THE EFFECT OF HIV/AIDS INFORMATION USAGE ON SEXUAL
BEHAVIOUR AMONG FARMERS IN BADAGRY LOCAL GOVERNMENT AREA OF LAGOS STATE,
NIGERIA: AN INFOMETRICS VIEWS
BY
WUSU,
Oluwaseyi Hodonu
Houdegbe
North American University, Cotonou, Benin
+22968887379,
+22965170598, +2348035916293
INTRODUCTION
1.1 Background
Since the first case of Acquired
Immune Deficiency Syndrome (AIDS) was recognized in 1981 in the United States
of America, its impact has been felt most severely on the economies of the
developing world. Given that AIDS affect most people irrespective of
their age group, it is therefore uniquely devastating in terms of increasing
poverty and reversing human development achievements (UNDP 2005). Incidence and prevalence rates in Africa and
most especially in Nigeria are staggering. According to Ayankogbe et al.
(2006), about 40 to 50 percent of the city dwellers in some African countries
have AIDS while in Nigeria; an estimated 3.6 percent of the population are
living with HIV and AIDS UNGASS, (2010).
Although 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 149 million) means that by the end of 2009, there were 3.3 million
people living with HIV (UNAIDS, 2010).
Nigeria is an agrarian economy
and the negative impact of HIV/AIDS on agriculture is monumental. In her
National Policy on HIV/AIDS, the government of the Federal Republic of Nigeria
acknowledges that a comprehensive information, education and communication
(IEC) system is central to the nation’s efforts to prevent the spread of
HIV/AIDS and mitigate its impact on rural/urban household (NACA, 2003). This
position conforms to the World Health Organization’s (WHO, 2005) strategy
regarding combating the disease, and it has led to the initiation and
implementation of various information, education and communication programmes
to improve the general public awareness especially farmers in the rural communities
about the disease. The expected outcome of the awareness programmes is that
individuals adopt appropriate behaviors and lifestyles that could protect them
from contracting the disease. The recognized role of information usage in
controlling behavioural diseases such as HIV/AIDS often results to communities
deploying all available information sources, without any discrimination of the
sources according to their use characteristics in the target communities Kirby
(2006).
In 2004 and 2006, United Nations
Commission on AIDS (UNAIDS, 2004, 2006) reported that adolescents and young
adults were the fastest growing population of newly infected cases of HIV
globally. The present study is therefore very crucial to agencies that are
responsible for HIV/AIDS control in Nigeria such as National Agency for the
Control of AIDS, State Agencies for the Control of AIDS, nongovernmental,
international and other organizations that are under pressure to make optimal
use of scarce resources. They could invest selectively on the information
sources that have greater potentials to inform audiences and result to a more
focused action on the control of the disease. The study has implication that a
few information sources could achieve the same level of HIV/AIDS awareness that
is often expected from several sources. This opinion is partly supported by
studies that show that actual use of information sources by various audiences
differs from preference expressed for the sources, although this study made no
effort to identify those few sources that could explain farmers’ awareness
about HIV/AIDS. Further understanding of the factors that account for the use
of the sources and the relationship between the use of these sources and sexual
behaviour among farmers could contribute immensely to HIV/AIDS programming and
management by government.
Crucially, investing in the few
sources that account for most of the information awareness among target
audiences will save cost and maximize scarce resources. Several studies that
examine the use of information sources abound in Nigeria, but apart from Nwagwu
(2007) study which attempted the establishment of the most effective sources,
these studies did not attempt to establish whether there existed few sources
that explained most of the information source used.
Kim and Free (2008) have
evaluated peer-led interventions in adolescent sexual health education
published during 1998-2005 and concluded that “despite promising results in
some trials, overall findings do not provide convincing evidence that peer-led
education improves sexual outcomes among adolescents”. Kim and Free (2008)
based their study on the famous peer-led intervention evaluations of Harden
(1999) which could not also reach robust conclusions regarding the
effectiveness of peer-led interventions for young people, although they made a
number of recommendations for the development and evaluation of such
interventions. They suggested that resource constraints, conflicting value
systems and constraints on young people's autonomy (especially among farmers,
as in this case) influence their identity and value system, and further affects
the role they could play in peer education and society. Harden (1999) suggested
that the important characteristics of peer educators are unclear and recommended
that authors should describe how peer educators were recruited and selected,
and that young peoples' views regarding an intervention in which they played
crucial roles be fully reported.
A study by Amsale et al. (2005)
in Ethiopia showed that television topped the rankings in terms of their
popularity as sources of HIV/AIDS and related information. But in a study in
Nigeria, Nwagwu (2007) showed that television was very effective for adolescent
girls more than they were for adult women who appeared to be better educated
about HIV/AIDS through community associations. Regarding how personal and
parental characteristics explain use of handbill, this study shows that younger
adolescents who are less likely to be males but are close to their mothers
might be learning about HIV/AIDS through handbills more than they did from
other sources.
According
to Unuigbe and Ogbeide (2009), one of the major challenges of farmers’
sexuality and reproductive health is lack of adequate information. They further
observed that young farmers need to be fully exposed to sex education and that
information on HIV/AIDS should be made readily available to them at home, on
the field or in public places.
Iyaniwura
(2004), in a study of the attitude of farmers reproductive health
interventions, highlighted the risk associated with farmers sexuality and
upheld that farmers need appropriate information and skills to help them make
informed sexual decisions. Iyaniwura further observed that information in
itself is not adequate to change the risk behavior of farmers, but the
information must be tailored to address the specific needs of the farmers.
Alongside information interventions, the implementation of measures to build
self-esteem and self-efficacy, and social skills in farmers has also been
recommended by Futterman (2005).
HIV/AIDS
information awareness programs make use of many different media to reach
farmers. These include: print media- books, posters, pamphlets, handbills; broadcast
media- various programs on radio and TV stations; family- which includes
parents, other parent-figures and siblings; friends and peers; and healthcare
workers in general. Others are formal and informal education activities,
telephone hotlines and the internet (Ybarra et al., 2006). According to a
number of researchers in different countries such as Buseh et al. (2002) in
Swaziland; Nwokocha and Nwakoby (2002) in Enugu State, Nigeria; Okonta and
Oseji (2006) in Delta State, Nigeria, the broadcast media seem to top the
rankings in terms of their popularity as sources of HIV/AIDS and related
information.
In a
study of 450 rural farmers in Addis Ababa, Ethiopia, Amsale et al. (2005)
defined various parameters for assessing actual source use such as perceived
credibility of the source, perceived appropriateness of the message, perceived
accessibility of the source, perceived timeliness of the information, perceived
applicability of the message and preferred source. According to the authors,
the most preferred source of HIV/AIDS information for the farmers was the
radio, followed by television, with healthcare workers ranking the least.
Berenson et al. (2007) have shown that the role of media as a source of
HIV/AIDS and reproductive health information to farmers is very important and
cannot be overlooked.
With
regard to farmers sexual behavior, the desired behavioral modifications as a
result of information intervention programs would include the following:
delayed onset of sexual initiation, decreased frequency of sexual intercourse,
reduction in number of partners, increased use of condoms at every instance of
sexual activity, not offering sex for money and total abstinence from sexual
intercourse until marriage. However, Kirby (2006) has cautioned that with
respect to the influence of sex education and other information intervention
programs on adolescent sexual behavior, expectations should be modest as
changing the behavior of people is generally difficult especially when that
behavior is strongly affected by hormones, physical desire and a host of other
factors. Despite some controversies in the literature over the role of the
media in adolescent sexual behaviour, there appears to be a consensus by
researchers that behavior modifications with regard to farmers’ sexuality and
HIV/AIDS can be achieved through well managed and comprehensive information
intervention programs (Brown et al., 2002). United National Children's
Emergency Fund (UNICEF, 2006) reported that the fall in the prevalence of
HIV/AIDS in Uganda during 1987 to 1997 was due to the use of strong public
information campaigns since the mid 1980s.
In
their own study, Kirby et al. (2006) who reviewed 83 evaluations of sex and HIV
programs that were based on a written curriculum and that were implemented
among groups of youth in schools, clinics and other community settings in both
developed and developing countries, found that that the programs had a
significant delay in sexual initiation. The programmes also reduced frequency
of sexual intercourse among the youths and also decreased the number of sexual
partners. The review found increases in perceived risk, improvement in measured
values and attitudes, improved perception of the disease, as well as increased
motivation to abstain from sexual intercourse or if not possible, reduce number
of sex partners.
In
another systematic review of all the research published on the impact of girls
education on sexual behavior and HIV in eastern, southern and central Africa,
Hargreaves and Boler (2006) found that increased levels of girls education was
associated with a delay in initiating sexual intercourse, higher levels of
condom use and lower association with coercive, transactional and commercial
sexual activity.
The
result of a study by Magnani et al. (2005) was however different. They found
that exposure to a full coverage life skills education program had no
significant effect on initiation of sexual intercourse, the programmes did not
result to any significant increase in the practice of secondary abstinence and
did not have any significant effect on number of sexual partners, although it
had significant effects on first sexual intercourse, consistency of use of
condom and use of condom at last intercourse.
The general objective of this study
is to examine the effect of HIV/AIDS
information sources on sexual behaviour among farmers in Badagry local
government area of Lagos state.
