CHAPTER ONE

1.0       INTRODUCTION

1.1       Background

HIV/AIDS is one of the most widespread and lethal diseases occurring in the world today. According to the latest estimates from UNAIDS; there were 36.9 million people living with HIV in 2014, up from 29.8 million in 2001 and about 1.2 million people have died of AIDS in 2014. (UNAIDS, 2015). What makes AIDS potent is that it can spread very quickly by attacking the very defence of human beings, their immune systems. Most of the people living with or at the risk for the infection do not have access to prevention, care and treatment, and there is still no cure. (UNAIDS, 2015).

In Europe and North America new drug tests and preventive measures are currently being researched to help stop the transmission and spread of HIV/AIDS.  In much of the developing world, however, where HIV/AIDS is a larger problem because of the portion of the population affected, such simple preventive measures (in Western biomedicine) as encouraging condom use are not very successful. In order to fully understand the effects of HIV/AIDS in developing countries, particularly in Africa, one must be able to take into account the political, economic, ecological, social, and cultural factors that influence the representations of HIV/AIDS and the ways in which Africans perceive their health outlook. Essential to this understanding is awareness of the context in which decisions regarding health, health-seeking behaviour, and sexual behaviour are constructed (FaIola & Heaton, 2007).

The HIV/AIDS epidemic has at least two major patterns of transmission: Pattern One and Pattern Two. Patten One refers to the spread of the virus through homosexual activities. This pattern exists mainly in the United States, Europe, and Australia. Drug injection is also believed to contribute to the spread of HIV in Pattern One regions. Pattern Two, on the other hand, refers to the transmission of the virus primarily through heterosexual activities. The regions highly affected by Pattern Two are sub-Saharan Africa, Latin America, and some parts of Asia (UNAIDS, 2004).

The Human Immuno-deficiency Virus has also two major types, HIV-1 and HIV-2. Although HIV-2 is the older version of the virus, it is rarer and causes much fewer infections. It is the HIV-1 strain that has spread so quickly worldwide, including in sub-Saharan Africa. Because of HIV’s immense genetic variation (evolves continuously), attempts by the scientific community to develop a successful vaccine for the virus have not succeeded (Nabel, 2002; UNAIDS, 2004). The antiretroviral medicines available today, at best, prolong – they do not cure – the lives of those infected with the HIV/AIDS, and the cost of such drugs has been a major problem particularly for poorer countries (UNAIDS, 2004).

There are indications that despite a multitude of prevention activities, people continue to be infected by HIV. Prevention programmes seem not to be as successful as intended. One possible explanation is that prevention programmes have focused on risk behaviour and behaviour change rather than considering factors which may encourage risk behaviour or make individuals vulnerable to infection with HIV. This could be factors such as poor education, poor living and working conditions and poverty. Another explanation is that prevention messages have failed to reach certain disadvantaged population groups. The messages may not have been accessible to certain groups, have not well been understood by them, or have not been related to their social and cultural context, and therefore have not been perceived as relevant to them. Prevention programmes may not have taken into account possible class- and socio-economic differences and their implications on HIV/AIDS.  In other words, the question being asked is whether cultural beliefs, attitudes, and practices are influencing people's decision making in sexual situations, specifically with practicing safe sex.

UNAIDS and WHO (2008) stated that at the end of 2007, about 33.2 million persons were estimated to be infected with HIV globally. Out of these, 22.5 million were in Sub-Sahara Africa and about 3 million in Nigeria. In its own report, the National Agency for the Control of AIDS (NACA, 2009) stated that “with an estimated 2.95 million people living with HIV in Nigeria in 2008, Nigeria ranks  as one of the countries with the highest burden of the virus in the world, next only to India and South Africa”. The report further stated that within the population of people living with HIV in Nigeria, females constitute almost three fifth (58.3%); as about 1.72 million women and girls are infected with HIV. Even more alarming is the fact that the highest prevalence rate of 5.6% occurs among the age group of 25-29 years; thus young people are disproportionately infected with HIV in Nigeria. The report equally observed that the April 2009 HIV/AIDS update indicated that an estimated 2.99 million people, consisting of 1.38 million males and 1.61 million females have so far died from HIV-related causes in Nigeria. 

