Perceived male sexual needs and male sexual behaviour in southwest Nigeria.

Part of a research programme studying methods of combating the AIDS epidemic was a survey and accompanying qualitative research focused on attitudes toward male sexuality and male sexual behaviour outside marriage and the extent and success of female attempts to control it. A survey of 1749 males and 1976 females was conducted in urban and rural populations in three states of southwest Nigeria. The majority of the community believes that males are by nature sexually polygynous, although about half the community believes that male sexuality can and should be confined to marriage. These beliefs arise out of the nature of the traditional society and are being changed by new ways of life, education and imported religions. Nevertheless, sufficiently rapid change is unlikely, even if promoted by government, to successfully combat a major AIDS epidemic, and the major strategy should attempt to reduce the rate of transmission, especially in high-risk relationships.

Male and female circumcision in Africa from a regional to a specific Nigerian examination.

There is a strong relationship between male and female circumcision in traditional thought and, north of the equator, in their practice by ethnic groups. The Southwest Nigeria Study, a 1994-95 survey of 1749 males and 1976 females in Nigeria's Ondo, Oyo and Lagos States, is used to examine contemporary levels of circumcision, reasons for carrying out the practice, and the circumstances of the circumcision operations. These findings are compared with earlier southwest Nigerian and West African studies. The persistence of the practices is confirmed, but rapid change towards their medicalization is also established. Possible links with AIDS are discussed.

Women's role in reproductive health decision making and vulnerability to STD and HIV/AIDS in Ekiti, Nigeria.

An exploratory study of women's role in reproductive decision making in Ekiti shows that women in the state are increasingly taking active decisions on matters affecting their daily lives. More women than ever before believed that they could take decisions on family size, when to have a baby and choice of spacing period. The cultural barrier against short postpartum abstinence appeared to have diminished and sex during lactation was not considered a major cultural and religious taboo. Knowledge of contraception has become universal in recent years, and the majority of women take decisions on the method and timing of family planning. All women who used family planning considered their decision in this regard very important. The ability of women to take decisions on these issues may not only enhance their bargaining power but also reduce their vulnerability to STDs including AIDS from diseased or high-risk partners.

The demographic situation in Nigeria and prospects for fertility transition.

PIP: Nigeria is described as having the largest population in sub-Saharan Africa in 1991 and as being the tenth largest country in the world. Continued population growth will make Nigeria the fourth most populated country in 2030 after China, India, and the US. The crude birth rate of 46/1000 population and the crude death rate of 15/1000 makes Nigeria one of 12 out of 40 countries in sub-Saharan Africa with a high growth rate. Growth rates are higher in urban than semi-urban and rural areas. Nigeria's prosperous oil boom occurred during 1967-87, when health services expanded and mortality declined. Political instability after 1987 and economic difficulties have resulted in declines in health care delivery. Many deaths among women and children are attributed to malnutrition. The country is expected to have 39.3% of the population living in urban areas by 1995 and 62% by 2025. 20% of Nigeria's urban growth is attributed to growth in Legist alone. The use of family labor for farming contributes to maintaining large family size. The extended family is the dominant economic and security unit for its members, which assures high fertility rates and justifies the belief that high fertility is rewarding. High fertility is maintained through norms perpetuating large family size, early marriage and childbearing, and low contraceptive use. Contraceptive use has increased to 43% of married women and 75% of single women, based on the 1990 Ekiti district study. Use is highest in the southeast and southwest, where marriage age is later than the north. Efforts are being directed to northern regions in order to decrease infant and child mortality and increase contraceptive use. The evidence is interpreted as suggesting that sustained fertility decline is occurring in the southeast and southwest, which together have about 45 million population. The fertility changes are occurring in the context of increased levels of education and other social and economic changes. Sustained fertility decline is considered to be dependent upon the commitment of government, which established a population policy in 1988, to family planning programs and the deterioration of institutions supporting high fertility.^ieng

African women's control over their sexuality in an era of AIDS. A study of the Yoruba of Nigeria.