The
specific objectives are to:
(i)
determine
the demographic information of farmers,
(ii)
establish
those information sources that are mostly used by farmers while seeking
for information on HIV/AIDS in
Badagry,
iii)
investigate
the level of farmers’ knowledge and awareness of HIV/AIDS,
iv)
determine
the factors that account for the use or not use of these sources and,
v)
establish
how these information sources relate to farmers change in sexual
behaviour.
1.4 Scope
The
research is limited in scope to examine the effect of HIV/AIDS information usage
on sexual behavior among rural-urban skilled farmers in Badagry Local
Government Area of Lagos State. The researcher finds it inevitable to limit
this study to rural-urban skilled farmers in Badagry because of time and
finances involved in carrying out a more elaborate study.
1.5 Significance
The study is very significant in
that it will examine
whether there existed some few information sources that could explain farmers’
choices of information sources on HIV/AIDS and how the use of these information
sources influenced their sexual behavior in the society. Also, it will expose farmers and others on the
factors that account for the use or not use of these information sources of
HIV/AIDS. It is also significant by promoting change in attitude of people
towards sexual
behavior in the
society.
2.0 Introduction
As the former United Nations
Secretary General Kofi Annan (2001) puts it, HIV is the ‘genocide of a
generation’. It is also believed that the epidemic has claimed more lives than
any war. Africa, the least developed and the poorest continent of the world
recorded the highest number of people with HIV/AIDS (UNFPA Report, 2005).
Studies
have shown that medical and clinical solution cannot produce the desired result
without adequate education through provision of information in print and
non-print materials/sources for awareness creation and improved factual
understanding that enhance behavioural change and overcome misconceptions.
According to Bature (2005), AIDS
has no cure. Information is the most potent weapon available in warring against
HIV/AIDS epidemic. This is why government at all levels plays a key role in the
dissemination of HIV/AIDS information to her citizen as well as reorientates
the society on the effect of the menace.
Nwagwu (2008) believes that many
people are of the opinion that the crisis of HIV/AIDS in Nigeria could largely be as a result of relaxed attitude of
the government in informing the population about the disease at its earliest
stages of infection in 1984 when the first victim was diagnosed. Although
significant reduction in the prevalence has been recorded – from 5.8 in 2005 –
a crucial and communication strategy should remain for a long time to come. Information
is power and has been recognized worldwide as being effective in changing
behavior and attitudes of people towards HIV/AIDS in Nigeria.
2.1.
History
of Badagry
The Ogu or Ogbugbe people of
Badagry Local Goverment Area in the Lagos southwest area are part of the
Yoruba/Popo sub-group who emigrated from the ancient Ketu Kingdom of present
day Benin Republic .According to the historical account, the Ogus originally
migrated from Ile-Ife in the late 13th century into the then Dahomey Empire
which subjugated Ketu Kingdom and from there broke into two different waves.
While a band of the Ogu moved westward into Accra and Lome to form Ga and Ewe
stocks respectively , the second group led by Akran Gbafoe, moved eastward
along Porto-Novo and Yewa creeks (later Badagry creeks). They settled along the
Kweme coastline and Olege lagoon to form the chain of Ogu communities with
Badagry as the epicentre in the 15th century.
Badagry which is the centre of
the Ogu population in Nigeria derived its name “Agbadarigi” from the Ogu
reference; Agbagreme which subsequently, at the advent of the Europeans in the
16th century was converted to Badagry. Since its founding, Badagry has grown
from a small principality of four Ogu sub-ethnic groups of Wheda ,Wheme Whra
and the Combined Ga/Ewe and Ajah to become an ancient major slave outpost ;
beacon of Western civilization and Christianity in Nigeria and headquarters of
Badagry division. It also becomes one the five administrative division of Lagos
state in time past. More importantly, the town was the place in Nigeria where
Christianity was first preached in 1842 by Rev.Thomas Birch Freeman. Also, the
first storey building in Nigeria, the C.M.S (Anglican) Mission house was built
in 1845 at the Marina. Badagry area is naturally endowed with monumental
tourist attraction which form part of the Ogu’s cultural heritage located on
the Guinea coast with its beautiful coconut-fringed sandy beaches dotted with
historical sites and relics, the City is a fascinating tourist destination. The
more important attractions include: Fist storey building in Nigeria, the Agia
monument, Slave Relics Museum, Obas palace, the Point of No Return.
The Ogu’s are mainly engaged in
mainly fishing, farming and animal husbandry. The people sail in dug-out canoes
along the lagoons, mangrove water and creeks using drag-nets, hand nets and
fishing lines. However in recent time, outboard fishing boat and farming gear
have given wider access to the exploitation of resources along the sea fringes
and far into the rivers. As a result, contributes significantly to the economy
nutrition of the Ogu people with buyers coming from the Lagos mainland and
Yoruba hinterland. Cottage industries in boat-building, net-making, raffia
works and fish processing have sprung up in large numbers in the Badagry area
to take advantage of the opportunities. Farming of maize, cassava and coconut
is also a major occupation in Badagry.
2.2. HIV/AIDS in Nigeria
In Nigeria, an estimated 3.6
percent of the population is living with HIV and AIDS UNGASS, (2010). Although
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 149 million)
means that by the end of 2009, there were 3.3 million people living with HIV
(UNAIDS, 2010).
Approximately 220,000 people died
from AIDS in Nigeria in 2009, UNAIDS (2010). With AIDS claiming so many lives,
Nigeria’s life expectancy has declined significantly. In 1991 the average life
expectancy was 54 years for women and 53 years for men (WHO, 2008). In 2009
these figures had fallen to 48 for women and 46 for men (UNAIDS (2010).
2.3. The History of HIV in Nigeria
The first two cases of HIV and
AIDS in Nigeria were identified in 1985 and were reported at an international
AIDS conference in 1986 (Adeyi, 2006). 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 (Kanki, and
Adeyi, 2006), and it was only in 1991 that the Federal Ministry of Health made
their first attempt to assess Nigeria's AIDS situation. The results showed that
around 1.8 percent of the population of Nigeria was infected with HIV.
Subsequent surveillance reports revealed that during the 1990s HIV prevalence
rose from 3.8% in 1993 to 4.5% in 1998 Sofo (2005).
When Olusegun Obasanjo became the
president of Nigeria 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 Organisation of African Unity’s first African
Summit on HIV/AIDS, Tuberculosis, and Other Related Infectious Diseases Adeyi
(2006).
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 percent of
HIV-infected women and men were receiving antiretroviral therapy and only 7
percent 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
requires an estimated N756 billion to implement AllAfrica, (2010). Some of the
main aims included in the framework are to reach 80 percent of sexually active
adults and 80 percent of most at-risk populations with HIV counselling and
testing by 2015; ensure 80 percent of eligible adults and 100 percent of
eligible children are receiving ART by 2015; and to improve access to quality
care and support services to at least 50 percent of people living with HIV by
2015 (NACA, 2009).
Despite being the largest oil
producer in Africa and the 12th largest in the world (EIA, 2007) Nigeria is
ranked 158 out of 177 on the United Nations Development Programme (UNDP) Human
Poverty Index (UNDP, 2008). This poor development position has meant that
Nigeria is faced with huge challenges in fighting its HIV and AIDS epidemic.
HIV/AIDS, Programmes, activities
and providers in Badagry area of Lagos State are undertaken by the District
council, village governments, civil society organizations and a number of other
agencies such as schools, health facilitators and religious institutions. The
HIV/AIDS activities implemented by the district council such as Obas’ Baales’
Chiefs etc. include: advocacy meetings, training of trainers, workshops for
HIV/AIDS facilitator and development of community plans.
Access to information source is
very limited by a number of structural and individual socio-economic factors.
The major source of HIV/AIDS information includes radio, health personnel,
television, local leaders, peers family members, NGO, and schools. The
information source such as radio is seen as a major access to HIV/AIDS
information on various aspects of the disease. This is so because of the
increasing access and affordability of radios in the rural areas, which tend to
inform the dwellers about the happenings in the town. Also, television is
another access to HIV/AIDS information. People could get information through
watching television at their home thereby changing their behavior towards HIV/AIDS
diseases and people living with the disease (PLWHA).
In Nigeria, HIV/AIDS Information
infrastructure is very weaken. Lack of a developed formal information
infrastructure on HIV/AIDS for general public is on high level. For instance,
in a study conducted by Paul in 2006 on HIV/AIDS information flow and access,
it was reported that radio and television were only sources of On HIV/AIDS
information to the public, only five (5) households have TV sets and only seven
(7) Video sets are available for
business. Radio ownership among households was also limited. There was no
regional or district public library, limited information resource centre.
HIV/AIDS knowledge, Information and experiences were not widely shared and
intense exposure was limited. To confirm this in his report, one woman made the
following observation, ‘‘most people in the area do not got information; they
have no radio, television sets and don’t get newspaper’’ one female complained
that she had never received any information on HIV/AIDS and her knowledge of
the disease is limited. The use of condom is also lacking according to the
report, a respondent had this to say on the use of condom. ‘‘ I don’t like to
use it nor hear about it, I think it has a hole at it tip’’. Some said they
have heard about condom but have not seen it’’.
Information
that could serve and create new awareness to the rural dwellers are scarce
resources based on money and time in caring for the victims, the rural
communities are poorly served with information infrastructures which could
provide the necessary awareness to the people.
