Are Nigerians Reporting enough on HIV/AIDS in Young People at International Meetings?

Background: Half of persons living with HIV/AIDS are below 25 years and majority of the remaining are believed to have been infected in their youth. The impact of HIV on young people has continued to generate increasing global medical; social; economic; political and academic interests. Aim: This paper reviews the pattern of existing documentation on HIV/AIDS regarding young people in Nigeria in presentations on this subject at international meetings and conferences. Methods: The review relied on a bibliography of 364 presentations from 17 books of abstracts and several solicited submissions; spanning 18 years; collated; indexed and published by the Nigerian Institute of Medical Research and the National Action Committee on AIDS. A matrix was constructed to categorize and tally the abstracts by several technical themes against the characteristics of the young people; aged 10 to 24 years that they reported on. Results: Eighty-five (23.5) out of the 364 were articles on adolescent/youths; the 18-year period; giving a rate of 4.7 articles per year. Regarding the context; 67 (78.8) out of the 364 were articles on adolescent/youths; the 18-year period; giving a rate of 4.7 articles per year. Regarding the context; 67 (78.8) concerned adolescents/ youths of both sexes. About half (47 or 55.3) involved out-of-school youths. Twenty-three (27.1) were conducted among schooling adolescents/youths; and 23 (27.1) titles were socio-medical research exploring knowledge; attitude; behaviour and practice; while three (3.5) were studies of biomedical nature; involving serologic investigations. Reports of interventions accounted for over half (47 or 55.3) of the presentations; most of which were on HIV awareness and prevention programmes. Conclusion: A low rate of reports on HIV/AIDS specific to young people at international conferences was observed; which does not reflect the level of importance and impact of the infection on this group of individuals. Amongst them; socio-medical studies; and interventions featuring awareness and prevention among schooling youths predominate. Interventions involving testing; treatment and care; and bio-medical studies especially involving vulnerable non-schooling youths; remain a challenge that must be faced

New Approaches; New activities and New Outcomes in International Conferences on HIV/AIDS in Africa: Report of the 3rd African Conference on the Social Aspects of HIV/AIDS; Dakar; 10-14 October 2005

Africa's HIV/AIDS situation remains cause for concern. The impact of HIV is considerable and threatens the survival and development of African societies. Although much has been attempted; the results still leave much to be desired. AIDS is an epidemic that needs to be addressed with much creativity and spirit of initiative. It is against this background that the 3rd African conference on the social aspects of HIV/AIDS brought innovations in the way international conferences are designed; activities implemented and results obtained. The innovations concerned the approach to international conferences and take into account reconceptualising HIV/AIDS so as to encourage holistic approaches and better visibility of vulnerable groups.The activities of the conference were organised in such a way as to get people living with HIV/AIDS (PLWHA); grassroots communities and marginalised groups to play a focal role.The conference offered an opportunity for developing cultural activities that would translate the African cultural concepts that had been identified as important in the HIV situation and response analysis. Interaction at the conference created an opportunity to analyse the various dimensions of the political; cultural and economic determinants. The conference offered food for thought around response construction while singling out the themes of urgency and acceleration of response; synergy construction; and coordination and conception of political responses

Accra; Ghana: Health ministers discuss health research: 15th to 17th June 2006

A high-level ministerial meeting convened by the Ministry of Health; Ghana and the Federal Ministry of Health; Nigeria; with technical and financial assistance from the World Health Organization (WHO) through the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR)

