Facilitating Achievement of MDGs: Focus on Strategies to Halt and Reverse

the Spread of HIV\AIDS in Tertiary Institution in Nigeria

By: Abdulfatai Tomori B.Sc, MBF

Introduction
The Millennium Development Goals (MDGs) are eight development goals that 189 United
Nations member states and at least 23 international organizations have agreed to achieve by the
year 2015. The MDGs were developed out of the eight chapters of the United Nations
Millennium Declaration, signed in September 2000. The Eight (8) Goals and Twenty-Two (22)
Targets were presented in the table one below:

Table 1: MDGs Eight Goals and 22 Targets

S\N Goals S\N Targets
1 Eradicate extreme 1 Halve, between 1990 and 2015, the proportion of people whose income is
poverty and less than one dollar a day
2 Achieve full and productive employment and decent work for all,
hunger
including women and young people
3 Halve, between 1990 and 2015, the proportion of people who suffer from
hunger
2 Achieve universal 4 Ensure that, by 2015, children everywhere, boys and girls alike, will be
primary able to complete a full course of primary schooling
education
3 Promote gender 5 Eliminate gender disparity in primary and secondary education preferably
equality and by 2005, and at all levels by 2015
empower women
4 Reduce child 6 Reduce by two-thirds, between 1990 and 2015, the under-five mortality
mortality rate
5 Improve maternal 7 Reduce by three quarters, between 1990 and 2015, the maternal mortality
health ratio
8 Achieve, by 2015, universal access to reproductive health
6 Combat 9 Have halted by 2015 and begun to reverse the spread of HIV/AIDS
10 Achieve, by 2010, universal access to treatment for HIV/AIDS for all
HIV/AIDS,
those who need it
malaria, and other
11 Have halted by 2015 and begun to reverse the incidence of malaria and
diseases
other major diseases

7 Ensure 12 Integrate the principles of sustainable development into country policies

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 environmental and programmes; reverse loss of environmental resources
13 Reduce biodiversity loss, achieving, by 2010, a significant reduction in
sustainability
the rate of loss
14 Halve, by 2015, the proportion of people without sustainable access to
safe drinking water and basic sanitation
15 By 2020, to have achieved a significant improvement in the lives of at
least 100 million slum-dwellers
8 Develop a global 16 Develop further an open trading and financial system that is rule-based,
partnership for predictable and non-discriminatory. Includes a commitment to good
development governance, development and poverty reduction—nationally and
internationally
17 Address the special needs of the least developed countries. This includes
tariff and quota free access for their exports; enhanced programme of
debt relief for heavily indebted poor countries; and cancellation of
official bilateral debt; and more generous official development assistance
for countries committed to poverty reduction
18 Address the special needs of landlocked and Small Island developing
States
19 Deal comprehensively with the debt problems of developing countries
through national and international measures in order to make debt
sustainable in the long term
20 In cooperation with developing countries, develop and implement
strategies for decent and productive work for youth
21 In cooperation with pharmaceutical companies, provide access to
affordable essential drugs in developing countries
22 In cooperation with the private sector, make available the benefits of new
technologies, especially information and communications

With around seven years left to the 2015 target date, there has been much stock-taking of where
we are, who is off-track, and what needs to be done especially in the area of combating
HIV\AIDS and other diseases. The MDG ‘Call to Action’ by several governments, faith leaders,
civil society groups and private sector companies signals a renewed momentum for change. In
this paper, we are focus on goal number six (6) which is Combating HIV\AIDS, Malaria,
Tuberculoses and other diseases, specifically strategies to halt and reverse the spread of
HIV\AIDS in tertiary institutions in Nigeria. Before doing this, there is the need to review some
literatures which are below.
Some Review of Literatures

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The HIV/AIDS epidemic presents a big challenge to tertiary education institutions worldwide.
Recognizing the implications of full-blown HIV/AIDS infection in African tertiary institutions,
Kelly (2001) observed that: In South Africa, the Association of Universities Vice-Chancellors
regards HIV/AIDS as a critical strategic issue for higher education for the next five years. With
the observed impact of HIV/AIDS in South Africa, the response of the Universities was uneven.
According to World Bank, 1997 tertiary institutions by their nature are in a position to provide
information and other services that benefit society but are not likely to be offered by private
enterprise because there is no sufficient incentive to do so (the concept of common good). It has
also been recognized that integrating HIV/AIDS education in school and training curricula for it
to reach a wider audience and at a minimal cost can be achieved through tertiary institutions
(World Bank, 1999). As the centers for training and capacity building, tertiary institutions have
the capacity to develop programmes that address the threat posed by the epidemic. In the African
setting according to Anarfi, 1999; Varga, 1999 the boarding school system creates conditions for
peer-pressure and conditions for sexual networking. It also provides an opportunity for reaching
a large number of people with programmes and services at within a short period. On the other
hand, tertiary institutions contain people who are vulnerable to HIV infection due to their age
and socio-spatial characteristics (Awusabo-Asare et al, 1999; Twa-Twa, 1997). We shall now
discuss the concept and some historical perspective of HIV\AIDS.

