ABSTRACT
Since the first case of HIV and AIDS in Nigeria, and
the epidemics continually evolved with,
Nigeria having a pathetic situation of fluctuating prevalence rate. In the bid
to forestall this undulating situation of HIV and AIDS prevalence rate, NACA
published the National HIV and AIDS BCC Strategy. Despite the availability of
the document, Nigeria still experienced
fluctuated HIV prevalence rate. In 2008, NACA launched the revised HIV and AIDS NPP for Nigeria, to provide the
States with minimum package of prevention activities. Drawing from the NPP, the National HIV and AIDS BCC Strategy, 2009-2014
was published with the major goal to reduce the rate of spread of HIV infection in Nigeria by
25% by year 2014. The study, therefore evaluated the implementation of
this document in the prevention of HIV and AIDS in Nigeria.
The study adopted the qualitative design with a
study population of thirteen HIV and AIDS implementing organisations registered
with NACA in 2008. Sample size of three HIV and AIDS implementing organisations
located were selected using the simple random sampling technique and the
purposive sampling to select two study areas; Ogun and Oyo States of the
South-west Nigeria. Face-to-face interviews were conducted on Key Informants
from the three HIV and AIDS implementing organisations, selected staff and AIDS
professionals to solicit information for appropriate evaluation. The face and
content validity were adopted to ensure that each item on the measuring
instrument had logical connection to research objectives and questions.
Reliability test was carried out by administering the research instrument to
two respondents who had knowledge of the document under investigation. The research instrument of unstructured
interview guide was self-administered to the key Informants. Interview
responses from the key Informants were transcribed and content analysed based
on identified themes in the objectives and research questions of the study.
Result showed that the communication strategy employed
by NACA in the implementation of the document under review met the set goal of
ensuring media message harmonisation, consistency and effective. The
fluctuation of HIV and AIDS prevalence rate within the period of 2011 to 2015
was addressed; stemming the rate of fluctuation from 4.1% in 2010 to 3.1% by
2015.This identified 3.1% HIV
prevalence rate in Nigeria is commensurate to the set goal of NACA, as the
agency met and surpassed the goal of reducing the rate of the spread of HIV
infection in Nigeria by 7.6% reduction. The operational plan of the document under review
provided the implementation modalities with players represented at all levels
of society. The M&E process as integrated in the NNRIMS and the Operational Plan,
2007-2010 were adopted as the M&E framework.
The study
concluded that the implementation of the document under investigation in the
prevention of HIV and AIDS in Nigeria was justifiably successful, and the
prevalence rate of HIV infection was stemmed. The study recommended that the NACA continues the dissemination of HIV
and AIDS information to the Nigeria citizenry to maintain this achievement.
CHAPTER ONE
INTRODUCTION
1.1
Background to the Study
Development
communication as a purposive communication driven by the need for positive
change and improvement of life, situation or something constitutes the focus of
health communication. With the emergence of development communication in the
1950s (Imoh, 2007, p. 20), and the recognition to development in the early
1960s (Moemeka, 1994 p. 23); many wonder if this discourse amongst scholars has
impacted on health communication particularly HIV and AIDS in Nigeria. The
human immunodeficiency virus and acquired immune deficiency syndrome (HIV and
AIDS) is one of the greatest natural challenges that have become a bane and
concern for humans in recent times (Ilo & Adeyemi, 2010, p. 1). The impact
of the development communication discourse amongst scholars on the health
communication of HIV and AIDS prevention in Nigeria calls for evaluation.