The Nigerian epidemic is characterized by fluctuations in HIV Sero-prevalence as obtained through sentinel surveys of antenatal care attendees. The prevalence shows an increase from 1.9% in 1991 to 5.8% in 2001 down to 5% in 2003 and 4.4% in 2005 followed by a recent rise to 4.6% in 2008. In Nigeria the prevalence also varies among the geopolitical Zones and States. For instance, the prevalence ranges from as high as 10% in Benue State (North Central Zone), 8% in Akwa Ibom State (South South Zone), 6.5% in Enugu State (South East Zone), 6.1% in Taraba State (North East Zone) to as low as 1.8% in Jigawa State (North West Zone) and 1.6% in Ekiti State (South West Zone)(FMOH, 2005). However, the 2008 national survey showed the HIV sero-prevalence to be 1.0 % in Ekiti State (South West geo-political zone) and 10.6% in Benue State (North Central geo-political zone). Seventeen states and the Federal Capital Territory (FCT) recorded sero-prevalence of 7% or higher; four of these were from South-South (Akwa Ibom, Bayelsa, Cross River and Rivers) while two are from the North Central (Benue and Nassarawa States) and one from the North West (Kaduna) geo-political zones of the country. Also in most States, higher prevalence rates were recorded in the urban than in the rural populations (NACA, 2009).

Investigations have shown that the high prevalence rate of the Acquired Immune Deficiency Syndrome in Enugu State was due to low knowledge about the disease by the majority of the people in the state. A review indicated that low risk perception, the belief by many people that they cannot contact the disease, further contributed to the spread of the scourge, especially in the metropolis. The state, with a 6.5 per cent prevalence rate, has the highest in the South East and the fourth in the nation and the pandemic is feared to be on the increase in recent times following indiscriminate sexual activities of teenagers and young adults who constitute a large portion of the population (Enugu State Action Committee on HIV/AIDS, 2009).

Eneh (2005) reported that twenty HIV most infected countries of the world were all in sub-Saharan Africa where AIDS is a leading killer.  One of the sub-Saharan African countries in which AIDS is a national disaster is Nigeria.  The first HIV case in Nigeria was found in 1981, with a 17-year old girl in Enugu (capital city of then Anambra State, and present Enugu State).  This renders Enugu State a wise target of HIV studies.

Eneh and Ugwu (2008) noted that socio-cultural factors fuelling HIV/AIDS varied with locality (rural or urban).  Enugu State is made up of 17 Local Government Areas (LGAs) which are neither socially or culturally homogeneous. However, disparities in socio-cultural factors are narrowed in LGAs with urban centers interplaying with rural areas. Enugu South Local Government Area is probably the only LGA in Enugu State with almost equal parts of rural and urban settlements. On this ground a balanced report on urban and rural situation is possible as the study is aimed at investigating the socio-cultural factors engendering vulnerability to HIV epidemic.

 1.2      Statement of the Problem

The HIV epidemic is one of the most complex health problems, looming as perhaps the single most serious threat to survival. The fast spreading of the epidemic spares no one from its devastating impact and has eaten deep into the fabrics of the society. HIV primarily affects those in their most productive years; about 38% of new infections are among those under the age of 25. HIV not only affects the health of individuals, it imparts households, communities, and the development and economic growth of nations. Many of the countries hardest hit by HIV also suffer from other infectious diseases, food insecurity, and other serious problems. (UNAIDS, 2015)

