Culture and HIV/AIDS in Africa: promoting reproductive health in light of spouse-sharing practice among the Okun people, Nigeria.

The Okun tribe, numbering about a million persons, accepts sexual relations between men and wives of their male kin. We identified and used features of spouse sharing that affect reproductive health to develop an interactive, community-based intervention. The intervention promoted discussion of spouse sharing as a risk factor in HIV/AIDS transmission, knowledge of AIDS/sexually transmitted diseases (STDs), perception of risk and alternative behaviors to avoid contracting HIV/AIDS. The intervention effects were evaluated using data collected in baseline and follow-up surveys in May 1999 and June 2000 among 1018 sexually active respondents in two sets of Okun communities - one with and the other without intervention. The intervention significantly increased knowledge of HIV/AIDS, perception of risk of contracting the disease and the intention to discontinue spouse sharing in the intervention communities. Those who perceived themselves at risk of contracting HIV/AIDS were more likely to express intention to discontinue spouse sharing (odds ratio 2.87) than those who did not. It was recommended that future community-based interventions to address traditional practices that could transmit HIV/AIDS should address the aspects of the practice that could transmit the disease and actively involve the people to make impact.

Evaluation of the Nigerian national antiretroviral (ARV) treatment training programme.

There is an understanding that greater availability of HIV treatment for the 40.3 million people currently infected with HIV is a humanitarian imperative that could prolong the lives of millions, restore economic productivity, and stabilise societies in some of the world's hardest-hit regions. The Nigerian government recognises that the country has the third highest burden of infection, with people living with HIV estimated to total 4.0 million, and so in 2002 commenced the implementation of one of Africa's largest antiretroviral (ARV) treatment programmes. A successful ARV programme requires that all components of a functional management system be put in place for effective and efficient functioning. This would include logistics, human resources, financial planning, and monitoring and evaluation systems, as well as sustainable institutional capacities. The Nigerian national ARV treatment training programme was conceived to meet the human resource needs in hospitals providing ARV therapy. This paper reports on the evaluation of the training programme. It examines knowledge and skills gained, and utilisation thereof. Recommendations are made for improved training effectiveness and for specific national policy on training, to meet the demand for scaling up therapy to the thousands who need ARV.

Gender differences in the reasons for participation in spouse sharing among the Okun in Nigeria.

This report examines the reasons for participation in spouse sharing among the Okun with a view to identifying some factors that may present particular obstacles to women and enhance their vulnerability to the practice. A total of 1029 sexually active respondents in 5 settlements where spouse sharing is being practiced participated in the questionnaire survey aspect of the study, while 82 respondents participated in the focus group discussions. About 65% of respondents reported having ale or alase and were involved in the practice of spouse sharing. Reasons for involvement in spouse sharing include the need for economic support, sexual satisfaction, increased social status, procreation, the problems of separation/divorce and widowhood. The focus group discussions revealed a possible exploitation of the gender-based economic weakness of the women by the men in the initiation and sustenance of the practice in the Okun communities. It is recommended that for any program to achieve a considerable reduction in the practice, differences in the reasons for participation in spouse sharing among the men and women must be documented with a view to solving those problems that compel women to participate.