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ARTICLES

::HIV/AIDS, STIGMA & DISCRIMINATION::

HIV & AIDS

• AIDS around the World

• HIV & AIDS: Stigma and Discrimination

• What's the big deal about HIV/AIDS?

• Do you know?

When AIDS first emerged as a disease over twenty years ago, few people could have predicted how the epidemic would evolve, and fewer still could have described with any certainty the best ways of combating it.Now, in the year 2006, it is known from experience that AIDS can devastate whole regions, knock decades off national development, widen the gulf between rich and poor nations and push already-stigmatized groups closer to the margins of society. Already, 21.8 million people around the world have died of AIDS, 4.3 million of them children, by the end of 2005. Nearly twice that many - 40 million - are now living with HIV, the virus that causes AIDS, and most of these are likely to die over the next decade or so.

::HIV & AIDS: Stigma and Discrimination::

From the moment scientists identified HIV and AIDS; social responses of fear, denial, stigma and discrimination have accompanied the epidemic. Discrimination has spread rapidly, fuelling anxiety and prejudice against the groups most affected, as well as those living with HIV or AIDS. It goes without saying that HIV and AIDS are as much about social phenomena as they are about biological and medical concerns. Across the world the global epidemic of HIV/AIDS has shown itself capable of triggering responses of compassion, solidarity and support, bringing out the best in people, their families and communities. But the disease is also associated with stigma, repression and discrimination, as individuals affected (or believed to be affected) by HIV have been rejected by their families, their loved ones and their communities. This rejection holds as true in the rich countries of the north as it does in the poorer countries of the south.

Stigma is a powerful tool of social control. Stigma can be used to marginalize, exclude and exercise power over individuals who show certain characteristics. While the societal rejection of certain social groups (e.g. 'homosexuals, injecting drug users, sex workers') may predate HIV/AIDS, the disease has, in many cases, reinforced this stigma. By blaming certain individuals or groups, society can excuse itself from the responsibility of caring for and looking after such populations. This is seen not only in the manner in which 'outsider' groups are often blamed for bringing HIV into a country, but also in how such groups are denied access to the services and treatment they need.

Why is there stigma related to HIV & AIDS?

In many societies people living with HIV and AIDS are often seen as shameful. In some societies the infection is associated with minority groups or behaviours, for example, homosexuality, In some cases HIV/AIDS may be linked to 'perversion' and those infected will be punished. Also, in some societies HIV/AIDS is seen as the result of personal irresponsibility. Sometimes, HIV and AIDS are believed to bring shame upon the family or community. And whilst negative responses to HIV/AIDS unfortunately widely exist, they often feed upon and reinforce dominant ideas of good and bad with respect to sex and illness, and proper and improper behaviours.

Factors, which contribute to HIV/AIDS -related stigma:

• HIV/AIDS is a life-threatening disease
• People are scared of contracting HIV
• The disease's association with behaviours (such as sex between men and injecting drug-use) that are already stigmatised in many societies
• People living with HIV/AIDS are often thought of as being responsible for becoming infected
• Religious or moral beliefs that lead some people to believe that having HIV/AIDS is the result of moral fault (such as promiscuity or ‘deviant sex’) that deserve to be punished.
• Sexually transmitted diseases are well known for triggering strong responses and reactions. In the past, in some epidemics, for example TB, the real or supposed contagiousness of the disease has resulted in the isolation and exclusion of infected people. From early in the AIDS epidemic a series of powerful images were used that reinforced and legitimised stigmatisation.
• HIV/AIDS as punishment (e.g. for immoral behaviour)
• HIV/AIDS as a crime (e.g. in relation to innocent and guilty victims)
• HIV/AIDS as otherness (in which the disease is an affliction of those set apart)

Together with the widespread belief that HIV/AIDS is shameful, these images represent 'ready-made' but inaccurate explanations that provide a powerful basis for both stigma and discrimination. These stereotypes also enable some people to deny that they personally are likely to be infected or affected.