Atlanto-occipital gap in Nigerians: Its relationship to difficult intubation

Background: Half of persons living with HIV/AIDS are below 25 years and majority of the remaining are believed to have been infected in their youth. The impact of HIV on young people has continued to generate increasing global medical; social; economic; political and academic interests. Aim: This paper reviews the pattern of existing documentation on HIV/AIDS regarding young people in Nigeria in presentations on this subject at international meetings and conferences. Methods: The review relied on a bibliography of 364 presentations from 17 books of abstracts and several solicited submissions; spanning 18 years; collated; indexed and published by the Nigerian Institute of Medical Research and the National Action Committee on AIDS. A matrix was constructed to categorize and tally the abstracts by several technical themes against the characteristics of the young people; aged 10 to 24 years that they reported on. Results: Eighty-five (23.5) out of the 364 were articles on adolescent/youths; the 18-year period; giving a rate of 4.7 articles per year. Regarding the context; 67 (78.8) concerned adolescents/ youths of both sexes. About half (47 or 55.3) were conducted among schooling adolescents/youths; and 23 (27.1) involved out-of-school youths. Twenty-three (27.1) titles were socio-medical research exploring knowledge; attitude; behaviour and practice; while three (3.5) were studies of biomedical nature; involving serologic investigations. Reports of interventions accounted for over half (47 or 55.3) of the presentations; most of which were on HIV awareness and prevention programmes. Conclusion: A low rate of reports on HIV/AIDS specific to young people at international conferences was observed; which does not reflect the level of importance and impact of the infection on this group of individuals. Amongst them; socio-medical studies; and interventions featuring awareness and prevention among schooling youths predominate. Interventions involving testing; treatment and care; and bio-medical studies especially involving vulnerable non-schooling youths; remain a challenge that must be faced

The Eighteenth African Health Sciences Congress : Dissemination of Research Results for Utilisation

The African Health Sciences Congress for 1997 will be held in Cape Town; South Africa; from 14 to 18 April. This congress has been an annual event where scientists from across the world meet to present research results and to discuss meaningful approaches to solving some of the world's pressing health problems. The congress which is under the aegis of the African Forum for Health Sciences (AFHES); focusses special attention on ways of finding solutions for problems that afflict the African. The AFHES aims to accentuate; through these meetings; practical approaches that can be used by African governments to tackle health-related matters in order to improve the socio-economic status of the people on the African continent. The common health-related matters that one would be expected to be covered at such a congress are the six major tropical diseases identified by the World Health Organisation (WHO); namely malaria; filariasis; schistosomiasis; leishmaniasis; trypanosomiasis and leprosy. But now; there are other health-related problems on the continent that must be dealt with in order to ensure quality of life. Among them are the new and re-emerging diseases like the haemorrhagic fevers (Ebola and Marbug) and yellowfever; the sexually-transmitted diseases including HIV/AIDS; acute respiratory infections and reproductive health. Then there are the less often mentioned health-related problems currently afflicting the African continent that are not given so much attention as the others. These include sanitation; famine and drought; and malnutrition which arise from political upheavals leading to refugees. The consequences of these socio-economic difficulties further exacerbate the prevalence of the existing tropical and other diseases. Scientists working in Africa should play leading roles in tackling the many health problems that afflict the peoples of Africa. They are well placed to collect direct information on these health issues and to provide practical and meaningful strategies for their solution. The WHO Africa Region has taken a meaningful step towards finding mechanisms of eliminating female mutilation in Africa; and this is highlighted in the Newsdesk pages of this issue of the Journal. This; it is hoped; will be achieved through the use of the African traditional foundation and wisdom. Similarly; the African traditional culture of health should provide the basis for utilising the wisdom of the traditional healers and traditional midwives for dealing with primary health care matters on the African continent. The Journal congratulates all the scientists working in Africa; be they Africans or non-Africans; and those outside Africa; who work tirelessly to solve problems that will pave the way for an acceptable quality of life for the world's peoples. It is earnestly hoped that the scientists in Cape Town during the 18th African Health Sciences Congress will deliberate; discuss and dedicate themselves to solving Africa's pressing health problems. The Journal also acknowledges with gratitude; the organisers of this congress; namely the South African Medical Research Council; the Kenya Medical Research Institute and the Epidemiological Society of Southern Africa (ESSA); which; under the auspices of the African Forum for Health Sciences; have made it possible to hold the Congress in cape Town this year

Access to treatment for HIV/AIDS: report of a meeting of international experts; 12-13 June 2001; Washington; DC; USA

This publication is a report of an international experts meeting held in 12-13 June 2003 at Washington (USA); which aims to explore and prioritise operations research questions about access to treatment for HIV/AIDS. Even if the discussions focused on treatment with ARVs; many of the issues raised and the research questions identified also pertain to treatment of opportunistic infections and the provision of palliative and end-of-life care