Nwagwu (2008) says that
information in the modern era is linked to technology, in that a poor electric
power supply and lack of paved roads, for example, will affect even the use of
transistor radios and television systems. He further asserts that the absence
of information infrastructures results in insufficient knowledge about the
disease, a situation that has large implications both on the management and
provision of care for the people who are infected, as well as exposing the
healthy persons to the risk of controlling the disease.
Lack of information
infrastructures is also associated with the information seeking practices of
people; people tend to make use of the resources which are available and
accessible to them. Although the Nigerian National Action Committee against
AIDS (NACA) programmes increased HIV prevention and, in 1999, worked on a
better information strategy, many rural communities still have poor
infrastructures, suggesting that many rural dwellers still lack adequate
HIV/AIDS awareness.
Several studies appear to focus
on awareness in the urban communities and less in the rural areas. Creating
awareness of HIV/AIDS has been an important information education communication
(IEC) agenda of the World Health Organization (WHO). A priority for policy in
‘low knowledge, low prevalence setting such as rural Nigerian communities would
be to increase, not only the awareness of HIV/AIDS among the people as a means
of providing some knowledge for health protection but to strengthen those
sources that could be considered very effective. Even when the sources of
information are available, the general knowledge of users may not enable them
to make use of this information. Several studies on awareness about HIV/AIDS in
Nigeria have not addresses this critical factor, which has great implications
for strengthening information sources in the communities.
Blumler and Katz (1974) have
argued that the needs of different audiences have social and psychological
characteristics, which generate certain explanations about the media, thus
leading to differential patterns of exposure and use. McQuail (1987) suggested
further that personal social circumstances and psychological dispositions
together influence both general habits of media use and beliefs, just as
expectations about the benefits offered by the media influence media choice and
consumption. Women and children are generally believed to be at a disadvantage
regarding accessing and using information and other resources because of social
and cultural factors which make them predominantly poorer and less empowered
than other members of the society.
In rural areas, this problem is
very intractable; cultural observances join poor infrastructure to complicate
information delivery, access and use of the rural dwellers especially farmers.
Therefore, from the on-going, we can deduce that the information infrastructure
on HIV/AIDS is not adequate in the society. Effort need to be expend on this in
order to curb or bring to minimal the rate at which the menace has on Nigerian
society Nwagwu (2007).
Since HIV/AIDS first emerged
globally, the role of behaviour change has been recognized as critical to the
control of the pandemic. The phrase “education is the only vaccine against
AIDS” was commonly aired during the early years to control the epidemic (Liskin
et al, 2004). Against this background, considerable efforts and energy were
devoted to implementing communication programs to educate people about HIV
transmission modes and prevention strategies. The underlying assumption of
these early activities was that improving people’s knowledge about the
infection and disease would lead to avoidance of risky behaviours.
According to the information,
education, and communication (IEC) model, “clear information presented in an
appropriate format and language would persuade those at risk to protect them
from the virus” (UNFPA, 2005). Despite over two decades of communication
efforts, however, HIV rates have continued to rise globally. It has become
increasingly clear that improved knowledge and education do not always lead to
positive behavioural changes. Human behaviour is complex, and behaviour change,
under any circumstance, can be difficult to achieve and maintain. Prochaska and
DiClemente (1992) have proposed a behaviour change model with five distinct
stages; this model emphasizes that behaviour change is a process rather than a
single event, with relapse possibly at any point in that process. The nature of
HIV infection particularly makes behaviour change a great challenge. On the one
hand, the risky behaviours associated with HIV transmission largely involve
sexual acts—and often people’s deepest, most intimate feelings. On the other
hand, the actions sought by HIV/AIDS control efforts are mainly in the realm of
primary prevention and while high-risk behaviours can increase the chances of
transmission, they do not always lead to infection. The long incubation period
of the virus, with symptoms often appearing many years after initial infection,
may also lower the motivation for at-risk individuals to change their
behaviour.
These scenarios present critical
challenges in HIV communication and highlight the need for more focused efforts
on behaviour change, which must go well beyond the basic education and
materials dissemination that have been the hallmark of many HIV-related IEC
programs. IEC activities—the first generation of HIV communication
interventions—have continuously occupied a central place in HIV prevention
efforts (Kalichman, Rompa and Coley, 2007). With the urgent impulse to “do
something and anything” to reduce the ravaging effects of HIV/AIDS,
particularly in the first decade of the epidemic, HIV prevention programs
pursued such goals as reaching a specified number of people with information
and distributing a specific number of condoms, with little attention paid to
the ultimate effectiveness of such activities in actually preventing HIV
transmission. Scant attention was given to establishing a strong scientific
rationale for HIV communication programs and activities. Thus, the use of
behaviour change models in designing HIV communication programs took some time
to evolve and to occur within the context of HIV prevention activities. Over
the years, it has become clear that while IEC programs have resulted in improved
knowledge about HIV/AIDS, they have often failed to produce behaviour change.
As the United State Centres for Disease Control and Prevention 2005 has noted,
“IEC campaigns are often better at imparting knowledge and information than
they are at inspiring behaviour change”. In sub-Saharan Africa, for example,
the level of AIDS awareness has increased significantly over the years, with
more than 90% of people in the worst affected countries reporting awareness of
the virus (Scalway and Deane, 2002).
There is little evidence to
suggest, however, a concomitant decrease in HIV-related risk behaviours in most
countries on the subcontinent. The awareness achieved is usually shallow and
includes neither accurate knowledge nor the development of the skills needed to
protect individuals from infection. In 2003 the National Demographic and Health
Survey (NDHS) showed wide gaps between awareness and correct knowledge of HIV
transmission and the appropriate methods of prevention (NPC, 2006). The results
of similar surveys across many African countries have revealed that awareness
and knowledge of HIV/AIDS “correlate only loosely with behaviour or perception
of risk” (Scalway and Deane, 2002).
This realization has increasingly
led to the conclusion that awareness, while an essential prerequisite for
changing behaviour, is insufficient. Thus, the emphasis in HIV/AIDS
communication efforts, globally, is increasingly shifting from IEC to behaviour
change communication (BCC), which has been described as a second-generation HIV
communication intervention (Kalichman, Rompa and Coley, 2007). This
programmatic evolution parallels the general development in the health
communication field, with the current period noted to be the “era of strategic
behaviour change communication, founded on behavioural science models”
(Piotrow, 2003).
Some confusion may exist about
how BCC differs from IEC. Whereas IEC largely focuses on improved awareness and
knowledge, the primary goal of BCC is sustained behaviour change. In practice,
IEC has often resulted in the production and dissemination of communication
materials, while BCC has been used to establish communication that is strategic
and integrated into entire programs (FHI, 2004). BCC also has the advantage of
being rooted in behaviour change models developed in the field of social
psychology.
BCC
has been defined as, “an interactive process with communities (as integrated
with an overall program) to develop messages and approaches using a variety of
communication channels to develop positive behaviours; promote and sustain
individual, community and societal behaviours change; and maintain appropriate
behaviour” (FHI, 2007).
In the context of HIV/AIDS
prevention and control, BCC entails the use of communication approaches and
tools to foster positive change in behaviour as well as improve knowledge and
attitudes about HIV and other sexually transmitted infections. BCC aims to
empower individuals and communities to make informed choices about their health
and well-being and to act on them. Behavior change approaches recognize that
presenting facts alone does not ensure behaviour change and that change may
take some time to occur. Behavior change interventions are, thus, designed to
accommodate the stage of behaviour adoption of an individual or group and to
cultivate the skills needed to enable and sustain change. In the context of HIV
prevention, BCC programs aim to:
2.
Increase
the use of appropriate HIV prevention and care services by both infected and uninfected persons;
3.
Reduce
the fear and stigmatization often associated with HIV/AIDS;
4.
Increase
acceptance and ownership of HIV/AIDS programs by the community; and
5.
Advocate
mobilizing and increasing resources for HIV/AIDS prevention and care programs
at community and government levels. (USAID, 2004).
Behavior change models vary
widely. Few of these, however, were developed specifically for HIV prevention.
One of the best known is the AIDS risk reduction model, which draws its
principal constructs from a number of older theories, including the health
belief model, the social cognitive theory, and the diffusion of innovation
theory (Catania, Kegeles and Coates, 1990). A 2005 Nigerian study has proposed
an integrated model for addressing HIV/AIDS in sub-Saharan Africa (Odutolu,
2005).
Within the social context of
Africa, the model was based on the convergence of three existing
theories—social learning, diffusion of innovation, and social networks.
Regardless of whether they were specifically developed for HIV/AIDS, such
theories can play valuable roles as frameworks for studying and understanding
human behaviour as it relates to the epidemic. While each type of behaviour is
unique, only a limited number of theoretical variables serve as the determinant
of any given behaviour (Fishbein, 2004). Appropriate use of existing behaviour
change theories enable us to understand these variables and their roles in
behaviour prediction, and thus to identify the determinants of specific
behaviours. In so doing, the theories provide us with valuable tools for
effective behaviour change and become pivotal in the design, implementation,
and evaluation of HIV-related BCC activities. Because discussions on individual
theories are beyond the scope of this chapter, Table below presents several
common behaviour change theories with examples of their applications in the
HIV/AIDS field.
