupils in the context of their cultural and societal norms that restrict unfastened treatment of sex.A The consequences showed a high degree of cognition about HIV / AIDS bar among teachers.A Nevertheless, instructors do non go through on this cognition because of cultural and societal taboos.A In add-on, instructors do non have proper preparation and motive on information, instruction and communicating on HIV / AIDS and sex instruction. ( Daniel C. Oshi et Al, 2005 )
It is hence necessary to increase handiness of sexual wellness services, create societal support for sex instruction in schools and build capacity on appropriate sex instruction.
Previous efforts at supplying sex instruction were interfered by spiritual and cultural resistance. In 2000 a new course of study was introduced for comprehensive sex instruction for 10-18 twelvemonth olds which concentrated on bettering pupil 's cognition and attitudes to sexual wellness and cut downing hazardous sexual behavior. However the execution of the undertaking was a entire failure and has since been abandoned. ( Avert, 2010 )
In a state where issues such as confidentiality around HIV proving is non covered by statute law, where no action is taken when human rights are broken in relation to HIV infection and stigmatisation. It seems the destiny of the immature people are in their custodies, owing to the absence of generative wellness ( RH ) institutes and deficiency of separate Torahs or statute law for immature people in relation to HIV bar. ( United Nations Global Coalition on Women and AIDS, 2004 )
POLICY AGENDA Setting
To accomplish this wellness policy, one must see the histrions that would be involved and analyze all stakeholders- so as to understand their behavior, purposes, inter-relations and involvements: and to measure the influence and resources they bring to bear on decision-making or execution procedure. ( Varvasovszky Z. , Brugha R. 2000 )
Stakeholder/ Actor analysis will place the type of people to interview, utilizing sweet sand verbena techniques, reappraisal questionnaires etc. It is of import to plan a semi-structured/ condense interview inquiries. Interviews will let comparison across cultural groups and faith ; and yet be sensitive to specific contexts.
Stake holder 's position has to be transformed into one that utilizes indexs to exemplify the extent of the job. They need to be informed of graduated table, tendencies and likely future class of HIV epidemic in their part or territory and within specific subgroups of the population.
Table 1: Stakeholders Analysis
Stakeholders
Engagement in the issue
Interest in the issue
Influence/ Power
Position
Impact of issue on histrion
Parents
Participate in Child Sexual Education and can act upon their kids 's determination
Medium
Low
Non-mobilized
High
Media Industry
Promote stakeholder 's positions and can act upon determination shapers by supplying dependable information
High
High
Supportive
Low
Ministry of Health
Promote healthy generative picks, direction of STIs and HIV related unwellnesss
High
Medium
Supportive
High
Presidential Council on AIDS
Survey policy proposals and do determinations on them
Medium
High
Non-mobilized
Medium
School Administration
Participate in policy Execution
High
Medium
Opposed
High
Ministry of Education
Ensure sex instruction is integrated in national course of study and implemented
Training of staff
Policy Implementation and Evaluation
High
High
Supportive
High
Bilateral Organizations
Provide support and proficient support
High
High
Supportive
High
Religious Leaderships
Influence the population through spiritual, moral and cultural beliefs
High
High
Opposed
Medium
Importers, Manufacturers and Sellers of the merchandise e.g. rubbers, text editions
Provide low-cost and high quality merchandise
Engagement in distribution
High
Low
Supportive
High
NACA
Develop and present to PCA all programs on HIV/AIDS in Nigeria for policy determinations
High
High
Supportive
High
Documentary/ Content analysis would be undertaken to place the grade of consistence between the present policies in the state. It would besides cover how far policy shapers draw on research findings in addresss during policy preparation and execution phases. The information beginnings would include research publications and studies, statute law, administrative/executive ordinances or orders, reimbursement agreements, guidelines and advice, meeting studies and proceedingss, policy statements, addresss, and articles.
