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  • Mapping of Ressources - Western Africa

    Nigeria

    1.  General and Epidemiological Data

    1.1.    General Data

    Nigeria , rightly called the giant of Africa is bounded to the West by Benin, to the North by Niger, to the East by Cameroon to the South by the Atlantic Ocean. It also shares a small border with Chad. Its area is 923,770 km². Its political or administrative capital is Abuja. Nigeria is the most populous country in Africa with a population of 108,945,000 inhabitants in 1999. The Nigerian economy is dependent on agriculture and oil exports. In 1998, Nigeria's imports amounted to US $ 5,713 million and exports stood at US $ 7,930 million.

    1.2.    Epidemiological Data

    Nigeria has not been spared by AIDS. AIDS prevalence in the general population was estimated in 1999 at 5.4%. The epidemiological situation evolves each year. It increased from 4.8% in 1992 to 5.4% in 1999.

    The most affected age group is between 15 and 34 years aCCounting for over 80% of cases. The principal mode of transmission is sexual.

    2.  National HIV/AIDS Infection Control Policy

    2.1.    Strategy Thrusts of HIV/AIDS Infection Control

    Unfortunately we could not meet with officers of the National AIDS Control Programme (NACP) whose headquarters has been relocated from Lagos to Abuja. Nevertheless we were able to gather information from NGOs operating in the area of HIV/AIDS.

    The NACP has been existing since the 1980s. Today, AIDS has been included among the priorities of the government. In fact, in the year 2000, an Inter-Ministerial Committee was established chaired by the President of the Republic in person. This committee is dependent on a multisectoral working group which comprises members of various ministries (health, education, youth and sport, employment, planning, finance, justice) and those of local and international NGOs. The plural character and multi-dimensional character of this working group shows that AIDS is no longer a health problem but has socio-economic implications.

    The priority strategic thrusts of the fight against AIDS over the next 24 months cover the following points:

    · Change in attitude

    · Institutional capacity building

    · Care of persons infected and affected by HIV/AIDS

    · The development of a safe blood transfusion policy

    · Prevention of transmission by mother to the child

    · The development of the strategy of the promotion of voluntary test and the promotion of the availability of drugs

    2.2.    Stakeholders Involved IN AIDS CONTROL

    In Nigeria, there are various types of stakeholders involved in AIDS control. Thus the Ministry of Health is supported by the other Ministries. The other stakeholders are national and international NGOs, bilateral cooperation agencies and development partners particularly, WHO, UNAIDS, the World Bank, UNDP, UNICEF, UNFPA, USAID...

    3.  Position and Involvement of the Churches and Religious Communities

    Within the framework of this study, we have met with officials of the following Churches and religious communities: Anglican Church, Baptist Church, Methodist Church, Catholic Church, Presbyterian Church, Salvation Army, Christian Council of Nigeria, and the Muslim community.

    3.1.    Perception of the Churches and Religious Communities

    It should be pointed out that the positions of these Churches are not different from those of other countries. As far as all the religious leaders are concerned, AIDS is a major health and social problem today in Nigeria, in view of the increase in the number of AIDS cases and all the socio-economic consequences which it engenders for families, Churches and the Nigerian society.

    ACCording to religious officials, there are factors which foster the propagation of the disease. Nigeria is a rich country. However, there is a concentration of the country's wealth in the hands of a minority which deepens poverty, unemployment, delinquency and drug addiction. At the same time, the Churches point out that AIDS is a phenomenon which transcends poverty because it affects both the poor and the rich. It is rather the latter who are the most affected. AIDS is rife in the USA, the richest country in the world: for Church officials this means that one should call into question the immoral attitudes of man which reflect the culture of debauchery in vogue and man's fearlessness of God. It is for this reason that AIDS can be considered as a punishment from God. As a matter of fact, “God does not kill his children, especially innocent babies. To say that AIDS is a punishment unleashed by God is a dangerous affirmation. AIDS strikes Africa more than the other continents. To say that AIDS is a punishment from God would then mean that God has cursed Africa. God likes Africa, whether or not this pleases some racists ideologies which wrongly interpret the Bible by affirming that Blacks are cursed by God. By abusing their freedom and intelligence, men are in the process of self destruction. Look at the nuclear bombs. It is not God who created them”. This is the position of an Anglican Reverend pastor.

