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ANIAGOLU, JOSEPHINE N.

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PROJECT TOPIC AND MATERIAL ON THE STATE AND HIV/AIDS CONTROL IN NIGERIA: A STUDY OF ENUGU STATE AGENCY FOR THE CONTROL OF AIDS (ENSACA)

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  • Name: THE STATE AND HIV/AIDS CONTROL IN NIGERIA: A STUDY OF ENUGU STATE AGENCY FOR THE CONTROL OF AIDS (ENSACA)
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ABSTRACT

According to Federal Ministry of Health’s Sentinel Survey of 2010, the prevalence rate of HIV/AIDS in Enugu State is 5.1% which is above the national rate of 4.1%. This study focused on Enugu State Agency for the Control of AIDS (ENSACA), the organization mandated with the multi-sector response to HIV/AIDS in Enugu State; to ascertain whether it has the capacity to deliver on its mandate. Methodologically, the study used instruments like questionnaires and the National Harmonized Organizational Capacity Assessment Tool (NHOCAT) a tool used nationally to assess organizations’ capacity in the HIV/AIDS response, to assess ENSACA’s capacity to deliver the response in the State. The results confirmed that ENSACA has the capacity to deal with the response, though there are still room for improvement. This study also delved into finding out whether the provision of financial, human and infrastructural resources by the State, has any impact on the control of HIV/AIDS in Enugu State. The results from the Binomial Statistical test carried out, showed that there is a 99% assurance that the provision of financial, human and infrastructural resources by the State impacts positively on the control of HIV/AIDS in the State. The study recommended that the following factors should be put in place to help in the response to HIV/AIDS in the State: capacity building of staff at all levels, more technical assistance and support from the government, more care and support to People Living with HIV/AIDS, proper Supply Chain of ART and other consumables, aggressive media hype for HCT & PMTCT, improving the HIV/AIDS database for monitoring and evaluation system, release of timely information to policy makers through Fact Sheets, qualitative and effective reporting at all levels, discipline and responsible dispatch of duties by staff at all levels, becoming a global stakeholder and reference point through website information, provision of sufficient vehicles, sensitization on the anti-discrimination and stigma law, developing proper referral systems and follow up of positive patients, provision of Mobile HCT Vans, transparency at all levels, proper motivation of staff for hard work, provision of more Comprehensive sites and the provision of office equipment and physical infrastructure for the response.

TABLE OF CONTENTS

Title Page – – – – – – – – – – – i Certification – – – – – – – – – – – ii Approval Page – – – – – – – – – – iii Dedication – – – – – – – – – – – iv Acknowledgement – – – – – – – – – – v Table of Contents – – – – – – – – – – vi List of Tables – – – – – – – – – – viii List of Figures and Charts – – – – – – – – – ix List of Acronyms and Abbreviations – – – – – – – x Abstract – – – – – – – – – – – xiii
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study – – – – – – – – 1 1.2 Statement of the Problem – – – – – – – – 3 1.3 Objectives of the Study – – – – – – – – 5 1.4 Significance of the Study – – – – – – – – – 5 1.5 Scope and Limitations of the Study: – – – – – – – 6
CHAPTER TWO: LITERATURE REVIEW
2.1 Introduction: – – – – – – – – – – 8 2.1.1 Country Profile – – – – – – – – – 9 2.1.2 Population – – – – – – – – – – 9 2.1.3 Administration – – – – – – – – – 9 2.1.4 Epidemiology of HIV and AIDS – – – – – – – – 10 2.1.5 Knowledge, Attitudes And Behaviours – – – – – – 12 2.1.6 National Response to HIV/AIDS – – – – – – – 12 2.1.7 HIV/AIDS Program Development Project (HPDP – 2) – – – – 15 2.1.8 Achievements of HPDP-1 – – – – – – – – 15 2.1.9 National Strategic Framework: – – – – – – – 16 2.1.10 National Economic Empowerment and Development – – – – 17 2.1.11 Linkage among NSF, NEEDS, MDG2 & HPDP-2 Goal – – – 17 2.1.12 State Response to HIV/AIDS: – – – – – – – 18 2.1.13 Stakeholders in the State Response – – – – – – 19 2.1.14 Funding Sources: – – – – – – – – – 19 2.1.15 Number of FunctionalHiv/Aids Sites: – – – – – – 19 2.1.16 Gap in Literature – – – – – – – – – 20 2.2 Hypothesis: – – – – – – – – – – 20 2.3 Operationalization of Key Concepts: – – – – – – 21 2.4 Methodology – – – – – – – – – 22 2.4.1 Theoretical Framework: – – – – – – – – 21 2.4.2 Research Design: – – – – – – – – – 22 2.4.3 Method of Data Collection: – – – – – – – 22 2.4.3.1Population of the Study – – – – – – – – 23 2.4.3.2 Sampling Technique: – – – – – – – – 24 2.4.3.3 Sources of Data Collection – – – – – – – 25

