Lagos State, Nigeria - Family Health International

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In-Depth Assessment Report 6.8 Ethnographic Account Lagos Mainland LGA is one of the oldest in the state, with a 1998-projected population of 341,834, mostly urban with very few rural settlements (Makoko and Iwaya). Shomolu LGA bounds the Mainland LGA in the north, Carter Bridge (Lagos Lagoon) in the south, Surulere LGA in the west and the 3rd Mainland Bridge in the east. The LGA includes many built-up areas, commercial centers housing both corporate and residential buildings. Nigerians here have diverse cultural backgrounds, with mostly Islamic, Christian and traditional religions. Many features make the LGA unique, such as the Nigerian Railway headquarters and rail line terminating at Iddo, military bases and military referral hospitals and motor parks for luxurious buses. The LGA has 39 secondary schools, 56 primary schools and five tertiary institutions. The LGA administers its public service through 42 functional Community-Based Development Associations (CDAs), which work with the LGA authorities to formulate and complement policies that affect residents. The CDA is a key agent of socialization and public administration. Residents are predominantly low-income earners, petty traders and market women. Several market sites sell motorcycles, spare parts, electronic/electrical products and other goods. Iddo and Otto parks house more expensive sales outlets and restaurants, bars and joints. The LGA can be divided into areas of high population density (such as Makoko, Ebute Metta, Iwaya, Akoka, Ijora and Otto) and low population density (such as Yaba, Jibowu and Sabo). 6.9 Community Leaders Community leaders are highly respected – they have at one time or the other been involved in mobilizing the communities for various political and health programs. These leaders have been in the community for an average of 18 years but have not been involved in any STI/HIV/AIDS programs except the distribution of condoms, which was done at the insistence of the LGA. Some leaders complained that distribution would encourage promiscuity. They favoured promoting abstinence. All leaders were interested in working on STI/HIV/AIDS implementation programs – though several felt that diseases like malaria and cholera are greater health problems that should be addressed in the community. The large presence of FSWs and out-of-school youths (‘area boys’) were also identified as problems. Programs have been put in place to keep the youths busy by organizing football matches within the local government. 24 The leaders are well -informed and knowledgeable about HIV/AIDS but their attitudes varied from willingness to be involved in the care and support of PLHA to unwillingness to be associated with the individuals so identified. Leaders indicated that information about infected individuals should not be divulged. One religious leader heads an NGO that promotes safe blood transfusion by collecting blood donations that are screened and kept for use in local blood banks. All the men interviewed are influential and highly placed, and have successfully mobilized their community members to participate in solving various issues in the community – FHI and related organisations can build upon their strength to reach the community in implementation programs. 6.10 Care and Support Lagos Mainland’s local government recently launched its own LACA, with eight members from the health, education, agriculture and accounts sectors. Care for PLHA is regarded as one of the major priorities in the LGA. Though facilities for their clinical care abound in the LGA, most AIDS cases are referred to the Lagos University Teaching Hospital (LUTH). The LGA has a budget line for HIV/AIDS: about N140, 000 was released out of N500, 000 allocated for 1999/2000. The NRC and Mainland hospitals provide care for the general populace, while the Military Hospital serves military personnel and their families. Cases of HIV and AIDS were first seen in the mid-1980s at the Mainland Hospital, in the early 1990s at the Military Hospital. No written guideline on care exists in any of the centres. Only the Military Hospital provides medical management of HIV/AIDS, ARV therapy and provision of VCT in addition to counselling, medical care for TB and palliative care – which all the others also provide. Bed occupancy rates vary from 43 percent (NRC) to 75 percent (Military Hospital). The proportion of HIV –related cases in the MH has increased to 1:10 in 2000 from the previous 1:20 in 1998. Presently, the MH routinely admits patients with AIDS for treatment, while other hospitals almost always refer such patients to LUTH. Feedback mechanism from LUTH is poor: no report is sent back to the referring hospital. Rapid screening tests are performed in all hospitals, but only the Military Hospital provides ELISA and Western Blot confirmation as well. Symptomatic treatment for common HIV-related illnesses is generally given in the hospitals. Mainland Hospital provides specialist care for TB cases – an average of 43 patients per month. TB cases are seen in the other hospitals as well, but DOTS is not practiced in
