Federal Ministry of Health
National Action Committee on AIDS

Situation Analysis Report on STD/HIV/AIDS in Nigeria
March 2000

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: 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 womens 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 NGOs,CBOs, PLWHAs, professional Associations  Existence of formal judicial systems Existing international laws Traditional Laws Religious laws Rights of the Child

Needs: Basic and Applied Research

Obstacles

Opportunities

Both Basic and Applied Research Poor documentation of social  cultural research findings Inadequate number of  trained personnel Poor research into pharmaco-kinetics of medicinal agents Poor funding of research Inadequate number of institutions for research Hoarding of information  Inadequate networking Inadequate sharing of information No national ethics committee Poor co-ordination and evaluation of findings Poor dissemination of results/poor feedback Poor access to current information (Internet, E-mail, library etc) Poor mobilization of resources (Human and material) Very high competition Poor co-ordination of finding at local and national level Poor coordination with international research at regional level and international level No feed back Basic Research - Lack of central research directive / priorities  Applied Research - No continuity of research    No functioning regulatory body Little exchange of information between private and public sector.

Existing research institutions, universities and teaching hospital Availability of some data   NGO, donor, professional association, pharmaceutical company Conferences and meetings Fellowship and scholarships Existing department of planning, research and statistics.

Cross Cutting Issues

In addition to key areas some cross cutting issues have been analyzed,  these are:  

• Management
• IEC
• Data collection
• Education
• Monitoring and evaluation
• Partnership
• Funding
• Multisectoriality
• Community involvement

Bibliography of Major Sources

• A Syndrome Based STD Surveillance System for Nigeria, Weir, M.J Ogundiran, A. Department of Genito-Urinary Medicine, Glasgow Royal infirmary, UK. STD Control Program, Oyo State Ministry of Health, Ibadan. Nigeria.  
• Acceptance of People living with AIDS (PLWAs) at Work place Pat No Monye G. Iroka J.A Adegbite S. Agbogun C.E Adigwe P.K Omole. Life Continuity Foundation 31 Church Street Mushin Lagos Nigeria.  
• Clinical Pattern of Human Immunodeficiency Virus infection (HIV) in pulmonary tuberculosis patients in Jos, Nigeria. Anteyi EA; Idoko JA; Ukoli CO; Bello CS. African Journal of Medical Sciences 1996 Dec. 25(4): 317-21  1996  
• Evaluation of Training on Syndromic management of STDs in Nigeria. Derex-Briggs, Ofosu-Barko K, Organization: National AIDS/STDs Control Program (NASCP), Federal Ministry of Health, Nigeria; UNAIDS, Nigeria. Email: izeduwa@excite.com  
• HIV Associated Disorders in Unsuspected Patients at a Nigerian University Teaching Hospital. Harry, D.N Bukbuk and A.E Moses, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria  
• Increasing Risk of Transfusion  associated AIDS as the pandemic spread experience in Maiduguri, Nigeria Harry, T.O; Moses A.E; Ola T.O; Obi S.O and Bajani M.D. Journal of Tropical Medicine and Hygiene. 1993; 96(2): 131-3  
• New AIDS policy in Nigeria raises the stakes  but optimism remains scarce Falobi O AIDS Analysis Africa. 1999 Feb-Mar, 9(5) 10-1. 1999  
• Problems of Communicating HIV/AIDS Prevention and control in Nigeria: How has the Media coped? Omololu Falobi. Punch Newspapers,  1. Kuyeti street Onipetest Ikeja, Lagos, Nigeria.  
• Sexually Transmitted Disease (STD):- Six years experience in Jos University Teaching Hospital Bello CSS, Egah DZ, Okwori EE, Nwokedi EE, Katung PY, Zoakah AI, Opajobi SO, Ayeni JA, Barau C, Mafuyai S.    
• Sickle Cell Anaemia and the Risk of HIV Infection in Lagos, Nigeria Ibironke Akinsete, Alani S. Akanmu, R. O. Olatunji, O.S Njoku, Dept. of Haemotology and Bld Trans. LUTH PMB 12003, Lagos; Dept of Haemotology, Luth, Lagos; Dept of Haemotology, GH, Lagos; Army Base Hospital, Yaba Lagos, Nigeria.   
• Sickle Cell Anaemia and the risk of Transfusion Transmitted Human Immunodeficiency and Hepatitis B Viral Infections in Lagos, Nigeria Olatunji R.O Ajanmu A.S. Akinsete I, Njoku O.S 1998   
• STD Treatment and Prevention among Nigerian Adolescents. Friday E. Okonofua, P.M Coplan, Mtemin, Womens Health and Action Research Center 4 alofeje Street Benin City, Edo state, Nigeria; Merch and CO INC. West point, USA WHO Geneva, Switzerland.  
• STDs and AIDS: a vicious circle of risks. AIDS watch. (1989), (7):2-4 Ogunseitan O; Mariasy J, - (Research/conferences)   
• STD Aids Prevention Strategy; appeal to conscience and evangelization Pinneh T; Mba U; Udok E; Sam I; Emoefe M; Coker, D, - (Research)       
• Sexual Practice that may Favour the transmission of HIV in a rural community in Nigeria. International quarterly of Community Health education. 1994; 14(4): 403  16 Ajuwom AJ; Oladepo O; Adeniyi JD; Brieger WR  (Research)   1999 
• HIV/Syphilis Sentinel Sero-Prevalence Survey in Nigeria Technical Report. National AIDS/STD Control programme. Federal Ministry of Health.   Annex

Team Members

List of Abbreviations