2.4.3.4 Tests of Validity and Reliability of Research Instruments – – – 26 2.4.3.5 Method of Data Analysis: – – – – – – – -27
CHAPTER THREE: THE STUDY AREA/GENERAL INFORMATION
3.1 Study Area: – – – – – – – – – – 28 3.2 Enugu State Agency for the Control of HIV/AIDS (ENSACA): – – 29 3.2.1 The Principle of “THREE ONES”: – – – – – – 30 3.2.2 Coordinating Authority at the State Level – – – – – 32 3.2.3 Functions of SACA – – – – – – – – – 32 3.2.4 Functions and Composition of the Governing Board Of SACA – – 33 3.2.5 Structure and Functions of the Departments Within SACA – – – 34 3.3 Enugu State HIV/AIDS Epidemiology – – – – – – 35 3.4 Basic Facts About HIV/AIDS – – – – – – – 36
CHAPTER FOUR: DATA PRESENTATION, ANALYSIS AND FINDINGS
4.0 Data Presentation – – – – – – – – – 38 4.1 Analysis and Interpretation of Research Questions – – – – 40 4.1.1 Research Question 1 – – – – – – – – – 40 4.1.2 Research Question 2 – – – – – – – – – 41 4.1.3 Research Question 3 – – – – – – – – – 43 4.2 Testing of Hypotheses – – – – – – – – 56 4.2.1 Testing Hypothesis I – – – – – – – – 56 4.2.2 Testing Hypothesis 2 – – – – – – – – 58 4.3 National Harmonized Organisational Capacity – – – – – 59 4.3.1 ENSACA NHOCAT Dashboard – – – – – – – 60
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1 Summary – – – – – – – – – – 64 5.2 Conclusion – – – – – – – – – 65 5.3 Recommendations – – – – – – – – – 66
References Appendices Appendix A Appendix B

CHAPTER ONE

INTRODUCTION
1.1 BACKGROUND TO THE STUDY:
According to Okoye [www.cokoye.com] the first two cases of HIV and AIDS in Nigeria were
identified in 1985 and were reported at an international AIDS Conference in 1986. In 1987 the
Nigerian Health sector established the National AIDS Advisory Committee, which was shortly
followed by the establishment of the National Expert Advisory Committee on AIDS
(NEACA).At first the Nigerian government was slow to respond to the increasing rates of HIV
transmission and it was only in 1991 that the Federal Ministry of Health made their first
attempt to assess the situation of HIV/AIDS in Nigeria. Global AIDS Response Progress
Report (GARPF 2012) reported that the results showed that around 1.8 percent of the
population of Nigeria were infected with HIV. Subsequent surveillance reports revealed that
during the 1990s HIV prevalence rose from 3.8 percent in 1983 to 5.4 per cent in 1999.
Following a peak of 5.8 per cent in 2001, HIV prevalence then declined steadily throughout the
decade with 4.1 percent in 2010 as reported by the 2010 Sentinel Surveillance Survey.
During President Obasanjo’s regime in 1999, HIV prevention, treatment and care became one
of the government’s primary concerns. The President’s Committee on AIDS and the National
Action Committee on AIDS (NACA) were created, and in 2001, the government set up a three
year HIV/AIDS Emergency Action Plan (HEAP). In the same year, Obasanjo hosted the
organization of African Unity’s first African Summit on HIV/AIDS, Tuberculosis, and other
Related Infectious Diseases (Adeyi et al 2006 in Okoye[Internet]).In 2005 a new framework
was developed covering the period from 2005 to 2009. Despite increased efforts to control the
epidemic, by 2006 it was estimated that just 10 per cent of HIV – infected women and men
were receiving antiretroviral therapy and only 7 per cent of pregnant women were receiving
treatment to reduce the risk of mother-to-child transmission of HIV (UNAIDS 2008).