any of them because of drugs and personnel logistics. STD treatments are based on etiologic diagnosis – alone or combined with clinical diagnosis, even though doctors have some knowledge of syndromic management. Clinical management and care training sessions have been held for physicians in the Mainland Hospital and NRC. The Mainland and Military hospitals have trained counselors; the Railway Hospital physician provides counselling. Counselling is still not popular at the Mainland Hospital, despite the presence of trained counselors there. MTCT and VCT measures are yet to be fully used in any of the hospitals. Counselling, clinical care and social support for PLHA are recognized as priority areas of focus to ensure comprehensive care across a continuum. Ajayi Memorial Hospital (AMC) and Ireti Hospital were the private hospitals visited. Little information was obtained from Ireti Hospital. AMC sees an average of one to two HIV/AIDS patients each month. Rapid HIV testing is done. Common HIV-related illnesses like cough and diarrhea are attended to. Most AIDS patients, however, request discharge because of stigma. TB is also treated at the facility. STD treatment is based on a combination of etiologic and clinical diagnosis. No training on syndromic management or HIV clinical management has been held for hospital staff. 25 6.11 Recommendations Lagos State Lagos Mainland LGA will benefit from a mini-comprehensive program for selected high-risk groups in the LGA: Iddo/Otto and Oyingbo communities. The program should also include the Batula community within the Olaleye area. Such a plan could reach all risk groups. The following specific recommendations are offered: 1. Use specific strategies, such as organized football matches, for out-of-school youths. 2. Strengthen hospitals’ counselling units by training more personnel. Encourage identified PLHA from Mainland Hospital to form a support group. 3. Utilize community leaders’ and community development associations’ ability to reach the public with information during program implementation. 4. Establish condom-friendly hotels by targeting hotel owners and associations; discuss programming with FSW chairladies. FSW should also be encouraged to use condoms with clients. 5. Encourage Luxurious Bus Association and National Union of Road Transport Workers to provide behaviour-change communications for their members. 6. Reach tertiary institution students to reduce high-risk sexual behaviours.
Page 1 and 2: Lagos State, Nigeria Report of the
Page 3 and 4: 3 Lagos State 6. Lagos Mainland LGA
Page 5 and 6: Acronyms AIDS Acquired Immune Defic
Page 7 and 8: 1. Introduction/Background A situat
Page 9 and 10: 3. Response to the HIV/AIDS Epidemi
Page 11 and 12: 4.4 Selection of Consultants Before
Page 13 and 14: 5. Findings 5.1 Ojo Local Governmen
Page 15 and 16: 5.5 Identification of Vulnerable Po
Page 17 and 18: 5.5.5 Other Vulnerable Populations
Page 19 and 20: 5.12 Conclusions It is obvious from
Page 21 and 22: 6.3 Ethnographic Overview Lagos Mai
Page 23: 6.4.4 Out-Of-School Youth Lagos Mai
Page 27 and 28: 7.3 Ethnographic Overview LGA/Site
Page 29 and 30: 7.4.5 Other Vulnerable Populations
Page 31 and 32: 7.9 Care and Support Though HIV car
Page 33 and 34: 8.3 Ethnographic Overview LGA/Site
Page 35 and 36: 8.4.3 In-School Youth LGA/Site 1. I
Page 37 and 38: 8.7.5 Onilekere Like Onigbongbo/Bar
Page 39 and 40: 9.3 Ethnographic Overview LGA/State
Page 41 and 42: 9.4.2 Truckers/Bus Drivers LGA/Site
Page 43 and 44: 9.7 Ethnographic Account Epe, the
Page 45 and 46: 10. State Summary and Conclusion Th
Page 47 and 48: 11. Recommendations Lagos State wil
Page 49 and 50: Appendix II: Life History of a Sex
Page 51 and 52: Appendix III Cont. S/N 22 23 24 25
Page 53 and 54: Notes 53 Lagos State
Page 55 and 56: Notes 55 Lagos State

Lagos State, Nigeria - Family Health International

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