ATTITUDES TOWARDS PEOPLE LIVING WITH HIV/AIDS: A STUDY OF IDEMILI NORTH AND OYI LOCAL GOVERNMENT AREAS OF ANAMBRA STATE, NIGERIA

The HIV/AIDS (Human Immune Deficiency Virus/Acquired immune Deficiency Syndrome) pandemic has brought the problem of attitudes towards people living with HIV/AIDS (PLHIV). The nature of the disease made it imperative to study people's attitudes towards PLHIV as it has serious implications for how PLHIV cope with the disease. Negative attitudes towards PLHIV make life very difficult for PLHIV. This study examined Anambra people's attitudes towards PLHIV with the goal of exploring those practices/behaviours that affect PLHIV. The study was carried out in Idemmili North and Oyi local government areas of Anambra State, Nigeria. Quantitative methodology was used to elicit information from respondents who are adult males and females of 18 years and above. The survey was employed. Questionnaires were administered on 1000 respondents and 914 questionnaires were completed. The findings were: The people generally have very positive attitudes to PLHIV. In conclusion, the positive attitudes towards PLHIV are products of the people's cultural beliefs and practices which made it imperative for the people to care for sick relations. This means that PLHIV in the study area receive care and support from relations. These cultural practices could be harnessed fully with effective intervention programmes.






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Publication: Ife Psychologia
Author: Muoghalu, Caroline O
Date published: September 1, 2011

Introduction

The HIV/ AIDS pandemic has been topical since the identification of the disease. It has devastated many countries especially in Subsanaran Africa. It is indeed a major event of our time. It has killed over 80,000 people and 70 percent of these are in Sub- Saharan Africa (UNDP 2003). The world over, 33.4 million people have been infected and 22.4 million of these are from Sub- Saharan Africa (UNAIDS 2009). Also, by the end of 2009, deaths due to AIDS was 2 million and 1.4 million of this were in Sub- Saharan Africa (UNAIDS 2009). Sub- Saharan Africa has one of the world's highest HIV prevalence and faces the greatest demographic impact. In the worst affected countries of East and Southern Africa, up to 60% of today's 15 year olds will not reach their 60th birthday (Timaeus and Jassen 2003). AIDS epidemic in Africa is a contemporary health crisis of staggering proportions and one with which African society and governments as well as the international health organizations are unable to cope. The African AIDS epidemic is mainly transmitted from person to person heterosexually.

In Nigeria, the HIV seropositive is 4.4 percent (Federal Ministry of Health 2006). By the end of 2009, the HIV seropositive rate was 3.1 percent with the number of women as many as 1.4 million, and children- 220,000 and death due to AIDS in 2009 in Nigeria was 170, 000 (UNAIDS 2009). Also, UNAIDS, (2009) had it that about 2.6 million Nigerians are living with HIV/ AIDS. The spread of the epidemic in Nigeria has been unprecedented with 1.8 percent sero-prevalence rate in 1991 to 4.5 percent in 1996. In 2001, the sero-prevalence was 5.8 percent and at the end of 2003, it was 5.0 percent. The HIV/AIDS epidemic in Nigeria shows a lot of variation. The state wide prevalence ranges from as high as 10 percent in Benue and 8 percent in Akwa Ibom to under 2 percent in Ekiti, Oyo and Jigawa.

The rate of HIV infection was significantly higher in males than in females at the on set of the disease in Nigeria. Males have also been shown to be the main bridging route between people who engage in high-risk sexual behaviour such as female sex workers and the general population (Adeyi , Kanki , Odutolu, and Idoko , 2006). Factors that favour the incidence of HIV in Nigeria are mostly socioeconomic circumstances: cultural practices, exposure to commercial sex and migration (Olasode and Alkali, 1999). They also found that extramarital affairs, travel, commercial sex and use of unscreened or improperly screened blood units for transfusion are major sources of the infection in Nigeria.

The nature of HIV/ AIDS lent it to the problem of stigma and negative attitudes to PLWHA and this had made life unbearable for PLHIV especially in Africa where community means so much to the individual. Stigma occurs when an individual is identified as deviant, linked with negative stereotypes that engender prejudiced attitudes, which are acted upon in discriminatory behaviour. These individuals were to be avoided or shunned, particularly in public places (Health line Network Ine, 2007). The stigmatised persons are reduced from accepted people to discounted ones, thus isolating the individual from self, as well as societal acceptance (Goffman 1963).

