FACTORS RESPONSIBLE FOR HIGH RATES OF HIV/AIDS PREVALENCE IN TWO SELECTED COMMUNITIES IN ENUGU STATE OF NIGERIA

ABSTRACT

This research work investigated the factors attributed to the high prevalence rates of HI V/AIDS in the two selected communities (Achi and Udi) in Enugu state, using Mpu as a control group for the validity of data. The study objective is to identfy and describe the determinants for the spread of HI V/A IDS, to examine the various factors that influence the deferential high prevalence rates in Achi and Udi communities in Enugu state,, to determine the effects/impact of HI V/AIDS on development in Enugu state, to critically examine the response strategies adopted by government and other stakeholders to mitigate the impact of HI V/AIDS in the state and proffer recommendations based on the results of the study. The research methodologies used for the data collection from the inhabitants of the selected communities were in-depth interview, questionnaire and focus group discussion. Some factors found to be responsible for the high HJV prevalence rates in these test communities are c1assfied into: behavioural, economic, cultural, and social factors; examples of these factors are: age, income-level, single parenthood practice and location. The impact of high HIV prevalence on development outcomes in the communities studied got across demographic, social/psychological, economic, political and health impacts. Finally, Chi square method of analysis was used in testing f there was a signfl cant difference between the high HIV prevalence rates in Achi and Udi communities and also, in testing if there was a signficant relationship of the high HIV prevalence between the socio economic-cultural factors available in the study locations. The test results for the null hypotheses which are. that, the high prevalence rate of HI V is not related to the socio-economic and cultural factors of the study locations and that, there is no signficant difference between the HIV prevalence rates in Achi and Udi, were rejected. In other words, the alternative hypotheses that, the high HIV prevalence rates in Achi and Udi are related to the socio-economic and cultural factors of the study locations and, that there is signflcant dfference between the HIV prevalence rates in Achi and Udi were accepted. Some of the policy recommendations from the study are: eradication of some of the cultural practices such as single parenthood practice with greater vigor and also, strengthening of socio-economic, nutritional and psychosocial support at state, local and community levels. These should become issues ofpolicy priority in the state.

CHAPTER ONE

INTRODUCTION

1.1  Background of the Study

AIDS was first recognized as a new distinct clinical entity in 1981 in the United States of America. During the next several years, as researchers sought to identify and isolate the etiologic agents, AIDS was beginning to be recognized in the other parts of the world.

Central Africans residing in Europe were presenting clinical signs and symptoms similar to those of AIDS, and early reports from Kinshasa, Zaire –now the Democratic Republic of Congo suggested high AIDS rates in association with a newly isolated virus, now known as Human Immunodeficiency Virus (HIV).

Globally, the pandemic of HIV and AIDS has continued to constitute serious health and socio-economic challenges for more than two decades. In underdeveloped and developing countries, it has reserved many of the healthy and developmental gains over the past three decades as reflected by the indices such as life expectancy and in fact, mortality rate among others. The epidemic has also facilitated the emergence of other disease conditions. While the rate of AIDS continues to rise, the effect of the disease on families is increasingly being noticed. This has led to serious decline in communities’ productivity because a lot of the public spending which are supposed to have been expended on other developmental projects are channeled towards prevention of HIV/AIDS, and care (WHO, 2000).

As at the end of 2007, about 33.2 million persons were estimated to be infected with Human Immunodeficiency Virus (HIV) globally. Of these, 22.5 million were in sub- Saharan Africa, and about 3.0 million in Nigeria (UNAIDS, 2007).

HIV prevalence was recently estimated using a population-based survey. In addition, the Federal Ministry of Health conducted antenatal surveillance. Based on this new data, approximately 3 million Nigerians are HIV infected. Of these, about 220,000 are pediatric cases (UNAIDS 2008). The most recent population based survey and antenatal surveillance results found a prevalence of 3.6 percent among those 15-49age range and 4.6 percent among women in antenatal clinics. These results have not yet been analyzed to generate prevalence estimated for individual states, but in 2005, study of HIV at antenatal sites reported large variation in prevalence from high of 10% in Benue to a low of 1.6% in Ekiti (FMOH, 2008).

1.2.1  Historical Background of Enugu State

The present Enugu State, the Coal City State, was created on August 27, 1991 out of the former Anambra State. The State derives its name from the capital city which was established in 1912 as a small coal mining town. The town of Enugu where a large commercial deposit of coal is found is euphemistically referred to as the ‘Coal City’.

