CHAPTER ONE

INTRODUCTION

1. BACKGROUND OF THE STUDY

The prevalence of HIV in the Middle East and North Africa (MENA) region is around 0.1 % among 15–49 year old’s, and this was designated as one of the lowest rates of HIV among world regions by the Joint United Nations Program on HIV/AIDS (UNAIDs). However, between 2001 and 2012, the MENA region experienced the highest rate of increase in the world, with a 73 % increase in the number of newly diagnosed individuals and a 52 % increase in the number of new infections. Jordan, with a population of just over 10 million, is considered a low HIV/AIDS prevalence country, with an estimated prevalence rate of 0.02 % among the general population. However, the number has doubled in the last 15 years, and some argue that this rate is an underestimation (Jordan, 2018). Low HIV/AIDS prevalence countries might contain a sizable amount of people living with HIV who are undiagnosed due to a lack of awareness about testing and attitudes towards self- or healthcare-initiated testing. Challenges related to knowledge and widespread stigmatizing beliefs and attitudes are well documented among healthcare providers (HCPs). These challenges interfere with preventative care and management, creating access barriers to patients seeking information, testing, and medical care. There is a paucity of published literature on the topic in Jordan. A 2012 systematic review of four databases and the grey literature, from 1980 to 2009, only found eight published articles related to behavioral and/or social outcomes of HIV/AIDS in Jordan, and all were cross-sectional. Only seven other studies were published between 2009 and 2021. Two of them were on HCPs, but only including nurses at primary health clinics (PHC) or specialty hospitals, and the rest were conducted on college students, patients, or men who have sex with men (MSM).

According to Amusan, Asekun-Olarinmoye, Bamidele, Egbewale, Odu and Olowu (2018) "Public health sector is the basic unit of society. It is a group of people of various ages usually related by birth, marriage or adoption". She went further to say that member of a public health sector feel that they have a special relationship with each other based on blood, affection, duty, shared experience and common interests. This special relationship is a knot that holds a public health sector together making it the most suitable human society. The public health sector is the institution through which socially approved coupling between man and woman takes place. It is the only institution in most, if not every society, recognized as qualified to carry out the roles of child bearing, and rearing as well as loving and caring for its members.

Action Health (2018) also defined the public health sector as the arena in which virtually the entire range of human experiences can take place. These include love, tenderness, honesty, communal sharing, joy, happiness, poverty, deceit, jealousy, envy, violence, warfare, guidance and acceptance. Avert International HIV/AIDS charity (2017) defined public health sector as a social group characterized by common residence, economic cooperation and reproduction. The public health sector, includes adult of both sexes, two of whom at least maintain a socially approved sexual relationship and one or more owned or adopted children of the sexually cohabiting adults. The African perspective of the public health sector is slightly different from the western perspective.

In the African context, and by extension, the Nigerian context, a public health sector consists of the husband, wife, children and the extended families of the couple.

Cooke (2015) defined the public health sector as a bio-social group, a network of persons intimately held together by a bond of social and kinship relationship or blood relationships.

Cooke (2015) goes on to say that in the Nigerian context, at least because of the phenomenon of extended public health sector system, the public health sector is made up of the married couple, their offsprings and immediate kit and kin, brothers and sisters of the bridegroom and his parents, relatives-in-laws, and any other dependant, so that the concept of nuclear families is a product of colonial experience in most parts of Africa. Following from the above, public health sector in the context of this study can be defined as a group of people closely related by blood, sharing common residence and interests consisting at least of two adults of both sexes who maintain socially approved sexual relationship and or one or more children of the sexually cohabiting adults.

According to 2015 UNAIDS estimates, the vast majority of countries where HIV prevalence among adolescent girls and young women aged 15 to 24 years exceeds 1% are in sub-Saharan Africa (with the exception of the Bahamas). Outside of sub-Saharan Africa, HIV prevalence in adolescent girls and young women exceeds 1% mostly among subpopulations (such as sex workers and communities with high drug use). Achieving reductions in new HIV infections among young key populations is essential to achieving the global target of fewer than 100 000 new HIV infections among adolescent girls and young women aged 15 to 24 years. Even within sub-Saharan Africa, there are large differences in epidemics among young women. For instance, HIV prevalence among young women aged 15 to 24 ranges from below 0.1 % in Senegal to 16.7% in Swaziland (2015).

In Nigeria, like other countries in the sub-Saharan Africa, HIV/AIDS continues to ravage families and communities. On a global level, 14,000 people become infected with HIV each day. High HIV prevalence among young women aged 15 to 24 years can serve as a proxy for HIV incidence in the absence of other data. Another option is to use modelled estimates of HIV incidence among young women, as they show variation between and within countries by age and location.

1.2 STATEMENT OF THE PROBLEM

In response to the epidemic, various measures have been taken at the local, national and international levels to prevent the transmission. Despite such programmes for prevention, efforts to date are not sufficiently impactful to adequately control HIV/AIDS. Various drugs have been invented, new ones are being discovered and administered, yet people are still being infected and are still subjected to various excruciating experiences. Prevention remains the best way of capturing the epidemic. Therefore, in recognition of existing lacunae in previous programmes and attempts made to prevent the epidemic, the study examines knowledge, attitude and practice (KAP) regarding HIV/AIDS stigma in public health facilities as the case study.

1.3 AIM AND OBJECTIVES OF THE STUDY

The study seeks to determine knowledge, attitude and practice (KAP) regarding HIV/AIDS stigma in public health facilities. The objectives of the study are:

1. To determine the consequences of HIV/AIDS among patients in public health facilities
2. To determine the prevalence of HIV/AIDS among patients in public health facilities
3. To investigate the factors affecting the role of public health sector in the prevention of HIV/AIDS among patient in public health facilities
4. To recommend ways for effective prevention of HIV/AIDS among patients in public health facilities

1.4 RESEARCH QUESTIONS

The research questions are:

1. What are the consequences of HIV/AIDS among patients in public health facilities?
2. What is the prevalence of HIV/AIDS among patients in public health facilities?
3. What are the factors affecting the role of public health sector in the prevention of HIV/AIDS among patient in public health facilities?
4. What are the ways for effective prevention of HIV/AIDS among patients in public health facilities?

1.5 STATEMENT OF THE HYPOTHESIS

H0: the stigma associated with people living with HIV/AIDS in public health facilities is low

H1: the stigma associated with people living with HIV/AIDS in public health facilities is high

1.6 SIGNIFICANCE OF THE STUDY

The following are the significance of this study:

1.    The outcome of this research will create awareness to both the general public and patients in public health facilities on the role of public health sector in prevention of HIV/AIDS among patients and curbing stigmatization.

2.    This research will be a contribution to the body of literature in the area of knowledge, attitude and practice (KAP) regarding HIV/AIDS stigma in public health facilities, thereby constituting the empirical literature for future research in the subject area.

1.7 SCOPE OF THE STUDY

The study covers on the role of public health sector in prevention of HIV/AIDS among patients with focus on Public health facilities

1.8 LIMIATION OF THE STUDY

Financial constraint- Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

Time constraint- The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.

1.9 DEFINITION OF TERMS

HIV: HIV (human immunodeficiency virus) is a virus that attacks the body's immune system. If HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome). There is currently no effective cure. Once people get HIV, they have it for life. But with proper medical care, HIV can be controlled.

AIDS: Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body's ability to fight infection and disease.

PATIENTS: a person receiving or registered to receive medical treatment