CHALLENGES TO UTILISATION OF HIV/AIDS PREVENTION INFORMATION IN RURAL COMMUNITIES OF AKWA IBOM STATE, NIGERIA

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1 CHALLENGES TO UTILISATION OF HIV/AIDS PREVENTION INFORMATION IN RURAL COMMUNITIES OF AKWA IBOM STATE, NIGERIA ABSTRACT Okoro, G. I. Department of Agricultural Economics and Extension, Faculty of Agriculture, University of Uyo, PMB. 1017, Uyo, Akwa Ibom State, Nigeria. Phone No: The study examined the challenges to utilization of HIV/AIDS prevention information in rural communities of Akwa Ibom State, Nigeria. Multistage sampling technique was used to select 341 respondents for the study. Data were collected using interview schedule and focus group discussion, and analyzed using descriptive and inferential statistical tools. Results show that majority of the respondents (69.50%) were above 30 years of age, while males accounted for 48.68%. Respondents with informal education were 30.50%, while 56.01% were married. Major income generating activities were farming (32.55%) and fishing (19.94%). Hawking was identified by 17.60% and fishing by 10.26% of the respondents as livelihood activities that could encourage promiscuity in the area. Stigmatization, insufficient knowledge of mode of transmission of the virus and inability to subdue sexual urge were ranked 1 st, 2 nd and 3 rd most serious challenges to use of the information. Age (r = , p < 0.05) and marital status ( 2 = , p < 0.05) were significantly related to the intensity of the challenges. There were significant differences in intensity of the challenges between young and old respondents (t = 4.25, p < 0.05), between young males and old males (t = 2.08, p < 0. 05) and between young females and old females (t = 3.68, p < 0.05). It is recommended that information on modes of transmission/control of the virus should be made more available through jingles and operas. Also, information discouraging stigmatization and encouragement of attitudinal change towards safe sexual practices should be made more available Keywords: Challenges, HIV/AIDS, Prevention, Stigmatization, Condom, Abstinence INTRODUCTION Food is one of the basic needs of man and central to man s survival. It provides the elements needed for mental and physical growth and development. However, food production is adversely affected by many factors including poor, dwindling and insufficient production resources. Among the resources that are insufficiently available and sometimes in poor state, are human resources. This is mostly felt in developing countries, especially in rural areas where agricultural mechanization is still low and human labour is needed in abundance. In Nigeria and Akwa Ibom State in particular where farming is the major livelihood activity of the people, rural dwellers supply a great part of the labour and other human resources needed for agricultural production. The bulk of the food consumed in both rural and urban areas of the country are produced by rural dwellers. It therefore implies that Nigeria s selfsufficiency in food production is dependent on the ability of the rural dwellers to produce enough to feed the nation and even have surplus for export. Acquired Immunodeficiency Syndrome (AIDS) has been identified as one of the factors responsible for the poor and dwindling agricultural labour force in Akwa Ibom State. The disease ravages the work force and introduces some levels of complications that continuously weaken the human resource base of the area. AIDS is caused by Human Immunodeficiency Virus (HIV). The virus attacks the defensive mechanism of the body and destroys it. Once the immune system of the body is destroyed, the victim is exposed to opportunistic infections which may eventually result in the death of the sufferer if early diagnosis and adequate measures are not taken to halt the development of the HIV to full blown AIDS. This gradually reduces the quantity and quality of agricultural labour force in the area. In order to avert the ugly consequences of HIV/AIDS and in the absence of a cure for the disease, individuals are encouraged to develop a positive attitude towards living a HIV/AIDS-free life. Information on modes of transmission of the virus and recommended prevention practices is disseminated to the masses to help them avert HIV infection. However, individuals must be willing to adhere to these practices to be free from AIDS. There must also be some commitments on the part of the government to aid in eliminating factors that work against efforts by individuals or groups to adhere to the prevention practices. The creation of employment opportunities could be an advantage. This is necessary because according to Pettifor et al. (2000), unemployment is one of the major factors that may hinder adherence to HIV/AIDS prevention practices. The researchers observed that almost all women in cities who are involved in prostitution came to town to look for employment (not sex work), but when no formal employment was found, they resorted to commercial sex work. It is however observed that though information on HIV/AIDS prevention is available for uptake, there are factors that hinder this. It is a common feature to see both spouses living or working in towns or cities that are far away NJAFE VOL. 10 No. 2,