An economic rating will be considered to measure and construe the value of this wellness intercession. This will mensurate the results in pecuniary footings every bit good as in wellness units. For this policy a cost effectivity analysis ( CEA ) will be more good in order to besiege the quandary of puting pecuniary value on human lives. It will compare the value of resources spent on the intercession to the measure of wellness gained as a consequence. ( David Wonderling et Al, 2005 )
A thorough apprehension of consistence of old policies with research findings, the grade of influence of research on policy docket scene, preparation and execution would be needed to guarantee a high degree of wellness research use in the determination devising of this wellness policy.
CLARITY OF MESSAGE
HIV bar, peculiarly sex instruction demands strong grounds in order to be recommended for consideration and broad spread execution.
Hall 's theoretical account of docket puting claims that the strength of this grounds depends on the issue 's Legitimacy, Feasibility and Support. ( Kent Buse, 2005 )
The issue at manus is legitimate as the HIV epidemic continues to harry the state, heterosexual sex being the most reported signifier of transmittal and high rate among immature people. It is executable since the policy will be implemented logistically through already bing systems, cost and resources will hence be reduced. Support can be generated through act uponing the population with the usage of media, raising consciousness and advancing rubber usage, affecting FBOs in policy execution.
There is besides no grounds that sex instruction or rubber handiness in schools will increase promiscuousness or cut down the age of first sexual intercourse of in school young person, hence this policy has no potency for inauspicious consequence. This policy 's acceptableness might be of concern, as there will be resistance from spiritual leaders and other involvement groups. This policy besides has other societal and wellness benefits, as the usage of rubbers will besides cut down other STIs, cut down unwanted gestations and the complications from illegal abortions, thereby cut downing maternal mortality. Previous work in Nigeria has shown that equal instruction works in HIV bar and this is soon being used to advance abstention and be faithful intercession plans.
Kingdom 's Model proposes that there are 3 watercourses of policy procedure and they need to cross for policies to be considered. ( Kent Buse, 2005 )
Problem watercourse: High prevalence of HIV among in school young person, with the highest signifier of transmittal being heterosexual sex
Politicss watercourse: The National HIV bar work program promotes condom scheduling and there have been ongoing arguments around this issue. In 2000, sex instruction was integrated into National course of study but was ne'er implemented. Meanwhile the prevalence amongst in school young person since so has increased.
Policy watercourse: Following the 2005 National HIV/Syphilis Sero prevalence lookout study for pregnant adult females go toing Ante-natal clinics in Nigeria. NACA has mounted more response to HIV bar. More support for HIV bar is being provided by bilateral organisations and NACA has become unfastened to execution of policies through FBOs and CSOs. Interventions are now being chosen and funded based on scientific grounds research.
POLICY FORMULATION AND IMPLEMENTATION
Legislators are influenced by media and runs, cultural beliefs, lobbyists, political parts and support every bit good as grounds based research. It is hence of import to guarantee they have adequate information from researches, prevalence of HIV and alternate solutions. The function of the media and other organisations can non be over emphatic.
This policy proposes the debut of structured sex instruction with condom publicity in secondary schools across Nigeria
It aims to cut down the prevalence of HIV/AIDS among in-school young persons
Aims
To better the cognition about HIV/AIDS amongst young person
To raise the age of first sexual brush amongst in-school young person by 5 old ages in 10 old ages
To promote rubber usage among in-school young person
To increase the figure of in school young person seeking intervention and attention for other STIs by 20 % in 5 old ages
To cut down teenage gestations by half in 5 old ages
Resistance to this policy 's credence could be limited by ab initio influencing policy alteration in southern urban parts where it will be more acceptable and if successful, scaled up to other less urban countries utilizing traditional and spiritual leaders to act upon credence.
A broad web and model of HIV/AIDS bar is soon on land in Nigeria, a assorted scanning attack will be ideal.