HIV\AIDS- Concept and Some Historical Antecedent

Concept of HIV/AIDS

Although HIV and AIDS are related, actually they are two different things (Gilks, 1998; Crowe,
2003 and Olufemi, 2004). The word HIV can be looked at literally where ‘H’ stands for Human,
that is ‘man’ or ’human being’ ‘I’ connotes Immunodeficiency; which means ‘human body
inefficient’ and ‘V’ represents ‘virus’, that is the virus that caused the inefficient of the body.
AIDS too can be literally defined in the same perspective where ‘A’ stands for Acquire; which
means ‘to get’, ‘I’ on the other hand means Immune; which means ‘protected’, ‘D’ stands for
Deficiency; ‘lack of’ and ‘S’ represents syndrome means; ‘a group of different signs of a disease’
(opportunistic infections). Therefore, AIDS is a condition that develops from an HIV infected
person. However, there are two types of HIV; they are HIV-1 and HIV-2. The former is the
earliest stage of the disease where as the latter means the development of the disease into a full-
blown AIDS which may result in death (Richards and Leonon, 1986).

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Historical Antecedent of HIV/AIDS

The story of HIV/AIDS emerged in 1979 and 1980 when doctors in the US observed clusters of
previously extremely unusual diseases. These included a type of pneumonia carried by birds
(Pneumocystics Carinii) and a cancer called Kaposi’s sarcoma (Whiteside and Barnett, 2003).
The phenomenon was first reported in the Morbidity and Mortality Weekly Report (MMWR) of
5 June 1981 published by the US Center for Disease control in Atlanta (Crowe, 2003; Mafeni
and Fajemisin, 2003; Whiteside and Barnett, 2003; Olufemi, 2004; WHO, 2004; David et al,
2005 and Okunna and Dunu, 2006). The MMWR recorded five cases of Pneumocystics Carinii
in Atlanta and clustering of Pneumocystics Carinii in New York in a month later (Crowe, 2003
and Whiteside and Barnett, 2003). Available evidence shows that AIDS epidemics began to take
root among heterosexual men, women and children in sub Saharan Africa shortly after its
detection in the United States (Crowe, 2003 and Whiteside and Barnett, 2003). The next section
will briefly summarized the current trends of HIV\AIDS in Nigeria.

HIV/AIDS Trend in Nigeria

UNAIDS, 2007 estimates that in Nigeria, around 3.1 percent of adults between ages 15-49 are
living with HIV/AIDS. Although the HIV prevalence is much lower in Nigeria than in other
African countries such as South Africa and Zambia, the size of Nigeria’s population (around 138
million) meant that by the end of 2007, there were an estimated 2,600,000 people infected with
HIV (UNAIDS, 2007 and NACA, 2008). Approximately 170,000 people died from AIDS in
2007 alone. With AIDS claiming so many people's lives, Nigeria’s life expectancy has declined.
In 1991 the average life expectancy was 53.8 years for women and 52.6 years for men. In 2007
these figures had fallen to 46 for women and 47 for men. Despite being the largest oil producer
in Africa and the 12th largest in the world, Nigeria is ranked 158 out of 177 on the United
Nations Development Programme (UNDP) Human Poverty Index (UNICEF, 2007). This poor
economic position has meant that Nigeria is faced with huge challenges in fighting its HIV/AIDS
epidemic. Below are some of modes of transmission of HIV in Nigeria.

Main modes of HIV Transmission in Nigeria

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According to report placed on avert.com, some 80% of HIV infections in Nigeria are transmitted
by heterosexual sex. Factors contributing to this, according to the report, include low levels of
condom use and high levels of sexually transmitted infections (STIs) such as Chlamydia and
Gonorrhea, which make it easier for the virus to be transmitted (avert.com, 2007). Blood
transfusions are responsible for about 10% of all HIV infections. The remaining 10% of HIV
infections are acquired through other routes such as, (according to avert.com) mother-to-child
transmission, homosexual sex and injecting drug use. Other factors are: lack of sexual health
information; stigma and discrimination; poor health services; gender and inequality; poverty;
harmful marriage and cultural affiliation and prostitution. Next section will highlight some
factors responsible for the spread of HIV in Nigeria.