Research on Diarrhoea in Uganda: Activities and GAPS

Introduction: The Ugandan CDD Programme was initiated in 1984. Since that time; a number of studies have been conducted at national local levels addressing different aspects of childhood diarrhoea. Despite the range of these studies; there is no central organised catalogue of the CDD studies and their findings. As a result of lacking an organised data base; there has been reduplication of some activities while other aspects have hardly been studied. Objectives: A joint CDD Programme/CHDC meeting in 1992 called for a study to review completed research on childhood diarrhoea; make an annotated bibliography and recommend research in aspects of childhood diarrhoea found lacking. Methods: A total of 29 reports on completed diarrhoea-related research conducted in Uganda between 1984 and 1992 were qualitatively reviewed. Information was extracted from the reports using pre-selected key questions. Results: Most studies had been carried out in the districts of Hoima; Kampala; Mbarara and Maindi. Little or no research has been done in the samll and remote districts e.g. Bundibugyo; Kapchorwa; Kisoro and the north and north-eastern part of the country. The most studied aspects of childhood diarrhoea were a) mother's knowledge of causes of diarrhoea b) maternal awareness and knowledge of preparation of ORS c) incidence of acute diarrhoea; and d) factors associated with a high incidence of dirrhoea. Studies of health provider management of diarrhoea have been limited to unit-based health workers and traditional healers. Management of diarrhoea by private practitioners and shop owners has hardly been studied. Despite frequent expression of concern about diarrhoea related deaths; there were no reports available documenting diarrhoeal diseases mortality. There were no interventional studies to assess the impact of related programmes on the incidence of diarrhoea; e.g. EPI; nutrition; water safety and availability; construction and use of latrines. Although discripancies were described between the knowledge of health workers and mothers on some aspects of diarrhoea; no study documented observation of health education sessions or made a critical analysis of health education materials. Different home available fluids were recommended for a child suffering from diarrhoea in different ethnic areas. Actual use of these fluids during diarrhoea was not observed; neither was the rationale for use determined. Conclusion: Considerable research has been done on diarrhoea particularly about maternal knowledge and practices for diarrhoea in their children. At the same time; a critical analysis of the achieved research has identified information gaps; especially regarding impact assessements; qualitative aspects of health education; and levels of diarrhoea mortality

"Cycles of Risks; The Harsh Realities of ""Married"" Adolescent Girls in an AIDS Impacted area in Rural SW Uganda."

"Objectives: To a)Profile the lives of ""married"" adolescent girls and the decisions made which may have placed them vulnerable to HIV infection b) Explore attitudes and perceptions of young girls toward the disease. pervasive in rural Rakai is the assumption that young girls are prey for older men. Although it is assumed that they are free from infection; their risk realities are far more complicated. Methods: This ethnographic study used both in depth; open ended interviews and focus groups with ""married"" girls less than 19. Results: The study site is a trading centre with high prevalence of HIV and extensive history of prostitution. This rural centre offers the young girl opportunity for employment (access to cash) as house or bar girls; and asylum from abusive situations stemming from stepmother scenarios and witchcraft in the village. Support is inevitably associated with men; either in marriage or multiple relationships. Fatalism encourages the ease with which a young girl will enter into successive relationships which constitute ""cycles"" of risk. Given the nature of the relationship; and the economic inflexibility of the partner; testing and condom negotiation are not acceptable alternatives. Conclusions: The profiles of young attached girls indicate the harsh realities many will experience in adolescent life. The voices and choices of young girls are vivid testimonials to the potential for transmission and the necessity of targeting interventions for adolescent girls."

Knowledge; Attitude and Practice to STDs Among Ugandan National STD Clinic Patients

Objectives: Study was to find out what patients know; practice and their attitude twards STDs for purposes of programme planning. Methods: Focus group discussions and indepth interviews were done among STD clinic patients. Data was alss collected from counselling sessions done in the clinic. Results: STDs were not taken as a serious health problem among these patients. Syphil and gonorrhea were the main STDs known with syphilis known to be cogenital and incurable. Self medication and treatment by unqualified health personel was common among these patients. However condom use was on the increase as a means of preventing HIV among more than 24 years males. Conclusion: There is low awareness about STDs among patients attending this clinic; where considerable awareness would have benefits in terms of STD/HIV prevention. Intensive IEC programmes in form of outreaches would have an impact. But whether such IEC programmes will be accompanied by sustained awareness is not known; other social; cultural; economic and gender issues need to be considered

International Collaboration for AIDS-Related Research

Uganda is committed to contribute to International efforts to fight the HIV/AIDS pandemic. In basic research the country has participated actively in global networks for development and clinical evaluation of treatments and HIV vaccines. Operational research has benefited from inter-agency and inter-institutional multicentre cooperation. The scientific advantages and the ethical; social and organisational impendiments encountered are reviewed to aid planning and policy formulation

