Situation Analysis Report on STD/HIV/AIDS in Nigeria

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.
• Centralisation of the programme, with little involvement of States and local governments.
• Despite excellent intentions, programmes are donor driven and often not sufficiently coordinated. Mostly "project oriented" activities with little programme 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 programmes 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 utilise 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 organisations, 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 sensitised 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 organised 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 programmes
• 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 utilisation of local languages (Increasing media response )
• There is an increasing consciousness among International organisations 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.

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