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THE IMPACT OF PEPFAR ON THE MINISTRY OF HEALTH IN NIGERIA

Chapter one Introduction

1.1 Background of Study The activities of HIV/AIDS have eaten into the fabrics of the well-being of people all over the world. Yet nowhere is the effect of this disease felt more deeply than in sub-Saharan Africa, where nearly two-thirds of the estimated 33 million people worldwide infected with HIV live (Cohen J, 2004). As part of the global response to HIV, there has been a significant increase in funding to low- and middle-income countries to strengthen treatment, prevention and research programmes (Kates J, Morrison, 2006). Nearly US$10 billion in funding was earmarked in 2008 for HIV/AIDS in low- and middle-income countries, representing an approximate 20-fold increase from a decade ago. The largest effort by a single government to combat HIV/AIDS, the President's Emergency Plan for AIDS Relief (PEPFAR) was first authorized by the United States Congress and signed into law in 2003 with a budget of US$15 billion over five years. Fifteen focus countries, 12 of them in sub-Saharan Africa, were chosen as beneficiaries of two-thirds of the PEPFAR funds (Gostin L.O, 2001). PEPFAR's five-year performance targets for the focus countries were to support prevention of seven million HIV infections, treat two million people with HIV/AIDS with antiretroviral therapy, and care for 10 million people infected with and affected by HIV/AIDS, including orphans and other vulnerable children (Jahn A, 2006). In its 2008 report to Congress, the Office of the United States Global AIDS Coordinator (OGAC) reported that many of these goals were close to being met (Leslie J.A., 2009) On 30 June 2008, the President of the United States, with the consent of Congress, reauthorized PEPFAR for five more years, increasing the budget between 2008 and 2013 to more than US$48 billion. An increasing number of published studies have supported the successes of PEPFAR. There has been a well-documented increase in individuals receiving HIV care in locations receiving PEPFAR funding, and several studies have suggested local decreases in mortality where HIV services have been scaled up (Bendavid E., 2005) Most recently, Bendavid and Bhattacharya, (2005) demonstrated that PEPFAR focus countries appear to be doing significantly better than non-focus countries when analyzing HIV-specific health outcomes, including HIV-related mortality and persons living with HIV. However, the question as to whether PEPFAR has had meaningful impact on the broader health care system remains unanswered.

1.2 Statement of Research Problem Over the years there have series of effort put in by the federal government of Nigeria through the ministry health to control the prevalence of HIV/AIDS in Nigeria. According to UNICEF, UNAIDS, PEPFAR, (2006) stated that most children orphaned by AIDS live with their extended families, usually grandparents, and most often grandmothers. An analysis of data from Demographic and Health Surveys (DHS) in Burkina Faso, Cameroon, Ethiopia, Ghana, Kenya, Malawi, Mozambique, Nigeria and Uganda found over 85% of orphans not living with the surviving parent were living with extended family. In addition, grandparents are more likely to be caretakers in high prevalence countries (in more than 50% of cases), whereas in low prevalence countries grandparents were identified as caretakers in 20- 40% of cases. Secondly there have been series of study on PEPFAR but not even a single study has been carried on the impact of president’s emergency plan for AIDS relief (PEPFAR) in Nigeria.

1.3 Research Questions The study came up with research questions so as to achieve the research objectives. The research questions for the study are: 1. What are the roles of PEPFAR in the support for HIV testing and counseling in Nigeria? 2. What is the effect of PEPFAR in the prevention of mother-to-child transmission (PMTCT)? 3. What is the relationship between PEPFAR and the ministry of health in the voluntary medical male circumcision in Nigeria?

1.4 Objectives of Study The main aim of the research work is to determine the impact of president’s emergency plan for AIDS relief. Other specific objectives of the study are: 1. to determine the roles of PEPFAR in the support for HIV testing and counseling in Nigeria 2. to determine the effect of PEPFAR in the prevention of mother-to-child transmission (PMTCT) 3. to determine the relationship between PEPFAR and the ministry of health in the voluntary medical male circumcision in Nigeria 4. to proffer solution to the above stated problem

1.5 Statement of Research Hypothesis Hypothesis 1 H0: there is no significant relationship between PEPFAR and the ministry of health in the voluntary medical male circumcision in Nigeria H1: there is significant relationship between PEPFAR and the ministry of health in the voluntary medical male circumcision in Nigeria Hypothesis 2 H0: PEPFAR does not play any role in HIV testing and counseling in Nigeria H1: PEPFAR plays a role in HIV testing and counseling in Nigeria

1.6 Significance of Study The study on the impact of president’s emergency plan for AIDS relief will be of immense benefit to the ministry of health, the government (local, state and the federal). The study will also served as a source of literature to other researchers that desire to carry out similar research on the above topic as the findings of the study will examine the role of PEPFAR in HIV testing, medical male circumcision, and the contribution of PEPFAR to investment development in Nigeria. Finally the study will contribute to the body of existing literature and knowledge in this field of study and provide a basis for further research.

1.7 Scope of Study The study will focus on the impact of president’s emergency plan for AIDS relief in Nigeria. The study will cover on the role of PEPFAR in HIV testing, medical male circumcision, and the contribution of PEPFAR to investment development in Nigeria 1.8 Definition of Terms/Acronyms

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