Globally, HIV and AIDS epidemic has remained a major public health, social,
economic and developmental challenge (Nigerian Health Review, 2006 & UNAIDS
Global Report, 2010). The technical
report of the 2010 national HIV
Sero-prevalence Sentinel Survey reveals that:
The HIV
and AIDS pandemic has continued to constitute serious health and socio economic
challenges for more than two decades. In underdeveloped and developing
countries, it has reversed many of the health and developmental gains over the
past three decades as reflected by indices such as life expectancy at birth and
infant mortality rate among others. (Federal Ministry of Health, 2010, p. 2)
According to Kanki and Adeyi (2006, p. 4), the first
case of HIV and AIDS in Nigeria was reported in 1986, and the HIV
and AIDS epidemics have continued to evolve in Nigeria
since this period (Federal Ministry Health, 2010, p. 2). In 1991, the Federal Ministry of Health (FMOH)
conducted the first sentinel sero-prevalence survey in Nigeria. In this survey,
and in subsequent surveys conducted in 1993, 1999, and 2001; pregnant women
attending antenatal clinics (ANCs), patients with sexually transmitted
infections (STIs), patients with tuberculosis (TB), and female commercial sex
workers (FCSWs) provided the population for HIV sero-prevalence estimates (Oruonye, 2011, p. 104).This
first sentinel surveillance survey showed the national HIV and
AIDS prevalence rate to stand at 1.8% in 1991 (FMOH, 2010, p. 2); and the prevalence
rate steadily increased from 1.8% in 1991, to 3.8% in 1993, 4.5% in 1995, 5.4%
in 1999, and 5.8% in 2001.
Nigeria had a grip of this undulating growth of the
HIV and AIDS epidemic, with the national adult infection rate at 5.8% in 2001
but witnessed a decline to 5.0% in 2003 (FMOH, 2001; 2004). Nigeria is Africa’s
most populous nation with a population estimated at well over 120 million in
2002. The National Policy on HIV and AIDS of 2003, indicate that more than 3.5
million Nigerians were infected with the virus in 2002. In the same year, HIV
and AIDS epidemic killed 1.7 million people, orphaned 1.5 million children,
which totalled the 3.5 million Nigerians
living with the virus in 2002 (Peterson & Obileye, 2002, p. 3).
Nigeria recorded further decline in the prevalence
rate of HIV in 2005, when the number of HIV infected adults ranked Nigeria
second, in the sub-Saharan region after South Africa; with a prevalence rate of
4.4% in 2005 (IPPF et al., 2006; National BCC Strategy, 2008). But a reverse
was the case in 2007 and 2008 when the HIV and AIDS prevalence rate increased
to 4.6%. It was estimated that 3.6% of the Nigeria population between ages 15 to
49 are infected, and living with HIV and AIDS (UNGASS, 2010; Oruonye, 2011, p. 104); with
approximately a death toll of 220,000 people resulting from AIDS in 2009 in
Nigeria (UNAIDS, 2010). This undulant situation of HIV and AIDS prevalence rate
posed significant threat to Nigeria’s development as the highest number of
people placed on antiretroviral therapy (ART) in Africa, which imposed huge
financial burden on the country (Oruonye,
2011, p. 104).
The first HIV and AIDS sentinel survey in Nigeria, conducted
in 1991 had 1.8% prevalence rate reported (NHEIA, 2014). Judging by the subsequent HIV and AIDS
sentinel surveys of Nigeria’s HIV sero-prevalence estimated within the two
decades as follows; 3.8% (1993), 4.5% (1996), 5.4% (1999), 5.8% (2001), 5.0%
(2003), 4.4% (2005), 4.6% (2008), 4.1% (2010), 3.34% (2011) , 3.0 in 2012; and
3.4% in 2013 (NACA 2012; NACA 2011a; NACA 2011b; NACA and UNAIDS 2010; NACA
2010; NACA 2007; NARHS, 2013); the situation poses major concern for
researchers and analysts of HIV and AIDS. The surveys within the two decades
were characterised by undulating appraisal of national HIV and AIDS prevalence
rates.
Nigeria however, still bore the second heaviest
burden of HIV in Africa after South Africa, with a total estimate of 3.14
million to 3.4 million Nigerians living with HIV in 2010, and 1.5 million
people in Nigeria in need of antiretroviral (ARV) drugs (FMOH, 2010). The Federal Ministry of Health equally
observed that by the end of 2011, a total of 217,148 AIDS-related deaths and a
cumulative total of 2.1 million AIDS-related deaths were documented since the
first AIDS case was identified in Nigeria, leaving an estimate of 2.2 million
AIDS-orphans (FMOH, 2011; NACA 2012; NACA 2011a; UNAIDS, 2010). The National Bureau of Statistics (NBS) equally
confirmed a total of 168,067 adults and children were living with HIV in
2013 nationally, which was a modest decrease from 322,529 in 2010 (National Bureau of Statistics, 2014,
p. 8).