A rational attack for explicating policies and go throughing the measure, which will be instantly diffused through the Ministry of Health to all schools
An incremental attack by ab initio increasing the cognition of in-school young person on HIV/AIDS by presenting sex instruction into the school course of study, presenting text editions and stuffs that educate pupils on HIV/AIDS and subsequently up-scaling to include RH clinics to turn to early intervention and bar of STIs. Formation of in-school HIV nines and groups will supply a forum for pupils to aerate their positions on abstention, sexual exposure and bar patterns and eventually condom handiness and distribution.
Cost will be reduced by utilizing bing resources and adult male power. Increased cognition of HIV/AIDS in the population with capacity edifice for instructors and in school young person will let for easy execution. A elaborate and careful pilot testing could be done in the relevant mark group to let for appropriate rating and alteration before broad spread execution. A underside up attack should besides be used to let for more engagement by implementers and uninterrupted rating and redefining of aims or schemes.
Evaluation
HIV bar intercessions are complex. There are legion intercessions and schemes to take from. The content and quality of intercessions may differ well from one another and intercessions may be implemented in different ways by different people. Specific intercessions may be interactive or even counter and yet most programmes will unite several intercession schemes, doing rating of the effects of specific intercessions or constituents within the programme bundle hard or impossible to extricate. ( UNAIDS, 2008 )
In measuring the effectivity of the policy, elaborate grounds on the existent procedure of bringing of the intercession that establishes the extent and quality of bringing will be gathered. Facility audit is besides of import to supply information on adequateness of substructure, equipment, proficient and operational guidelines.
The success of the policy execution will besides be evaluated utilizing the five key United Nations General Assembly Special Session ( UNGASS ) ends. ( WHO Technical study series, 2006 )
Provide appropriate information to immature people and grounds of betterments in their resulting cognition
Provide appropriate accomplishments developing to immature people and grounds of their ability to show these accomplishments, and utilize these accomplishments to diminish their hazard of going infected
Supply appropriate skills-based preparation, equipment and supplies to implementers and grounds of this ensuing in increased bringing of effectual, high quality wellness services to immature people.
Provide grounds of reduced exposure of HIV among immature people, such as alterations in the attitudes and behaviors of immature people
Provide grounds of a decrease in HIV prevalence among immature people that can be attributed to the intercession
Donabedian 's model for measuring health care conceptualizes `` Inputs, Process and Outcome '' . ( Kent Buse et Al, 2005 )
Table 2: Policy Implementation and Evaluation
Undertaking IMPLEMENTATION
Undertaking EVALUATION
INPUT/RESOURCES
ACTIVITIES/INTERVENTION SERVICE
End product
OUTCOME/IMPACT
MEASUREMENT METHOD/INDICATORS
Staff
Monitoring and rating preparation for plan directors and implementers
Training of school nurses and instructors
Training of spouses and stakeholders on young person and HIV
Media preparation on Sexual activity instruction and Condom publicity
Capacity edifice for implementers
Change in supplier behavior in relation to school young person
Change in supplier behavior in relation to describing systems
Improvement in administrative and describing systems
Experimental surveies
Number of instructors and school nurses trained in supplying sexual instruction and wellness services to school young person
Number of stakeholders trained on HIV and the young person
Quality appraisal of describing systems
Media support
Awareness creative activity for rubber publicity to interrupt barriers
Commission and air jangles on the impact of sex instruction on school young person.
Media run aiming socio cultural issues disaggregated by age, sex and location.