    On the whole, as far as the Churches are concerned, AIDS is a self-inflected punishment on man.

    3.2.    Position of Churches and Religious Communities

    In order to be protected against HIV/AIDS, all Churches have agreed that man should revert to the word of God by avoiding adultery, fornication and sexual promiscuity. The issues that divide them is the expediency of whether or not to recommend condoms to the faithful. The Anglicans, Methodists, Muslims and Baptists are in favour of the use of condoms whereas the Catholics are against it, just as the Nigerian Presbyterians.

    3.3.    Involvement of the Churches in HIV/AIDS Infection Control

    3.3.1.   The Methodist Church

    Prevention Activities

    The Church puts a special emphasis on sexual education. The reason for this is that it is of the view that the youth of today should be provided with appropriate sex education in conformity with the Word of God and the realities of the modern world. This explains why every Sunday the Church organises in the parishes Bible studies during which issues of sexuality are discussed, particularly pre and extra-marital sexual relations, the notions of abstinence, fidelity in marriage, etc... The question of sexuality has always been tackled in relation with the AIDS problem.

    In order to combat AIDS, the Church focuses on information and education of the faithful. In this connection, awareness-raising seminars on the disease are organised for the youth. AIDS is included in the Bible studies programmes. Seminars and lectures-discussions are regularly organised and directed by doctors who are AIDS specialists. The Church trains counsellors in education who in turn organise awareness-creation tours with the projection of films in the parishes. They are supported by catechists and pastors who were themselves trained. The Church manages about twenty health centres countrywide. The medical personnel of these structures regularly organise educational discussions for the sick and visitors. It should be pointed out that the Methodists are not against the use of condoms.

    Care

    In the field of the care of PLWA, it should be pointed out that all the health facilities of the Church, the medical and para medical staff are responsible for the medical, psychological care of PLWA. However the Church points out that it does not do enough for AIDS patients particularly in the area of medical and food assistance. Consequently, the next phase of the Control Programme is to support AIDS patients with drugs, food and clothing.

    It is important to note that the Church does not yet have an official position concerning voluntary test. Some pastors encourage people to undergo voluntary test, however it is clear that people are reluctant to do so in view of the rejection of the infected or affected persons or the stigma attached to them.

    Support to AIDS orphans

    There are homes for orphans including AIDS orphans. The Church educates feeds, clothes them and monitors their health status.

    3.3.2.   The Anglican Church

    Prevention Activities

    The main AIDS control activities are the regular organisation of lectures-discussions organised by specialists, the projection of films, the distribution of posters and leaflets. Furthermore, once every three months AIDS is the theme of preaching in the various church services. The Church also focuses on sexual education. For a long time, the question of sexuality has been a taboo matter. However the appearance of AIDS has made it compelling for the Churches to review its methodology. Thus, in addition to the discussions carried out within groups for youth and women, the Church invites specialists on sexuality to organise conferences followed by projection of films and slides which generates very interesting discussions between the youth, parents and pastors.

    The Anglican church emphasises that AIDS can be prevented through fidelity and abstinence. However the Church is not opposed to the use of condoms.

    Care of PLWAs

    The Church does not have organised departments for the care of the sick. The cases which arise are discreetly managed by pastors and volunteer doctors of the Church. Indeed, it happens that a number of pastors are formerly doctors. Furthermore, in Lagos there is a clinic belonging to the Church where a number of volunteer doctors, who are members of the Church, work. These doctors take care of the psychological and spiritual problems of the sick. From time to time the Church organises fund raising in order to come to the assistance of persons affected with drugs and food. Within the Church, there is a committee responsible for visiting the PLWA at home in order to provide them with moral support. This committee is composed of pastors, laymen and doctors. The Church intends to reorganise it in order to extend its mission to provide a more varied support.

    With regard to the issue of voluntary testing, the Church does not have an official position on the matter; it neither encourages nor implies voluntary testing on the faithful not even on those who are preparing to celebrate their wedding. However, a number of couples voluntarily undergo the test and it has already turned out that one of them is HIV positive. There are parents who aCCept the culmination of the process and there are some who reject it and this creates delicate problems which the Church must handle.

