CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency

Syndrome (AIDS) remain major public health concerns in many parts of the world,

particularly in sub-Saharan Africa. According to the Joint United Nations

Programme on HIV/AIDS (UNAIDS), there were approximately 38 million people

living with HIV globally in 2019, with 67% of them residing in sub-Saharan Africa

(UNAIDS, 2020). Nigeria, in particular, has one of the highest HIV/AIDS

prevalence rates in the world, with an estimated 1.5 million people living with the

disease in 2020 (UNAIDS, 2020). Women, especially pregnant women, are

particularly vulnerable to the disease, with mother-to-child transmission being a

significant mode of HIV transmission (UNAIDS, 2020).

In Nigeria, the prevalence of HIV/AIDS among pregnant women attending

antenatal care is a major concern. According to the Nigerian National HIV/AIDS

Indicator and Impact Survey (NAIIS) conducted in 2018, the HIV/AIDS

prevalence among pregnant women in Nigeria was estimated to be 1.4% (Federal

Ministry of Health, 2019). The study also revealed significant variations in

prevalence rates across different states in the country, with some states having

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prevalence rates as high as 5.6% (Federal Ministry of Health, 2019). One of such

place is Bwari FCT, located in the capital part of Nigeria, with an estimated HIV

prevalence rate of 2.9% (Federal Ministry of Health, 2019).

Bwari Area Council (BAC) is one of the 12 BAC in FCT, with an estimated

population of 183,666 people (National Population Commission, 2006). The BAC

is predominantly rural and agrarian, with farming being the main occupation of the

people. Health care services in the BAC are provided by a combination of

government-owned health facilities and private health facilities. However, despite

the availability of healthcare services, the prevalence of HIV/AIDS among

pregnant women attending antenatal care in the BAC is still a major concern.

Identifying the risk factors associated with HIV/AIDS among pregnant

women attending antenatal care is crucial to developing effective prevention and

control strategies. Previous studies have identified several risk factors associated

with the disease, including low level of education, poor knowledge of HIV/AIDS,

early sexual debut, multiple sexual partners, and lack of access to healthcare

services (Alemayehu et al., 2017; Awolude et al., 2014; Tessema et al., 2014). In

addition, studies have shown that the use of antiretroviral drugs during pregnancy

and the adoption of safe sex practices are effective preventive measures that can

reduce the prevalence of HIV/AIDS among pregnant women (Chopra et al., 2017;

WHO, 2016).
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 However, there is a paucity of research on the risk factors and preventive

measures of HIV/AIDS among pregnant women attending antenatal care in Bwari

Area Council. Therefore, this study aims to address this gap by exploring the risk

factors associated with HIV/AIDS among pregnant women attending antenatal care

in the BAC and identifying preventive measures that can be taken to reduce the

prevalence of the disease. The findings of the study will provide valuable

information to policymakers, healthcare providers, and other stakeholders involved

in the prevention and control of HIV/AIDS in the study area.

In summary, the study aims to contribute to the body of knowledge on the risk

factors and preventive measures of HIV/AIDS among pregnant women attending

antenatal care in Bwari Area Council. The study is significant in that it provides an

opportunity to identify the challenges and barriers to HIV/AIDS prevention and

control in the study area, and to develop targeted interventions that address these

challenges. The study will also help to increase awareness and understanding of

HIV/AIDS among pregnant women and healthcare providers, and encourage the

adoption of safe sex practices and the use of antiretroviral drugs to prevent mother-

to-child transmission of the disease.

The study adopts a quantitative research design, utilizing a structured

questionnaire to collect data from 200 pregnant women attending antenatal care in

selected health facilities in Bwari Area Council. The questionnaire will be

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administered by trained research assistants, and will collect information on socio-

demographic characteristics, knowledge of HIV/AIDS, access to healthcare

services, sexual behavior, and preventive measures employed to reduce the risk of

HIV/AIDS transmission. Data collected will be analyzed using descriptive

statistics and logistic regression analysis to identify risk factors associated with

HIV/AIDS among pregnant women attending antenatal care in the BAC.

The study has some limitations, including the possibility of social desirability bias,

which may lead to participants providing socially acceptable responses rather than

their true opinions. In addition, the study is limited to pregnant women attending

antenatal care, and therefore may not be representative of the entire population of

women in the BAC. Nevertheless, the findings of the study will provide valuable

insights into the risk factors and preventive measures of HIV/AIDS among

pregnant women in the study area, and will contribute to the development of

effective prevention and control strategies.

