CHAPTER ONE

INTRODUCTION

1.1      Background of the Study

            The scourge of HIV/AIDS has, no doubt, continued to ravage virtually all parts of the world. According to statistics, 34 million people are estimated to be living with HIV worldwide; 16.7 million of these are women and 3.4 million are children younger than 15 years of age. In 2011, a total of 2.5 million people were newly infected with HIV globally; an estimation of 330 thousand of these new infections are children under 15 years of age. Also in 2011, the world recorded 1.7 million deaths orchestrated by AIDS of which 230 thousand children under 15 years of age were involved (UNAIDS, 2012).

            Sub-Saharan Africa (including Nigeria), with more than two-third of the world’s total number of HIV-infected people, remains the region most affected by the HIV/AIDS pandemic. About 68% of all the people living with HIV reside in sub-Saharan Africa, a region with only 12% of the global population. The region also accounted for 70% of new HIV infections in 2010 while in 2011, an estimate of 270,000 children in sub-Saharan Africa were newly infected with HIV. AIDS has claimed at least, one thousand lives annually in sub-Saharan Africa since 1998 (UNAIDS, 2012 and 2011).

            According to the National Agency for the control of AIDS (NACA), Nigeria has an estimated 3.1 million people living with HIV/AIDS, with an annual HIV positive births of 56, 681, a cumulative AIDS deaths of 2.1 million and an annual AIDS death of 215, 130 people (NACA, 2011). Statistics from the agency further show that an estimated 281, 180 new HIV infections have been recorded; 126, 260 are adults while 154, 920 children were involved in the new infections. Women, however, constitute 57% of adults infected with HIV in the country (NACA, 2011, FMOH and MASI, 2006). The pandemic is, no doubt, having a serious effect on the reproductive health of women (Adeleke, Mukhtar and Gwarzo, 2009, p.21).

            HIV is the leading cause of mortality among women of reproductive age worldwide and is a major contributor to maternal, infant and child mortality. Without treatment, one third of children living with HIV die before they reach one year of age and 50% die by the second year of life (WHO and UNAIDS, 2009).

            Globally, the number of women dying from AIDS related cases during pregnancy or within 42 days after pregnancy was estimated to be 37 million. Also, among the 21 high priority countries (including Nigeria), 33,000 pregnancy – related deaths among women were recorded (UNAIDS, 2012 and 2011). Statistics also indicate that maternal mortality was still very high in Nigeria (630/100,000 live births) (UNAIDS, 2011).

            From the figures presented above, it is very correct to aver that in all the HIV infections and deaths, children have continued to be seriously victimized. One avenue that has fundamentally aided the infection of children with this deadly disease (HIV) is Mother-to-Child Transmission (MCT). This has, no doubt, served as a major pathway for the spread of the HIV virus. For instance, in Nigeria alone, UNAIDS reported that an estimated 84, 200 children were newly infected with HIV through mother-to-child transmission in 2009. To this end, the World Health Organisation (WHO) in 2010 reported that the prevention of mother-to-child transmission of HIV (PMTCT) has been at the forefront of global HIV prevention activities since 1998.

            The transmission of HIV from an HIV positive mother to her child during pregnancy, delivering or breast feeding is called mother-to-child transmission (WHO, 2010). Children, no doubt, are mainly infected with HIV through mother-to-child transmission at the time of pregnancy, child labor and delivery or through breastfeeding. This has created enormous social and economic problems. Aside the dominant hetero-sexual transmission of HIV, vertical transmission from mother to child accounts for more than 90% of pediatric AIDS. Particularly in developing countries, mother to child transmission has become a critical child health problem (Goncho, 2009, p.6).

            The menace of mother to child transmission has been very devastating. Many children have been infected which has resulted to their early deaths. According to a progress report by UNAIDS 2012, an estimate of 3.4 million children younger than 15 years were living with HIV globally in 2011, 919 of them in sub-Saharan Africa (where Nigeria is situated). An estimated 230 thousand children died from AIDS-related illness in the same year.

