Death is pre-ordained, it will come when it is due: attitude of men to death in the presence of AIDS in Nigeria

This paper examines men’s sexual behaviour, knowledge and transmission of HIV/AIDS, and resistance to behavioural change in the presence of AIDS in Nigeria. There was a general belief that it was not possible for men to confine themselves to one woman over a lifetime. The frequency of sexual contact with commercial sex workers was high while knowledge of AIDS and its transmission mechanism was nearly universal. Only one-fifth of the men believed that they were at risk of contracting AIDS in spite of their risky sexual behaviour, and only a few were protecting themselves against the disease. There was near-universal agreement that death was inevitable but the majority were not afraid of death. We suggest the adoption of intervention strategies that will aim at behavioural change, the only known method of curtailing the spread of AIDS in the absence of a vaccine or a cure. The AIDS epidemic in Africa has reached alarming proportions. It is now generally regarded as the major health crisis of the twentieth century and one of the terrible epidemics in human history. In December 1997, nearly 31 million people in the world were believed to have HIV or AIDS; 21 million or two-thirds of them were in sub-Saharan Africa (UNAIDS 1997), the home of less than one-tenth of the world population. In Nigeria, the first HIV-positive person was identified in 1986 as a sex worker from one of the West African countries; this discovery led to an erroneous belief among the general population as well as government officials that the disease was foreign and could not affect the Nigerians. Subsequent developments in the last five years or so have proved that the assumption was wrong. By December 1998, the records of the National HIV/AIDS and STDs control program (NASCP) indicated that between two and three million Nigerians may have been infected with the AIDS virus and about 100, 000 either have AIDS or have already died from it. The number of infected people in Nigeria is expected to rise to 5.5 million by the end of 1999 (Nigeria 1998). When AIDS was first reported in Nigeria, there were denials and under-reactions to the epidemic (Caldwell, Orubuloye and Caldwell 1992). The denial was so widespread and so deep that relatives would not even allow the diagnosis of AIDS to appear on the death certificates of their loved ones (Ransome-Kuti 1998). Despite the denials among the general population, the then Minister of Health, Olikoye Ransome-Kuti, was quick to accept that there was a problem. Thus, he developed a comprehensive AIDS program, which was managed by an experienced person; government and non-governmental organization support was received at the initial stage of the program. AIDS prevention and control committees were set up at the 102 I.O. Orubuloye and F. Oguntimehin state and local government council levels. All levels of government were directed to make statutory budgetary allocations for the control of HIV, AIDS and STDs. This was annually deductable from the Federation Account. By about 1994, government support for the AIDS program had disappeared and the international organizations withdrew their support for political reasons. The national AIDS program suffered a major setback because of lack of government support and commitment from political leaders. Nigeria has now passed the stage of denial and government attitude to the epidemic has changed in the last two years. A National AIDS and STDs control program was launched in the middle of 1998 (Nigeria 1997), ten years after work started on it and three years after a draft policy was prepared. The first National Conference on HIV/AIDS and STDs control and prevention took place in December 1998, nearly ten years after the first AIDS case was reported. The main objectives of the first Nigerian national conference on HIV/AIDS and STDs were to provide advocacy at the highest level for HIV/AIDS and STDs prevention and control; to advocate co-operation, collaboration and support from all agencies and bodies for successful Petroleum Trust Fund-assisted HIV/AIDS prevention and control programs; to develop and articulate a plan of action towards effective HIV/AIDS prevention and control throughout the nation; to create a forum for exchange of experience by involved persons and to streamline HIV/AIDS intervention in Nigeria; and to review and update the National Policy on HIV/AIDS in Nigeria. These objectives clearly indicate the beginning of a long journey that many countries in Africa and elsewhere in the world started more than ten years ago. Awareness about AIDS and possibly sales of condoms have increased significantly, especially since the death of Fela Anikulapo-Kuti, the famous Nigerian musician who died of AIDS in August 1997. The earlier confusion and myth surrounding the disease have gradually disappeared. The national level of awareness is now estimated at about 90 per cent in Nigeria. Despite the acceptance that AIDS is now real in Nigeria, there has been resistance to social and behaviour change, especially among men, who continue to engage in risky sexual behaviour that was a way of life before the epidemic began. One major factor that has continued to resist change is the attitude of men to death and to STDs and AIDS.