Coordinating a multi-sectoral response to the HIV AIDS epidemic, the Uganda experience

The Uganda AIDS commission is the reference point for coordinating AIDS control and prevention activities in Uganda. In the two years the Commission has been in existence; it has developed coordination mechanisms which utilize existing political; institutional and societal infrastructure in the country. Coordination at national; central level is achieved through Interaction of members of the Commission; Advisory Committees; several Expert Technical Committees; Task Forces and Special Consultative Groups. At the district level; District AIDS Coordination Committees coordinate activities down to the grassroots community level. This presentation illustrates the mechanisms alluded to and highlights the constraints experienced to-date

AIDS Prevention through Community Participation: Lesson Learned from the Islamic Community in Uganda

Objectives: The Islamic Medical Association of Uganda (IMAU) is implementing a pilot project to educate the Muslim minorities in two districts regarding AIDS and prevention of HIV transmission. Methods: Two districts with over 20Muslim minorities were selected for project implementation. Imams and volunteers are trained to encourage behaviour change during repeated family visits. Results: Project staff have been active in soliciting and incorporating community involvement in designing the project and in creating specific messages. Reliance on volunteers ensures that interventions are responsive to the perceived needs of the lack of community. Supervision of volunteers is constrained by the lack of transport. Condom promotion is controversial among religious leaders but the communities are demanding condom education and distribution. Conclusion: Community participation and support has been an essential element in the success of this project to date. Reliance on community participation has enabled the project to include condom education and distribution in response to community demand in spite of continuing ambivalence in the religious leadership. Behaviour change and condom education is enhanced by local participation in the design and implementation of the project

Nuptiality and AIDS in Rakai District Uganda

Objectives: To examine the relationship between union status and AIDS prevalence; number of sexual partners and condom use. Methods: Questionnaire was administered in 1991 to 2;607 adults 13 years and above to report their marital status; number of sexual partners in the past 12 months and condom use. HIV-1 serology was done for 3123 consenting adults. Results: Prevalence ranged from 1.4among individuals who were single and had never had sex to 30.1among the separate/divorced. The polygamous and the widowed also had high prevalence of 22.5and 27.4respectively. Monogamous people and individuals not in union but sexually active had the same sero-prevalence of about 18. Age group 20-29 had the highest sero-prevalence (32) while the 60+ yrs had the lowest (4). Over 70of the sexually active single individuals reported to have had sex in the past 12 months; with 23reporting more than one partner. Sexual exposure in the past 12 months was 31among the widowed compared to 46among the separated/divorced. 7of individuals in monogamous would be expected; the sexually active single individuals reported the highest condom use rate of 22. The rest of union categories had rates below 8. Conclusions: The high HIV prevalence among the sexually active single; calls for an intensification of the Health Education Programme emphasing partner reduction and condom use among others. it is yet to be established whether or not the high prevalence among the sepated/divorced preceeds or succeeds their current marital status

Seroprevalence and Incidence of Sexually Transmitted Diseases (STD) in a Rural Ugandan Community

Introduction: Reliable information on prevalence and incidence of STD in general populations is relevant for AIDS/STD control strategies but difficults to obtain. Objectives: To determine the seroprevalence and incidence of STD and their association with HIV-1 serostatus; in a rural community in SW Uganda. Methods: 294 adult (ages 13+) residents of 2 neighboring villages provided blood specimen at enrolment and after 12 months. Both specimens were tested for anti-bodies (Ab) against HIV-1; T-.pallidum (tp); H. ducreyi (Hd); C.trachomatis (Ct) and herpes simplex virus type 2 (HSV-2). Results: Seroprevalence rates for HIV-1; Tp; Hd were between 8-11; and around 67for Ct and HSV-2. HIV - Ab peaked in those aged 25-34; Tp-Ab showed no age trend; reactivity for Hd; Ct and HSV-2 increased steeply from 155 at age 15-16 to nearly 100at age 24-25. HIV-1 prevalence was 3.8in those not reactive for any other STD; 7.4in those 1-2 STD; and 19.2with 3-4 STD X2 for linear trend 5.2; P

A Community Based Approaches to Assist Orphans and Vulnerable Children in Luwero; Uganda-Strategies for Implementation