::Forms of HIV/AIDS-related stigma and discrimination::

In some societies, laws, rules and policies can increase the stigmatisation of people living with HIV/AIDS. Such legislation may include compulsory screening and testing, as well as limitations on international travel and migration. In most cases, discriminatory practices such as the compulsory screening of 'risk groups', both further the stigmatisation of such groups as well as creating a false sense of security among individuals who are not considered at high-risk. Laws that insist on the compulsory notification of HIV/AIDS cases, and the restriction of a person's right to anonymity and confidentiality, as well as the right to movement of those infected, have been justified on the grounds that the disease forms a public health risk.
Governments and national authorities sometimes cover up and hide cases, or fail to maintain reliable reporting systems. Ignoring the existence of HIV and AIDS, neglecting to respond to the needs of those living with HIV infection, and failing to recognize growing epidemics in the belief that HIV/AIDS 'can never happen to us' are some of the most common forms of denial. These denial fuels AIDS stigmas by making those individuals who are infected appear abnormal and exceptional. Stigma and discrimination can arise from community-level responses to HIV and AIDS. The harassing of individuals suspected of being infected or of belonging to a particular group has been widely reported. It is often motivated by the need to blame and punish and in extreme circumstances can extend to acts of violence and murder.

::Women and Stigma::

The impact of HIV/AIDS on women is particularly acute. In many developing countries, women are often economically, culturally and socially disadvantaged and lack equal access to treatment, financial support and education. In a number of societies, women are mistakenly perceived as the main transmitters of sexually transmitted diseases (STDs). Together with traditional beliefs about sex, blood and the transmission of other diseases, these beliefs provide a basis for the further stigma of women within the context of HIV and AIDS. HIV - positive women are treated very differently from men in many developing countries. Men are likely to be 'excused' for their behaviour that resulted in their infection, whereas women are not. Rejection by wider family members is also common. In some African countries, women, whose husbands have died from AIDS-related infections, have been blamed for their deaths.

::Employment::

While HIV is not transmitted in the majority of workplace settings, the supposed risk of transmission has been used by numerous employers to terminate or refuse employment. There is also evidence that if people living with HIV/AIDS are open about their infection status at work, they may well experience stigmatisation and discrimination by others. Pre-employment screening takes place in many industries, particularly in countries where the means for testing are available and affordable. In poorer countries screening has also been reported as taking place, especially in industries where health benefits are available to employees. Employer-sponsored insurance schemes providing medical care and pensions for their workers have come under increasing pressure in countries that have been seriously affected by HIV and AIDS. Some employers have used this pressure to deny employment to people with HIV or AIDS.

::Health Care::

Many reports reveal the extent to which people are stigmatised and discriminated against by health care systems. Many studies reveal the reality of withheld treatment, non-attendance of hospital staff to patients, HIV testing without consent, lack of confidentiality and denial of hospital facilities and medicines. Also fuelling such responses are ignorance and lack of knowledge about HIV transmission. A survey conducted in 2002 among some 1,000 physicians, nurses and midwives in four Nigerian states, returned disturbing findings. One in 10 doctors and nurses admitted having refused to care for an HIV/AIDS patient or had denied HIV/AIDS patients admission to a hospital. Almost 40% thought a person's appearance betrayed his or her HIV-positive status, and 20% felt that people living with HIV/AIDS had behaved immorally and deserved their fate. One factor-fuelling stigma among doctors and nurses is the fear of exposure to HIV as a result of lack of protective equipment. Also at play, it appears was the frustration at not having medicines for treating HIV/AIDS patients, who therefore were seen as 'doomed' to die.

::The Way Forward::

HIV-related stigma and discrimination remains an enormous barrier to effectively fighting the HIV and AIDS epidemic. Fear of discrimination often prevents people from seeking treatment for AIDS or from admitting their HIV status publicly. People with or suspected of having HIV may be turned away from healthcare services, employment, refused entry to foreign country. In some cases, they may be evicted from home by their families and rejected by their friends and colleagues. The stigma attached to HIV/AIDS can extend into the next generation, placing an emotional burden on those left behind. However, no policy or laws can alone combat HIV/AIDS related discrimination. The fear and prejudice that lies at the core of the HIV/AIDS discrimination needs to be tackled at the community and national levels. A more enabling environment needs to be created to increase the visibility of people with HIV/AIDS as a 'normal' part of any society. In the future, the task is to confront the fear based messages and biased social attitudes, in order to reduce the discrimination and stigma Perhaps as a response, numerous countries have now enacted legislation to protect the rights and freedoms of people living with HIV and AIDS and to safeguard them from discrimination. Much of this legislation has sought to ensure their right to employment, education, privacy and confidentiality, as well as the right to access information, treatment and support. of people who are living with HIV or AIDS.