Some experts have argued that the
current theories and models may not provide an adequate foundation on which to
develop interventions (Figueroa et al 2002; Kelly et al, 2000; and UNFPA, 2005)
and may be particularly unsuitable in sub-Saharan Africa and the developing
world (UNAIDS, 2008). Others have argued that the existing theories are
adequate and no new theories are needed; rather, what is needed “is for
investigators and interventionists to better understand and correctly utilize
existing empirically supported behavioural theories in developing and
evaluating behaviour change interventions” (Fishbein, 2004). Overall, there is
consensus that well-designed and targeted theory-based behaviour change
interventions can succeed in achieving desired health-related goals, and
evidence is growing that these interventions are effective in the area of
HIV/AIDS prevention and control (Glanz and Rimer, 2005).
Behavior change is a complex
process motivated by multiple factors, including an awareness of the need to
change, an understanding of the benefits of such change, a belief in one’s
ability to put the required skills into practice in different settings, and
confidence in one’s ability to maintain new behavior in the light of changing
circumstances. To be successful, BCC must move people from awareness to action
by instilling the belief that desired outcomes will be obtained by changing behavior
and by increasing individuals’ sense of control over their own behavior. BCC
must go beyond an informational or purely cognitive approach to one that
combines both informational and emotional appeals. In this regard, the
following elements have been identified as being crucial to the success of
HIV-related BCC messages and activities (Liskin et al, 2004):
1.
The
rational element, based on knowledge:
People need to know the basic facts about transmission— how the virus is and is
not transmitted, how likely they are to become infected, and what they can do
to avoid infection.
2.
The
emotional element, based on the intensity of attitudes or feelings: Individuals need to feel an
intense and personal vulnerability to the virus in order to develop an
emotional commitment to the behaviours needed to avoid it.
3.
The
practical element, based on personal skills in the new behavior: People need to be competent in
practicing the new behavior and be confident in their ability to do so. They
need a sense of self-efficacy to adopt new, health-protective behaviours.
4.
The
interpersonal element, or social networks: People need to associate with and be supported by
their significant others (such as family members and peer groups) whose
knowledge, emotions, and skills can reinforce healthy changes.
5.
The
structural element, or the social, economic, legal, and technological context
in which Behavior takes place:
People need to have access to necessary supplies and services (such as condoms
and voluntary counseling and testing facilities), and to live in an environment
where safer behaviours are accepted and promoted while risky behaviours are
discouraged. Based on its analysis of the techniques employed by successful BCC
activities, the U.S. Centres for Disease Control and Prevention has identified
best practices in mounting innovative behavior change interventions. Successful
interventions tend to:
6.
Be
personalized: Individually
targeted action works best, and in the case of successful large-scale public
health projects, the public messages are reinforced interpersonally and in
concert with other services and sectors.
7.
Be
emotionally compelling:
Successful programs go beyond simply providing information to also creating an
emotional stake that motivates individuals and people to act positively.
8.
Make
extensive use of role models:
Role models motivate individuals to change their behaviours by providing
concrete examples of behaviours that can be emulated, increasing their
confidence in encourage a systematic national response. These steps included
the public announcement of the death of his brother, Fela Anikulapo-Kuti, a
Nigerian musician of considerable national and international fame, as a result
of AIDS, and the establishment of a framework for a national HIV/AIDS response
from 1986 to 1993.With the change in government in 1993, the nation experienced
reductions in the pace and scale of HIV communication activities. Since the
country’s return to democracy in 1999, the HIV/AIDS response in the country has
received a considerable boost and has enjoyed the highest political support in
the country.
2.9.
Trends in HIV/AIDS Communication in Nigeria
The following section discusses
trends in HIV/AIDS communication in Nigeria and associated achievements.
1986–1993
The early epidemic in Nigeria was
marked by efforts to establish the institutional framework necessary for
prevention efforts and to provide information to the people about HIV/AIDS.
While the government initiated the National AIDS Prevention and Control Program
(NACP) in 1988, the general attitude of the population and the civil society
was one of cynicism and disbelief regarding the disease. In 1989, the federal
government set up a multidisciplinary national AIDS committee, which inspired
creation by the states of their various AIDS committees. That year also
witnessed the development of a three-year Medium-Term Plan (1990–1992) for the
prevention and control of HIV/AIDS, which included plans to educate Nigerians
about the disease.
The government, under the
leadership of General Ibrahim Babangida, launched a “National War against
HIV/AIDS” in 1991. Financial resources were provided and program efforts
received greater impetus as part of this national initiative. In 1992, the NACP
and the National Sexually Transmitted Disease Program merged to become the
National AIDS and STDs Control Program (NASCP), housed in the Department of
Primary Health Care and Disease Control of the Federal Ministry of Health. A
second Medium-Term Plan (1993–1997) was developed; it focused on preventing
sexual transmission of HIV through behavioural change interventions and the
case management of sexually transmitted infections.
Thus, the era witnessed
substantial efforts in laying the structural foundations for a national
programmatic response to HIV/AIDS, including BCC activities. One of the major
achievements of that period in HIV communication was the production of a
national documentary on HIV/AIDS titled “Dawn of Reality.” The documentary,
which featured interviews from many leading national HIV/AIDS experts, also
involved people infected with the virus.
The period from 1993 to 1999 was
marked by some expansion in the program activity of NASCP, although the
government exhibited considerable apathy to large-scale HIV communications,
particularly
Recent HIV report by prevalence
groups in Nigeria indicate that the worst affected is the 25-29 years age
group, with a prevalence of 5.6 percent. The current estimates by the federal
ministry of health (FMOH) indicate that by 2009, 2.98million people were living
with HIV/AIDS in Nigeria. It also noted that despite the reduction in national
prevalence of 4.6 percent, Nigeria, with about 2.98 million PLWHIV, makes up
about nine percent of the global HIV burden. Though Nigeria is one of the
countries said to have a stabilized epidemic by the persistence high risk
behaviour in spite of high level of awareness particularly among young people,
this indicates that the country’s war against the deadly virus is far from
over. (Okachie, 2011).
The
mass media—consisting of print outlets, such as newspapers and magazines, and
broadcast outlets, such as radio and television—have important roles to play in
BCC. While some controversy has arisen about the effectiveness of mass media in
public health campaigns aimed at producing healthier behavior (Agha, 2003), the
mass media clearly have the capacity to inform and educate people. At the very
least, they can provide the foundation for possible behavior change. They can
also affect people’s perception of social norms, which in turn support people’s
efforts to change behavior. The media can also play a powerful advocacy role
for policies that support sustainable behavior change at the population level.
Furthermore, radio and television
are important channels for enter-educate approaches such as soap opera and
drama series, which are powerful catalysts for behavior change.
The positive impact of the mass
media on risk perception, self-efficacy, and other behavioural predictors as
well as HIV/AIDS risk behavior has been documented (Agha, 2003 and De Vroome et
al, 1993).
As Rogers noted with regard to
the growing use of mass communication strategies in health information
dissemination, new communication technologies facilitate health information
exchange and optimize decision-making De Vroome et al, (1993). The trend in the
HIV/AIDS communication field, globally and nationally, is toward the increasing
involvement of the media in control efforts.
Findings from the NDHS attest to
the importance of the mass media in the Nigerian HIV/AIDS field. The 1999 survey
found that the most frequently quoted source of AIDS information was the radio
(72.1% of men and 45.6% of women), followed by television (39.8% of men and
46.6% of women), and newspapers (25.4% of men and 9.3% of women).
The National HIV/AIDS and Reproductive
Health Survey, conducted in 2003, showed that most Nigerians consider all forms
of mass media acceptable for reaching the populace with information about HIV/AIDS and family
planning (FMH, 2003). Radio was the most accepted (89.3%), followed by
television (82.3%), and the print media (79.8%). The survey also found that
most Nigerians listen to the radio regularly, with 50.4% indicating that they
listen every day or almost every day; another 18.9% listen at least once a
week. Twenty-eight percent watch television every day or almost every day and
12.9% watch television at least once a week.
Thus, the media habits of
Nigerians are such that a good proportion can be reached through well packaged
mass media programs, particularly radio programs. The success recorded with the
use of mass media techniques in family planning in Nigeria (Piotrow, et al 1990
and Bankole, 2004) lends credence for their use in HIV/AIDS control, as well as
for other health and social development activities.
In general, Nigeria has had a
fluctuating experience in its HIV/AIDS response, particularly with regard to
communication activities. While the early phase of the epidemic witnessed a
predictably slow response, Nigeria was awakened from its state of disbelief
about the presence of the virus in the country by the late Olikoye
Ransome-Kuti, then the federal health minister, who took many positive steps to
epidemic. While most program designers and implementers still operated within
the mindset of IEC—with the primary focus being on giving more presentations,
organizing more workshops, and distributing more educational materials—there
was an increasing awareness of the need to shift toward BCC. The faith-based
community and networks of people living with HIV/AIDS (PLWHAs) emerged as
important forces during this era. A stronger attention was also paid to
networking and coalition building among NGOs. Programs and NGOs with a focus on
a particular vulnerable population—such as armed forces personnel or men having
sex with men—also emerged.