Discrimination has been found to be present in people's attitudes towards people living with HIV/ AIDS. In a study of residents of Lagos, Nigeria, Adejuyigbe 8c Obiyan (2009) found that many of the people living with HIV/ AIDS have been stigmatized and the tend to hide their seropositive status with great implication for the spread of the disease. In a study of students attitudes to fellow students living with HIV/ AIDS in South west Nigeria, Omoteso (2004) found that the attitudes of students continues to be that of discrimination, rejection and stigmatization in -spite of the fact that HIV/ AIDS awareness is increasing phenomenally with the passing of each day. In a similar study of HIV/ AIDS knowledge, attitudes and opinion among adolescents in River State, Nigeria, Wode (2005) found that respondents were of the opinion that a HIV positive person should not be allowed to teach if a teacher or not be allowed in class if a student. This was corroborated by UNAIDS (2004) epidemic update research in 4 Nigerian states which found discriminatory and unethical AIDS related behaviour among doctors, nurses and midwives ranging from denial of care, testing without consent, and breaches of confidentiality. One in ten care providers reported refusing to care for HIV positive patient, 10% reported refusing them admission to a hospital. Furthermore, 65% reported seeing other healthcare workers refusing to care for an HIV or AIDS patient. Some 20% felt that many people living with HIV had behaved immorally and deserved to be infected. In a similar study by Ijaduola, Ijaduola, Abiona, Odu, & Akinyemi (2007), most of the physicians perceived HIV positively but expectations of the patients concerning communication were not being met. Only 45 percent of the physicians expressed comfort engaging people living with HIV/ AIDS in lengthy discussions or communicating diagnosis of HIV to patients.

This study examined the Anambra people's attitudes towards PLWHA using the following research questions:

* Can you shake hands with PLWHA?

* Would you eat with the same wares with PLWHA?

* Are you willing to care for PLWHA?

* Can you work in the farm/ business of PLHIV?

* Are you willing to help PLWHA to treatment Centres?

* Do peoples' level of education and age influence their attitudes to PLHIV?

Conceptual Clarification

Attitudes: Attitude is a complex tendency of persons to behave in positive or negative ways or to respond. Attitudes are formed through experience and contact with the world around us (Davis and Houghton 1995). As individuals develop, they acquire a set of beliefs and attitudes that in part influence how they interact and this may be altered by new experiences and information. Attitudes in this paper were willingness to shake hands with PLWHA, take care of them, work in their farm or business, eat with the same wares with PLWHA and willing to help PLWHA to treatment centres.

Theoretical Framework

The theoretical framework for this paper is the action frame of reference (Max Weber, 1960). The choice of this theoretical frame of reference stems from the fact that attitudes are shaped by the cultural setting in which actors find themselves and this is the thrust of Weber's Action Theory. Indeed, it is within the context of culture, environment and level of knowledge that the people's attitudes towards PLWHA are located.

The action theory posited that the action of an individual towards an issue or object is determined or influenced by the definition of the situation. The definition of the situation is determined by the culture of the people. This sociological perspective focuses on the acting individual and the acting group. As explained by Weber 1960, explanation of social action must arise from the definitions of the situation and purposes of the actors. In action is included all human behaviour when and in so far as the acting individual attaches a subjective meaning to it. Weber postulated that cultural values circumscribe and direct social action and as such, another main defining agency is the community.

Applying action theory to the study of attitudes of Anambra people towards PLHIV is based on the fact that social action (in this case attitudes) must arise from the definition of the situation, which is to a great extent culturally defined. The Anambra people defined HIV/ AIDS as serious illness and their attitudes to PLHIV are their normal attitudes toward sick relations. It is this culture's ability to define the situation for the people that is responsible for these uniformities in Anambra people's attitudes towards PLWHA.

Methodology

The study employed quantitative and qualitative data collection methods (the survey and In-depth Interviews) to generate data for the examination of attitudes towards PLWHA in the study area. The independent variables were age, sex, educational level and marital status. A total of 1000 questionnaires were administered on respondents and 914 were completed and 10 in-depth interviews were conducted on 4 PLHIV and 6 opinion leaders.

Before the commencement of the administration of the questionnaires, community heads were contacted and the study and its purpose were explained to them. Respondents were assured of the harmlessness of the study and the confidentiality their identity and all information generated in the study. In the same way, interview respondents were assured of the confidentiality of their identity and information given out to the researchers. The consent of the interviewees was obtained before the interview was conducted and participation in the study was voluntary.