16.2of children in Uganda are orphans; mainly due to AIDS and civil war. The magnitude of the problem makes institutional solutions unfeasible; and methods of assisting orphans and their guardians in the community are being tested. In 2 sub-counties in Luwero district; 5;360 orphans have been identified in a total population of about 39;000. A needs assessment identified schooling; feeding; bedding; clothing; health care; and housing as highest priorities. Rather then directly paying school fees; admission of orphans to school in exchange for material assistance to the school was negotiated. This has allowed 1;200 orphans to enter school; eliminates the problem of direct cash payments; improves the quality of education for all in the school; and requires community involvement in negotiating assistance; choosing those to be assisted; and in establishing school projects to sustain0 assistance in the future. Guardian groups and individual guardians are also provided material assistance to increase the potential for income in the guardian households; rather than giving direct payments to guardians. Guardian committees and local leaders identify and certify those needing assistance most. The method requires considerable time in negotiating agreements with schools and guardians committees and in monitoring implementation of activities; but it does foster a sense of community resaponsibility from the onset

Rapid Assessment of Sexually Transmitted Diseases Development of A Survey Methodology

A multicentre study was conducted in Senegal and Uganda to assess potential STD indicators to develop a standardised survey methodology would be useful to define the magnitude of the STD problem in the district level; to monitor trends in STD prevalence at time intervals; and to indicate the potential for HIV spread. Twelve potential indicators which included current symptoms; physical finding and simple laboratory tests were studied among three different populations: women attending atenatal clinic; were identified with sensitivity over 70. These are physical finding of vaginal discharge; urine leucocyte esterase test; and the RPR teardrop card test. Among these only one; the RPR teardrop card test; had a high specificity (96as opposed to specifity less than 50for physicval finding of vaginal discharge and the urine leucocyte esterase test). Based on the results of this study; these three indicators will be further studied to evaluate their usefulness in a field survey methodology among women attending antenatal clinics

Development and Evaluation of Guidelines for the Clinical Management of HIV Infection in Adults and Children in Uganda

Objective: To assist health workers in diagnosis and treatment and rational use of drugs in symptomatic HIV infection. Methods: The different stages of the development and evaluation: 1. Development of draft guidelines through national consensus of policy makers; programme managers and AIDS Care workers. 2. Training of personnel in selected health units in the use of the guidelines. 3. Field testing of the guidelines for a period of 5 months. 4. Evaluation workshop. 5. Second National Consensus Seminar. Results and Conclusions: 1. The guidelines were applicable in the field and were mostly used by nurses and medical assistants. 2. Restriction of the number of drugs was difficult because of the multiple complaints of the patients: 24; of the patients received more than 3 different drugs. 3. Most conditions were easily managed but for chronic diarrhoea only 40of the health workers adhered to the treatment guidelines. 4. Further training with regular evaluation is required in the use of the guidelines

Building Community Capacity to Cope with Adversity: The Role of Traditional Support Networks

"Introduction: In parts of Uganda the Impact of the AIDS epidemic is overwelming. Traditional community support networks have; however; been weakened due to the past economic and political turmoil; aid agencies are increasingly involved in providing ""emergency aid"". Objective: To examine how best external aid can contribute to the building of a self-sustainable community developmental activities in approximately 50 villages using a community based approach. The role of the unit is limited to facilitating the developmental process by providing expertise and advice to communities on how to harness available resources for development. Methods: The MRPA community support and counseling unit was set up in 1990 and carries out health; counselling; educational and developmental activities in approximately 50 villages using a community based approach. The role of the unit is limited to facilitating the developmental processes by providing expertise and advice to communities on how to harness available resources for development. Results: In two years more than 30 village committees were established to provide support for community health work. Volunteer community health workers and birth attendants carry out community health activities. The number of active women's groups in the area increased from nil to 13. Particularly interesting is the recent self initiated revival of a ""Munno Mu Kabi"" group (litterary: yours in need); by a group of women from 7 villages. Members meet forthnightly to discuss the problems on needy familities in their villages; in particular those with AIDS patients. These families are visted and advice is given as well as material assistance. To date the group has helped 56 families. Conclusion: Our experience indicates that external support can result in community initiatives which are suggestive for the existance of a community developmental capacity; it is rather early; however; to know if this capacity is sustainable . The revival of a traditional system suggests the external agencies aiming at community capacity development should explore the use of traditional support structures."