    Support to AIDS orphans

    There is no special programme for AIDS orphans. However, the Church has an assistance programme for orphans in general. The few AIDS orphans gain benefit from this assistance.

    3.3.3.   The Presbyterian Church

    The Church trained peer educators counsellors in the youth groups, adults and women who are in turn responsible for creating awareness in their peers. Furthermore, they organise spiritual activities and house-to-house visits. A number of pastors are trained to supervise awareness-raising activities.

    An AIDS control unit called “PRESBY-AIDS”was established within the Church. It is composed of pastors and laymen. It is responsible for mobilising the community against AIDS and also to ensure family planning and the monitoring of activities in the parishes. Meetings are organised periodically by the Church to evaluate the activities. With the assistance of USAID and Family Health International, posters and leaflets were produced on STD and HIV/AIDS, to serve as teaching aids during the awareness-raising exercises.

    It should be emphasised that this Church is vehemently against the use of condoms. It recommends only fidelity and abstinence to its members. Furthermore, it does not have an official position on the issue of mandatory tests before marriage or on voluntary tests.

    With regard to the care of the sick, the Church has three hospital centres which treat opportunistic diseases. The Church is faced with a few rare cases which they entrusted to the NGOs which have the PLWAs and HIV positive care component in their programme. However, PRESBY-AID has just created a committee for the care of the affected and infected persons.

    The Church does not yet have an AIDS orphans support project; but this is being considered.

    3.3.4.   The Salvation Army

    The Salvation Army is an international Christian organisation present in several countries of the world with its headquarters in London.

    Prevention Activities

    The Salvation Army is one of the churches the most involved in AIDS control in Nigeria. It executes various health development programmes and AIDS is included in it. Health counsellors are trained among youth groups and adult women for involvement in education and awareness-raising activities in their localities and parishes. They organise house-to-house visits in order to discuss health and AIDS problems, in particular with people at home. They intervene also in prayer groups in order to communicate their message.

    The counsellors create anti-AIDS clubs in their localities and parishes. They established and also run drama groups which act plays on themes concerning AIDS. The Church organises symposia on AIDS. The project developed a pedagogical medium through the production of posters, leaflets and stickers...

    The counsellors encourage people to undergo voluntary screening tests. This has yielded results because, apart from a few cases of hesitation, people began, little by little, to aCCept to undergo the tests. Those who do it voluntarily are psychologically prepared to aCCept the results. In either case, the persons concerned are managed by the counsellors.

    Support to AIDS orphans

    The Church organises the care of AIDS orphans. There is no special centre for them, but they remain in their family. The counsellors visit them regularly and partially provide for their food needs and health problems. The counsellors prepare the foster families to take care of the children. It should be pointed out that the foster families are for the most part relatives of the orphans.

    3.3.5.   The Catholic Church of Nigeria

    We were not able to meet the Secretary of the Health Department of the Catholic Church. Information was sent to us by mail.

    The Catholic Church is one of the most active Churches in AIDS control. Since the appearance of AIDS, it was the first to embark in educational activities of its faithful. Seminars were organised for the clergy and laity. Prevention and education programmes were initiated in the various dioceses of the country as well as training sessions for staff of the various laboratories operating in all the health facilities in the country. Following this, the Health Department of the Catholic secretariat of the Catholic Church in Nigeria took the decision to procure blood kits from German health institutions with the aim of guaranteeing the safety of blood transfusions. This project is continuing to date.

    Faced with the escalation in the epidemics, the Episcopal Health Committee decided to send 5 health workers to Uganda, to be trained in counselling techniques and care of the sick in the hospital and at home. This group of trainers in turn trained other counsellors in the various localities of the country. The Church has contributed largely to educational aids such as posters, stickers, leaflets and audio cassettes produced in English and in the different languages of the country.

    4.  Poverty and Human Rights

    The Churches initiate development projects in the country. They grant credit to women and officers of small and medium scale enterprises. They established hospital centres, vocational training centres, schools and even universities. Furthermore, they have funds for orphans and

    the needy without religious discrimination. The Christian industrialists and bankers are called upon to consider favourably the applications of the jobless youths which are submitted to their institutions. With regard to human rights, Churches focus on the civic education of their faithful. They denounce arbitrary arrests and all forms of Human Rights violation.

