In this paper we will identify the role of various determinants in both the onset of STI/HIV among the Nigerian youth and in the effectiveness of interventions. We will also evaluate whether the determinants that affect STI/HIV among the Nigerian youth are similar to those determinants identified in the efforts to eradicate smallpox, polio and malaria.
ROLE OF DETERMINANTS ON THE ONSET OF STI/HIV
Various social science models have been used to explain the role of determinants on the onset of diseases. Thus STI/HIV among Nigerian youth can be analyzed via such models of biosociopsychological and ecological model which showed the relationship between health and disease or man and his environment (Havelka et al, 2009). The biosociopsycological model operates at three stages: social, psychological, and biological systems. However the social system contributes to the onset of HIV at society, community and family levels.
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SOCIAL LEVEL: There is a high social tolerance for and frequent resort to non-consensual sex (including rape) with girls by older men in communities, educational institutions, works settings and so on (Orubuloye, et al, 1992; Ajuwon et al, 2001). Indeed, for the majority of girls in Nigeria, as in much of Africa, sexual debut is often unplanned and unwanted (Ahonsi, 2013).
COMMUNITY LEVEL: There is frequent resort to and a generalised expectation of extra-marital sex by married men including exchange of money or material goods for such sex (Smith, 2007). In fact, a prominent feature of the social landscape of Nigeria’s towns and cities is formal and informal or disguised commercial sex on offer by female youth to a large population of generally older men.
FAMILY LEVEL: Poor child-parent/guardian/teacher communication and a habit of silence around youth sexuality with reliance on mass media and peer by youth for sexual information and counsel which are often unreliable sources (Ahonsi, 2013).
For the psychological system Havelka et al (2009) explained the link between experience, behavior and disease. The youths have less knowledge or experience about safe sex practice which invariably responsible for low risk perception among this group. And for the biological system the immature organs, cells and tissues make them prone to STI.
EFFECTIVENES OF INTERVENTIONS
Diagnosing HIV infection outside medical settings (Idoko, 2012).
This intervention aims at scaling up HIV counselling and testing uptake. It uses testing as a means to prevention. Many have been trained and stand-alone centres activated to provide services. The waiting time for service is reduced and confidentiality is increased at stand-alone centres. This intervention has been very successful as youths have more confidence in accessing HCT outside the medical settings.
Prevention programs, peer education, condom distribution (Idoko, 2012).
There are different prevention programs in Nigeria but most of the interventions target condom messaging and distribution, referral. A trained peer educator meets his peers weekly to quantify number of condoms enough for weekly sex episodes and distribute. This aims at promoting behaviour change and risk reduction practices among youths. However this has been less successful because of the social factor which stigmatizes adolescent purchasing or possessing aa condom.
Parent-child sex education (Ahonsi, 2013).
This intervention is effective but the shortcoming is the unwillingness of many parents to engage their children in sex education. Peers therefore depend to a large extent on the media or the internet source which is often unfiltered. Alternatively this could be included in the
NYSC HIV project (Idoko, 2012).
The current HIV project for the National Youth Service Corps in Nigeria is one intervention that has been both strategic and effective. Youth volunteer are mentored to provide increase RH/HIV knowledge among corpers, provide life skills & promote peer education. They are guided sexual health messages for their peers and encouraged to promote safe sex practices.
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Key Words: Prevention, Sexually Transmitted Infection, Youth, Nigeria
DETERMINATS THAT AFFECT STI/HIV AMONG YOUTH AND THAT IDENTIFIED IN SMALLPOX, POLIO AND MALARIA
The health of a community results from numerous determinants. Variables such as socioeconomic status, illiteracy, geographic and political freedom, access to food, beliefs, water, sanitation, insecurity, civil unrest and religion were identified in the efforts to eradicate smallpox polio and malaria (Henderson & Klepac, 2013).
Also there are health determinants of STI among youth in Nigeria which are similar to those identified in the eradication of smallpox polio and malaria. The interlocking factors include poverty, illiteracy, unemployment and lack of amenities, social or political conflicts.
