The United Nations has set aside the 1st of December every year for the celebration of the World AIDS day. The day is usually marked by intensified activities drawing attention to the disease and its effects. The theme for the 2001 is "Men make a difference" while the slogan is "I care, do you?" Men have been particularly targeted because of the role they play in the transmission of the virus and the roles they can play in HIV/AIDS prevention, control and provision of care for people who are living with the virus/AIDS within families. The AIDS Prevention Initiative in Nigeria (APIN) project is participating in this year's celebration. Our involvement is with the goal of increasing awareness on HIV/AIDS and enlisting the participation of men in the prevention and control of the disease in Lagos, Plateau and Oyo States Nigeria through the use of innovative media approaches. It is our belief that the event will also create media opportunity for publicizing the activities of APIN in Nigeria.

Precisely two decades ago, scientists in the United States reported the first clinical evidence of a disease that would become known as Acquired Immunodeficiency Syndrome or AIDS. Within the period, the AIDS epidemic has spread to every corner of the world. Almost 22 million people have lost their lives to the disease and 40 million people are today living with HIV, the virus that causes AIDS. It has been twenty years of struggles, harrowing and devastating experiences for individuals, families, communities and nations. According to a report from Panos Institute, AIDS is the primary cause of death in Africa and the fourth highest cause of death worldwide. It predominantly targets adults from 15 to 50, depriving communities of their strongest and most productive citizens and leaving the old to care for the very young. Sadly enough more than 70% of people living with HIV live in sub-Saharan Africa. By the 1999 estimation about 2.6 million Nigerians are living with HIV.

As earlier mentioned the World AIDS Day provides another opportunity for the global community to increase awareness on the disease and strengthen prevention efforts. Despite all the advances made in the last twenty years there is no definitive cure to AIDS and no vaccine to prevent the disease. Hence, prevention remains central to the control of HIV/AIDS. The UNAIDS for two years running has been focusing on men. Men have vital roles to play in the prevention and control of HIV. Globally, over half of all people living with HIV/AIDS are men (53%). In most regions of the world, two-thirds or more of the people living with HIV/AIDS are men.

The UNAIDS is using the campaign to spotlight the many ways in which men contribute to the AIDS epidemic and the powerful roles they can also play in tackling it. As the slogan implies, this year's campaign challenges men everywhere to make a difference in the struggle against AIDS'. The agency reiterates that:

• All over the world, women find themselves at special risk of HIV infection because they lack the power to determine where, when and how sex takes place. But the same expectations, cultural beliefs and social customs of men that so disempower women also heighten men's own vulnerability. HIV infections and AIDS deaths among men outnumber those of women on every continent except sub-Saharan Africa. The younger the men are, the more they are at risk: men under 25 years of age make up about a quarter of the 36.1 million people currently living with HIV/AIDS.
  
  
• Curbing the AIDS epidemic demands that harmful notions of masculinity be reshaped, along with the many common attitudes that shape how boys are socialized to become men and how men regard risk. The customary association of manhood with physical strength, emotional indifference, virility and daring can translate into behaviour that threatens the health and well-being of men and their sex partners.
  
  
• Research shows that people generally maintain behavioural patterns that they learn at an early age. It is therefore easier to achieve the goal of 100% condom use if young men adopt that behaviour as soon as they become sexually active. Given the appropriate information and life skills, boys and young men can be empowered to make responsible and healthy choices that include abstinence and delayed sexual activity, as well as safer sex.
  
  
• The World AIDS Campaign's emphasis on men also reflects the fact that men are less likely to seek health care than women. In all but a handful of countries, men have a lower life expectancy at birth and experience higher death rates during adulthood than women. Yet, boys are often brought up to think of themselves as impervious to illness or risk. Real men, they are led to believe, do not get sick. The Campaign sets out to ensure that the health needs of men (including those living with HIV and AIDS) get the attention they deserve—not least from men themselves.

Drawing men into the struggle against AIDS

Men have to become more involved in the fight against AIDS. Over 70% of HIV infections worldwide occur through sex between men and women, and 10% through sex between men. Approximately 5% of infections occur among people who inject drugs—four-fifths of them men. All over the world, men tend to have more sex partners (as well as extramarital partners) than women, thereby increasing their own and their primary partners' risk of contracting HIV. The secrecy, stigma and shame associated with HIV further compound matters, since they discourage men and women from discovering or even acknowledging their HIV-positive status.

Dangerous behaviour

Some circumstances place men at especially high risk of contracting HIV. Men who migrate for work and are separated from their families may pay for sex and use substances, such as alcohol, to cope with the stress and solitude. That combination increases their risk of infection. So does the culture of risk-taking that tends to characterize predominantly male environments like the military. In all-male institutions such as prisons, men who otherwise prefer women as sex partners may have unsafe sex with other men. In a world of AIDS, this can be deadly. Male violence is an important factor in the spread of HIV through the displacement of communities by wars and civil conflict, as well as through coerced sex. Each year, millions of men commit sexual violence against women, girls and other males—often in their own family or household. According to a UNICEF report, worldwide at least one in three women will, in their lifetime, be beaten, sexually assaulted or otherwise abused.