In 2010 NACA launched its comprehensive National Strategic Framework to cover 2010 to
2015, which required an estimated #756 billion (around US $5billion) to implement (All Africa
2010, 30th March).According to NACA (2009) some of the main aims included in the
framework are to reach 80 per cent of sexually active adults and 80 per cent of Most-at-risk
populations (MARPS), with HIV counselling and testing by 2015, ensure 80 per cent of
eligible children are receiving antiretroviral therapy (ART) by 2015, and to improve access to
quality care and support services to at least 50 per cent of people living with HIV/AIDS by
2015.Despite being the largest oil producer in Africa and the 12th largest in the world, (Official
Energy Statistics from the United States Government 2007), Nigeria is ranked 156 out of 187
on the United Nations Development Programme (UNDP 2011) Human Poverty Index. This
poor development position has meant that Nigeria is faced with huge challenges in fighting its
HIV and AIDS epidemic.
As a consequence, the Federal Government in 2012 came up with the Presidential
Comprehensive Response Plan (PCRP). According to the President’s Comprehensive
Response Plan document (2012) “Nigeria carries the 2nd highest burden of HIV globally. The
prevalence of HIV in Nigeria as at 2010 was 4.1 per cent (PCRP 2012). Women and children
constitute the largest percentage of those infected and affected in Nigeria. Analysis of the 2010
national HIV prevalence report shows that 58 per cent of People Living with HIV (PLHIV)
population are women.The number of persons living with HIV (PLHIV) at the end of 2011 in
Nigeria was about 3.4 million (PCRP 2012). An estimated 388,864 became newly infected
with HIV in 2011 and an estimated 217,148 people died from AIDS related causes in 2006. In
addition, the number of persons requiring ART rose to about 1.66 million.Although the
national median HIV prevalence has been reducing since 2002, other indices continue to
worsen.”
According to the Standard Operational Manual of the National Agency for the control of AIDS
(NACA), “Nigeria’s response to HIV/AIDS has progressed from a health sector focus to multi
faceted and multi-sectoral approach that cuts across the three tiers of government. Despite
achievements towards control of HIV/AIDS, there still exist capacity gaps for effective
planning, budgeting, coordination and delivery of HIV/AIDS relat
monitoring and evaluation of the response most especially at the state and local government
levels.”
Fig 1. HIV PREVALENCE TREND IN NIGERIA 1991
Source: Technical report on National HIV Sero Pregnant Women Attending Antenatal Clinics in Nigeria.
1.2 STATEMENT OF THE PROBLEM:
The Global Health Observatory (GHO 2011),
from AIDS-related causes worldwide is steadily decreasing from a peak of 2.3 million in 2005 to
an estimated 1.7 million in 2011. AIDS
Africa, South and South East Asia and Caribbean and has continued subsequently. Two signal
developments have caused this decline: first, the increased availability of antiretroviral therapy, as
well as care and support to people living with HIV, especially in Sub Sah
fewer people newly infected with HIV since the peak in 1997.
The effects of antiretroviral therapy are especially evident in Sub
sectoral approach that cuts across the three tiers of government. Despite
achievements towards control of HIV/AIDS, there still exist capacity gaps for effective
planning, budgeting, coordination and delivery of HIV/AIDS related services as well as
monitoring and evaluation of the response most especially at the state and local government
Fig 1. HIV PREVALENCE TREND IN NIGERIA 1991-2010
Source: Technical report on National HIV Sero-prevalence Sentinel Survey among egnant Women Attending Antenatal Clinics in Nigeria.
STATEMENT OF THE PROBLEM:
The Global Health Observatory (GHO 2011), explained that the annual number of people dying
related causes worldwide is steadily decreasing from a peak of 2.3 million in 2005 to
an estimated 1.7 million in 2011. AIDS-related mortality began to decline in 2005 in Sub
h and South East Asia and Caribbean and has continued subsequently. Two signal
developments have caused this decline: first, the increased availability of antiretroviral therapy, as
well as care and support to people living with HIV, especially in Sub Saharan Africa and second,
fewer people newly infected with HIV since the peak in 1997.
The effects of antiretroviral therapy are especially evident in Sub-Saharan Africa, where number of