The National Policy on HIV/AIDS,
developed in 2003, has a stronger focus on communication activities—especially
BCC—than the earlier policy. The policy explicitly states the government’s
commitment to “foster behavior change as the main means of controlling the
epidemic.” Moreover, one of its targets is to “improve the behavior and the
practice of the general population and high risk groups related to safe sex by
20% by the year 2005 and 50% by the year 2010 (FGN, 2003). Another goal is to
“reduce by 25% the percentage of persons openly expressing negative attitudes
about persons living with HIV/AIDS by 2005” (FGN, 2003). Since 1999, most
HIV-related BCC activities have taken place in the context of schools and youth
focused settings, faith communities, workplaces, and health facilities.
School-based
BCC interventions have been undertaken largely to address risky sexual
behaviours and injection drug use among school-based populations. The country
has developed and adopted the National Family Life and HIV Education
Curriculum, which covers the primary to tertiary levels of education. Its
implementation has been poor, however, with a low proportion of secondary schools
implementing the curriculum as a result of lack of skilled teachers and an
inadequate attention to the issue by state educational authorities.
Implementation at the primary school level has been virtually non-existent,
while at the tertiary level, the institutional response to HIV/AIDS has been
feeble, and awareness of the provision of the national curriculum poor (Fatusi,
2004).
Community- and mass media–based
BCC approaches have been implemented in various parts of the country. These
initiatives complement the school-based approach for the schooling population
and provide opportunities to reach the out-of-school population, which has been
poorly reached. Community based programs have been implemented primarily by
civil society organizations, with those focused on adolescents playing a
leading role. Major BCC approaches included peer education, behavior modeling,
sporting activities, and enter-educative approaches such as musical concerts,
video shows, and drama.
Mass media approaches richly
complemented these methods, particularly through the use of adolescent-the use
of the national television and radio stations. On the other hand, it was an era
marked by the strong emergence of the nongovernmental organizations (NGOs) in
HIV/AIDS prevention programs, with the majority of them engaged in information
sharing and distribution of educational materials. Considerable attention was
focused on the most at-risk groups, including rural dwellers, long-distance
truck drivers, young people, and sex workers. One of the factors that
influenced the increased presence and activities of NGOs in HIV/AIDS
communication was the rise in available funds from donor agencies, particularly
the United States Agency for International Development (USAID).
The United State government held
sanctions against Nigeria from 1993 to 1999, a period in which the Nigerian
government and its agencies were barred from receiving aid from the Unite State
government. Therefore, USAID could only work with NGOs during this period.
Through the activities of the Joint United Nations Program on HIV/AIDS
(UNAIDS), United Nation agencies, individually and as group, constituted the
major sources of donor support to the Nigerian government during this period.
The British Department for International Development also supported a number of
community-based HIV/AIDS communication initiatives, particularly in Sagamu
(Ogun State) and Gboko (Benue State).
During this period, USAID,
through the AIDSTECH project (AIDS Technical Support Project) (1988–1992) and
AIDSCAP (AIDS Control and Prevention) Project (1992–1997), implemented by
Family Health International (FHI), funded NGOs and NGO networks to conduct a
range of communication activities (Oke, 2004; and FHI, 2007). In 1997, musician
Fela Anikulapo-Kuti’s death from AIDS brought the reality of the disease to
bear on the psyche of many Nigerians for the first time. A review of the
efforts by FHI showed limited national impact of the programs (Oke, 2004);
while analysis of the national response as a whole showed “insufficient
nationwide awareness reflected by weak advocacy and information programs toward
general populations and specifically at risk groups—youth and women” (NACA,
2001).
Nigeria’s HIV/AIDS response
witnessed a significant boost with the inception of the civilian administration
in 1999. The level of political commitment, the government’s presence, and
donor activities and support were unprecedented in the history of the epidemic.
The national response broadened from a health-focused approach to a
multisectoral one with a coordination structure in place—the National Action
Committee on AIDS (NACA) at the federal level, the state action committees on
AIDS (SACAs) at the state level, and the local action committees on AIDS
(LACAs) at the local level.
The country’s first action plan
on HIV/AIDS—the HIV/AIDS Emergency Action Plan (HEAP)—was approved in 2001
(NACA, 2000). The plan, which was designed to cover a three-year period, placed
a premium on BCC objectives, which included: increasing awareness of the
epidemic among the general population and key stakeholders; promoting behavior
change in both low- and high-risk populations; empowering communities and
individuals to design and initiate community-specific action plans; and
ensuring that laws and policies encourage the mitigation of the epidemic.
Both governmental and
nongovernmental bodies scaled up the level of educational and communication
activities considerably with the implicit aim of facilitating behavioural
changes and curbing the Health Facility–Based Interventions. A stronger focus
on BCC emerged within health care settings, although a considerable degree of
improvement is still needed to maximize effectiveness. Messages related to this
focus have included promotion of safe environments and safer practices to
reduce the potential for transmitting HIV within health facilities,
discouragement of discrimination and stigmatization of PLWHAs especially in the
rural areas, and promotion of quality AIDS-related prevention and care
services, such as voluntary counseling and testing and prevention of
mother-to-child transmission in the management of pregnant PLWHAs. Approaches
included innovative and targeted educational material and message design,
interactive learning methods, counseling, and orientation activities to
facilitate improved patient-provider interaction and communication.
At the initial stage of the
HIV/AIDS challenge, the occasional news items on the pandemic in Nigerian mass
media tended to focus on stories and issues from developed countries with
little or no local relevance. Moreover, most HIV/AIDS stories failed to make
the front page in print or lead in electronic media, because editors gave them
a lower priority than stories on politics, business, sports, or the economy. On
the other hand, many media reports on local events relating to the epidemic
bordered more on sensationalizing the issues with such headlines as, “Another
AIDS victim is dead” (Akeredolu, 1987); “New killer sexual disease discovered”
(Stephen, 1986); “Who’s afraid of the big bad AIDS?—Not Nigerian Men”
(Fagbohun, 1987); “11 out of 12 AIDS carriers now dead—Medical Director”
(Adekoya, 1988); and “Call girls spread AIDS” (Adekoya, 1988).
Numerous media reports also
bordered on being inaccurate, false, or denying of the reality of the threat
that HIV poses to Nigerian society. At other times, media coverage of HIV/AIDS
issues in Nigeria was largely limited to government events and activities as
well as the reactions on HIV/AIDS from health-focused NGOs, research
institutions, and government agencies. The situation has been changing
gradually, however, as a recent analysis of mass media reports and activities
found a growing media interest in the epidemic and greater involvement of media
practitioners in HIV control efforts, particularly communication activities.
The use of alternative media strategies—such as street theatre, home videos,
documentary films, public service announcements, posters, and music—has also
increased use. Content analysis of 2,156 reproductive health articles published
in four national print media between 1986 and 1997 showed a greater attention—56%—on
sexually transmitted infections, including HIV, than other major reproductive
health issues. Most of the reports, however, covered workshops, conferences,
and government pronouncements rather than in-depth field reports and analysis
of the country’s HIV epidemic. News items rated as the most common type of
HIV/AIDS (72% to 82%) reports in various newspapers (DCN, 2001).
In general, the media paid little
attention to the science and prevention of HIV/AIDS between 1986 and 1997, a
period during which the government’s activities and support for HIV prevention
were low. Most news coverage on the epidemic in that era related to NGO
activities rather than accurate descriptions of HIV/AIDS itself focused
television drama serials such as “I Need to Know”; radio dramas aimed at
improving personal risk perception; customized youth magazines; innovative
info-commercials such as “Zip Up on Nigerian Radio Stations,” a multimedia
campaign on abstinence; and social marketing of condoms.
The faith community grew
considerably in its response to the Nigerian epidemic and engaged in a variety
of BCC programs directed not only at prevention but also at care and support
for PLWHAs and mitigation of the impact on those affected. Many faith
communities and congregations—such as the Redeemed Christian Church of God, the
Anglican Communion, and the Catholic Church—have developed HIV/AIDS policy and
programs, of which BCC constitutes a significant element. The Interfaith
Coalition on HIV/AIDS, a network organization of faith communities, was also
engaged in HIV communication activities. The range of approaches adopted by
faith communities included innovative use of sermons in churches and mosques,
peer-led approaches among young people as well as their gatekeepers, modeling,
publications, and enter-educative methods.
Workplace-based BCC activities
occurred in a number of establishments within the formal sector of the economy,
including the oil and gas, beverage production, and banking industries. Such
BCC activities often included peer education, dissemination of information
through formal and informal networks, and the use of multimedia communication
methods. These were initiated as an integral part of holistic workplace
HIV/AIDS interventions with a number of complementary components, including
formulation of an HIV/AIDS policy, condom promotion and distribution, voluntary
counseling and testing, and the provision of care and support for the affected
and the infected.
The Armed Forces Program for AIDS
Control (AFPAC) can be viewed as a special type of workplace intervention in
Nigeria. The program has a rich BCC component, which includes peer education;
social mobilization directed at military personnel within the barracks and
“mammy markets” (the adjoining shanty civilian trading posts and living
facilities that often spring up to service military personnel); condom
promotion and distribution; video recording and distribution of drama
production targeted at military personnel and their families; and integration
of HIV/AIDS education into sporting events. AFPAC also strategically organizes
an annual HIV/AIDS week, during which enter-educative approaches are used to
promote behavior changes among military personnel across the Army, Air Force,
and Navy.