1.2.2      Physical Setting

Enugu State lies in West African tropical rainforest region between

latitudes 5^o 055’ and 7 ^o 10’ North and longitude 6 ^o50’ and 7 ^o55’ East. The State is bounded in the East by Ebonyi State, in South by Abia State, in the North by Kogi and Benue States and in the West by Anambra State. Enugu State covers a large expanse of land of about 7,738 sqkms. Topography shows that about 15% of the terrain is covered by highlands, more prominently are the Udi, Nsukka and Awgu hills.Seventy two percent of the land terrain is covered by plains, while 13% of the terrain is covered by wetlands/water bodies. The State is made up of two distinctive landscape features namely: Enugu Awgu escarpment and Udi Nsukka Plateau.

1.2.3    Demography and Social Characteristics

Ethnically and linguistically Enugu State is Igbo. English is also widely spoken as the second language. The Igbos are generally known to be very resourceful, enterprising and hardworking. The State naturally divides into two cultural zones based on local dialectical and choreographic patterns. These are the Enugu and Nsukka zones. According to 2006, National Population and housing census figures, the population of Enugu State was 3,267,837 showing 1,596,042 males and 1,671,795 females. Enugu State comprises of five (5) urban local government areas (Enugu North, Enugu South, Enugu East, Nsukka and Oji River) and twelve (12) Rural Local Government Areas: Aninri, Awgu, Ezeagu, Uzo Uwani, Igbo Eze South, Udenu, Isi Uzo, Nkanu West, Nkanu East, Udi, Udenu, and Igbo Etiti (WHO, 2000).

1.3  Description of the study Locations

This study was conducted in Udi community in Udi Local Government Area and in Achi community in Oji River Local Government Area in Enugu state of Nigeria.

1.3.1   Udi Community

1. Historical Background of Udi Community

This is a rural community bounded by Igbo- Etiti LGA in the North, Oji River in the South, Ezeagu LGA in the West and Enugu LGA in the East. It is made up of 30 communities with the estimated population of 262,159 people. The town has a historic background which is still told and handed over from one generation to another through word of mouth and other written documents. This community soil type is mostly loamy and sandy soil.

1. Occupation of Udi People

Traditionally and until date, Udi is a community with peasant farmers and palm wine tappers predominantly. The major crops they produce include: cash crops, cassava among others. Other occupations came with civilization and these include: civil service basically teaching and local government work, petty trading and commercial sex work. On Orie and Afor market days, the Amukwu and Ukwu markets are attended by the villagers and outsiders alike. Nkwo and Eke complete the rest of the local four weekly calendar days. Also, Udi is a community that accommodates commercial drivers at different locations of the Community ( Enu,2011).

III Culture of Udi People

Igbo language is common language used as a major means of communication especially, in business transactions. It was also noted that the language is used as a means of teaching in junior classes in some primary schools. New yam festival, Aju festival, marriage ceremony and burial rites are some of the community based ceremonies that is, they involve the participation of the entire community members. It was observed that the community women dress in wrapper and blouses while the men in traditional jumpa and trousers( Enu,2011).

1.3.2    Achi Community

1. Historical Background of Achi Community

Achi is a small town located in Enugu state of Nigeria. However, it is the largest town in Oji River Local Government Area of Enugu state. Achi is made up of 12 villages. If the town is imaginarily divided into two sections, we have the popularly known native phrases “isii na ulo” and isii na agu”. These literally mean that there are six villages in the northern section and six villages in the southern section of the town. Achi town is surrounded by some other towns namely Isuochi ( Abia state), Inyi ( Oji River LGA), Ugbo and Obeagu (Awgu LGA) and some parts of Udi LGA of Enugu state.

1. Occupation of Achi People

The people of Achi community are known to be predominantly peasant farmers. They cultivate cassava and melon. However, it is an obvious fact that cashew trees do grow fairly well in Achi but they cannot legitimately lay claim to be the biggest producer of any cash crop in Eastern Nigeria. The type of soil found in Achi is mostly sandy soil which is not particularly fertile. As a result, Achi people are not known for the cultivation of any cash crops. They also engage in petty trading while some are engaged in politics, government work and commercial sex work.

III. Culture of Achi People

Igbo language is common language used as a major means of communication especially, in business transactions. It was also noted that the language is used as a means of teaching in junior classes in some primary schools. New yam festival, Aji ala and ihejioku festivals, Marriage ceremony and burial rites are some of the community based events, that is, they involve the participation of the entire community members. The people of Achi are known to be hospitable and they are mostly notable for the manner in which they entertain their visitors by preparing cassava in the form of dishes and serving it with fish. It was observed that the community women dress in wrapper and blouses while the men in traditional jumpa and trousers (Ibeneme, 2011).

1. Education in Achi Community

There are several primary schools in Achi with all 12 villages at least with one primary school. The oldest education institutions in Achi include Corpus Christi College founded in the year 1960, Girls’ Secondary school founded in 1962. Interestingly, there is a fairly old institution known as Achi farm school founded in 1960 or there about. The institution has been training agricultural extension officers who are currently scattered all over Eastern Nigeria.