sectoral approach that cuts across the three tiers of government. Despite
achievements towards control of HIV/AIDS, there still exist capacity gaps for effective
ed services as well as
monitoring and evaluation of the response most especially at the state and local government
prevalence Sentinel Survey among
explained that the annual number of people dying
related causes worldwide is steadily decreasing from a peak of 2.3 million in 2005 to
related mortality began to decline in 2005 in Sub-Saharan
h and South East Asia and Caribbean and has continued subsequently. Two signal
developments have caused this decline: first, the increased availability of antiretroviral therapy, as
aran Africa and second,
Saharan Africa, where number of

people dying from AIDS related causes in Sub-Saharan Africa declined by 32% from 2005 to
2011, although the region still accounted for 70% of all the people dying from AIDS in 2011.
According to the President’s Comprehensive Response Plan (2012), Nigeria has pursued a vision
to halt and reverse the HIV and AIDS epidemic in the country in line with global commitments.
With the valuable support of local and international partners, the country has seen the epidemic
profile change significantly from a HIV prevalence rate of 5.8% in 2001 to 4.1% in 2010.
Nigeria has the 2nd highest HIV burden in the world with 3.4 million people (PCRP 2012)
estimated to be living with HIV in 2012. At the end of December 2012, only 491,021 HIV
positive populations of 1.6 million were accessing ART (30% of national need). This exemplifies
the scale of the service gaps and the urgent need to address them.
Attaining the status of a country with stable change in the incidence rate of HIV infection among
adults 15-49 years old between 2001 and 2011 is a significant achievement, but the overall gaps in
access to HIV/AIDS service remains a great challenge. Systemic reviews of the national response
have identified key challenges which revolve around limited domestic financing of the response,
weak coordination at national and state levels, inadequate State government contribution to
resourcing the response; challenges with human resources for health, weak supply chain
management systems, limited service delivery capacity and limited access to HIV services.
AIDS related deaths in Nigeria amount to about 220,000 annually and affects mostly the working
age group of 15 – 59 years (PCRP 2012). This means that if the virus is not controlled on time, the
working population will be reduced to the barest minimum and this will in turn affect production
of goods and services, which will subsequently impact negatively on the economy.The urgency of
the situation caught the attention of His Excellency Dr. GoodluckEbele Jonathan GCON GCFR,
the President of the Federal Republic of Nigeria, who in demonstrating high level of commitment
to the national response to HIV, requested the development of a comprehensive response plan to
bridge existing gaps and establish the framework for achieving global targets by 2015.
The President’s Emergency Response Plan for HIV/AIDS in Nigeria (PERP 2013-2015) is a

