CHAPTER ONE
INTRODUCTION
1.1 Background of the Study:
The first case of Acquired Immune Deficiency Syndrome (AIDS) in Nigeria was reported in 1986. Since then, infection with Human Immunodeficiency Virus (HIV) has spread to become a generalized epidemic affecting all population groups and sparing no geographical area in the country.
HIV/ AIDS have negatively impacted every sector of the economy, and continue to threaten the national development gains of the past decades. The effect of HIV and AIDS remain great as it continues to devastate individuals, families and households, affecting their physical, social, psychological, and economic well-being. Unarguably, HIV and AIDS constitute a leading development challenge and a major threat to the general advancement of the nation as well as her capacity to achieve the Millennium Development Goals (MDGs).
HIV/AIDS is a global crisis with Nigeria ranking second in Africa on the number of people living with HIV/AIDS after South Africa. UNAIDS estimated 33.4million people living with HIV in 2008 in the world. Nigeria, with about 2.98million people living with HIV, makes about 9% of the global HIV burden. However, there is gender inequality in the distribution with males accounting for 1.23million and female accounting for 1.72million in the HIV estimates and projections for 2008.
Nigeria HIV prevalence is estimated at 4.6 % based on antenatal sentinel survey that has been used to monitor the trend of the epidemic over time, which could be considered a progress from 5.8% in 2001. Current estimates by the Federal Ministry of Health (FMOH) indicate that 2.98 million people are living with HIV/AIDS in Nigeria in 2009 with a total AIDS death of 192,000 in 2009. One of the most remarkable social and economic impacts of HIV/AIDS is the ever increasing number of AIDS orphans which was estimated at 2.12million in 2008 and 2.175million in 2009. Despite national prevalence of 4.6%, there are several variations by state and local government area. At the zonal level, prevalence is lowest in the South West (2.0%) and highest in the South-South (7.0%). Age group specific prevalence is highest in the age group 25-29 years (5.6%) and lowest in the 40-44 years age group (2.9%) from the 2008 ANC survey.
The government of Nigeria has shown great commitment to the fight against the HIV/AIDS scourge. It is in pursuit of this purpose that the government through the HIV/AIDS governing body, NACA formulated policies that affect every area of the nation's multi-sectorial response to HIV/AIDS.
The revised HIV/AIDS policy is as a result of broad consultations with the relevant stakeholders in the response. These include civil society organizations, PLWHA, line ministries and parastatals, development partners, donor agencies,
Faith-based organizations and community based organizations. The HIV/AIDS policy serves as a statement of Nigeria's determination to reverse the tide of the epidemic and mitigate its impact on millions of lives of Nigerians. Furthermore, it serves as a catalyst to speed up and generate a more coordinated and effective response to the epidemic.
The first policy statement was developed in 1997 by the Federal Ministry of Health. This was at the advent of the epidemic. This policy statement was later revised in 2003 by the National Agency for the Control of AIDS in collaboration with other stakeholders with the sole aim of mitigating the impact of the HIV/AIDS. The policy focused on five thematic areas:
1. Prevention of HIV/AIDS
2. Law and ethics
3. Care and support
4. Communication
5. Program management and support
In a bid to strengthen the national response and to incorporate emerging issues, a 2009 revised policy was developed. Some of the issues that the revised policy hoped to critically address were the following:
1. The rising HIV prevalence among women
2. The expansion in number of orphans and vulnerable children
3. The stigmatization of people living with HIV/AIDS and violation of their rights as well as their roles and responsibilities.
4. The differences in communication messages on abstinence, condom use etc in secondary schools and higher institutions of learning.
5. The issues associated with increased access to treatment and care.
These issues have been incorporated into the new revised policy. The aim of the national policy is to provide a framework for advancing the multi-sectoral response to HIV/AIDS in Nigeria. The main target of the policy document is to have 'halted, by 2015 and to began to reverse the spread of the HIV/AIDS virus
Among Nigerians.
The National Strategic Framework (NSF) was developed from this policy statement. The NSF has been in operation since 2005 till the end of 2009 as a skeletal structure on which HIV plans and activities are hinged on. The 2005 – 2009 NSF has been reviewed and a new NSF II 2010 – 2015 is in place. The thematic areas in the revised policy are as follows:
1. Prevention of new infections and behavior change
2. Treatment of HIV/AIDS and related health problems
3. Care and support for people living with and affected by AIDS
4. Institutional architecture and resourcing
5. Advocacy, legal issues and human rights
6. Monitoring and evaluation
7. Research and knowledge management
The response to HIV/AIDS is multi-sectorial response involving civil society organizations, network of people living with AIDS, faith based organizations, line ministries, non-governmental organizations, development partners and the private sector. There has been improved participation of the private sector,
Civil societies and international partners over the years in the national response. This multi-sectorial response has led to better resource mobilization and coordination among stakeholders (public, private and the civil societies) in a “Three Ones Model” (one national structure, one strategic plan and one monitoring and evaluation framework).
Nasarawa State has become the fourth highest in the HIV/AIDS prevalence rate in the country, having been rated 8.1. This has prompted the government of the state to allocate more resources in the fight against HIV/AIDS. While acknowledging the fact that government alone cannot successfully tackle the menace of HIV/AIDS in the state, the government has entered into partnership with the private sector so as to combat the menace of HIV/AIDS.