Factors Contributing to the Spread of HIV in Nigeria

Some of the factors contribute to the spread of HIV\AIDS in Nigeria is as follows:
Lack of sexual health information and education
Sex is traditionally a very private subject in Nigeria and the discussion of sex with teenagers is
often seen as inappropriate. Up until recently there was little or no sexual health education for
young people and this has been a major barrier to reducing rates of HIV and other STDs.
UNAIDS, 2006 estimate that only 18 percent of women and 21 percent of men between the ages
of 15 and 24 correctly identify ways to prevent HIV. Lack of accurate information about sexual
health has meant there are many myths and misconceptions about sex and HIV, contributing to
increasing transmission rates as well as stigma and discrimination towards people living with
HIV/AIDS.
HIV Testing
Another contributing factor to the spread of HIV in Nigeria is the distinct lack of voluntary and
routine HIV testing. In a 2003 survey, just 6 percent of women and 14 percent of men had ever
been tested for HIV and received the results (Avert, 2007). In 2005, only around 1 percent of
pregnant women were being tested for HIV (UNAIDS, 2006). In other to lead by example and as
well as to promote the services and information available to people in Nigeria, the former
president Obasanjo in 2006 publicly received an HIV test and counseling on World AIDS Day.
He stated on the day which was transmitted live on National Television, the speech was read in
part “… a great majority of Nigerians have now come to accept the reality of AIDS …”.
However, the current statistics show that the Nigerian government desperately needs to scale up
HIV testing rates in order to bring the epidemic under control.
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Cultural Practices
Women are particularly affected by the epidemic in Nigeria. In 2006 UNAIDS estimated that
women accounted for 61.5 percent of all adults aged 15 and above living with HIV (UNAIDS,
2007). Traditionally, women in Nigeria marry young, although the average age at which they
marry varies between states (Avert, 2007). A 2007 study revealed that 54 percent of girls from
the North West aged between 15 and 24 were married by age 15, and 81 percent were married by
age 18 (Avert, 2007). The study showed that the younger married girls lacked knowledge on
reproductive health, which included HIV/AIDS. They also tend to lack the power and education
needed to insist upon the use of a condom during sex. Coupled with the high probability that the
husband will be significantly older than the girl and therefore is more likely to have had more
sexual partners in the past, young women are more vulnerable to HIV infection within marriage.
Poor Healthcare System
Over the last two decades, Nigeria's healthcare system has deteriorated as a result of political
instability, corruption and a mismanaged economy. Large parts of the country lack even basic
healthcare provision, making it difficult to establish HIV testing and prevention services such as
those for the prevention of mother-to-child transmission. Sexual health clinics providing
contraception, testing and treatment for other STDs are also few and far between. This makes it
particularly difficult to keep the spread of the epidemic under control. Below are some of
characteristics of tertiary institutions in Nigeria.

Tertiary Educational Institutions in Nigeria

Theoretically, all post-secondary level institutions constitute the tertiary level. However, in
Nigeria, and as in many countries, the concept is used to refer to diploma and degree-awarding
educational institutions. In Nigeria, three categories of such institutions can be identified:
Universities, Polytechnics\Monotechnics and Colleges of Education. The notional age group into
these tertiary institutions is 16-30 years, the peak period for HIV infection in the country. It is,
therefore, important for the country, the administrators and the students of these institutions to
take steps to minimize the potential for infection among students. Next section will look at
incidence of HIV\AIDS in Nigeria tertiary institutions.