What's the big deal about HIV/AIDS?

It's easy to think that AIDS is something for other people to worry about - gay people, drug users, people who sleep around. This is wrong - all teens, adolescent, young people whoever they are, wherever they live need to take the threat of HIV seriously. To be able to protect yourself, you need to know the facts, and know how to avoid becoming infected.

Isn't it only a problem for adults? No. HIV is a big problem for young people, as well as adults. In 2002, it was estimated that there were 3.2 million teens under 15 living with HIV.

What's the difference between HIV and AIDS? HIV (Human Immunodeficiency Virus) is the virus that causes AIDS. AIDS is a serious condition in which the body's defences against some illnesses are broken down. This means that people with AIDS can get many different kinds of diseases which a healthy person's body would normally fight off quite easily.

How long does it take for HIV to cause AIDS? The length of time between being infected with HIV and being diagnosed with AIDS depends on lots of different things. These days, there are many drugs that can be used to help people with HIV, and most doctors believe that a lot of people can be treated for a very long time. Many people do not know exactly when they were infected with HIV, and the length of time between this happening and them being diagnosed with AIDS can be very variable.

So how do you get infected? HIV is passed on in the sexual fluids or blood of an infected person, so if infected blood or sexual fluid gets into your body, you can become infected. This usually happens by either having sexual intercourse with an infected person or by sharing needles used to inject drugs with an infected person. Being born to a mother who has HIV can also infect people and a very small number of people become infected by having medical treatment using infected blood transfusions.
Kissing, hugging or shaking hands with an infected person can’t catch HIV, and sneezes, doors handles or dirty glasses can’t transmit it.

What is safer sex? Safer sex also means using a condom during sexual intercourse. Using a condom is not absolutely safe as condoms can break, but condoms can be effective if they are used correctly.
Can you get infected on your first time Sex? Yes, if your partner has HIV and you have unsafe sex, then you can become infected.

Is there a cure? There is no cure for HIV. HIV is a virus, and no cure has been found for any type of virus. Recently, doctors have been able to control the virus once a person is infected, which means that a person with HIV can stay healthy for longer, but they have not managed to get rid of the virus in the body completely.
How can I tell if someone's infected with HIV? There is no way to tell just by looking at someone whether they are infected with HIV. Someone can be infected but have no symptoms and still look perfectly healthy. They might also feel perfectly healthy and not know themselves that they are infected. The only way to know if a person is infected or not is if they have a blood test.

How can I get tested? You may find it helpful to talk to an adult - perhaps a parent, school nurse or teacher may be able to advise you where you can have a test. It's much better to talk to someone than to worry on your own. The clinic will suggest that you wait three months after your last risky sexual contact before having a test. This is because the virus is difficult to detect immediately after infection.

Do you know!

1. AIDS is not over. Scientists believe that young people between the ages of 13 and 24 accounts for over 60% of every new HIV infections.

2. Most young people who are already HIV-infected don’t know it.

3. The vast majority of HIV-infected youth do not receive adequate medical care.

4. For many young people infected with HIV, new medical treatments could lead to long, productive lives. To make this a reality, they need youth-friendly access to HIV counselling and testing, medical care (including mental health care), and other support services.

5. The best treatments fall far short of a cure and we have no vaccine. Behaviour change is still the key to preventing HIV and protecting America’s youth.

6. Prevention science has identified programs that can reduce risk behaviour, but these programs are not offered in most schools and communities. Some of the proven programs were designed for small group or classroom use. With an emphasis on communication, negotiation and refusal skills, they state clearly that abstinence is important, and also provide information about condoms and other contraceptives. Other effective programs offer individualised counselling to high-risk youth, or use outreach workers to deliver prevention messages. A final group of programs mentor young people in activities that make the future seem brighter and staying safe seem worthwhile.

7. We still need answers to major questions about preventing and treating HIV and AIDS in young people. For example, we need to know how medical treatments for HIV affect a person who is still developing physically.

8. All young people need the tools to protect themselves from AIDS. The youths at highest risk of HIV infection need additional help. They are confronted with poverty, racism, sexism and homophobia. Many are out of school, lack access to health care, and are exploited by adults, youth at highest risk urgently need school and community-based prevention programs that address all the daunting challenges they face.