In the bid to forestall this undulating situation of
HIV and AIDS prevalence rate in Nigeria, the National
Agency for the Control of AIDS (NACA) published the National HIV and AIDS Behaviour Change
Communication Strategy of 2004 to 2008 and the second edition of 2009 to
2014. Behaviour change communication (BCC) according to FHI and USAID (2002) refers to the
interactive process with communities (as integrated with an overall programme)
to develop tailored messages and approaches using a variety of communication
channels to develop positive behaviours; promote and sustain individual,
community and societal behaviour change; and maintain appropriate behaviours.
BCC is a process of delivering information about the behaviour change on the
general procedures of how undesirable behaviours are discouraged (Opondo,
2009).
In the context of this work, BCC became an essential
part of NACA’s comprehensive programme which included both services (medical,
social, psychological and spiritual) and commodities (for example, condoms,
needles and syringes). The National HIV
and AIDS BehaviourChange Communication Strategy of 2009-2014 was part of the national
response to prevent HIV and AIDS in Nigeria. In
view of the undulating situation of HIV and AIDS prevalence rates, the agency
sort to address with the document; the challenges of HIV and AIDS information,
risk reduction, change in behaviours, adoption of key attitudes, skills
and access to appropriate products and services. The aim is to educate the
public on improving the knowledge, skills and attitudes towards HIV and AIDS.
Since the first global emergence of HIV and AIDS,
the role of Behaviour Change has been recognised as critical to the control of
the pandemic (Fatusi & Jimoh, 2006, p. 324). The phrase “education is the
only vaccine against AIDS” was commonly aired during the early years to control
the epidemic (Liskin, Church, Piotrow & Harris, 1989, p. 3). Against this
background, considerable efforts and energy of NACA were devoted to
implementing communication programmes to educate people about HIV transmission
modes and prevention strategies. The underlying assumption of these early
activities was that, improving people’s knowledge about the infection and
disease would lead to avoidance of risky behaviours (Fatusi & Jimoh, 2006,
p. 324).
Nigeria
witnessed fluctuations in HIV prevalence rate in the last two decades, but with
an overall picture of significant increase within the period. The national
response to prevent HIV and AIDS in Nigeria is one of the major tasks of the National Agency for the Control of AIDS (NACA)
set up by the government. With considerable success achieved in coordinating
prevention programmes and activities over the years, the necessity for possible
eradication of the epidemic has become a discourse among scholars. A
retrospective review of national HIV and AIDS prevention plans in Nigeria shows
changes in the strategic focus and approach to prevention. Single intervention
approach did not actualise the expected levels of behavioural change required
to avert new HIV infections in the country.
1.2 Statement of the Problem
Before
the introduction of the National HIV
and AIDS Behaviour Change Communication Strategy of 2004 to 2008 by
NACA; Nigeria was at a crossroad with 3.5million Nigerians between ages 15 and
49 years infected with the virus. HIV prevalence had already reached pandemic
proportions with adult HIV prevalence rates increasing from 1.8% in 1991 to 4.5%
in 1996, and 5.8% in 2001. By 2008 when the
National HIV and AIDS BehaviourChange Communication Strategy of 2009-2014 was
published, the Nigeria population of over 140 million people faced HIV
epidemic that could easily spin out of control. The national HIV prevalence
rate cited at 4.4% in the National AIDS and Reproductive Health Survey (NARHS)
of 2005, which translated to more than 2.9 million people living with the
virus, and made Nigeria the third highest burdened for HIV in the world,
further increased to 4.6% in 2008.
However,
despite the introduction the National
HIV and AIDS BehaviourChange Communication Strategy, Nigeria still experienced
a fluctuated HIV prevalence rate. In 2008, the National Agency for the Control of AIDS (NACA) launched the revised
HIV and AIDS National Prevention Plan for Nigeria, which sought to provide the
Nigeria states with a minimum package of prevention activities. Drawing from
the National Prevention Plan, the second publication of the National HIV and AIDS Behaviour Change Communication
Strategy of (2009-2014) had the major goal to reduce the rate of spread of
HIV infection in Nigeria by 25% by year 2014 (NACA, 2008, p. 9).