Challenges ahead

• Part of the answer lies in men emerging from behind their veils of silence and fortitude. Men — especially those who lead countries, religious organizations, communities and businesses — need to speak out as friends, parents, partners and citizens. They need to lead by example.
  
  
• By focusing on men, the World AIDS Campaign challenges leaders and role models — from politicians to sports stars and entertainers — to affirm and demonstrate their commitment to fight AIDS. It offers them a platform to do so and provides avenues for supporting prevention and care programmes around the world.
  
  
• But a balance must be struck between recognizing how men's behaviour contributes to the epidemic and building on their potential to make a difference. As politicians, entertainers, pioneers, frontline workers, fathers, sons, brothers, partners and friends, men have much to give. Their capacity for nurturing and caring within the community needs to be encouraged. Similarly, they need to be prompted to take a much stronger hand in caring for their partners and families — a responsibility that is magnified by an AIDS epidemic that has robbed more than 13 million children of their mother or both parents.

None of this suggests an end to prevention programmes for women and girls. Rather, the Campaign complements those endeavours by recognizing that until men everywhere dare to care, the struggle against HIV/AIDS will only be half-won.

APIN's contributions to HIV/AIDS Prevention and Control in Nigeria

The AIDS prevention Initiative in Nigeria is a project of Harvard School of Public Health. The project draws support form the Bill and Melinda Gates Foundation. It is a five year project and it is barely ten months only. Its activities are at the federal and state levels. APIN focuses on Lagos, Oyo and Plateau States. The project's activities include:

1. Support for the 2001 HIV/syphilis Sentinel survey: capacity building for Nigerian laboratory scientists, provision of freezers, reagents and laboratory supplies for allthe states of the federation, developing and equipping a national archival center in Abuja. Other related activities include support activities for molecular virology on the samples in UCH Ibadan.

We have done this with the belief that surveillance is a critical part of prevention and that to develop effective intervention strategies, it is vitally important to monitor the epidemic and the virus regularly and to disseminate the information widely. We hope that with the sentinel survey and our other projects in JUTH, UCH and Plateau State Specialist Hospital, we will be able to generate a complete cartography of the HIV types and subtypes present in each state in Nigeria. These data will be extremely informative for understanding the dynamics of the country's current and potential HIV/AIDS epidemics.

2. Support for Community Intervention Programs: APIN supports community based intervention programs in our focus states - Lagos, Oyo and Plateau. We provide grants for Lagos States HIV/AIDS Foundation (LSHAF) or Lagos SACA, which in turn has worked with moe than ten non-governmental organizations within the State. Other NGOs that we support are the Association for Reproductive and Family Health (AFRH) Ibadan, STOPAIDS Lagos, SWAAN Jos, NNELA Ibadan and Halt AIDS in Plateau States.

3. Support for Educational activities: Four Nigerians professionals reported at the Harvard School of Public Health in September and early October to commence their various studies. The fifth APIN fellow is still awaiting his visa. Two of them are studying at master's level, one at a doctoral level while the other two are post-doctoral research fellows. As a follow up to its first training workshop in HIV testing and surveillance, APIN is planning a workshop on Ethics in Research for December 2001.

4. Collaboration with Universities and Allied Institutions: APIN is collaborating with University College Hospital Ibadan, the Jos University Teaching Hospital and the Plateau State Specialist Hospital to develop their capacities in HIV surveillance, Sexually transmitted diseases diagnosis and treatment and prevention of mother to child transmission. APIN is also building collaboration between the Center for International Development (CID) at the Kennedy School of Government and NISER to carry out a project on AIDS, Development and Finance. The project will essentially develop and produce advocacy modules, conduct advocacy seminars for legislators at national, state and local levels; policy makers, religious leaders etc. It will identify and conduct research into the socio-economic impacts of AIDS on the different sectors of the economy and disseminate such information. The project is expected to mainstream HIV/AIDS into key developmental instruments e.g. poverty reduction and debt relief.

5. Collaboration with State Action Committees on AIDS (SACA): APIN is assisting Oyo and Plateau States to develop their program of Action.

6. APIN is also supported six NGOs for World AIDS Day campaign. The activities of these NGOs are diverse and rich and we believe that the activities complemented our various prevention and control efforts.

The comprehensiveness of the project speaks for itself and the leadership of the project believes that as the results of our various research efforts begin to unfold many more community interventions will be designed and implemented. The current scenario of the epidemic in Nigeria calls for wider participation by all Nigerians from all works of life. The media has a vital role to play in jostling the men to action, especially those that bear authority and resources that could be channeled towards mitigating the impact of the epidemic on the infected and affected persons. Men can really make the difference in the prevention of HIV and providing care. I care, do you?