2 from each other. They may leave their homes and remain in these towns for periods ranging from few days to months or even years. Some of these individuals patronize the services of commercial sex workers or engage in other forms of extra-marital sexual relationships which may expose them to HIV/AIDS infection. In some areas, houses are overcrowded, with male and female members who are not closely related living together freely. In such a setting, the members are at risk of unintended sexual involvements. Women and girls face the dangers of being sexually abused or drafted into un-consensual sexual activities (South African Council of Churches, 2003). The socio-cultural practices of an area also pose some problems to adherence to the prevention practices. These and other factors affecting adherent to the prevention practices abound. However, these challenges and their intensities on adherent to HIV/AIDS prevention practices differ from place to place and from one culture to the other. Consequently, to prevent or reduce the effects of these factors, the various challenges and their relative intensities are essential. It therefore became pertinent that these factors and their intensities are identified in order to help in prioritizing and developing informed approaches to reduce the spread of the disease and its effects on farm labour and food production. The study therefore investigated the intensities of the various challenges to utilization of HIV/AIDS prevention information among inhabitants of rural communities of Akwa Ibom State. To achieve this, specific objectives were set to: Assess the livelihood activities that could encourage promiscuity and/or spread of HIV/AIDS in Akwa Ibom State. Examine ways in which the livelihood activities could encourage promiscuity and/or spread of HIV/AIDS in the area. Identify the challenges to utilization of HIV/AIDS prevention information. Assess the intensities of the various challenges to utilization of HIV/AIDS prevention information in the State. The following hypotheses were tested: There is no significant relationship between the personal characteristics of the respondents and intensities of the challenges to utilization of HIV/AIDS prevention information. There is no significant difference in the intensities of the challenges to utilization of HIV/AIDS prevention information among gender and generations of rural dwellers in Akwa Ibom State. METHODOLOGY The study was conducted in Akwa Ibom State, Nigeria. The state is one of the coastal states and occupies an area adjacent to Atlantic Ocean to the south (Akwa Ibom State Government, 2008). According to 2006 National Population and Housing Census report, Akwa Ibom State has a population of about 3,920,208 (National Population Commission, 2006). The state has 31 Local Government Areas (LGAs) with many villages. The major livelihood activities of the people are crop farming and fishing. Akwa Ibom State was ranked 2 nd in the country in terms of HIV/AIDS prevalence during the 2005 National HIV/Syphilis sero-prevalence sentinel survey, with a prevalence rate of up to 14.7% in some rural communities. Since then, the prevalence rate of the disease in the area remains high. The high prevalence rate of HIV/AIDS in the state necessitated the choice of the area for the study. The population of the study comprised all rural dwellers in Akwa Ibom State, Nigeria. Four Local Government Areas (Ikono, Ibesikpe/Asutan, Mbo and Eastern Obolo) were purposively selected out of the 31 LGAs of the state. Simple random sampling method was used to select thirty-three villages, representing about ten percent of the villages in the four sampled LGAs. Households were identified through household listing and ten percent of the households in each of the selected villages were selected using systematic sampling method. This gave a total of 341 households. In each of the sampled households, members of the households (18 years and above) were identified and simple random sampling method was used to select a member from a household for the study. This gave a total of 341 respondents. On the basis of age, respondents who were thirty years and below were categorized as being young, while those above thirty years were conceptualized as old respondents. Data were collected using structured interview schedule and Focus Group Discussion (FGD). In all, 341 interview schedules (researcher administered questionnaire) and 8 FGDs were conducted. Two FGDs each were conducted for the young men, young women, old men and old women. Each FGD consisted of about 8-10 participants. Quantitative data were analyzed using frequency counts, percentage and mean. Chi-square, Pearson Product Moment Correlation (PPMC) and t-test were used to test the hypotheses. In the case of qualitative data obtained from FGD, the contributions of the participants were considered thoroughly and the responses selected and presented represent the views of majority of the discussants. NJAFE VOL. 10 No. 2,