In selecting respondents for the administration of questionnaires, Household census was carried out in three purposively-selected communities in each local government area (Umuoji, Ogidi and Nkpor in Idemmili North and Nteje, Ogbunike and Nkwele-Ezunaka in Oyi). These communities were the three biggest communities in each of the selected local government and as such were the microcosm of the LGAs. All the households in each selected community were listed serially to form the sampling frame. Systematic random technique was used in selecting every fifth household. The systematic random method has the strength of making the sample more representative of the population. In the selected households, questionnaires were administered on adult males and females (18 years and above). In each selected household, there was balloting (if there were two adult in a household, the researcher would bring pieces of paper and writes "no" in one and "yes" in one) and any of the adults in the household that picks yes was given the questionnaire. This meant that only one respondent was chosen from each selected household. Four university graduates of the social sciences were recruited and trained as research assistants for the data collection. A total of 1000 respondents were interviewed using questionnaires and 914 were completed successfully and analysed. A pilot qualitative study was carried out before the designing of the questionnaire. The questionnaires were designed in two sections; the first section was on the demographic characteristics of respondents and the second section was on the people's attitudes towards PLHIV.

In selecting PLHIV for interview, the researchers used village informants to locate them in their homes because in the study area, PLHIV are confined by their families and nobody lives with HIV in the study area. The opinion leaders were also located in their homes and their location was made easy by village informants. The essence of interviewing opinion leaders was that their opinions on issues reflect the general opinion of the people.

Analyses of quantitative data were both descriptive and analytical using SPSS software version 11.1 to enter the data in the system. Univariate analysis in the form of frequencies and percentages contributed to the understanding of the distribution of each variable across survey respondents. Bivariate analyses were conducted using Cross tabulations. The qualitative data was analyzed in themes based on the objectives and was used to support the data from the questionnaires. The qualitative data was used as a resource for more personal comments from the respondents about their attitudes.

Findings:

Table 1 showed the social, economic and demographic features of the respondents using the following variables: age, marital status, educational level, religion, occupation and sex. The table showed that majority of the respondents were within the ages of 18 years and 56 years. It was also indicated that majority of the respondents were secondary school graduates and that most of them were married and almost half were males while the remaining half were females.

The Anambra People's Attitudes towards PLHIV

Respondents attitudes to PLHIV were explored in table 2 using variables such as eat with the same wares, care for PLHIV, Help to treatment centres, shaking of hands, help in the farm/ biz of PLHIV. Findings showed a positive attitude to PLHIV with 53.7 percent willing to eat with the same wares with PLHIV, 82.1 percent willing to care for PLHIV, 85.2 percent are ready to accompany PLHIV to treatment centres, 72.8 percent can shake hands with PLHIV and 93.2 percent were willing to help in the farm/ business of PLHIV.

Majority of the respondents were willing to use the same eating utensils, share toilet, shake hands and accompany PLHIV to treatment centres. This general attitude test result was an indication of positive attitudes to PLHIV in the study area.

In the interviews, the respondents still maintained that it is expected of one to help the sick especially a blood relation no matter the situation. Therefore many indicated that they were willing to help PLHIV in any way they could. Indeed, a female interview respondent indicated thus:

I can shake hands and eat with the same utensils with PLHIV especially if the person is my blood relation. I don't think that there is any thing wrong with that

Another female respondent also indicated that

There is no way an individual runs away from his/her responsibilities to a blood relation because the individual's life and activities revolve around relations and the community, so the best thing is to carry out the responsibility as much as possible to the best of ones abilities.

According to a male respondent

Taking care of the sick has always been our cultural practice and the case of PLHIV would not be different. I am willing to help in the farm or business of PLHIV and to do whatever I can do for them. Usually in the event of any misfortune or illness, the relatives of the sick gather together and attend to the farm or business of the sick person so that the person would not go bankrupt. It is also part of care for the sick in this area.

According to a female respondent

It is our obligation to our ancestors to look after blood relations especially those who are sick. So one does not need to be told to take care of PLHIV especially if they are blood relations.

Cross Tabulation of Age, Educational Level and Attitudes to People Living With HIV

Table 3: examined the relationship between age, attitudes to PLHIV and educational level and attitudes using the variable "care till the end"

Cross tabulation of age and attitudes to PLHIV indicated that majority of the respondents in each age group were willing to care for a relation living with HIV till the end. However, the percentage of people willing to care for PLHIV was highest among people between the ages of 3 1 - 43 years and lowest among people between the ages of 18 and 30 years. This means that the older people were more willing to care for PLHIV than the younger people corroborating a male interview respondent who said that;

Young people are no longer interested in the family, they do not want to help any family member in distress, they only think about themselves. I don't know whether it is what they read in books or watch in the television that is causing all these. Indeed, the care economy is no longer as effective and strong as it used to be.