            In the absence of interventions, the range of 20-45% of infants would be infected with the deadly HIV through mother to child transmission during pregnancy. 10-20% of infants would be infected during labour and delivery, while 5-20% will be infected through breast feeding. With appropriate interventions, the overall risk can be reduced to less than 2% (WHO, UNAIDS, UNICEF, 2008) cited in (Goncho, 2009, p.7).

            To nip this deadly scourge in the bud, renewed efforts were made to scale-up the prevention of mother-to-child transmission (PMTCT) programmes globally. The Millennium Development Goals (MDGs) adopted by the UN General Assembly in 2010 committed the international community to reducing child mortality; improving maternal health, and combating HIV/AIDS, Malaria and other diseases by 2015. At the UN General Assembly Special Session (UNGASS) in 2001, governments, further committed to reduce by 50% the proportion of infants infected by HIV by 2010 by ensuring 80% of pregnant women accessing antenatal care receive PMTCT services (WHO, 2010, p.11). Also, in 2005, representatives of governments, multilateral agencies, development partners, research institutions, civil societies and people living with HIV assembled at the PMTCT High level global partners forum in Abuja, Nigeria, which resulted in a “call for Action” for the elimination of HIV infection in infants and children and an HIV-and AIDS free generation (WHO, 2007, p.4).

            To effectively combat mother-to-child transmission, the United Nations came up with four-pronged strategy for PMTCT which addresses a broad range of HIV related prevention, care, treatment and support needs of pregnant women, mother, their children and families. This comprehensive approach includes four elements-the primary prevention of HIV infection among women, especially young women, the prevention of unintended pregnancies among HIV-infected women, provision of specific interventions to reduce HIV transmission from HIV-infect women to their infants, and provision of treatment, care and support for HIV-infected mothers, their infants and family (FMOH, 2010, p.4-5).

            The potential for PMTCT to reduce the risk of HIV transmission to less than 2% of births to HIV-positive mothers underscores the importance of a communication strategy that reaches all relevant stakeholders (CADRE, 2009, p.12). This calls for the provision of adequate information to the general population and relevant service providers on the programme through well coordinated campaigns to create awareness and positively influence attitudes, norms, values, and behaviours of the public regarding PMTCT and to improve the capacity and skills of healthcare providers for standard PMTCT services.

1.2      Statement of the Research Problem

            Countless number of HIV prevention campaigns have been going on globally, Nigeria not exempted. The campaigns sponsored by various organizations and bodies such as the World Health Organization (WHO), Society for Family Health (SFH), United Nations Programme on HIV/AIDS (UNAIDS), United Nations Children Fund (UNICEF), United States Agency for International Development (USAID) and many others, including Nigeria’s Federal Ministries of Health and Information, have all been targeted towards the prevention of HIV. Recognizing the high prevalent rate of mother to child transmission, the campaigns have as well given priority attention in sensitizing mothers to embrace the prevention of mother to child transmission programme. For instance, the global campaign, “Unite for Children, Unite against AIDS”, which was launched in October 2005, is a concerted effort by the international community to ensure that children and adolescents are effectively included in HIV and AIDS prevention, protection, and treatment strategies. The campaign provides a child-focused framework for nationally owned programmes around four main areas known as the “four Ps” which prevention of mother to child transmission of HIV is the first ‘P’.

            The Nigerian Federal Ministry of Health initiated the National Prevention of HIV in 2001, with the aim of reducing vertical transmission of HIV. This heralded so many sensitization/advocacy campaigns by government ministries, agencies and private organizations such as the Federal Ministries of Health and Information, National Action Committee on HIV/AIDS (NACA), Life Link Organization (LLO), Social Sciences and Reproductive Health Network (SSRHN), Safe Motherhood Partner (SMP), National Council of Women Society (NCWS), Federation of Muslim Women Association in Nigeria (FOMWAN) etc.