Sexual and Reproductive Health

• Adolescent Reproductive Health in Nigeria

• Emergency Contraception

• What are Microbicides?

::Adolescent Reproductive Health in Nigeria::

One third (36.5 million) of Nigeria's total population of 123 million are youth between the ages of 10 and 24. By 2025, the number of Nigerian youth will exceed 57 million. Lack of sexual health information and services places these young people at risk of pregnancy, abortion, sexually transmitted infections (STI), and HIV/AIDS. Yet effective, innovative programs can provide youth with the sexual health information and services they need.
Nigeria Teens Face Reproductive and Sexual Health Risks
Over 16 percent of teenage females reported first sexual intercourse by age 15. Among young women ages 20-24, nearly half (49.4%)reported first sex by age 18. Among teenage males, 8.3 % reported first sex by age 15. Among those ages 20-24, 36.3 % reported first sexual intercourse by age 18.In 1999, Nigeria’s adolescent fertility rate was 111 births per 1,000 women age 15-19, and Nigerian women average more than five births during their lifetime. Teenage mothers were more likely than older women to suffer from serious complications during delivery, resulting in higher morbidity and mortality for both mothers and infants. Performing or seeking an abortion in Nigeria, except to save a woman’s life. Yet, experts estimate that more than 600,000 Nigerian women obtain abortions each year.
One study found that one-third of women obtaining abortion were adolescents. Hospital-based studies showed that up to 80 % of Nigerian patients with abortion-related complications were adolescents.

Adolescent lack knowledge of contraceptives and use it inconsistently.
Among teenage women, 37.5% knew some methods of contraception, 36.3% knew a modern method. Among teenage men, 50.3% knew some meth0d; the same percentage knew modern method. However, in another survey among single youth ages 18-24, 97.7% of male and 98.4% of females knew at least one method of contraception. Among sexual active, single youth, reasons of nonuse of contraception included fear of complications (46.7% of male and 48.5% of females) and religious beliefs (12.0% of males and 21.2% of females). Forty percent of youth believed that condom would reduce sexual pleasure.
STI/HIV/AIDS Knowledge is low and infection rates are high
Nigeria’s STD/HIV Control estimates that more 60% of new HIV infections occur in youth ages 15-25.While most youth ages 15-24 knew about HIV/AIDS and gonorrhea, less than 15% of females and 27% of males knew about syphilis and less than five percent knew about human papillomavirus. Among 15-19 years old, over 37% of women and 19% of men had no knowledge of any STI. Among 20-24 years olds, 30.8 percent of women and 4.3 percent of men lacked knowledge of any STI. Among sexually active youth in one study, 87% of males and 78% of females knew that having sex with a stable partner and using condoms consistently could prevent HIV infection. Although many youth chose contraception to prevent disease with casual partners, these youth did not choose condoms significantly more often than other methods.

Social and Cultural Issues Complicate Adolescents’ Development; Prevention Programs can be Effective.
Compared to almost half of women ages 45-49, 25% or fewer of women under age 30 have experienced female genital cutting. Nearly 42% of circumcised women underwent the procedure before age one. A study of 330 female rape victims in Benin City, Nigeria, reported that a majority of rape victims were females ages 13-19; 48% were under ages 13. in another study, 75% of rape victims were unmarried and ages 13-19.
When peer educators provided information and services, youth showed positive changes in reproductive and sexual health knowledge. Students’ knowledge improved regarding transmission of HIV through unprotected sexual intercourse with an infected person (from 72-90%) and through exchange of body fluids (from 72-81%). Students also demonstrated an increase in knowledge of contraceptive options.

::EMERGENCY CONTRACEPTION::