Media run on inter-generational sex
Harmonization of stuff development, distribution and usage
Increase consciousness on sex instruction and rubber rebranding
Sexual activity instruction and sex literacy as a societal norm
Condom usage as a societal norm
Behavioural surveillance study
Condom handiness and handiness
Stigmatization around sex instruction and rubber usage
Number of jangles aired on sex instruction and rubber usage among school young person
Education
Production and distribution of IEC Materials
Production of text editions integrated with cognition of STI and HIV
Development and version of course of study on sex instruction
Sexual instruction Sessionss in schools
Condom dialogue accomplishments developing for school young person
Improve school young persons consciousness on HIV/AIDS
Improve rubber negociating accomplishments among school young person
Improve rubber usage among school young person
Reduce STI incidence
Reduce HIV morbidity and mortality
Reduce teenage gestations and it 's complications
Reduce maternal mortality associated with teenage gestations
Annual National HI/AIDS sero-prevalence lookouts study among in school young person
Prevalence of STI and HIV among school young person
Number of teenage gestations and maternal deceases related to them
No of rubber distributed
No of school young person who used rubbers in their last sexual brush
Facilities
Handiness of friendly accessible service Centres for school young person within and outside the school
Build effectual linkage/referral systems for STI direction in communities
Establish regional offices through the Ministry of Education to supervise disposal and M & A ; E
Increase entree to RH services
Promote dealingss among assorted organisations involved
Allow easy monitoring and rating of execution
School young person will be able to entree RH services without stigmatisation
Provide utile information on execution procedure and success
Behavioural surveillance study
No of young person accessing RH services before and after intercession
No of RH services available to youth
No of young person referred through linkage systems
Research
Population based study on Sexual activity instruction, rubber usage and publicity in school young person
Increase cognition base on sex instruction and rubber scheduling
Increase cognition on the young person 's sexual hazard behavior
Making future sex instruction programming policies based on grounds based scientific research
Experimental surveies
Number of research proposals and surveies carried out on sex instruction, hazard behaviors, rubber scheduling and usage among school young person
Community Mobilization
Battle of FBOs, CSOs, community and spiritual groups and parents on HIV/AIDS cognition
Skills and services community mobilisation for HIV
Sensitization of community leaders against stigmatising or opposing sexual instruction among school young person
Increase consciousness of FBOs, NGOs and parents on HIV and the young person
Promote rubbers as a double method
Rebrand rubber usage as a positive thing
Engagement of policy execution at grass root degree
Improve community consciousness and integrity in the battle against HIV/AIDS
Enable societal and cultural credence about sex instruction
Constitution of young person groups
Experimental surveies
Number of young person groups on HIV/AIDS advancing sex literacy and rubber usage
Number of community stakeholders involved in young person groups
Number of outreach events advancing sex instruction
Advocacy/policy
Recommending for policy reforms on socio-cultural and economic issues that promote HIV transmittal, stigma and favoritism among young person
Increase consciousness of stakeholders on HIV and young person
HIV and youth issues get on the policy docket
Laws on HIV and young person, stigma and favoritism enacted
Experimental surveies
Nature and type of issues incorporated into the National Youth policy
No of public hearings on the bill of exchange measure and Young person policy
Decision
The immature can non talk for themselves in doing lawful determinations that impact their ain lives. Their determinations are influenced by parents, the community, equal force per unit area, and their personal cognition. It is hence of import that the cognition they have is sufficient and diverse to enable them do informed determinations refering their sexual wellness.
Surveies done have shown adequate grounds that sexual instruction addition in-school young person 's consciousness of HIV/AIDS and can act upon their attitude or do behaviour alteration.
Health system research findings in the Nigeria will stay impotent unless translated into public wellness action through effectual public policy-making. ( Shamsuzzoha B Syed et al.,2008 )
Policy docket scene, preparation, execution and rating are all necessary phases in achieving policy alteration. In world, they all happen at the same time and can be revisited and changed while the procedure is ongoing.
Stakeholder 's influence is really important in policy devising and acceptance. The media is a really powerful tool which should be used suitably.
Policy execution should be done carefully without rigidness utilizing bottom up attacks.
Evaluation is necessary in order to mensurate the success of the plan and larn more for future policy executions.
Reducing HIV/AIDS prevalence amongst in-school young person goes a long manner in cut downing prevalence in the general population and promises a healthier brighter hereafter, free from HIV/AIDS.