Prevalence of HIV\AIDS in Nigeria Tertiary Institutions

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While many populations in Nigeria are at risk for HIV infection, college and university students,
due to unsafe sexual behaviors, experimentation with alcohol and drugs, and failure to see
themselves at risk for infection, are particularly vulnerable to this disease (Ubuane et al., 1999).
The poor economic conditions in Nigeria exert great pressure on young people to engage in
unsafe sexual activities (Mafeni and Fajemisin, 2003). Many youths, especially females who
attend college, have turned to commercial sex work to supplement their income (e.g., to help pay
for college, care for family). In many cases, wealthy older men, referred to as "sugar daddies,"
entice these young women with money to have unprotected sex, such circumstances may have
contributed to HIV/AIDS infection among youths (Mafeni and Fajemisin, 2003). The poor
economy in Nigeria has resulted in youths, many of whom are attending colleges, becoming
involved in sexual networking to earn a living.
To further complicate matters, young Nigerians are poorly informed about reproductive health
and HIV/AIDS in particular (Faleyimu et al., 1999). The Nigerian Sexual Behavior and Condom
Use survey found that sexual risk perception among Nigerians posed its own set of challenges.
Many Nigerians do not consider AIDS to be a serious concern, further decreasing the likelihood
of using prevention methods consistently. Even among high-risk groups, risk perception is poor
(Van Rossem, Meekers & Akinyemi, 2001). Harding et al. (1999) surveyed 380 Nigerian
students on one campus. They found that while the majority (92%) was sexually active and
knowledgeable about HIV transmission, it did not prevent them from engaging in risky
behaviors--60% of females and 71% of males reported vaginal sex without condoms. This was
confirmed in studies by Odebiyi (1992) and Olayinka and Osho (1997) who reported that
although students knew that condoms might prevent AIDS, they were unwilling to use them.
The impact of HIV/AIDS among tertiary institutions is also significant. Chetty and Michel
(2005) purport that HIV/AIDS has an effect on all the categories of people that make up the
university community: students, academic staff, clerical staff, administrative staff and support
staff. These effects manifest themselves in a host of different ways. Illness, death, trauma, and
reduced capacity to work and study affect both staff and students. Institutions lose students and
staff through mortalities. Illness and absenteeism affect productivity. The pool of skills and
knowledge that sustains universities is depleted and the loss of staff and students may ultimately
call into question the viability of the institution. The magnitude of the HIV/AIDS epidemic calls
for more studies than ever before, geared toward controlling and limiting the further spread of
the disease (SADC, 2002 and World Bank, 2002). One way of achieving this is through

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conducting impact surveys to inform policy, programme development, advocacy efforts,
curricula, strategic plans, financing models, human resource plans and skill succession plans.
Against this background, this study has suggested some strategies in halting and reverses the
menace of the disease is as follows.

Some Strategies to Halt HIV\AIDS in Nigeria Tertiary Institutions

1. Abstain / Faithfulness
While abstainess simply mean one should totally desist from any sexual intercourse. On the other
hand, faithfulness is for married couple to be faithful to their partners.
2. More Advocacy on Safer Sex
There are a number of effective ways to encourage people to adopt safer sexual behavior,
including campaigns, social marketing, peer education and small group counseling. These
activities should be carefully tailored to the needs and circumstances of the people they intend to
help. Specific programmes should target key people who are more vulnerable to the disease. In
the mean time, condom is one of the easiest ways to safer sex; it has no side effect, very cheap
and accessible.
3. HIV/AIDS Policy Development
To be successful, a comprehensive HIV prevention programme needs strong political leadership.
This means politicians and leaders in all sectors must speak out openly about AIDS and not shy
away from difficult issues like sex, sexuality and drug use. An effective response requires
strategic planning based on good quality science and surveillance, as well as consideration of
local society and culture. Protecting and promoting human rights should be an essential part of
any comprehensive HIV prevention strategy. This includes legislating against the many forms of
stigma and discrimination that increase vulnerability.
4. Health\Sex Education
Comprehensive sex education for young people is an essential part of HIV prevention. This
should include training in life skills such as negotiating healthy sexual relationships, as well as
accurate and explicit information about how to practice safer sex. Studies have shown that this
kind of comprehensive sex education is more effective at preventing sexually transmitted
infections than education that focuses solely on teaching abstinence until marriage. In the past,
attempts at providing sex education for young people were hampered by religious and cultural
objections. However, the new curriculum was developed with consultation from religious and
community leaders and is expected to remain in place in the future.
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5. Behavioral Modification
There is the need for behavioral changes as the high levels of ignorance about HIV and the denial
of the risks of HIV transmission among the people. It's not surprising that many of the earliest
prevention activities were designed to change mode of our thinking. Notably amongst these is
the billboard at the various tertiary institution that encourages abstinence and misuse of drugs,
this which has contributed to the reduction in the indiscriminate sexual intercourse amongst the
students as well as staffs in tertiary institutions. The next section is ways to reverse the AID
epidemic, is as follow:

Ways to Reverse HIV\AIDS in Nigeria Tertiary Institutions

i. Advocacy on Voluntary HIV\AIDS Counseling\Testing
Another essential part of a prevention programme is HIV counseling and testing. People living
with HIV are less likely to transmit the virus to others if they know they are infected and if they
have received counseling about safer behavior. In particular, a pregnant woman who has HIV
will not be able to benefit from interventions to protect her child unless her infection is
diagnosed. Those who discover they are uninfected can also benefit, by receiving counseling on
how to remain that way.
ii. Media Campaigns & Public Awareness
As Nigeria is such a large and diverse country, media campaigns to raise awareness of HIV are a
practical way of reaching many people in different regions. Radio campaigns like the one created
by the Society for Family Health are thought to have been successful in increasing knowledge
and changing behavior. "Future Dreams", was a radio serial broadcast in 2001 in nine languages
on 42 radio channels. In 2005, a campaign was launched in Nigeria in a bid to raise more public
awareness of HIV/AIDS. This campaign took advantage of the recent increase in owners of
mobile phones and sent text messages with information about HIV/AIDS to 9 million people
(Avert, 2007).
iii. More Access to Antiretroviral Treatment\Drugs
This treatment enables people living with HIV to enjoy longer, healthier lives, and as such it acts
as an incentive for HIV testing. It also brings HIV-positive people into contact with health care
workers who can deliver prevention messages and interventions. Studies suggest that HIV-
positive people may be less likely to engage in risky behavior if they are enrolled in treatment
programmes. Nevertheless, it is also possible that widespread availability of treatment may make

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some members of the wider population less fearful of HIV infection, and hence less willing to
take precautions.

iv. Accurate data on the HIV\AIDS prevalence

Many higher education institutions in Africa do not seem to have accurate prevalence rates
among their populations. It seems critical for higher education institutions to be able to better
estimate the prevalence of HIV/AIDS in their populations. In some institutions, studies point to a
higher prevalence among better educated compared to the general population due to their
affluence, mobility, and desire to push sexual boundaries.
v. Establishment of more HIV Testing and Counseling Center
There is the need for more HIV\AIDS testing and Counseling Center across the country; so that
people would not have to go far before finds HIV\AIDS testing and counseling center. If some
testing were to be done on campus on a voluntary basis (VCT), that would provide more
information and it would make both staffs and students to have more access to information on
HIV. Interestingly, some institutions in Nigeria have established VCT centers in their campuses;
these are in collaboration with NACA and other agency.
vi. Teaching of a Compulsory Module
It has become clear, however, that it is necessary to have a structured programme on HIV/AIDS
education aimed at brining about long-term behavior change in sexual lifestyles. In order to
achieve this goal, the HIV/AIDS programme would need to be integrated with both formal and
continuing education, with adolescent development being the central topic, in order for it to be
stable and sustainable. The approach must be multi-sectoral and multi-disciplinary. This must be
reflected in all the activities, including the HIV/AIDS education programmes for new students
(Fresher) in all the tertiary institutions in Nigeria.

Conclusion
Education is at the core of one of the great challenges facing humanity in winning the fight
against AIDS. Education is life-sustaining, it furnishes the tools with which children and young
people carve out their lives, and is a life-long source of comfort, renewal and strength. The
world’s goals in promoting education for all and in turning back the AIDS epidemic are mutually
dependent. Without education, AIDS will continue its rampant spread. With AIDS out of control,
education will be out of reach. One of the most devastating criticisms of academics environment

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in Africa is that they do not play a role in addressing some of the most critical problems in
Africa, and hence do not make a contribution to development efforts. The most critical problems
in Africa include the HIV/AIDS pandemic. Tertiary institutions must be in the forefront of
research, education and action in this area. With this, I belief we will succeed in overcoming the
menace of HIV\AIDS by year 2015.
On a final note

“We should stop pretending that HIV\AIDS does not exist in Nigeria. All hands must be on deck
to prevent the spread of this killer virus” - Olusegun Obasanjo, Former Nigeria President
(1999-2007)

For Further Reading

Avert.com (2007), HIV-AIDS in Nigeria http//www.avert.org/aidsNigeria.httm

Crowe, D. (February, 2003), HIV/AIDS: Science or Religion. http://aliveandwell.org
Gilks, C. F. (1998), Sexual Health and Health Care: Care and Support for People with
HIV/AIDS in Resource –Poor Setting. London Department for International
Development
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Mafeni, J. O and Fajemisin, O. A. (October, 2003), HIV/AIDS in Nigeria; Situation, Response
and Prospects.
Olufemi, M.O. (July, 2004), The Dreaded Virus: HIV and AIDS. International Nigeria
Conference on AIDS. July 11-16. Pathfinder International Nigeria. Lagos, Nigeria
Richard, P and Leonon, M. (1986), Target Setting for Basic Need. Geneva International Labour
Office www.google.com
UNAIDS (2007), National HIV-Syphilis Sero-Prevalence Sentinel Survey in Nigeria.
http://data.unaids.org/Publications
UNAIDS/WHO (2006), Epidemiological Fact Sheet Nigeria up date.
http://data.unaids.org/Publications/Fact-Sheets01/Nigeria_EN.pdf.

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