HIV/AIDS has assumed centre stage in Nigeria and with the rising prevalence rate of the epidemic, which is felt not only by those living with the infection but also those who are indirectly affected. AIDS has rendered so many children orphans, many of which are born with the infection. It is also killing the most productive age-group of the population. It has been observed that despite the many programmes organized to inform people about the problem of HIV/AIDS, the rate of its infection continues to be on the increase. The Joint United Nations Programme on HIV/AIDS ascertained that over a third of 15 years old may die of the AIDS in the near future (UNAIDS, 2004). In addition, the country’s high levels of infant and childhood mortality draw attention away from complications arising from the secondary epidemic of pediatric AIDS and the need to make prevention of mother-to-child transmission (PMTCT) a robust element of HIV/AIDS control programmes (UNAIDS, 2004).

While the epidemiological approach addressed issues of human behaviour, it did not extend to other major contextual factors affecting the spread of HIV or its impact on society. Several years were to pass before it was recognized that HIV and AIDS affect the functioning of society at every level. Likewise several years passed before it came to be recognized that the way society operates, and the way it is structured, have major implications for the AIDS epidemic.

HIV and AIDS are a developmental issue that extends beyond medical and epidemiological concerns, and this has major implications for the response to the epidemic. Any response to the epidemic must take account of the contribution of society, and how society relates to successes and failures in dealing with the epidemic. The inadequate global response may be attributed to the large part to a failure to pay attention to this complex, two way interaction: between the epidemic and the society on the one hand and between the society and the epidemic on the other hand.

1.3       Objectives of the Study

The main purpose of this study is to investigate the social cultural factors engendering vulnerability to HIV epidemic in Enugu South Local Government Area.  To this end, this study specifically tried to;

i.                    To determine the socio-cultural factors engendering vulnerability to HIV epidemic in Enugu South Local Government Area;

ii.                  To determine the effect of socio-cultural factors engendering vulnerability to HIV epidemic in Enugu South Local Government Area; and

iii.                To determine the socio-cultural issues militating against mitigation of HIV impacts in Enugu South LGA.

1.4       Research Questions

Based on the proposed study objectives, the study examined the following questions:

(i)         What are the socio-cultural factors engendering vulnerability of HIV epidemic in Enugu South Local Government Area?

i.                    What effects do socio-cultural factors engendering vulnerability to HIV have in Enugu South Local Government Area?

ii.                  What are the socio-cultural issues militating against the mitigation of HIV impacts in Enugu South Local Government Area?

1.5       Research Hypotheses

Three hypotheses formulated to guide the study were:

Ho1:     There are no socio-cultural factors engendering vulnerability to HIV epidemic in Enugu South Local Government Area.

Ho2:     Socio-cultural factors engendering vulnerability have no significant effect on HIV epidemic in Enugu South Local Government Area.

Ho3:     Socio-cultural issues do not militate against the mitigation of HIV impact in Enugu South Local Government Area.

1.6       Significance of the Study

This study will help expose the socio-cultural factors engendering vulnerability to HIV epidemic and improve the success of HIV/AIDS prevention interventions. This will be of immense benefit to the government of Nigeria at the national, state and local government levels, as study will serve as a reference material to guide in the development and implementation of an effective national policy on HIV/AIDS, based on the understanding of socio-cultural implications of any such policies.  Findings from this study will also serve as a reference material for further studies and will be relevant to the body of academia.  Also, the findings from this study will be of immense value to the international community, donor agencies and implementing agencies in designing and implementation effective culturally acceptable strategies that will effective mitigate HIV epidemic.    

1.7       Scope of the Study

The study aimed at investigating the social and cultural factors engendering vulnerability to HIV epidemic. The scope of study is limited to Enugu South Local government Area of Enugu State, Nigeria. This area of study is chosen as it has both the characteristics of urban and rural settlement, where the modern and traditional socio-cultural practices are observed. The study shall focus on subjects aged 18 years to 65 years, because this age group shows characteristics of both the young and the old and those that may not have a proper cultural orientation and those that have core traditional orientations respectively.

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