Within the informal sector, BCC
approaches have been targeted mainly at the most-at-risk groups such as sex
workers and transport workers. Many such activities have often taken place
within the vicinity of their operational base such as junction towns, motor
parks, and brothels. BCC approaches with these groups have commonly included
peer education, condom promotion and distribution, dramatic skits, and road
shows which tend to be sponsored events or commercial adverts, are more
expensive and less sustainable than media-led approaches. Overall, it can be
argued that the Nigerian mass media, much like most population subgroups, has
moved through the usual stages of denial, sensationalism, and blame but is now
responding more constructively to the HIV/AIDS epidemic. This is in line with
the pattern found within the media elsewhere in Africa (Lear, 1990).
The
sample design for this work is a multi-stage sampling selection procedure. In
the first stage, 10% of the 1000 farmers were selected for the study from
Badagry central of the local government area by purposive for reason of ease of
accessibility. In the next stage of the sampling procedure, thirteen (13)
villages were selected randomly from the three (3) wards, one each from the
regions Ward F, I and J. The table shown below gives the number of farmers in
each of the sampled ward and the major villages in the wards.
Number
of villages in the sampled wards in Badagry Local Government.
Wards
|
Number of Selected Farmers
|
Major Villages
|
Number of Villages in Wards
|
Ward
A
|
-
|
Hunto,
Jegba and Whlakoh
|
3
|
Ward
B
|
-
|
Posukoh,
and Ganho
|
2
|
Ward
C
|
-
|
Awhanjigoh,
Boekoh and Gberefu
|
3
|
Ward
D
|
-
|
Soweh,
Asagoh, Agonkanmeh and Ahovikoh
|
4
|
Ward
E
|
-
|
Ajara
Vetho, Ajara Agamathen, Ajara Agelaso, Ajara Tosarikoh, Ajara Afoyonde and
Ajara Lopo
|
6
|
Ward
F
|
35
|
Ajara
Lopo, Ajara Dokoh, Ajara Torikoh, Ajara Sejeh and Ajara Topa
|
5
|
Ward
G
|
-
|
Ajido,
Akarakunmo, Povita and Ebute Olofin
|
4
|
Ward
H
|
-
|
Ajara
Isalu, Iyafin, Agbovipe, Panko and Agadangba
|
5
|
Ward
I
|
35
|
Ikoga, Pota, Erekiti, Iragon and Janvie
|
5
|
Ward
J
|
30
|
Topo,
Idale and Whedakoh
|
3
|
Total
|
105
|
40
|
3.1
Data Collection Method
Data
in this survey was collected using a questionnaire that combined both
structured and unstructured questions. The structured questions provided the
respondents with alternative answers to choose from, hence facilitating the
ease of response; the unstructured questions allowed for a greater depth of
response as these respondents were not limited to the alternatives provided by
the researcher but were free to adequately express their opinions in the
matter.
The questionnaire was made up of
four (4) sections (A to D). Section A elicited data on the socio-demographic
characteristics of the respondents; Section B centered on the respondent's
general awareness of HIV/AIDS. Section C collected information on the various
sources through which people normally contact HIV/AIDS information, as well as
sources from which they preferred to get frequent information on HIV/AIDS and
Section D, explored the effect of HIV/AIDS information usage on sexual
behaviour of the farmers trying to determine aspects of behaviour that can be
attributed to HIV/AIDS information usage.
The
retrieved questionnaires were sorted. A coding guide was developed and used to
code all the responses which were later entered into a computer. The data
collected was subjected to statistical analysis using statistical packages for
social sciences (SPSS) software. Descriptive statistic such as frequency,
percentage distribution, mean, standard deviation and regression were used to
describe respondents.
4.1 Results Presentation and
Interpretation
This section is divided into four
sub-sections namely socio-demographic information, respondent's general
awareness of HIV/AIDS, the various HIV/AIDS Information usages and the effect
of HIV/AIDS information sexual behaviour of the farmers.
Table 4.1 shows that above half
61.9% of the respondents were males while 38.1% of them were females. This was
a reflection of a previous studies by other researchers (Fatusi, and Iyaniwura,
2004) Also, the table reveals that about 56.2% of the respondents were married,
while about 34.1%, 1.9%and 6.7% of them were single, divorced,
widowed/separated respectively. It is also indicated in the table
that the overall mean age of the respondents is 34.7years with the largest
proportion of respondents within the age group of 30-39 years (33.3%),
participated in the study.
Table 4.1 Socio-Demographic
Characteristics of Respondents
N= 105
S/N
|
Variable
|
Frequency
|
Percentage
|
|
1
|
Gender
|
Male
|
65
|
61.9
|
Female
|
40
|
38.1
|
||
2
|
Marital Status
|
Single
|
33
|
31.4
|
Married
|
59
|
56.2
|
||
Divorced
|
2
|
1.9
|
||
Widowed/Separated
|
7
|
6.7
|
||
3
|
Age (Years)
|
Less
than 20 years
|
2
|
1.9
|
20-29
years
|
23
|
21.9
|
||
30-39
years
|
35
|
33.3
|
||
40-49
years
|
26
|
24.8
|
||
50-59
years
|
19
|
18.1
|
||
4
|
Educational Level
|
No
Formal/Primary Education
|
25
|
23.8
|
Secondary
Education
|
30
|
28.6
|
||
Tertiary/Other
Education
|
50
|
47.6
|
4.1.2
Awareness
About Information Usage on HIV/AIDS of the Respondents
From the findings, it shows that
all the respondents 105(100.0%) are aware of HIV/AIDS. Therefore, it will be
sound to conclude that knowledge on HIV/AIDS does not guarantee a change in the
risk sexual behavior of respondents.
The respondents were asked which
sources they used to receive information on HIV/AIDS and to what extent was
their used. From the analysis in Table 4.2, it was reported that Billboards and
Manuals (56.2% each) followed by Posters, and Magazines (55.2% each) as well as
Handbills and Newspapers (53.3% and 51.4% respectively) accounted for high
extent on the information received and used on HIV/AIDS by the respondents
while Story Book on Health, Textbooks and Journals (32.4%, 30.5% and 24.8%
respectively) accounted for the least extent on the information received and
used on HIV/AIDS by the respondents in formal sources.
It was also shown that medical
personnel and religious meeting (church and mosque) (62.9% and 60.0%) accounted
for high extent on the information received and used on HIV/AIDS sources in
Informal Sources, while village meetings (51.4%), friends and discussion at
workshop/seminars, (49.5% each) accounted for the least extent on the
information received and used on HIV/AIDS sources.
Also, it was reported by the
respondents that radio (79.0%) and television (63.8%) had high extent on the
information received and used by the respondents on HIV/AIDS on electronic
sources, while online forum (38.1%), mobile phones and websites (34.3% each),
social network (26.7%) and e-mail (22.9%)
had the least extent on electronic sources.
S/N
|
Formal Sources
|
No extent
|
Little
extent
|
High extent
|
|||
F
|
%
|
F
|
%
|
F
|
%
|
||
1
|
Billboards
|
17
|
16.2
|
29
|
27.6
|
59
|
56.2
|
2
|
Manuals
|
28
|
26.7
|
18
|
17.1
|
59
|
56.2
|
3
|
Posters
|
15
|
14.3
|
32
|
30.5
|
58
|
55.2
|
4
|
Magazines
|
28
|
26.7
|
19
|
18.1
|
58
|
55.2
|
5
|
Handbills
|
23
|
21.9
|
26
|
24.8
|
56
|
53.3
|
6
|
Newspapers
|
24
|
22.9
|
27
|
25.7
|
54
|
51.4
|
7
|
Story
Books on Health
|
34
|
32.4
|
37
|
35.2
|
34
|
32.4
|
8
|
Textbooks
|
49
|
46.7
|
24
|
22.9
|
32
|
30.5
|
9
|
Journals
|
40
|
38.1
|
39
|
37.1
|
26
|
24.8
|
Informal Sources
|
|||||||
10
|
Medical
Personnel
|
18
|
17.1
|
21
|
20.0
|
66
|
62.9
|
11
|
Religious
Meeting (Church and Mosque)
|
24
|
22.9
|
18
|
17.1
|
63
|
60.0
|
12
|
Village
Meetings
|
34
|
32.4
|
17
|
16.2
|
54
|
51.4
|
13
|
Friends
|
29
|
27.6
|
24
|
22.9
|
52
|
49.5
|
14
|
Discussion
at workshops and Seminars
|
27
|
25.7
|
26
|
24.8
|
52
|
49.5
|
Electronic Sources
|
|||||||
15
|
Radio
|
9
|
8.6
|
13
|
12.4
|
83
|
79.0
|
16
|
Television
|
17
|
16.2
|
21
|
20.0
|
67
|
63.8
|
17
|
Online
forums
|
48
|
45.7
|
17
|
16.2
|
40
|
38.1
|
18
|
Mobile
Phones
|
45
|
42.9
|
24
|
22.9
|
36
|
34.3
|
19
|
Websites
|
45
|
42.9
|
24
|
22.9
|
36
|
34.3
|
20
|
Social
Networks (facebook, twitter, etc)
|
51
|
48.6
|
26
|
24.8
|
28
|
26.7
|
21
|
E-mail
|
56
|
53.3
|
25
|
23.8
|
24
|
22.9
|
4.1.3
Extent/Factors Influencing Usage of HIV/AIDS
information Sources
by the
Respondents
Table 4.3 shows that Language,
accessibility and accuracy of the source accounted for (64.8%, 63.8%, and 60.0%), had a high extent in influencing
their usage of the source. More so, location,
currency and reliability of the source accounted for (58.1%, 55.2%, and
53.3%) had a little extent in influencing their usage of the source, while
availability and affordability of the source accounted for (48.6% each), and
relevance as well as timeliness of the source accounted for (46.7% and 45.7%)
had the least extent in influencing their usage of the source.
