SMALL GRANT ONE
Fertility Intention of HIV Positive Nigerians: Implications and Prospects
Dr. Olutosin Alaba Awolude
Dept. of Obstetrics and Gynaecology,
College of Medicine, University of Ibadan, Nigeria.
Of the 40.3 million people infected with HIV worldwide by the end of 2005, 25.4 million were in sub-Saharan Africa of which Nigeria is a major contributor. Women make up almost 57% of all people infected with HIV in sub-Saharan Africa. The implication of these is that a lot of them will consider having biological children of their own especially with prolongation of life now associated with the availability of effective HAART. This is especially relevant for our environment because of the high premium placed on child bearing. However, procreation remains a fundamental right of every individual. A pilot study to assess the desires of HIV positive women for children to help with reproductive health policy and plan for our setting was conducted.
Antiretroviral treatment (ART) for eligible HIV patients using HAART commenced in University College Hospital (UCH), in 2002 as one of the Federal Government sites and later supported with assistance from PEPFAR through the Harvard School of Public Health. As part of the care provided, counseling on the need for use of condom during sexual intercourse all the time is usually emphasized among other reproductive health advices. A quantitative and qualitative survey of the fertility intentions of HIV positive patients age group 15.49 years attending ARV clinic was conducted.
During this study 211 HIV positive patients (110 women and 101 men) had in-depth interview. The mean age of the study group was 35.5+- 7.0 years (female 33.2 =- 6.3 Years; males 38.2=-6.8 years; p = 0.0000) with the youngest respondent being 21 year old university undergraduate. Sixty-six female as compared with 56 male (68.0% Vs 67.5%; p=0.935) of the respondents expressed the intention to have biological children of their own and the main reasons for this decision are the availability of better treatment and prevention of mother to child transmission of HIV and the fact that most of them are of low parity with the mean parity of 2.4 (=- 1.9) babies. There is an encouraging trend in that many of the respondents now see stigmatization as less pronounced but rather perceives the societal feelings towards their condition and their intention to have children as encouraging.
This study confirmed the believe that with better treatment of HIV in developing countries there is going to be high demand for conception by the affected couples. The implication of this is that, with the improvement in their quality of life due to expanding availability of HAART and other treatment measures, a lot of these women will form bulk of patients in our fertility clinics. There is, therefore, the need to start measures to address these needs by development of a technique of achieving conception that is suitable, sustainable and safe without the risk of infection to the seronegative partners and the babies at a supposedly low cost.
Youths are among the segments of the population hose sexuality and reproductive health practices are of particular interest. Adolescents’ access to and utilization of reproductive services is low. This low utilization might be improved by determining the factors influencing the utilization of youth friendly clinics amongst in-school adolescents.
Data were collected through a Focus Group Discussion (FGD) held with a selected number of adolescents and a pre-tested semi-structure questionnaire for 300 adolescents. All were asked about their knowledge of youth friendly clinics, the types of services provided in youth friendly clinics, their interaction with health services provider of youth friendly clinics, their attitudes to utilization of services and the barriers to utilization of services and suggestions for overcoming the barriers. Also an in-depth interview was used to collect information from staff of a youth friendly clinic.
Unawareness of the existence of youth friendly clinic was an overriding factor in the utilization of youth friendly clinics by adolescents. Majority of the respondents that were aware of the youth friendly clinics had not utilized any of the services provided in a youth friendly because they had no knowledge of the services rendered in the youth friendly clinics. This awareness and lack of knowledge of youth friendly clinic services appears to be the major reasons why adolescents do not utilize youth friendly clinics.
The need to educate the adolescents about friendly clinics and services provided is paramount if reproductive health problems amongst adolescents are to be reduced to the minimal in Nigeria. Further analysis is still going on.
SMALL GRANT two
The greatest health problem threatening the human race in our time is the HIV/AIDS pandemic of which the burden is greatest in Sub-Saharan African.