This study seeks to examine the impact of the partnership between the public and private sectors in addressing the problems posed by HIV/AIDS in Nigeria, using Nasarawa State as a case study.
1.2 Statement of the Research Problem:
Nigeria has witnessed fluctuations in HIV prevalence level in the last 15 years, but with an overall picture of significant increase within the period. The result of the periodic national HIV sero-prevalence survey, which is obtained through sentinel survey of antenatal care attendees, showed an increase from 1.9 percent in 1991 to 5.8 percent in 2001. The HIV prevalence then declined to 5.0 percent in 2003 and further to 4.4 percent in 2005. This decline, unfortunately, has been followed by a recent rise to 4.6 percent in 2008 and then 5.2% in 2014. Based on the latest result, NACA estimates that 2.95 million people in Nigeria are currently infected, of which 278,000 are children and 1.72 million (58.3percent) are females.
The drivers of the HIV epidemic in Nigeria include: low risk perception, multiple concurrent partners, informal transactional and inter-generational sex, lack of effective services for sexually transmitted infections (STIs), and poor quality of health services. Gender inequalities, poverty and HIV/AIDS-related stigma and
Discrimination also contributes to the continuing spread of the infection.
Despite mounting various responses over two decades, the challenge of HIV/AIDS has continued to increase in Nigeria, particularly in terms of the number of people infected and affected.
Estimates from the Joint United Nations Program on HIV/AIDS (UNAIDS), for example, show a rise of 400,000 in the number of people living with HIV/AIDS in Nigeria between 2001 and 2014. With an estimated 3.95 million people living with HIV in Nigeria in 2014, Nigeria ranks as one of the countries with the highest burden of HIV infection in the world, next only to India and South Africa.
These realities compel urgent review of the national response and re-strategizing to achieve a more effective control of the epidemic; the national policy constitutes a cornerstone and veritable instrument for renewed national vision and efforts to combat the HIV/AIDS challenge.
It is against this background that this study seeks to access the collective roles of both the public and private sectors in the eradication of HIV/AIDS in Nigeria, using Nasarawa State as a reference point.
1.3 Research Questions:
This research work shall be guided by the following research questions:
• How has the public/private partnership helped in combating HIV/AIDS in Nasarawa State?
• What is the major cause of the HIV/AIDS prevalence rate in Nasarawa State?
• What is the role of the government and nongovernmental organizations in combating the spread of HIV/AIDs in Nasarawa State?
• How can the problem of HIV/AIDS be solved?
1.3 Objective of the Study:
The study seeks to achieve the following objectives.
i. Accessing the impact of Public and private partnership in the eradication of HIV/AIDs in Nasarawa State.
ii. Bring together some of the risk factors responsible for the high prevalence rate of HIV/AIDS IN Nasarawa State.
iii. Identify the factors that seem to have more effect than the others in the spread of HIV/AIDS in Nasarawa State of Nigeria.
iv. Proffer solutions to the problems observed.
1.4 Significance of the Study:
Whilst acknowledging the fact that this study is not the first of its kind using Nigerian data, however, it shall go a little further than earlier work as it looks at the partnership between the public and private sectors in combating the menace of HIV/AIDS in Nigeria, using Nasarawa State as a reference point.
This study will contribute to existing knowledge as researchers, students, women and the academics will update existing knowledge from the useful information and analysis provided. Also, this study will enable policy makers to promote maternal mortality reduction through appropriate policy recommendations.
Finally, the study period was extended to 2014, to enable us update existing knowledge on the subject matter.
1.5 Scope of the Study:
The study will assess the impact of the public private partnership in the eradication of HIV/AIDS in Nigeria, using Nasarawa State as a case study for the period 2001 to 2014.
1.6 Limitations of the Study:
The study is limited to available data gathered from the Nasarawa State ministry of health, UNICEF and WHO Journals and other related sources. Also, data that may be used for the empirical analysis may be porous and as such are often manipulated for political reasons.
The study is also limited to Nasarawa State HIV/AIDS prevalence rate which shall be used as a sample for the Nigerian situation.
1.7 Research Hypothesis:
H0: Public and Private sector partnership has no significant impact in the eradication of HIV/AIDS in Nasarawa State.
H1: Public and Private Sector Partnership have a significant impact in the reduction of HIV/AIDS in Nasarawa State.
1.8 Study Outline:
This study shall contain five chapters. The first chapter shall contain the introduction. Chapter two would present the literature review on the subject matter. The methodology to be adopted in the study would be stated in chapter three. Chapter four shall focus on the presentation and interpretation of results. Chapter five presents the summary of the findings, conclusion and appropriate recommendations.
1.9 Definition of Terms:
Terms which are considered necessary and suitable for the proper understanding of the subject matter are hereby defined to enhance proper understanding of the subject matter:
• HIV/AIDS: These stands for Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrone. It is a disease spectrum of the human immune system caused by infection with human immunodeficiency virus. It has no cure for now and leads to death.
• Public Private Partnership: This is a venture that is jointly managed and funded by both the government and private agencies.
Call 07032879723 or send a mail to michaelonjewu@yahoo for the complete project
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