CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
The most pressing issue in global health today is Acquired Immuno Deficiency Syndrome (AIDS) (Henslin, 1999). The prevalence and incidence rate of the virus has prompted worldwide emergency measures and programs to tackle the spread of the pandemic. Measures taken include; the establishment of international, national and state agencies charged with the responsibility of articulating policies and coordinating programs to control the spread of the virus.
Globally, about 33.4 million people were living with the disease as at 2012 and the number is increasingly at an alarming rate (Kendall, 2005). Africa has the highest incidence rate of the virus and it contributes about 66% of all new cases in the world (Macionis, 2006). By the sheer size of the population, Nigeria is the second highest hit country in Sub-Sahara Africa (Aderinto, 2010). As at 2012, the prevalence of the virus in Akwa Ibom State was estimated at 6.5% and it occupied 2nd position in the South-South Zone and 6th position in the country (Awogo and Ekpenyong 2013), but the latest statistics released by National Agency for the control of AIDS (NACA), indicated that the state ranks first on the chart of states with the highest prevalence of the virus with a prevalence rate of 5.5%.
Acquired Immune Deficiency Syndrome (AIDS) is caused by Human Immunodeficiency Virus (HIV). The virus attacks the immune system paving the way for some opportunistic infections to thrive in the body’s defenseless system. People differ widely in the time it takes them to develop AIDS after contracting the Virus (Sternberg, 2001; Macionis, 2006; and Kendall, 2005). At the initial stage of infection, people living with HIV display no symptoms at all, so many are unaware of their condition. The symptoms may not appear for a year or longer. This long latency period allows an infected person to spread the virus as he having poorly judge and evaluate the symptoms, could not detect the disease at the onset, may not report for test, outrightly deny the existence of the disease, refrain from using condom while keeping multiple sex partners, does not patronize proper/formal medical care and instead resort to prayer houses or choose self-treatment at home, etc. These and other aspects of health seeking behavior are critical behavioral correlates influencing the spread of the virus.
According to Henslin (1999), a person’s health seeking behavior – a sequence of remedial actions that is undertaken to rectify perceived ill-health, determine when infection is suspected, the timing of initiation of care, the place where care is sought and the type of treatment received. In Akwa Ibom State pregnant women especially in rural areas always choose to patronize Traditional Birth Attendants (TBAs) instead of going for the services of certified and trained medical personnel (Eshiet, Jackson & Akwaowo 2016). This exposes them to the risk of contracting the virus and subsequent transmission of the virus to the unborn child. Traditional Birth Attendance may use an unsterilized sharp object such as razor or needle from an infected client on another client. Also some cultural practices such as female circumcision or female genital mutilation have facilitated the spread of the virus. In some of the parts of the state especially rural and semi-urban areas, people still regard HIV/AIDS as a myth (Modo & Enang, 2011; Abasiubong & Idung, 2015).
On perception of ill-health, a proper medical care may not be sought and the timing of suchcare seeking may be late. Also, reports have it that of over three million people in the state, only very few people have reported for HIV/AIDS test for fear of victimization and a reasonable percentage ofthose who tested positive of the virus refuse to avail themselves of anti-retroviral treatment (Anthony, 2019). Others who keep multiple sex partners refuse to use condoms especially in urban Akwa Ibom (AKSACA, 2019). Still on perception of ill-health, someindigenes resort to prayer houses or visit the nearest patent medicine shop for prescription or worse still apply self medication. The above patterns of health seeking behavior are believed to have a huge bearing on the morbidity rate of HIV/AIDS in the state.
1.2 STATEMENT OF THE PROBLEM
Human Infection Virus and Acquired immune deficiency syndrome is both a medical and social problem as it affects a huge number of people while defying to a reasonable extent innovations in biomedicine. Since the discovery of AIDS, more than three decades ago, 60 million people have been infected and more than 20 million have died from AIDS- related illnesses (Elbe, 2010). In Akwa Ibom State, the virus became so severe and destructive as at 2012 with the youths as most casualties (Awoyo & Ekpenyong, 2013). Unlike 2012 when the state was 6th on the chart of states with the highest prevalence of the disease, it has now moved to the top of the chart (NACA, 2019).
According to AKSACA (2017), 55% of married couples have tested positive to the virus in 2017 accounting for the highest prevalence while prostitution and commercial sex workers accounted for only 4%. Those who engaged in casual sex recorded second highest (30%). In a study conducted by the state government in collaboration with the United States Agency for International development in 2018, among children aged 0-14% years, the prevalence rate was 0.4% while those 15 years and older was 4.8%. The study also revealed 0.41% annual incidence of HIV among people aged 15 years and older with similar rate of incidence in both males and females (0.41% for females & 0.42% for males). The incidence was higher in 15-19 year olds than other age groups, translating into half of the new HIV infections occurring in adults. Generally, there exists a voluminous body of literature on factors influencing the spread of HIV/AIDS globally, nationally and locally. A wide range of scholarly research and studies has been devoted to examining the causes, impacts and prevention of the pandemic. Khan (2014) attributed the high prevalence of the disease in Pakistan to the variations in understanding and perceptions of the virus in Pakistani society.
A similar study by Janahai, Mustapha, Alsari, Al-mannai & Par hat (2016) in Bahrain indicated that participants attitude and approach to the virus were important to attempts at controlling the virus, The study posits that these attitudes were informed by the various perceptions and misconceptions which affect and influences their health behavior. They argue that this can go a long way to undermine the fight against the virus.
In Nigeria, Egbo (2015) reiterated the fact that although the general level of awareness of virus was high among women farmers in Ebonyi state the women still harbor negative attitude toward prevention strategies and victims of the virus. Adaramaja and Tijani (2014) highlighted some demographic variables such as age, sex, status etc as significant correlates of HIV/AIDS related health behaviours and attitudes.
In Akwa Ibom State, studies aiming at an appraisal of the causes and impacts of the virus have focused on the role of socio-cultural factors such as patriarchy, gender and poverty (Modo & Enang, 2011) community characteristics (Abasiubong & Idung, 2015) and social tigmatization (Unadike, Ekrikpo & Bassey, 2012) as key contributors to the rate of incidence and level of prevalence of the virus in the state.
From the foregoing, research works focusing specifically on the role of health seeking behavior in the spread of the virus has been limited. Most researchers have focused on the socio-cultural dynamics and the awareness factor but Lerton (1991) contends that patients/individuals are not passive but active agents in the overall health care delivery system and as such there is the need for an extension of the analysis of the causal factors of AIDS to the sphere of health seeking behavior. An active agent in the overall functioning of health care delivery system implies that an examination of health seeking behavior remains indispensable to enabling individuals and communities improve control over the incidence and prevalence of AIDS. Hence, this research is intended to fill such gap and stimulate further enquiry on the role of certain aspects of health seeking behavior on the prevalence and incidence of HIV/AIDS in the state.
