1 An Ethnically Sensitive and Gender-Specific HIV/AIDS Preventive Risk-Appraisal of Nigerian Women: A Comparative Study of Christian and Muslim, South Western Nigeria. by Ademola M. Omishakin, MPH, PhD, MBA; Charles Uwakewe, PhD; Ayo Hammed, PhD; Ajibola Falaye, PhD; and Joseph Fehintola PhD.

2 The Purposes of this Study were to: Examine the level of understanding, attitude, beliefs, myths and misconceptions and the various high-risk behavioral factors that influence the mortality and rate of infectiousness of HIV/AIDS among Nigerian women in South Western Nigeria. Identify enabling and barriers factors that act as catalysts in understanding the perceptions affecting the distribution and transmission of HIV/AIDS in Nigerian female population of South Western Nigeria.

3 NEEDS FOR THE STUDY This Study Became Necessary Because  Higher Incidence, Prevalence and Mortality Rates due to HIV infections have been reported, in excess, in women in Nigeria in recent years, than the rest of Nigeria population;  Advocates of the religious paradigm view the HIV/AIDS epidemic as a curse and punishment from God for humanity’s sexual excesses ;  Currently, Nigerian women represent 62% of all adults aged 15 and above living with HIV;  Nigeria’s epidemic is largely fueled by mother-to-child transmission;

4 Methodology Study Design A multistage sampling procedure was adopted in the process of selecting the respondents 2 States were randomly selected from the 6 States in the South Western Nigeria 2 local governments were randomly picked from each of the States 1 urban town and 2 rural towns were selected from each of the local government respectively 2 rural towns and 1 urban town picked were used for data collection (Questionnaires & FGD)

5 METHODOLOGY Study Design Cont’d.  Stratified sampling technique was used to select respondents at the rural towns and urban town ;  while Accidental sampling was employed at the rural and urban town for FGD - Nigerian Christian and Muslim Female in - - Nigerian Christian and Muslim Female in - - Urban and Rural Communities of South Western Nigeria, - Urban and Rural Communities of South Western Nigeria,  Randomly selected States for the study areas were – Oyo and Osun.

6 The Study Sample We drew our subjects from:  Religious groups and other women organizations;  Mosques and Churches;  Government Health centers. Our Study was approved by the Human Subject Committee of University of Ibadan, Ibadan, Nigeria.  By the 2 States Ethical Committees.

7 Subjects’ Eligibility Criteria for the study Included:  Aged between 18 and 55 years;  Must be residing in 2 States and 2 local governments randomly selected for the study;  Oyo33 LGAs Ido and Akinyele  Osun30 LGAsOla Oluwa and Ayedire  And must not be working in a health institution or be a member of public health or allied health professions.

8 Instrumentation: To assess factors favoring the high incidence and prevalence of HIV/AIDS among the Women in South Western Nigeria Communities:  We utilized a comprehensive 50-item culturally- sensitive and gender-specific survey instrument developed by the authors for the assessment of Nigerian women.  Instrument comprised three major areas: - knowledge, myths & misconception base - Attitude/feelings - behavior/practices

9  For the Attitude questions items in the instrument, we utilized a 5-point Likert Scale, ranging from “1” (Strongly Disagree/Most Unlikely) to “5” (Strongly Agree/Most likely) with mid-points representing ambivalence responses.  Prior reliability testing for the instrument achieved a Cronbach’s Alpha of 0.78 which was high enough to meet our study criteria. Instrumentation: Cont’d.

10 Instrument administration Final instrument for the study : We utilized Person-to-Person interview to administer the instrument * (Very low community literacy rate) 100% of the respondents were subjected to person-to-person interview. It took approximately minutes to administer the Instrument

11 Statistical Analysis Data were analyzed with SPSS version 17.0 A one-way analysis of variance (ANOVA) was used at the 0.05 level of significance We utilized Pearson Correlation to test associations between the independent and dependent variables.