Due to the severe economic, emotional and health related consequences of this infection, coupled with high levels of poverty and unemployment in many parts of Sub-Saharan Africa, there are increasing reports of high levels of tension as a result in many homes, leading to pockets of violence. This is especially true if the woman is HIV positive because she is considered to constitute the added burden to the family. This study sought to assess, describe and determine the prevalence and severity of such violence against women living with the HIV virus attending an ARV clinic in Ibadan.
A descriptive cross sectional survey conducted among 300 HIV positive women attending the anti-retroviral clinic at the University College hospital, Ibadan, Nigeria. All consenting women who attended the clinic between October and December 2005 were interviewed. Data was collected using an interviewer administered questionnaire.
The mean age of subjects was 35.5 years (range: 20-63). Majority were from the south-western zone of the country (96%); 50% were married; 69.9% had less than twelve years of education; 91.7% had disclosed their status to at least one person. The median number of persons disclosure had been made to was 2 (range1-7). Immediately negative consequences associated with partners knowing they were HIV-positive were reported by 16.6%; 8.7% said objects were thrown at them; 5% were thrown out of their house; 2.3% said they were slapped, kicked or beaten. 58.3% said such immediate, negative reactions continued following the disclosure. 12.5% said it increased in intensity while 29.2% said it subsided. A comparative analysis of abuse before diagnosis and disclosure and after diagnosis and disclosure revealed the following: 34% of the respondents suffered emotional abuse after disclosure, particularly being ignored and treated indifferently, being insulted and intimidated on purpose, compared with 30% experienced physical abuse was negligible both before and after disclosure, accounting for 0.3%. Economic abuse after disclosure which in this case was partner refusing to give money to respondent was 13%. Abuse experienced from others include: from in-laws 4.3%; female family member 5%; father 1.3%; neighbors and social acquaintances 11.7%. 29.4% were emotional abuse while 1.3% was physical abuse.
The results are not yet conclusive but it is clear that more women experienced emotional abuse after disclosure as compared with before disclosure and less physical abuse after disclosure as compared with HIV status before disclosure. A significant number also experienced economic abuse. Final results will follow shortly after other factors associated with abuse have been evaluated and analyzed.
SMALL GRANT THREE
The central role men play in population and family life control, especially in Africa with her male dominated structure has been documented in various studies. However, it’s role has not influenced their involvement in some household issues, which have direct influence on child’s nutrition, reproductive health and overall development. The aim of this study was to investigate the level of male participation in childcare practices at the household level. A descriptive study was conducted among 622 men in urban communities to provide information on male participation in household nutrition and reproductive health using variables, which include knowledge of basic nutrient requirement, disposition to family planning practices, concern for basic hygiene and especially level of support for exclusive breastfeeding and immunization, among others. Information was collected using a set of measureable indicators through case study, qualitative and quantitative data collection techniques. The summary of results obtained from case study revealed that men are main decision makers at the family level and their participation in family matter has been limited mainly to provision of financial support and maintenance of child’s discipline in few cases. The qualitative results from focus group discussions revealed that culture and societal expectations play significant roles in determining the level of male participation in childcare. The quantitative data showed that variables including level of education, religion and age of men at marriage were significantly related to male participation in childcare at p^0.05, while respondents. Level of income was not significantly related at p^0.05. In the assessment of level of male participation, using the using the Cornell/Radimer rating scale, the data showed that 458 (73.6%) respondents scored below 50% measure of participation and only 136 (21.9%) men scored above 50% level of participation in childcare. This study was able to discover that when men were asked general questions on their level of participation in childcare, they all claimed to be actively involved. However, it was discovered that when measurable indicators were applied to determine their level of participation, majority of men were found to be inadequately involved in childcare practices. Although, the majority of men mentioned that they have never had the opportunity of attending a sensitization programme for men on what should be their level of male participation in childcare, it is suggested that awareness programme should be created for men to improve their participation.
Further analysis still continues for final submission