Emergency contraception (EC) implies the use of contraceptive methods or techniques at “emergency” situations. It is the method of using pills or intra-uterine devices to prevent unplanned pregnancy or abortion after unprotected sexual intercourse within 72 hours (3days) of the act. Such emergency situations arises when
1. no contraceptive method has been used in cases of rape, spontaneous and unplanned sexual act
2. is failure or misuse of a contraceptive method such as
• When a condom breaks or slips
• When the diaphragm or caps dislodges, breaks or tears
• When you miss consecutively two or more family planning pills
• When you are more than two weeks late for family planning injections
What do EC pills contain? They contain hormones similar to that found naturally in the human being. Hormones are substances produced by the body to produce specific responses for the general well being of an individual.
How do they work? They work by making it difficult for the sperm to get to the ovum and by interfering with ovulation and implantation. In these ways, pregnancy is prevented.
Is it difficult to use? EC is an easy technique that can be employed individually without going to the hospital or seeking medical advise from a health care professional. All you need to do is to go to a nearby pharmacy outlet and buy the drug.
How can I identify them? Currently present in the Nigerian market are drug products containing these hormones such as
• Postinor 1
• Postinor 2
• Lofemenal
• Duofem (confidence)
• Neogynon
• Microgynon
o Postinor 1 and 2 contains 0.75mg of levonorgestrel in each tablet.
o Lofeminal and Duofem (confidence) both contain 0.3mg norgestrel and 0.03mg ethinyloestradiol per tablet.
o Neogynon contain 0.05mg of ethinyloestradiol and 0.25mg of levonorgestrel
o Microgynon contains 0.03mg of ethinyloestradiol and 0.15mg of levonorgestrel.
How do I use EC?
Depending on the particular brand you have, the amount of tablets that could be used varies.
In postinor 1, one tablet is taken and another one 12 hours later within 72hours (3days) of the sexual act. Each sachet contains 10 tablets. With postinor 2, one tablet is taken and another one 12hours later within 72hours (3days) of the sexual act. It is only different from Postinor 1 in that it is a specially designed pack containing only two tablets. With lofeminal, Microgynon, Neogynon or duofem, four of the white tablets are swallowed and another four swallowed 12 hours later within 72hours (3days) of the sexual act. Each sachet of these contains 21 white tablets and 7 brown ones.
When inserted within 72 hours of the sexual act, IUCDs could provide a useful emergency contraceptive option.

::SIDE EFFECTS::

These could range from headache, nausea, vomiting, abdominal pain, fatigue, dizziness, breast tenderness, vaginal spotting or bleeding and alteration in menstrual cycle.

NB; If vomiting occurs within 2hours of swallowing the tablets, the doses should be repeated.

::CAUTION::

Emergency contraception as a contraceptive method SHOULD NOT be used in place of other contraceptive methods such as daily pills or IUCDs. It is merely an adjunct to prevent unplanned pregnancy and consequently abortion.
It does not prevent against STD and HIV/AIDS.
Do you know that contraception is NOT abortion?
Contraception means to prevent a pregnancy or conception from occurring.
Conception or pregnancy is considered to have started after fertilization or fusion of the sperm with the ovum. This usually takes place between the first 72 hours (3days) after sexual intercourse. So, any measure taken before or within this period to impede or prevent this from happening is called contraception. There are various methods of achieving contraception and this range from the use of
1. Hormonal preparations in the form of tablets and injections,
2. Physical barriers in the form of diaphragm, cervical caps, sponges, condoms (male and female), intra-uterine contraceptive devise (IUCDs)
3. Surgery to more recently EMERGENCY CONTRACEPTION technique.
Abortion on the other hand means to remove or get rid of an existing pregnancy. This involves the use of drugs or other physical means. Illegal abortions account for the death of 200 women daily including adolescents. So, YOU can PREVENT unplanned pregnancies and ABORTION if you imbibe adequate measures and practices regularly such as CONTRACEPTION.
REMEMBER: Contraception PREVENTS abortion!!!!

Contributed by Ekekhomen Donald

What are Microbicides?

A "microbicide" is a substance that can substantially reduce transmission of sexually transmitted infections (STIs) when applied in the vagina. Like today's spermicides, a microbicide could be produced in many forms, including; gels, creams, suppositories, films, or in the form of a sponge or a vaginal ring that slowly releases the active ingredient over time. Microbicides are not currently available, but scientists are pursuing over 60 product leads.

What kinds of Microbicides are they trying to create? Scientists are presently exploring developing three different types of microbicides. Among these are substances that:

• Kill or immobilize STI pathogens;
• Block infection by creating a barrier between the pathogen and the vagina; or
• Prevent the infection from taking hold after it has entered the body.
Other important information about microbicides

Microbicides will not replace condoms as the preferred option for better protection against HIV and STIs. But they will be an option for people who cannot or will not use a condom, and particularly for women whose partners refuse to use condoms, or women who fear violence if they request condom use.

Also, since STIs are caused by different pathogens (some viral, some bacterial), there will not be a microbicide that works against all STIs at the same time.