12 RESULTS Demographic Analysis (age) Most respondents (60%) in the study were aged years Mean age distribution was 26.9

13 Demographic Analysis Cont’d. Percent Distribution of Respondents by Marital Status In terms of marital status, married women (70%) outnumbered all other categories Single women (29.3%) followed the married women The widowed (0.7%) were the least represented in the study.

14 Demographic Analysis Cont’d. Percent Distribution of respondents by Level of Education Respondents had very low literacy rate with (70.0%) not completing high school Only 1.3 comprised college graduates.

15 Demographic Analysis Contd. Respondents’ Distribution by Income Level There were no significant differences among the socioeconomic groups in income distribution, as the majority of the respondents was petty traders

16 RESULTS Age, employment status, level of education were correlated with subjects’ level of knowledge on HIV/AIDS and related high risk behavioral factors. Older rural respondents aged and years scored less in the awareness test than those younger subjects, aged ; & years.

Table 1: Religion in Relation to HIV virus Religion (Christian or Muslim) plays a role for a woman to contract HIV Virus N=800 Christian True200 (57.1 %) False70 (20%) Don’t Know80 (22.86%) Muslim True120 (26.66%) False220 (48.88%) Don’t Know110 (24.44%) 17

Table 2: Knowledge, Beliefs, and Attitudes It is easier for a woman to contract HIV virus from man than otherwise? N=800 Christian350 No Risk85 (24.28%) Some/Low Risk122 (34.85%) High Risk78 (22.28%) Don’t Know65 (18.57%) Muslim450 No Risk130 (28.88%) Some/Low Risk66 (14.66%) High Risk119 (26.44%) Don’t Know135 (30.00%) 18

Table:3 Sexual Behavior YesNo Do you use condoms consistently when engaging in sexual intercourse? Christian 40 (11.43%)310 (88.57%) Muslim 48 (10.66%)402 (89.33%) Why no condoms? Mutually monogamousChristian 230 (65.71%)120 (34.28%) Muslim 110 (44.44%)340 (75.55%) Condoms reduce sexual pleasureChristian 279 (79.71%) Muslim 109 (24.22%) My partner may get upset if I suggest condom use. Christian 110 (31.42%) Muslim 375 (83.33%) 19

Table 4: Self Perceived Risk How do you rate your level of risk of contracting HIV? Very Low Christian Muslim 202 (57.71%) 270 (60.0%) Low Christian Muslim 70 (20.00%) 60 (13.33%) High Christian Muslim 50 (14.28%) 40 (8.88%) Very High Christian Muslim 28 (8.00%) 80 (17.77%) 20

21 RESULTS The variable of annual income in our analysis indicated no significant difference among the groups in terms of HIV/AIDS knowledge and related high-risk sexual behavior.

22 RESULTS (cont’d) In this study a large proportion of the subjects (71.6%) strongly believed that HIV/AIDS was created by the developed countries (governments) to destroy not only Africans but also the entire black race. 70.6% of the women participants indicated positive attitude toward the statement that “anyone who contracts AIDS deserves it, most especially if she is a prostitute.”

23 RESULTS (cont’d) 88% of the women respondents indicated that teachers and others who are AIDS victims and have been working with children should be removed from their jobs.

24 HIV/AIDS Ethnic-Specific Community-Based Interventions Group Prevention and Support Mobilize public health practitioners and non-governmental organizations (NGOs) to design HIV/AIDS culturally sensitive and gender-specific health sensitization, education, and disease prevention Faith-based communities School systems Colleges and universities

25 Mass Communication/Media Continued to utilize the national and States Broadcasting Networks and TV to market and disseminate HIV/AIDS awareness and prevention messages to Nigerian women -

26 Intervention Cont’d State and National newspapers State and National televisions Colleges and Universities newspapers/newsletters

27 Voluntary Health Workers (VHWs) Train and certify VHWs who are Nigerian women to work as HIV/AIDS educators in the their communities.  Church and Mosque members  High School students  Colleges and Universities students