3 RESULTS AND DISCUSSION Personal characteristics of the rural dwellers Table 1 shows that 30.50% of the respondents were not more than 30 years of age. This young generation is prone to new HIV/AIDS infection (AVERT, 2008) as the age is associated with increased sexual activities and peer influence. However, to reverse the trend, there is need for caution among these young individuals. Fifty-one percent of the respondents were females, while males accounted for 48.68%. With more than a half of the respondents being females, the virus could spread further. According to Crosby, DiClemente and Wingwood (2008), power imbalance between males and females and fear of negotiating condom use are significant in determining whether young women engage in unprotected vaginal sex or not. According to Table 1, more than a half of the respondents (56.01%) were married, while 43.99% were unmarried. With this distribution, the spread of the virus is expected to reduce. However, while the unmarried are faced with the struggle to abstain from sex and adhere to other prevention practices, the married ones are faced with the obligation of subjecting themselves to the traditional gender expectation in marriage. This is expected even in polygamous relationship or relationship marred by marital infidelity which could be a source of contact with the virus. Moreover, as noted by Coovadia and Hadingham (2005) spouses who live separately from each other may utilize the services of commercial sex workers to satisfy their sexual desires. The table also shows that 30.50% of the respondents were without formal education. This low educational status can affect access to HIV/AIDS prevention information and consequently its use. Thirty-two and a half percent and 19.94% of the respondents engaged in farming and fishing respectively as their major income generating activities. Some of these activities such as fishing and long distance driving may encourage the spread of HIV/AIDS in the area as spouses are separated from each other for weeks or months, which could lead to marital infidelity. Livelihood activities that can encourage promiscuity Result of investigation into the contributions of some livelihood activities to the spread of HIV/AIDS in the area shows that 10.26% and 17.6% of the respondents indicated fishing and hawking as livelihood activities that can encourage promiscuity or spread of the virus in the area. The traditional fishing activities take the fishermen from their homes for many weeks to fishing settlements thereby separating spouses from each other, a situation that could encourage unfaithfulness in sexual relationship. In a related study, Iboro et al. (2007) found that HIV prevalence was higher among traders and itinerary fishermen who engaged in multiple unprotected sexual activities during visits to the beach. Moreover, 7.92% of the respondents submitted that driving; including commercial motorcycling also encourage promiscuity in the area. This indicates that individuals involved in these livelihood activities are among the high risked groups and should be specially targeted with HIV/AIDS prevention information in order to modify their attitude towards utilization of the prevention information. According to Table 3, 12.61% of the respondents observed that these livelihood activities can encourage promiscuity or spread of the virus by bringing about separation of one spouse from the other for a long time. Also, 29.62% indicated that the livelihood activities could do this by exposing the individuals to sexual advances. Self restrain, discipline and adherence to cultural norms and values are needed in these regards by individuals involved if a positive impact of the campaign against HIV/AIDS is to be achieved. Challenges to adherence to HIV/AIDS prevention practices Table 4 shows that 26.98% of the respondents indicated fear of being rejected or stigmatized as one of the major challenges to the use of the information in the area. This could be the major reason that most residents of the area are unwilling to subject themselves to free HIV screening. Moreover, 8.21% of the respondents noted that insufficient knowledge of mode of transmission and control of the virus and consequent fear of being infected is yet another major problem faced by the rural dwellers. This may be responsible for non-acceptance of people living or suspected to be living with HIV/AIDS. Alubo et al. (2002) also observed a high level of stigmatization of people living with HIV/AIDS in Nigeria. During FGD sessions, the participants noted that though they are told that one can eat with an infected person without contacting the disease, they cannot eat nor drink from the same cup with such a person for fear of being infected. Old females in one of the FGDs bared their minds: We have heard over the radio and TV that someone can eat with a person living with HIV/AIDS yet not infected, to tell you the truth, we cannot eat with such a person. It is easy to say, but very difficult to practice. Someone may mistakenly get infected in the process. NJAFE VOL. 10 No. 2,

4 Table 1: Personal characteristics of the respondents Variable description Freq % Mean Age (Years) < > Sex Male Female Marital status Single Married Divorced Widowed Educational status Non-formal Primary Secondary NCE / OND B. Sc and above Income generating activity Farming Fishing Trading Civil Service Fish processing Driving Food vending Processing of farm produce Hired laboring Artisans and others Table 2: Livelihood activities that can encourage promiscuity Livelihood activity Does not encourage Encourages Freq % Freq % Fishing Trading Driving Hawking Fish processing Others (specify) Table 3: Method of encouragement of promiscuity by livelihood activities Method of encouragement Freq % Separation from spouse Exposure to sexual advances Another major challenge to the use of HIV/AIDS prevention information in the area as identified by 14.66% of the respondents is inability to subdue sexual urge. Married individuals, co-habiting and people in steady relationships can satisfy their sex urge with their partners, but singles, divorcees and widows who may not be in any steady relationship could find it difficult to suppress the urge wherever it rises. These groups of people may find a way of satisfying themselves, which