As
at 2008, when the document under investigation was published, the Nigeria
population stood at about 151.2 million and HIV and AIDS national prevalence
rate was 4.6%; which reveals that 6,955,200 people were infected. By 2014, the
Nigeria population had increased to over 167 million people, and the HIV and
AIDS national prevalence rate had reduced to 3.2%; which means 5,344,000 people
were infected. However, the current national HIV prevalence rate stands at
4.1%, which translates to about 3.4million people living with HIV. Thus, there
seem to be a significant increase of HIV prevalence rate in Nigeria.
The
need for behaviour change to ensure HIV and AIDS prevention in Nigeria remains
a critical challenge and equally a priorityin the continuous fight against the
epidemic. The National HIV and AIDS Behaviour Change Communication (BCC)
Strategy 2009-2014 published by NACA; provided Nigeria with the platform for an
effective and coordinatedBCC response to the epidemic. The goal of the document
was to reduce the rate of spread of HIV infection in Nigeria by 25% by year 2014. The
implementation procedure includes a five step process of; know your epidemic, know what works in BCC,
develop the BCC strategy and key strategic interventions, operationalise the
strategy and measure what is achieved.
Thus,
this work seeks to evaluate the achievements and effectiveness of the National
Behaviour Change Communication (BCC) Strategy (2009-2014), find out the
implementation level of the document, and whether or not the agency met the set
goal in the prevention of HIV and AIDS in Nigeria. Furthermore, the work seeks
to find out the extent at which the programme as documented, had significant
impact on the reduction of HIV and AIDS prevalence rate in Nigeria, and finally
find out the drawbacks and challenges experienced in the implementation of the
programme.
1.3 Objective of the Study
The main objective of this
empirical study is to evaluate the achievement and effectiveness of the
implementation of the National Behaviour Change Communication (BCC) Strategy
between 2009 and 2014, in the prevention of HIV and AIDS in Nigeria. The
specific objectives are to:
1. determine
the extent to which the communication strategy employed in the National HIV and
AIDS Behaviour Change Communication (BCC) Strategy, 2009-2014 met the set goal
of HIV and AIDS reduction;
2. determine
the extent to which the National HIV and AIDS Behaviour Change Communication
(BCC) Strategy, 2009-2014 addressed the fluctuation of HIV and AIDS prevalence
rates within the period;
3. find
out if the identified decrease in HIV and AIDS prevalence rate in Nigeria is
commensurate to the set goal in the National HIV and AIDS Behaviour Change
Communication (BCC) Strategy, 2009-2014;
4. identify
the implementation modalities that ensured the actualisation of National HIV
and AIDS Behaviour Change Communication (BCC) Strategy, 2009-2014, and
5. identify
the monitoring and evaluation (M&E) process for keeping the programme on
course.
1.4 Research Questions
- To
what extent did the communication strategy employed in the National HIV
and AIDS Behaviour Change Communication (BCC) Strategy, 2009-2014 meet the
set goal of HIV and AIDS reduction?
- To
what extent did the National HIV and AIDS Behaviour Change Communication
(BCC) Strategy, 2009-2014 addressed the fluctuation of HIV and AIDS
prevalence rate within the period?
- What
is the extent to which the identified decrease in HIV and AIDS prevalence
rate in Nigeria is commensurate to the set goal in the National HIV and
AIDS Behaviour Change Communication (BCC) Strategy of 2009-2014?
- What
are the implementation modalities that ensured the actualisation of
National HIV and AIDS Behaviour Change Communication (BCC) Strategy of
2009-2014?
- What are the identifiable monitoring and evaluation (M&E) process for keeping the programme on course?
1.5 Significance of the Study
The National Behaviour Change Communication (BCC)
Strategy, 2009-2014 provides the framework for HIV and AIDS prevention and its
reduction in Nigeria through behaviour change communication. This work seeks to
evaluate the implementation of the framework in relation to HIV and AIDS
prevention in Nigeria, and justify whether or not the goal was met. The
National Behaviour Change Communication (BCC) Strategy (2009-2014) published in
2008 by the National Agency for the Control of AIDS (NACA), was to enable HIV and
AIDS implementation stakeholders develop and implement more effective HIV
interventions by strengthening the BCC capacity of their programme managers.
The document was equally proposed to provide a strategic focus to plan BCC for
a harmonised and coordinated response at all levels (NACA, 2008, p. 8).