Very limited knowledge is available about African women's control over their sexual relations with husbands or other stable partners in situations where there is a high risk of STDs and HIV/AIDS. Such control must be seen as encompassing women's control over their sexuality and reproduction as well as the broader areas over which they can make decisions. The paper examines other research findings in sub-Saharan Africa, and then reports a study carried out by survey and anthropological methodologies among the Yoruba people in Ado-Ekiti, a town in southwestern Nigeria. Because the AIDS epidemic is still at an early stage in Nigeria and because of the relation of STD infection to HIV-transmission, as well as the probability that the behaviour developed for limiting STD transmission will subsequently be employed to limit HIV transmission, the study focused on STDs. Yoruba women have a considerable ability to refuse sexual relations for a limited time, and they are placed at greater risk of STD infection by their ignorance of whether their partner is infected than by a lack of ability to control the situation when STDs have been identified. This ability may be more limited in the case of AIDS because of its longer duration.

African families and AIDS: context, reactions and potential interventions.

This paper reviews publications and research reports on how sub-Saharan African families have been affected by, and reacted to, the AIDS epidemic. The nature of the African family and its variation across the regions is shown to be basic to both an understanding of how the epidemic spread and of its impact. The volume of good social science research undertaken until now on the disease in Africa is shown to be extremely small relative to the need.

Diffusion and focus in sexual networking: identifying partners and partners' partners.

This article describes the second stage of a research project on sexual networking that aims to further understanding of the spread of sexually transmitted diseases and HIV/AIDS in Ondo State, Nigeria. A sample of 488 males aged 15-50 were interviewed in depth to ascertain (1) the numbers and characteristics of their sexual partners, (2) the numbers and characteristics of the partners of those partners, and (3) the extent to which these relationships were commercial. In addition, a census was taken of all commercial sex establishments in order to estimate the numbers of their clients. The results show that male (and female) sexual networking is extensive, that in most nonmarital relationships men do not have accurate knowledge of their partners' partners, and that detailed questioning provides a reasonably accurate picture of the number of these relationships that are commercial in nature. The situation revealed was one of sexual diffusion rather than one with a strong focus on commercial sex workers, which fits the model of a slowly increasing HIV/AIDS epidemic rather than an explosive one.

Underreaction to AIDS in Sub-Saharan Africa.

In those parts of Sub-Saharan Africa most affected by the HIV/AIDS epidemic both public and private reaction to the seriousness of the epidemic have been less than might have been anticipated. This limited reaction weakens national, community and family responses to the epidemic and also reduces the pressure on international donors to provide adequate support. The paper first examines the reasons for underreaction by governments. These reasons include an assessment that successes will not be easily achieved, a reluctance to give leadership in areas of private sensitivity, an awareness of the fragility of the data base, a persistent feeling that it is a disease of foreign origin with a foreign overreaction to the situation in Africa, and the nature of the disease itself with a long latency period, obscure symptoms and an urban bias. Nevertheless, the paper argues that the more fundamental underreaction, shaping the reactions of governments, is that from the community itself. This arises partly from the demonstration that it is a sexually transmitted disease in societies where the discussion of sexual relations between the generations and the sexes has always been difficult and where new religions have in some societies reinforced older attitudes towards the shame of being discovered to have had illicit relationships. However, the main reasons lie in continuing aspects of the cultures which emphasize the multiple antecedents of misfortune and plural explanations of death, an element of predestination in when death takes place, a concept of good fortune--sometimes arising from or demonstrated by sexual activity--which renders misadventure unlikely, and a courage when facing death which is partly attributable to belief about survival beyond this event.

The implications of the demographic transition theory for fertility change in Nigeria.