    5.  Ecumenical Movements and Health Facilities

    5.1.    Young Men's Christian Association (YMCA)

    In the opinion of a number of partners, YMCA Nigeria is one of the most active NGOs in the country. Just like the country, it is a big and dynamic institution.

    This institution has been involved in AIDS control. It established an AIDS control project which began in June 1999 and spreads over a three-year period. The population targeted is estimated at 55,000 youths. The strategy is peer education. The project has been established in three States namely, Lagos, Kaduna, and Oweri. 24 peer educators and 11 supervisors were trained.

    Benevolent peer educators are the main project stakeholders. Their main activities are the organisation of educational discussions, counselling on STI/AIDS, family planning, sexual education and Bible studies. To this, one should add the sale of condoms, the projection of films, radio-television broadcasts, and publicity campaigns with the aid of posters and leaflets.

    The project also puts a special emphasis on the fight against STD through prevention and the medical care of those who are infected. The project does not yet have a component for the care of PLWAs and AIDS orphans. It encourages the youth to undergo voluntary tests in order to know their serological status.

    The YMCA of Nigeria initiated throughout the country development projects which are its hallmark. Its contribution to the moral and civic education of the youth has been highly appreciated. Interesting pedagogical documents were prepared for this purpose.

    5.2.    The Salvation Army HIV/AIDS Action Center

    Besides prevention activities, the care of sick and infected or affected persons is the field in which the Salvation Army excels. It has established countrywide 8 counselling and care centres called “The Salvation Army HIV/AIDS Action Resource Centres”. Each centre's personnel is comprised of five people. The mission of these counselling centres is to organise the medical, spiritual and psycho-social care of the sick. The motto of these centres is “From Fear to Hope” . In addition to care at the hospital, from time to time, counsellors organise house-to-house visits with the consent of the persons concerned. These visits are aimed at providing them not only with moral and medical support but also at convincing their families to take care of them, since there are numerous cases of rejection. Currently the Lagos centre cares for 25 sick persons and about sixty HIV positives.

    5.3.    Saint-Joseph Ogobia and Saint-Thomas d'Ihugh

    Today a number of Catholic hospitals are very active in the care of the sick. In this regard, they constitute “pilot clinics” in Nigeria, for the care of the sick in the hospital and at home. These hospitals also serve as reference centres for epidemiological surveillance. The hospitals are the Saint Joseph Ogobia hospital and the Saint Thomas of Ihugh Catholic Hospital.

    Finally, virtually all the Catholic health centres are deeply involved in activities concerning AIDS prevention and care of infected and affected persons. The counsellors' training programmes are being pursued.

    6.  Network between the Churches and the Ecumenical Organisations

    Strictly speaking, there is not yet a well structured and functional network in Nigeria. There are only two major church associations namely: the Christian Council of Nigeria (CCN) and the Christian Association of Nigeria (CAN).

    These two Associations defend the common interests of Church members, however aCCording to every indication, the CAN is more extensive because in addition to the Protestant and evangelical Churches, it includes Catholics. All Churches who met affirmed their membership to the CAN. It has also been observed that there is an apparent solidarity between the Churches. This can be understood in the particular context of Nigeria where there are periodic clashes between the Churches and Muslims.

    Even though it is not yet deeply involved in AIDS control, it can be affirmed that CAN can already be considered as a network of churches. In this framework, from 4 to 6 September 2000 it organised a seminar bringing together the clergy of all Churches members. The purpose of this seminar was to sensitise Churches on the seriousness of AIDS and reflect together on the ways and means to be adopted in order to combat this scourge. All officials of Churches who met welcomed this initiative deemed necessary for a quick concerted action against the illness. It should also be emphasised that traditional Church officials have ruled out the possibility of collaboration with the sects which are currently proliferating in Nigeria. They describe their leaders as illusory and immoral peddlers who exploit the misery of the people to enrich themselves.

    The traditionalists however do not preclude a collaboration with the Muslims.

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