In view of the above, this research work may serve
as reference and guide for government agencies in the health sector to include
or further utilise certain communication strategies in their programmes. The
outcome of this study may help these agencies in the critical analysis of their
communication strategies and implementation. Information provided in this study
could equally help government agencies in the allocation of available resources
on HIV and AIDS programmes. This study could also serve as resource material
for health workers particularly on HIV and AIDS, and the need for constant
evaluation of the programmes. This study could provide useful information for
these health workers to appropriately implement the programmes and measure
their outcomes and impact as agents. This study may equally be useful to social
marketers, health communicators, policy makers and other concerned agencies on
the communication content and strategy that best meets the needs for HIV and
AIDS prevention and risk-reduction in Nigeria. The information provided in this
work could be a resource material for these agencies to mirror the situation of
HIV and AIDS in Nigeria, and proffer the most appropriate communication content,
policies and strategies of programme implementation. By and large, this
research effort could provide data to enrich the databank of National Agency
for the Control of AIDS (NACA) and State Agency for the Control of AIDS (SACA);
and other AIDS related agencies such as World Health Organisation (WHO), AIDS
Prevention Initiative Nigeria (APIN), United States Agency for International
Development (USAID) et cetera, in planning and implementation of programmes.
Finally, the study may be beneficial to researchers in area of health and
behaviour change communication in Nigeria.
1.6 Scope of the Study
To determine the success or
limitations of the strategies and goal of the National HIV and AIDS Behaviour Change Communication Strategy,
2009-2014 published in 2008 by NACA, both local and international implementing organisations in Oyo and Ogun States, whose mandate
is to address the HIV and AIDS crisis between 2009 and 2014 will be critically studied.
1.7 Operational Definition of Terms
Behaviour Change:
refers to the expected positive outcome in the disposition and lifestyle of
Nigerians in relation to HIV and AIDS as a result of the communication channels
used. This also refers to the development, promotion and sustenance of positive
behaviours amongst the Nigeria populace. This will be evaluated based on the
interview responses and opinions of HIV and AIDS professionals.
Behaviour Change Communication:refers
to the inter-related process of developing tailored messages and approaches
using a variety of communication channels to encourage the development of
positive behaviours of individual and the community. It is also the
communication geared towards the encouragement of behaviour change, as well as
the maintenance of the appropriate behaviours with individuals and communities.
It refers to the process of delivering behavioural change information on the
general procedures of how undesirable behaviours are discouraged. This will be
analysed based on the general outcome of the major communication employed for
behaviour change.
Evaluation: the
appraisal of the need, drawbacks, and achievements of the National HIV and AIDS
Behaviour Change Communication Strategy of 2009 to 2014 in relation to
prevention in Nigeria. This forms a major focus of this study and it will
analysed based on the critical review of HIV and AIDS documents.
Development
Communication:
refers to the communication used for promote development and its purpose
to change or improve HIV and AIDS situation in Nigeria. It refers to the
messages designed to transform the behaviour of Nigerians for quality and
healthy lifestyle, and change in health behaviour to promote the prevention of
AIDS in Nigeria.
Prevention: refers
to the singular purpose to inhibiting the spread of HIV and AIDS in Nigeria. It
refers to the formulation and promotion of communication messages that affect
the spread of HIV in Nigeria. This will be evaluated based on the communication
messages and prevention modalities made available to Nigerians through the
implementing agencies.
Communication
Strategies: refers to the communication modalities used in the
implementation of the National HIV and AIDS
Behaviour Change Communication Strategy, 2009-2014 in the prevention of HIV and
AIDS in Nigeria. These communication strategies will be analysed in relations
to their achievements.
HIV Prevalence Rate: refers
to the percentage of Nigeria population between ages 15-49 who are infected
with HIV in Nigeria. The HIV prevalence rate is the indices that will be used
to identify the level of HIV and AIDS increase or decrease in Nigeria.
AntiretroviralTherapycoverage:
the percentage of Nigerians living with HIV who are receiving government’s
technical and health-related responses for prevention of AIDS, care and support
to HIV and AIDS treatment. It also includes the policies and guidelines for
voluntary counselling and testing for HIV, medications and drugs and the
prevention of mother-to-child transmission of AIDS.
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