PIP: Data on educated urban women in Nigeria demonstrate the effect women's education and urbanization has on reproductive behavior, marriage, family formation, and family relationships. Available health services contribute to a fall in infant mortality, but most services are in urban areas. Further, people of high socioeconomic status who have access to modern health services are more concerned about public health problems than those in the low group. Urbanization occurs at a rate of about 11%/year. In Lagos, people with primary education delay marriage 1-2 years longer than those who have no education. Further, 71% of uneducated people in Ibadan who were = or + 38 years old were in a polygynous marriage compared to 38% of educated people in the same age group. The actual and desired family size in Nigeria ranks amoung the highest in the world. In addition, only 20% of the total population use modern contraceptives and usage is highest in Lagos and Ibadan. Most acceptors are educated urban middle class who use contraceptives to space births instead of the traditional spacing methods of postpartum abstinence and prolonged lactation. Eventually more and more urban middle class women will use contraceptives to prevent births. 1% of these acceptors are demographic innovators, however. Further they begin to use contraceptives at high parities. Still child mortality among them is lower than others. Since the late 1970s, as people are being exposed to Western culture, the economy has improved, mortality has fallen, more children attend schools, yet fertility has grown substantially in urban and rural areas. With the expansion of Western education to females, the changing pattern of life style of the educated urban middle class, and increase of women in nontraditional professions, expectations and needs of children will change. Around 2000 Nigeria will begin its demographic transition from high to low fertility.^ieng

The impact of family and budget structure on health treatment in Nigeria.

Health-treatment decisions, in much of the world, are affected by the family's ability to meet the cost. In West Africa the situation is more complex because husbands and wives typically have separate budgets. This article reports an exploration of the impact on treatment of divided family budgets in Nigeria where health services now charge for prescribed drugs. It was found that most child treatment is paid for by one person only, usually a parent, and that the treatment chosen is decided by the person meeting the cost. Mothers are most likely to pay for minor illnesses but the father's role becomes more important as the cost rises. Because the type, and even fact, of treatment depends on the ability to pay, and because the family is not a unity in these decisions, the health system may have to devise charging procedures that make both parents responsible, possibly with community involvement in securing payment.

Sexual networking in the Ekiti district of Nigeria.

The confirmation of a significant number of HIV-positive persons and some deaths due to AIDS in Nigeria has rendered more urgent the study of sexual networking, both for an understanding of the risk of HIV transmission and also that of sexually transmitted diseases, which may serve as a vehicle for HIV infection. This article reports on a research project that concentrated initially on developing both small-scale survey and anthropological methodology to a point where reliable information was obtained. The research was carried out in both urban and rural areas of Ekiti, Nigeria, a Yoruba district 150 miles northeast of Lagos. Findings are reported from both the survey of 200 men and 200 women and the supplementary specialized in-depth studies. A high level of premarital and extramarital sexual activity was shown to exist, with higher levels among men than women and in urban than rural areas. Most female extramarital relations in rural areas were occasioned by the need for material or economic assistance and were highest among the younger wives in polygynous marriages. Male extramarital relations were highest in monogamous marriages and were frequently explained by wives' periods of postpartum sexual abstinence. Polygyny and postpartum sexual abstinence were underlying social institutions that explained much of the sexual networking. Reported levels of sexually transmitted disease were high, as were beliefs that these disease could be treated successfully by traditional healers.

Primary health care in developing countries: the case of Nigeria, Sri Lanka and Tanzania.

The country health programmes reviewed in this paper are aimed at meeting the World Health Organization's (WHO) target of providing basic health services for all by the year 2000. In accordance with the objective of the programme, each of the country health programme is expected to focus on the mechanisms for expanding health facilities and strengthening the health planning machinery in order to achieve an equitable distribution of health facilities in the foreseeable future as part of social development and in the spirit of social justice. Although there are marked differences in the approach to the realization of the objectives of the various country programmes reviewed in this paper, the primary aim is to bridge the widening gap between the health 'haves' and the health 'have-nots' in the respective countries. A substantial part of the resources of these countries are now being set aside for the implementation of the health care programmes so as to meet the health aspirations of their people. It is our belief that the health programmes of these countries are laudable and if properly implemented they will meet the health needs of the people of the various countries. A continuous evaluation of the programmes will enable each country to assess the successes and failures of the schemes and the organizational bottlenecks that may make the realization of stated objectives a well nigh impossible task.