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However factors such as concubinage, marriage for the dead, surrogate marriage of woman to woman or man to man, stigma and religion are determinants of HIV/STI among youths in Nigeria but have no impact on the eradication of smallpox polio and malaria (Dibua, 2011).
IMPLICATIONS FOR DEVELOPING ALTERNATIVE APPROACHES
Funding: There is need for heads of government to be committed to reducing poverty, unemployment and illiteracy. These are common determinants in STI among youth and eradication of polio, malaria and smallpox. When fund and resources are committed there would be less movement of people, improved knowledge about health and increased access to healthcare.
Infrastructure: Efforts that improve social amenities in a community will indirectly improve hygiene. There can provide easy access to early diagnosis of infection which prompt early treatment of infection.
Surveillance: The gap between the eradication smallpox and that of malaria and polio is the strong surveillance concept of the former. This is necessary to monitor the progress and success of interventions at various stages. This structure needs be in place to monitor and capture new cases of malaria, polio and STI.
Inequalities: Health inequality is driven by socioeconomic of differences and gender inequalities. In fact healthcare system in Nigeria is funded mainly by out-of-pocket financing method. Free medical care system can help more people to access hospital for professional care.
Ajuwon, A. J., Akin-Jimoh, I., Olley, B., & O. Akintola, (2001) ‘Perceptions of sexual coercion: learning from young people in Ibadan, Nigeria’, Reproductive Health Matters, 9(17) pp. 128-136
Ahonsi, B. A., (2013) Targeting Youth for HIV Prevention and Care in Nigeria: What Role for Governments?’, African Journal of Reproductive Health, 17(4) pp. 1-20
Henderson, D. A., & P. Klepac, (2013) ‘Lessons from the Eradication of Smallpox: An Interview with D. A. Henderson’, Philosophical Transactions of the Royal Society B, 368 p. 1623
Orubuloye, I., Caldwell, P. and Caldwell, J. (1992) ‘Diffusion and focus in sexual networking: Identifying partners and partners’ partners’, Studies in Family Planning 23(6) pp. 343-351.
Smith, D. J., (2007) ‘Modern marriage, men’s extramarital sex, and HIV risk in southeastern Nigeria’, American Journal of Public Health, 97(6) pp. 997-1005
Havelka, M., J. D. Lucanin, & D. Lucanin, (2009) ‘Biopsychosocial Model – The Integrated Approach to Health and Disease, Collegium Antropologicum’, 33 (1) pp.303-310
Dibua U., (2011) ‘HIV/Aids Fact Sheet – Predisposing Factors the Nigeria Situation, Microbes, Viruses and Parasites in AIDS Process’, Available from: http://www.intechopen.com/books/microbes-viruses-and-parasites-in-aids-process/hiv-aids-fact-sheetpredisposing-factors-the-nigeria-situation, (accessed: 21/6/15)
In this reflective portfolio we will talk about the eradication programs and biopsychosocial models approach to health and disease.
In this unit I learnt about the public health approach to the eradication of smallpox, poliomyelitis, yawn and malaria in the world. In my opinion two major factors helped the smallpox program to succeed. First was the ability to quickly innovate e.g. production of bifurcated vaccination needle and production of health stable vaccine. Second was the concept of surveillance and containment. I think that other eradication programs have not succeeded because of lack of commitment from all heads of government. However I think that the eradication of HIV is possible if leaders can be committed to it and adequate funding mechanism is available.
I also learnt about the Havelka et al application of “Biopsychosocial Model” to health and disease (2009). This model helped me to see the socio-psychological situation of the men who have sex with men. My previous interventions for the MSM community had been dominated by biomedical model which is about screening for STI and HIV. With the knowledge of other determinants of health I can henceforth include programs that integrate psychosocial model into the intervention for the MSM. Although funding will be a challenge to such intervention but leveraging on other programs can be a way forward.
Havelka, M., J. D. Lucanin, & D. Lucanin, (2009) ‘Biopsychosocial Model – The Integrated Approach to Health and Disease’, Collegium Antropologicum, 33 (1) pp.303-310
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