1. Institution in Achi Community

Achi joint hospital, which is a fairly old hospital, for several years was and is still the best hospital. It was used to be known as Awgu division in the then East central state.

1.4    Statement of the Research Problem

Enugu state has the highest HIV prevalence rate in the South East geopolitical zone of Nigeria. Documented HIV prevalence in the state rose from 1.3% in 1991 to 10.2% in 1995-1996 and from then fell to 5.2% in 2001, 4.9% in 2003.In the year 2005, it increased to 6.5% and declined again to 5.8% in 2008.

A further breakdown showed that 4629 and 6719 persons infected with the virus are youths aged 15 -24 years and pregnant women respectively. The increasing infection rate has been attributed to early sex debut, child marriage, wife inheritance and multiple sex partners (FMOH, 2003). Others include lack of women empowerment to negotiate sexual matters, polygamy, and wife sharing and pervading poor access of women to sustainable income generating activities, widowhood practice, female genital cutting and lack of legislation on women rights. Communities such as Achi and parts of Udi with significantly high HIV prevalence rates are located at inter-state border posts/areas /highways; these sites are characterized with intense night long commercial activities. There is a high level of transit population including the Long Distance Drivers (LDD with overnight stay) in these communities. What is yet uncertain are the factors precisely influencing the differential high prevalence rates among certain populations or persons in Enugu state particularly, “these hot spots” of the state. Is it age, culture, income or location? To this end, the import to design and conduct survey at these locations that can test given hypotheses as to generate verifiable information that will be used to develop evidence based HIV interventions and programme design that will be used by programme implementers become imperative (CDC,2002).

1.5    Objectives of the Study

The aim of this project is to identify some of the socio-cultural factors that can possibly underpin the relatively higher prevalence rates of HIV/AIDS in Achi and Udi Communities of the state. In particular,

1. To identify and describe the determinants for the spread of HIV/AIDS.
2. To examine the various factors that influence the differential high prevalence rates in Achi and Udi communities in Enugu state.

• To determine the effects/impact of HIV/AIDS on development in Enugu state

1. To critically examine the response strategies adopted by government and other stakeholders to mitigate the impact of HIV/AIDS in the state.
2. To proffer recommendations based on the results of the study.

1.6   Research Questions

For this study, the following research questions will be used.

1. What is HIV/AIDS?
2. What are the determinants of spread of HIV and AIDS?

• What are the factors that influence the differential high prevalence rates in these two communities?

1. What are the impacts of HIV/AIDS on development in Enugu state?
2. What is the response update in Enugu state?

1.7    Hypothesis Formulation.

Hypothesis 1

H₀: There is no significant difference between the HIV prevalence rates in Achi and Udi communities.

Hypothesis 2

H₀: The high HIV prevalence rate is not related to the socio economic and cultural factors available in the study locations/areas.

1.8   Significance of the study

It is hoped that when the study is completed, some facts probably established will serve as basis for providing valuable information for the programme managers, community leaders, voluntary agencies and government.

The data generated from this study can be used by programme managers to design and develop programmes of interventions as well as programmatic approaches. It is expected that this programmatic approach will be responsive to the facts emergent from this study. This can add value to the programming of HIV in these specific communities of the state.

The voluntary agencies shall be able to design campaigns and other containment strategies around the noted cultural and social peculiarities of the peoples of the studied communities namely Achi and Udi. The study will equally help the community leaders to contribute to the adjustment or eradication of some certain cultural practices that lead to the high HIV prevalence rates in these selected communities. Finally, the results will be utilized by government of Enugu state in particular, and Nigeria in general, for effective planning and implementations of various strategies for the mitigating the high HIV prevalence rates in Achi and Udi.

1.9   Scope of the study

The scope of the study is concerned with a detailed factor that can drive spread of HIV in the selected communities to validate the hypotheses above or otherwise. It also entails the comparative analysis of the low and high HIV prevalence rate in some communities as to validate the information collected.

1.10  Limitations of the study

The accessing of the locations of the study area was quite challenging as the study required obtaining a representational sample of the communities. Also, the making the respondents to comply and answer to the many personal questions on the questionnaire was a major challenge rather some potential respondents go to a large extent of demanding some of gratification before opening up.

1.11      Definition of concepts

1.11.1   HIV (Human Immunodeficiency Virus)

Human Immunodeficiency Virus (HIV) is the virus that causes AIDS in humans and it belongs to the retrovirus family. It can be transmitted through unprotected sexual intercourse, transfusion of infected blood, infected pregnant mother to child and unsterilized use of sharp objects.

1.11.2   AIDS (Acquired Immune Deficiency Syndrome)

The acronym “AIDS” stands for Acquired Immune-Deficiency Syndrome. It is a disease condition in which the HIV-infected individual’s immume system is unable to fight the opportunistic infections which leads to clinical signs and symptoms.

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