            These are efforts geared towards creating the much desired awareness on PMTCT by extension influencing attitudes and practices of the target group (women). How successful these campaigns had been in achieving desired objectives is the trust of this study.

1.3      Objectives of the Study

            The following objectives will guide the study;

1.      To ascertain whether southeast Nigerian women are exposed to PMTCT campaigns.

2.      To unravel their major source of exposure to PMTCT campaigns.

3.      To find out the knowledge level of Southeast Nigerian women about the PMTCT programme

4.      To ascertain the attitude of Southeast Nigerian women on PMTCT campaigns

5.      To determine whether the PMTCT campaigns have influenced Southeast Nigerian women to participate in the programme.

1.4      Research Questions

In line with the set objectives of the study, the researcher will ask the following research questions

1.      Are Southeast Nigerian women exposed to PMTCT campaigns?

2.      What is the major source of Southeast women’s exposure to PMTCT campaigns?

3.      What is the knowledge level of Southeast Nigerian women on the PMTCT programme?

4.      What is the attitude of Southeast Nigerian women on the PMTCT campaigns?

5.      Have the PMTCT campaigns influenced Southeast Nigerian women to participate in the programme?

1.5      Significance of the Study

            The significance of the study to the media managers, health organizations and agencies, academic community, campaign planners and the general society cannot be over emphasized.

Media and other professionals who are involved in planning PMTCT campaigns will know the extent to which such campaigns influence knowledge, attitude and practice of the audience towards PMTCT services. The study will emphasize the need for aggressive campaigns relative to appropriate timing, simplicity of campaign messages and influence of the campaigns. This will enable them to understand how best to structure PMTCT campaign messages to yield the desired influence.

The Ministry of Health and other health organizations and agencies (local and international) will equally find the outcome of this study very relevant. The study shall enable them to know the extent to which their campaign messages have been able to influence the knowledge, attitudes and practice/behaviours of Southeastern Nigerian women towards PMTCT services. Statistical data on infection and mortality rate may stir up concerns for better promotion of knowledge on PMTCT; placing emphasis on prevention. When this is achieved, increase in transmission and consequent death of children would have been reduced.

Theoretically, this study will provide an academic platform for testing claims put up by some theories on attitude and behavioural change.

Also, the study will contribute to knowledge in the academia. It will serve as a reference document for further studies on the topic. It will be helpful in the teaching and learning of health communication. Therefore, it will contribute to the pool of literature in health communication.

Finally, the general public who are interested in health communication, specifically, HIV/AIDS and PMTCT campaigns will find this study useful.

1.6      Operational Definition of Terms

MTCT: An acronym for “Mother-to-Child Transmission of HIV”. This means the transmission of the HIV virus from an infected mother (in Southeastern Nigeria) to her child during pregnancy, delivery and during breast-feeding of the baby.

PMTCT: This is also an acronym of “Prevention of Mother-to-Child Transmission of HIV”. It is a strategy designed to prevent the transmission of the HIV virus from an infected woman (in the Southeastern Nigeria) to her baby.

Campaigns: These are awareness and sensitization efforts made by the government, health organizations, media and other professionals aimed at engendering adequate knowledge, positive attitudes and behaviours of women towards PMTCT in Southeastern Nigeria.

Influence: This refers to how the PMTCT campaigns are able to bring about changes in the knowledge, attitude and practices among women in Southeastern Nigeria.

Knowledge: The extent to which women in Southeastern Nigerian know about PMTCT through the different campaigns.

Attitudes: The disposition of women in Southeastern Nigeria about PMTCT.

Practices: All conscious efforts by the women in Southeastern Nigeria to practice the messages of the PMTCT campaigns which amongst others involve going for HIV test, accepting antiretroviral drugs if tested positive and adhering to instructions from the medical personnel.

Southeast Nigerian women: These are all females in the five states that made up the Southeastern region of Nigeria. The states are Abia, Anambra, Imo, Ebonyi, and Enugu.

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