Table 4.3: Frequency Distribution
of Respondents on Factors Influencing Usage
Sources
on HIV/AIDS information (N=105)
S/N
|
Factors
influencing usage
|
No extent
|
Little extent
|
High extent
|
|||
F
|
%
|
F
|
%
|
F
|
%
|
||
1
|
Language of the source
|
14
|
13.3
|
23
|
21.9
|
68
|
64.8
|
2
|
Accessibility of the source
|
11
|
10.5
|
27
|
25.7
|
67
|
63.8
|
3
|
Accuracy of the source
|
14
|
13.3
|
28
|
26.7
|
63
|
60.0
|
4
|
Location of the source
|
16
|
15.2
|
28
|
26.7
|
61
|
58.1
|
5
|
Up to date/currency of the source
|
12
|
11.4
|
35
|
33.3
|
58
|
55.2
|
6
|
Reliability of the source
|
8
|
7.6
|
41
|
39.0
|
56
|
53.3
|
7
|
Availability of the source
|
32
|
21.9
|
31
|
29.5
|
51
|
48.6
|
8
|
Affordability of the source
|
15
|
14.3
|
39
|
37.1
|
51
|
48.6
|
9
|
Relevance of the source
|
17
|
16.2
|
39
|
37.1
|
49
|
46.7
|
10
|
Timeliness of the source
|
12
|
11.4
|
45
|
42.9
|
48
|
45.7
|
Concern
for HIV/AIDS information usage is/are intended to bring an attitudinal change in sexual behaviour of farmers
as well as preventing and reducing the menace to the bearest minimum in the
society. The respondents were asked
the effect of HIV/AIDS information usage on their sexual behavior? The table
below presents their results.
Table: 4.4 Regression Analysis
Showing Relative Effect of HIV/AIDS Information
Usage on sexual
Behaviour of farmers
Predictor/Independent Variable
(Information sources)
|
B
|
T
|
Sig. Level
|
R Square
|
|
Handbills
|
-.217
|
-2.141
|
.035
|
.410
|
|
Medical
Personnel
|
-.262
|
-2.826
|
.006
|
||
Discussion/Seminar
|
.191
|
2.253
|
.027
|
||
Online
Forum
|
.168
|
1.992
|
.050
|
||
Dependent variable : Dependent
Variable: enlighten me on indiscriminate sex
|
|||||
Predictor/Independent Variable
(Information sources)
|
B
|
T
|
Sig. Level
|
R Square
|
|
Handbills
|
-.236
|
-1.958
|
.054
|
.377
|
|
Magazines
|
.277
|
2.216
|
.029
|
||
Television
|
.205
|
2.446
|
.017
|
||
Social
Network
|
-.292
|
-2.368
|
.020
|
||
Dependent variable : Extra
Marital Sex
|
|||||
Predictor/Independent Variable
(Information sources)
|
B
|
T
|
Sig. Level
|
R Square
|
|
Handbills
|
-.178
|
-1.967
|
.052
|
.545
|
|
Medical
Personnel
|
.302
|
4.487
|
.000
|
||
Discussion
|
.144
|
1.924
|
.058
|
||
Mobile
Phones
|
.216
|
3.331
|
.001
|
||
Television
|
.280
|
3.416
|
.001
|
||
Radio
|
-.186
|
-2.203
|
.030
|
||
Dependent variable : Prevent
Illicit Sex
|
|||||
Predictor/Independent Variable
(Information sources)
|
B
|
T
|
Sig. Level
|
R Square
|
|
Journals
|
-.136
|
-2.243
|
.028
|
.440
|
|
Posters
|
.257
|
2.453
|
.016
|
||
Handbills
|
-.358
|
-3.511
|
.001
|
||
Friends
|
-.185
|
-2.353
|
.021
|
||
Religious
Meeting
|
-.123
|
-2.112
|
.038
|
||
Mobile
Phones
|
.255
|
3.481
|
.001
|
||
Websites
|
-.233
|
-2.221
|
.029
|
||
Dependent variable :
Use of Condom
|
|||||
Predictor/Independent Variable
(Information sources)
|
B
|
T
|
Sig. Level
|
R Square
|
|
Handbills
|
-.251
|
-2.704
|
.008
|
.294
|
|
Dependent variable :
Influence sources
|
|||||
Predictor Variable
|
B
|
T
|
Sig. Level
|
R Square
|
|
Religious
Meeting
|
.115
|
2.154
|
.034
|
||
Television
|
.186
|
2.196
|
.031
|
||
Social
Networks
|
.326
|
3.125
|
.002
|
||
Websites
|
-.388
|
-4.028
|
.000
|
||
Dependent variable : Take
Caution in Indiscriminate Sex
|
|||||
Predictor Variables
|
B
|
T
|
Sig. Level
|
R Square
|
|
Posters
|
.159
|
2.143
|
.035
|
.296
|
|
Websites
|
-.167
|
-2.249
|
.027
|
||
Dependent variable : Caution
Using Unsterilized Object
|
|||||
Predictor Variables
|
B
|
T
|
Sig. Level
|
R Square
|
|
Journals
|
-.153
|
-2.462
|
.016
|
.275
|
|
Mobile Phones
|
.147
|
1.970
|
.052
|
||
Dependent variable : Pre-Marital
Sex
|
|||||
Variable
1: It enlightens
me the more about the dangers involves in indiscriminate sex.
The
result in table 4.4 shows that at p<0.05, there is a negative slope and very
weak significant relationship between Handbills and the enlightenment given
about the dangers involved in indiscriminate sex which accounted for 41.0% of
the total variation with (p=0.035, B=-0.217, t=-2.141) on (R square 0.410). It
also shows that there is a negative slope and very weak significant
relationship between Medical Personnel and the enlightenment given about the
dangers involved in indiscriminate sex with (p=0.006, B=-0.262, t=-2.826).
Variable
2: It prevents
me from having extra-marital sex.
The result in Table 4.4 shows that prevention from having
extra-marital sex by the farmers explained 37.7% of the total variance on
effect of HIV/AIDS information usage on their sexual behaviour. The result also
indicates a negative slope and significant relationship (B=-0.236, p<0.054)
between handbills and having extra-marital sex by the farmers.
From Table 4.4, the result reveals that at p<0.05, there
is a positive slope and very weak significant relationship between magazines
and prevention from having extra-marital sex which accounted for 37.7% of the total
variation with (p=0.029, B=0.277, t=2.216) on (R square 0.377). It
further indicates a
positive slope and very weak significant relationship (B=0.205, p<0.017)
between Television and having extra-marital sex by the farmers on (R square
0.377).
Variable
3: It prevents
me from having illicit sex.
The result in Table 4.4 reveals that
prevention from
having illicit sex by the farmers explained 54.5% of the total variance on
effect of HIV/AIDS information usage on their sexual behaviour. The result also
indicates a negative slope and significant relationship (B=-0.178, p<0.052)
between handbills and having illicit sex by the farmers on (R square
0.545).
Table 4.4 also indicates a positive slope and
significant relationship (B=0.302, p<0.006) between Medical Personnel and
having illicit
sex by the farmers.
It also reveals
a positive slope and significant relationship (B=0.144, p<0.058) between
Discussion at workshops and Seminars and having illicit sex by the farmers.
More
so, there is a positive slope and significant relationship between Mobile
Phones, Television and having illicit sex by the farmers with (p=0.001,
B=0.216, t=3.331, B=0.280, t=3.416) respectively. And from the Table 4.4 above, there is a
negative slope and weak significant relationship (B=-0.186, p<0.030) between
Radio and having illicit sex by the farmers with (R square 0.545).
Variable
4: It enlightens
me on how to use condom.
The
result in table 4.4 shows that at p<0.05, there is a negative slope and very
weak significant relationship between Journals and the enlightenment given
about the usage of Condom which accounted for 44.0% of the total variation with
(p=0.028, B=-0.136, t=-2.243). It also shows that there is a positive slope and
very weak significant relationship between Posters and the enlightenment given
about the usage of Condom with (p=0.016, B=0.257, t=2.453) on (R square 0.440).
The table also indicates that there is a negative slope but overwhelming
significant relationship between Handbills and the enlightenment given about
the usage of condom with (p=0.001, B=-0.358, t=-3.211). More so, there
is a negative slope and very weak significant relationship between Friends and
the enlightenment given about the dangers involves in indiscriminate sex with
(p=0.021, B=-0.185, t=-2.353). The table also indicates a negative slope and weak significant
relationship (B=-0.123, p<0.038) between Religious Meeting and the
enlightenment given about the usage of condom by the farmers, and further
indicates a positive slope and overwhelming significant relationship (B=0.255,
p<0.001) between Mobile Phones and the enlightenment given about the usage
of condom by the farmers.