response tool to the challenges facing the national response. It is designed with the mindset of
addressing the challenges to HIV/AIDS response in Nigeria like provision of finances, Health
Centres, Human resources, infrastructure, consumables, capacity building of stakeholders etc. The
PERP framework will be cascaded down to the States and Local governments.
In addressing this topic the following research questions have been proposed:
i. Does the provision of financial, human and infrastructural resources by the State have
any impact on the control of HIV/AIDS in Enugu State?
ii. Has Enugu State Agency for the Control of AIDS (ENSACA) the capacity to
coordinate the HIV/AIDS response programmes in Enugu State?
iii. What are the factors that should be put in place to provide the way forward in the
response to HIV/AIDS in Enugu State?
1.3 OBJECTIVES OF THE STUDY:
The broad objective of this study is to find out the factors that impacts on the control of HIV/AIDS
in the State, to assess the capacity of the coordinating body to control HIV/AIDS in the State and
to find out what should be done to halt the spread of HIV/AIDS in the State.
The specific objectives of this study are :
i. To find out whether the provision of financial, human and infrastructural resources by
the State, has any impact on the control of HIV/AIDS in Enugu State.
ii. To assess the capacity ofEnugu State Agency for the Control of AIDS (ENSACA), to
coordinate the HIV/AIDS response in Enugu State.
iii. To ascertain those factors that should be put in place to move the response to
HIV/AIDS in Enugu State forward.
1.4 SIGNIFICANCE OF THE STUDY:
This study has a theoretical significance because it has added to the frontiers of knowledge as both
scholars and students in the area of HIV/AIDS will as a result of this study advance their
knowledge by having an insight into the subject from the administrative point of view. Hitherto,

materials on HIV/AIDS dwelt more on the clinical, preventive andcurative aspects of HIV/AIDS.
This study has an empirical importance as the findings and recommendations will be used by
ENSACA and its Stakeholders to improve on their service delivery on HIV/AIDS in the State.
In the light of the fact that HIV/AIDS pandemic is threatening to wipe out the working populations
around the world, this study also has economic significance, as HIV/AIDS counselling and testing
will help the working population know their HIV status and help the HIV/AIDS positive
populations access their drugs and live positively and remain productive for the rest of their lives.
HIV/AIDS if well managed is not the worst killer; there are other diseases like cancers, diabetes
and hypertension which kill much faster than HIV/AIDS.
The study also has ethical significance as it advocates abstinence from sex among the Youth
as a way of avoiding HIV/AIDS and other sexually transmitted diseases. This study has social
significance as discrimination and stigmatization of people living with HIV/AIDS was
discouraged. Stigmatization and discrimination helps to propagate the virus as positive patients go
underground and continue to perpetuate and spread the virus; whereas if they are accepted and
respected, they will come out openly to declare their status and will be helped to access drugs and
live positively and productively.
1.5 SCOPE AND LIMITATIONS OF THE STUDY:
The scope of this study is Enugu State and specifically Enugu State Agency for the Control of
AIDS (ENSACA) as it pertains to its coordinating and controlling of the multi sector response to
HIV & AIDS in Enugu State. The health sector response includes all the activities of the State
Ministry of Health, the State Health Board,Tertiary Health Facilities, District Hospitals,
Comprehensive Sites and Health Facilities in the State, while the non Health sector response
includes the activities of Civil Society Organizations, Networks, Support Groups, and Faith-Based
Organisations.
The limitation of the study was the inability to study the activities of all the health sector and non
health sector institutions in the State on HIV & AIDS. Another challenge encountered in the

process of this study was the difficulty in determining the HIV & AIDS resource gap in the State
as the Enugu State Agency for the Control of AIDS (ENSACA) does not know the resource
envelope and work plan of Implementing Partners due to the lack of a State Unified Operational
Plan (SUOP). However, the process to harmonize a state-wide work plan for HIV/AIDS
intervention in 2014 has been kick started.

 

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