Yet another respondent added:

Children of these days do not care so much about the extended family. Education and westernisation make them imbibe the white man's culture and they forget about our tradition and they now see it as valueless and inhibiting.

Furthermore, table 3 indicated that majority of the respondents in each educational level group were willing to care for PLHIV till the end. Interestingly, people with no formal education were more willing than any other group to care for PLHIV.

Discussion of Findings

The demographic characteristics of the respondents indicated that majority of them were within the ages of 18 years and 56 years and were mainly secondary school graduates, married and are Christians. It is important to note here that even as majority were Christians, they still adhered to their traditional religious beliefs and practices and this has implications for their attitudes towards PLHIV. The implication of this adherence to traditional beliefs and practices for their attitudes towards PLHIV was that PLHIV in the area would be well catered for. This is because ancestral worship in the area forbids the people from abandoning a blood relation no matter the situation. Furthermore, the strong marital bond in the study area does not give room for a person to divorce or abandon a sick spouse and all these culminates in making life more comfortable for the sick including PLHIV. Marriage in the study area does not have room for divorce even after the death of a spouse. All these culminate in making life more comfortable for the sick including PLHIV.

The people's attitudes to PLHIV indicated a general positive attitudes - being willing to share eating utensils, shaking hands, willing to help in the farms of PLHIV.

These respondents were ready to care for blood relations living with HIV/ AIDS in-spite of the stigma because it was culturally binding on them. The people's belief system is such that a person who abandons a blood relation has failed to represent his/her ancestors well and cannot be blessed by the ancestors. Because of this, everybody strives to fulfil all obligations towards blood relations no matter what it cost him/her so as to endear themselves to their ancestors because there is a bond between the living and the dead in the study area in which it is believed that the dead looks after the living and blesses the good ones. It is important to point out here that these positive attitudes were mainly a the level of immediate and extended family because families take it as obligations to take care of distressed blood relations. As such, the family is invaluable in giving PLHIV a sense of belonging and reasons to keep on struggling to live. This is why the family and community mean so much to people in the study area. This shared values and norms of the society support Action theory's position that culture and environment shape the action of an individual. These positive attitudes was also reported by Dane (1998) in a study of women living with HIV/ AIDS in which it was found that the women were given full support by their families which in turn influenced and improved the women's health tremendously

Interestingly, people with no formal education were more willing to care for PLHIV than any other group. This could be as a result of the fact that people with no formal education were mainly artisans and traders who are their own bosses and could go out or do anything they want to do at any time without having to seek the permission of their bosses. It could also be as a result of the fact that the people with no education were mainly older people who were more attached to the traditional values of the people.

Furthermore, age has been found to be very important in determining people's attitudes to PLHIV, young people were found not to be ready to care or help PLHIV as much as the older people. This could be as a result of the fact that the youths are not as attached to the cultural practices in the area as the older generation. Older people are more appreciative of the cultural heritage of the people as a result of the fact that they grew up in a different era and as such have a different cultural orientation (socialization). It could also be due to the influence of westernisation, which has brought about youth insensitivity to family problems or an indication of a new cultural orientation.

The implication of positive attitudes to PLHIV for the health of PLHIV is that it would make life easier for them. This in turn would help PLHIV in coping with the disease thereby prolonging their lives. The result of this study has actually shown that the family can provide the safety net needed by PLHIV to live normal lives in the study area. The family members see to it that PLHIV are cared for However, it is important to point out here that in attitudinal studies like this, one is not fully certain that the positive attitudes of the people is what they will actually do in real life situation because there may be difference between people's attitudes and their behaviour when it comes to real life situations but as this author is a member of this community, I can say that to a great extent, the people would do what they said when it comes to real life situations. .

Conclusion and Recommendations

Majority of the respondents have very positive attitudes towards PLHIV. These positive attitudes of the people towards PLHIV were products of the cultural practices of the people. These practices made it possible for the respondents to still have important reasons to care for PLHIV. Therefore, the people's cultural practices and belief systems are very powerful tools in making life more meaningful for PLHIV in the study area.

The recommendation was that awareness campaigns should be carried out in the study area so as to create more knowledge about HIV/ AIDS which would help to strengthen the people's positive disposition towards PLHIV. These practices should be harnessed in order to secure maximum care and support for PLHIV and this would also help in the containment of the pandemic.

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Author affiliation:

Caroline O. Muoghalu (P.hd)1* & A. S. Jegede2

1 Department of Sociology and Anthropology, Obafemi

Awolowo University, Ile-Ife, Nigeria

2 Department of Sociology, University of Ibadan, Nigeria

Author affiliation:

* Email: omuoghal@yahoo.co.uk Phone: 08056681600

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