eventually increases their chances of being exposed to the virus, if the use of condom is ignored. However, this is a deviation from the traditional societies where premarital and other forms of sex outside marriage were severely sanctioned. Eight and a half percent of the respondents indicated that reduction in sexual pleasure when condom is used is another major challenge faced in the use of the prevention information. The challenge may be a major determinant of low condom use in the area. Also, 9.98% of the respondents indicated dissatisfaction with one sex partner as a mild constraint. In an attempt to elicit reasons from male discussants why married men would leave their wives for another woman and even engage in casual sex without condom when they know that AIDS is deadly, the men in one of the FGDs without delay remarked: NJAFE VOL. 10 No. 2,

5 It s nothing more than greed or whether you call it enjoyment, sometimes drunkenness or unbelief of the existence of the disease. For condom use, some men say it makes the act less enjoyable. Some of the respondents (11.44%) observed that peer influence and separation from spouse though adjudged mild, are impediments to the use of HIV/AIDS prevention information in the area. Tanzanian Commission for AIDS (2008) observed that Tanzanian women who travelled away from home five or more times in 12 months were twice as likely to be HIV-positive as those who did not travel. The results also show that 2.35% of the respondents indicated cultural/religious beliefs as a minor challenge to utilization of HIV/AIDS prevention information. This has great impact on use of the information as most religious adherents tend to believe their leaders out-rightly without reservation. According to U.S Centre for Disease Control and Prevention (2003), some religious leaders believe and teach that AIDS is a punishment from God to adulterers. However, in a bit to find out the contributions of other aspects of the culture of the people to the spread of the disease, several observations were made during the various FGD sessions. In their words in some of the FGD sessions: Young males observed:...substance abuse, like alcoholism may make one engage in an unprotected sex. Young females also observed: sexual advances and persuasion by both young and old men, we resist much but sometimes may be tempted to give in after too much persuasion. Poverty has also been identified by 3.52% of the respondents as a major challenge to the use of the information. Poverty increases economic dependency and encourage the exchange of sex for money. In an earlier survey, South African Council of Churches (2003) observed an inter-correlation between poverty and HIV/AIDS spread. Table 4 also shows that among the factors that hinder adherence to HIV/AIDS prevention practices, fear of rejection (stigmatization), insufficient knowledge of mode of transmission and control of AIDS virus and inability to subdue sexual urge ranked 1 st, 2 nd and 3 rd most serious hindrances to adherence to HIV/AIDS prevention practices. Table 4: Distribution of respondents based on intensity of challenges to use of HIV/AIDS prevention information Factor Not a Mild Severe Intensity Challenge (%) Challenge (%) challenge (%) Index Rank Language of communicating th HIV/AIDS information Fear of rejection (stigmatisation) if others st know of one s HIV/AIDS status Poverty th Peer influence th Gender expectations in marriage/ th sexual relationship Family structure e.g. polygamy th Scarcity of condom th High cost of condom th Exposure by livelihood activity th to sexual advances Religious/Cultural beliefs th Inability to subdue sexual urge rd Reduction in sexual pleasure th when condom is used Dissatisfaction with one sex partner th Separation from spouse for a long time th Poor knowledge of proper use of condom th Insufficient knowledge of mode of nd transmission and control of AIDS virus Hypothesis 1: There is no significant relationship between the personal characteristics of the respondents and intensity of the challenges to utilisation of HIVAIDS prevention information. Table 5 shows that there is a significant relationship between age and intensity of the challenges to utilization of HIV/AIDS prevention information (r = , p < 0.05), with the intensity of the challenges to use of the information decreasing with increase in age of the respondents. The results also show that marital status is significantly related to the intensity of the challenges faced by the respondents ( 2 = 66.39, p < 0.05). These imply that HIV/AIDS control or NJAFE VOL. 10 No. 2,

6 mitigation programmes in the area must be patterned to accommodate the plight of the various age groups and marital statuses. Table 5: Relationships between respondents personal characteristics and intensities of the challenges to utilization of HIV/AIDS prevention information Variables 2 value cc r-value p - value Decision Age S Sex NS Marital status S Educational attainment NS Primary income generating activity NS Hypothesis 2: There is no significant difference in intensities of the challenges to use of HIV/AIDS prevention information among gender and generations of rural dwellers in the study area. Results of the test of differences in intensities of the challenges to use of HIV/AIDS prevention information among gender and generations of the respondents (Table 6) shows that there is a significant difference in intensities of the challenges to use of the information between young and old respondents (t = 4.25, p < 0.05). Significant