Also, there is a negative slope and very weak significantly relationship
between Websites and the enlightenment
given about the usage of condom by the farmers with (p=0.029, B=-0.233,
t=-2.221) on (R square 0.440).
Table 4.4 reveals that
identification of sources influence usage of information on HIV/AIDS by the farmers with 29.4% of the
total variance on effect of HIV/AIDS information usage on their sexual
behaviour. The result also indicates a negative slope and significant
relationship (B=-0.251, p<0.008) between handbills and identification
of sources that influence usage of HIV/AIDS information by the farmers on (R square
0.294).
Variable
6: It enables me
to take caution in avoiding indiscriminate sex.
The result in Table 4.4 reveals that
caution in avoiding
indiscriminate sex by the farmers explained 41.5% of the total variance on
effect of HIV/AIDS information usage on their sexual behaviour. The result also
indicates that at p<0.05, there is a positive slope and weak significant
relationship (B=0.115, p<0.034) between Religious Meeting and taking caution
in indiscriminate sex by the farmers. It further shows that there is a positive
slope and weak significant relationship between Television and taking caution
in indiscriminate sex by the farmers with (p=0.031, B=0.186, t=2.196).
Also,
Table 4.4 indicates
a positive slope and significant relationship (B=0.326, p<0.002) between
social networks and taking caution in indiscriminate sex by the farmers. Lastly, there is
a negative slope and overwhelming significant
relationship between Websites and taking caution in indiscriminate sex by the
farmers with (p=0.000, B=-0.388, t=4.028) on (R square 0.415).
The result in Table 4.4 reveals that it
helps in taking caution
on using unsterilized objects by the farmers which accounted for 29.6% of the
total variance on effect of HIV/AIDS information usage on their sexual
behaviour. The result also indicates a positive slope and weak significant
relationship (B=0.159, p<0.035) between Posters and taking caution on
unsterilized objects by the farmers. The table as well shows that at
p<0.05, there is a negative slope and very weak significant relationship
between Websites and
taking caution on unsterilized objects by the farmers with (p=0.027,
B=-0.167, t=-2.249) on (R square 0.296).
Variable 8: It
prevents me from having pre-marital sex.
The result in Table 4.4 shows that prevention from having
pre-marital sex by the farmers explained 27.5% of the total variance on effect
of HIV/AIDS information usage on their sexual behaviour. The result also
indicates a negative slope and very weak significant relationship (B=-0.153,
p<0.016) between Journals and having pre-marital sex by the farmers.
From Table 4.9, the result shows that at
p<0.05, there is a positive
slope and significant relationship (B=0.147, p<0.052) between Mobile Phones
and having pre-marital
sex by the farmers with (R square
0.275).
4.2.
Discussion of Findings
The
discussion of the research findings is based on the stated research questions.
Awareness
about Information Usage on HIV/AIDS
It has
become very important to raise the level of knowledge and awareness related to
HIV/AIDS usage, using all information sources at our disposal particularly among
farmers where a great deal of effort is required at spreading the information
on HIV/AIDS in Nigeria. The findings from the study are in some ways consistent
with findings from other studies done by other scholars (Ogundipe, 2006 and
Odutolu, 2005). The general consensus seems to be that farmers are well aware
of the HIV and AIDS but the awareness really does not translate to change in
sexual behavior.
It was also indicated by the
respondents that radio, television, discussion at workshops and seminars,
posters as well as medical personnel were the most importance sources about
HIV/AIDS information usage. This significance of this observation is
highlighted by Nwagwu (2007) who argued that although it is good to adopt
multiple information strategies in HIV/AIDS awareness activities, much cost
could be saved if a few sources that account for much of the knowledge and
awareness among a people are used as a strategy.
Effect of HIV/AIDS Information
Usage on Sexual Behaviour of Farmers
Results show that the impact of
the information usage on sources such as handbills and medical personnel on the
dangers involved in indiscriminate sex by the farmers negatively and
significantly affect HIV/AIDS information on sexual behavior of the farmers;
while Discussion/seminars and Online Forum play a positive and significant
effect on HIV/AIDS information on sexual behavior of the farmers. Therefore, it
can be inferred that the information sources exposed to by the farmers
enlightened them about the dangers involved in indiscriminate sex. This was in
line with Bankole and Mabekoje (2008) who studied the awareness and preferred information usage about
HIV/AIDS by secondary school teachers in Ogun State. They reported that the
kind of information sources exposed to by the students tends to create more
awareness about the disease in the society. Also, a greater understanding and
awareness of HIV and AIDS is thought to lead to changes in sexual behaviour,
which has been shown to reduce the number of new HIV infections (UNAIDS, 2006).
Also, the usage of handbills,
magazines, television and social networks accounted for the prevention of
having extra marital sex by the famers which significantly have effect on
HIV/AIDS information on their sexual behavior. This was in line with Nwagwu,
Okoye and Isiugo-Abanihe (2011)
on major HIV/AIDS information sources
used by adolescents in Ekwusigo local
government area of Anambra state, Nigeria. They reported that handbills accounted for 23.44% of
the total variation; the second factor was loaded on friends that accounted for
15.76%, while the third was loaded on television, accounting for 13.67%. From
the on-going one can deduce that the information sources exposed to by the
farmers help in preventing them from indulging in extra marital sex.
In
addition, findings show that there is a positive and significant relationship
between medical personnel, discussion/seminars, mobile phone as well as television and having
illicit sex by the farmers such that the effect may be weaker on the farmers’
sexuality. Thus the claim of Buseh et al., (2002) that sexual behavior of
farmers attenuates the amount of information sources acquired and utilized
before the decision is made. Therefore,
if farmers are in the habit of using a particular source, the predictive power
of indulging in it is attenuated. In other words, the stronger the attitude
towards sex, the weaker the effect on having or indulging in illicit sex.
Furthermore, findings show that
the impact of information sources on the usage of condom by the farmers have
significantly effect on HIV/AIDS information on sexual behavior of the farmers.
Posters and mobile phones were positive and significantly used most to elicit
information on the usage of condom by the farmers. This result corroborates Beck
(2002) who noted that condom use is the best available strategy to prevent HIV
infection. Also, Journal, handbills, friends, religious meetings and websites
have a negative but significantly related with the use of condom by the
farmers. The results indicate that having the knowledge is not enough to reduce
sexual risk-taking behaviour(s) (Weston, 2006).
Moreover, findings shows that the
impact of the information sources such as religious meeting, television and
social networks enable farmers to take caution in indulging in indiscriminate
sex which
have positive and significant effect on HIV/AIDS information on sexual behavior
of the farmers; while websites plays a negative and overwhelming evidence of
significant relationship effect on HIV/AIDS information on sexual behavior of
the farmers. Therefore, it can be inferred that the information sources exposed
to by the farmers enlightened them about the dangers involved in indiscriminate
sex as earlier reported by Bankole and Mabekoje (2008). Also, the impact of the
information sources reflected through the use of posters which enable farmers
to take caution while using unsterilized objects has positive and significant
effect on HIV/AIDS information on sexual behavior of the farmers. However,
websites plays a negative and very weak significant effect on HIV/AIDS
information on sexual behavior of the farmers. Thus, the information sources
exposed to by the farmers caution them about the dangers involved in using
unsterilized objects.
Finally,
there is a negative and significant relationship between journals and prevention of pre-marital
sex by the farmers. According to UNDP (2005) journals are characterized as
one of the information sources that helps in informing the populace about the
dangers in indulging pre-marital sex.
This agrees with the result of Nwagwu (2007) on reproductive health of the girl
child in Imo State, Nigeria. Also, mobile phones play a very vital role in
preventing pre-marital sex by the young farmers as we can see in the study that
there is a positive and significance relationship between usage of mobile
phones and preventing pre-marital sex by the farmers.
5.0 Conclusion
In
conclusion, a lot need to be done to ensure adequate penetration of information
regarding HIV/AIDS information usage among farmers in Badagry local government
area of Lagos State, Nigeria. The study established that provision of
information usage on HIV/AIDS had effectively increased the level of awareness
of the disease in the country. Hence, there is a need to ensure better HIV/AIDS
programming particularly on electronic sources, which could be enforce and
adequately passed across to people in order to influence and change their risky
sexual behavior.
Based
on the findings, it becomes pertinent to make the following recommendations.
1.
That
there should be better HIV/AIDS programming on electronic sources (such as
radio, television, mobile phones, social networks, websites etc). Strong effort
to ensure that the programmes on these sources that deal with HIV/AIDS are
adequately passed across to the farmers which would help in informing them
about the dangers involves in HIV/AIDS in the society.
2.
Regular
assessment of sexual behavior patterns in relation to the usage of information
exposed to the farmers are needed to evaluate the performance of the various
sources and programmes that bring HIV/AIDS awareness information to the people
and to help them re-position and strategize
for effective delivery.
3.
Means
should be sought to exploit the opportunity in the village through seminars and
other religious meetings as veritable tools for spreading awareness about the
HIV/AIDS scourge. Ways should be sought to make these meetings interesting
enough to draw and hold attention as well as comprehend by the farmers in the
village, so that they can regularly attend.
4.
The
role of medical personnel as authoritative source of HIV/AIDS awareness
information has to be fully exploited as it appears from the results of this
study that a large number of the farmers in the village would pay better
attention to the information if they interacted more with medical personnel as
sources of the information.
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