differences in intensities of the challenges to use of the information also exist between young males and old males (t = 2.08, p < 0.05) and between young females and old females (t = 3.68, p < 0.05). The results obtained shows that the young generations were more challenged in the use of the information than the old generations. This may be as a result of the fact that most challenges faced in the use of the information are directly or indirectly linked to sexual activities and the younger generations are more sexually active than the older ones. Moreover, youth is a stage in human development that is full of vigour, curiosity and enthusiasm to experiment that which is learnt, seen or heard over the radio, TV, the internet and other mass media. Therefore, they are faced with two opposing ambitions: the need to adhere to HIV/AIDS prevention messages especially abstinence from sex, faithfulness to one sex partner and consistent use of condom on one hand; and on the other hand, the desire to test their potency, have fun and practice some of the acts watched in pornographic films or the internet. The result is corroborated by the findings of Egbochukwu and Ekanem (2008) who observed that exposure to pornographic films has a significant influence on adolescents attitude toward sexual practices. Table 6: Differences in intensities of challenges to utilization of HIV/AIDS prevention information among gender and generations of the respondents Test (differences in intensities of the challenges between) Male and Female respondents Young respondents and Old respondents Young males and Old males Young females and Old females Young males and Young females Old males and Old females Mean index Std dev t value p value Decision NS S S S NS NS CONCLUSION AND RECOMMENDATIONS Majority of the inhabitants of rural communities of Akwa Ibom State had farming and fishing as their major livelihood activities. Hawking and fishing were some of the potential livelihood activities that could indirectly encourage promiscuity or spread of HIV in the area. Major challenges to utilization of the prevention information were stigmatization, insufficient knowledge of mode of transmission and control of AIDS virus and inability to subdue sexual urge. They ranked 1 st, 2 nd and 3 rd in terms of the intensities of their challenges to use of the information. These and other challenges are mostly socio-economic, cultural and attitudinal problems and require multi-sectoral approach in dealing with them. It is therefore recommended that information on modes of transmission and control of the virus should be made more available through jingles and entertainment education in radio and television. These media should also be used to discourage stigmatization of people living with NJAFE VOL. 10 No. 2,

7 HIV/AIDS. Also, government should create employment opportunities to raise the economic status of the people to reduce the level of exchange of sex for money. Traditional institutions should liaise with all sectors of the economy to put an end to culturally related factors like polygamy that hinder adherence to the prevention information. People involved in activities that may predispose them to the virus should be enlightened by development agencies on how best to prevent contact with the virus. Making alternative livelihood activities available by government, especially for those who exchange sex for money could be an advantage. Religious and traditional/community leaders should be encouraged to counsel their subjects on how to avert the virus. ACKNOWLEDGEMENT I am grateful to the United Nations Development Programme for the grant which supported the research from which this article is written. I also thank our data capturers and the study participants for contributing to the success of the study. REFERENCES Akwa Ibom State Government Akwa Ibom State: geography and location. Alubo, S. O., Zwandor, A., Jolayemi, T. and Omudu, E Acceptance and stigmatization of people living with HIV/AIDS in Nigeria. AIDS Care, 14(1), Averting HIV/AIDS (AVERT) Worldwide HIV/AIDS statistics: global HIV/AIDS estimates at the end of Coovadia, H. M. and Hadingham, J HIV/AIDS: global trends, global funds and delivery bottlenecks. Crosby, R. A., DiClemente, R. J., and Wingwood, G. M Sexual agency versus relational factors: a study of condom use antecedents among high-risk young African American women. Sexual Health, 5(1), Egbochuku, E. O. and Ekanem, I. B Attitude of Nigerian secondary school adolescents toward sexual practices: implications for counseling practices European Journal of Scientific Research 22(2), Iboro, N., Udoh, J. I. and Samuel, I Assessing the socio-economic factors that drive HIV/AIDS epidemic in four coastal areas of Akwa Ibom State, Nigeria. A paper presented at the 4th International AIDS Society Conference on HIV Pathogenesis and Treatment. Sydney, Australia on July 22-25, National Population Commission National population and housing census report, Pettifor, A. E., Beksinska, M. E. and Rees, H. V High knowledge and high risk behaviour: a profile of hotel-based sex workers in Inner-City Johannesburg. African Journal of Reproductive Health. In F. E. Okonofua and R. C. Snow (Eds). 4(2), South African Council of Churches HIV/AIDS, poverty and BIG. Fact sheet No 7. Tanzania Commission for AIDS Tanzania HIV/AIDS and malaria indicator survey Tanzania Commission for AIDS. U.S. Center for Disease Control and Prevention Female genital mutilation: cause of increased HIV/AIDS in Somalia. NJAFE VOL. 10 No. 2,