In conclusion, HIV/AIDS remains a major public health concern in many

parts of the world, particularly in sub-Saharan Africa, and pregnant women are

particularly vulnerable to the disease. Identifying the risk factors associated with

HIV/AIDS among pregnant women and exploring effective preventive measures is

crucial to reducing the prevalence of the disease. This study aims to address this

gap by exploring the risk factors and preventive measures of HIV/AIDS among
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pregnant women attending antenatal care in Bwari Area Council. The findings of

the study will provide valuable information to policymakers, healthcare providers,

and other stakeholders involved in the prevention and control of HIV/AIDS in the

study area, and contribute to the global effort to reduce the burden of HIV/AIDS.

1.2 Statement of the Problem

Despite the significant progress made in the prevention and treatment of

HIV/AIDS, the disease remains a major public health concern, particularly in sub-

Saharan Africa, where the prevalence of HIV/AIDS is highest (UNAIDS, 2020).

Pregnant women are particularly vulnerable to HIV/AIDS, with mother-to-child

transmission being one of the primary modes of transmission (UNAIDS, 2020). In

Nigeria, the prevalence of HIV/AIDS among pregnant women attending antenatal

care is estimated to be 1.4%, with a higher prevalence in some regions (National

Agency for the Control of AIDS, 2021).

Bwari Area Council (BAC) is one of the council in FCT with a high prevalence of

HIV/AIDS among pregnant women attending antenatal care (Mark J, 2020).

Despite efforts to prevent the spread of HIV/AIDS in the region, the disease

continues to pose a significant threat to the health and well-being of pregnant

women and their unborn children. Therefore, there is a need to identify the risk

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 factors associated with HIV/AIDS among pregnant women in the BAC and explore

effective preventive measures to reduce the prevalence of the disease.

While some studies have been conducted on HIV/AIDS among pregnant

women in Nigeria, there is a dearth of information on the risk factors and

preventive measures of HIV/AIDS among pregnant women attending antenatal

care in Bwari Area Council (BAC). This gap in knowledge poses a significant

challenge to the development of effective prevention and control strategies for the

disease in the region. Therefore, there is a need for further research to address this

gap in knowledge and provide evidence-based information to policymakers,

healthcare providers, and other stakeholders involved in the prevention and control

of HIV/AIDS in the region.

1.3 Research Objectives

The main aim of this study is to examine risk factors and preventive measure of

hiv/aids among pregnant women attending ante natal care in Bwari Area Council.

Specific objectives include:

1 To identify the sources of information about HIV/Aids among pregnant

women attending antenatal care in Bwari.

i. To identify the risk factors associated with HIV/AIDS among pregnant women

attending antenatal care in Bwari Area Council.

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ii. To assess the preventive measures employed by pregnant women to reduce the risk

of HIV/AIDS transmission in Kubwa, Bwari Area Council.

1.4 Research Questions

i. What are the sources of information about Hiv/Aids among pregnant women

attending antenatal care in Kubwa, Bwari Area Council?

ii. What are the risk factors associated with HIV/AIDS among pregnant women

attending antenatal care in Kubwa, Bwari Area Council?

iii. What are the preventive measures employed by pregnant women to reduce the risk

of HIV/AIDS transmission in Kubwa, Bwari Area Council?

1.5 Significance of the Study

The study on risk factors and preventive measures of HIV/AIDS among

pregnant women attending antenatal care in Kubwa, Bwari Area Council is

significant for several reasons.

Firstly, it will provide important information on the prevalence of HIV/AIDS

among pregnant women in the region, which can help inform public health policies

and interventions to reduce the incidence of the disease.

Secondly, the study will identify the risk factors associated with HIV/AIDS

among pregnant women in the region. This information can help healthcare

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providers and policymakers to develop effective prevention and control strategies

for the disease in the region.

Thirdly, the study will assess the preventive measures employed by pregnant

women to reduce the risk of HIV/AIDS transmission. This information can help

identify effective strategies to promote safer sexual behavior and reduce the risk of

mother-to-child transmission of the disease.

Overall, the study will contribute to the body of knowledge on HIV/AIDS

among pregnant women in Nigeria, and provide evidence-based information to

inform public health policies and interventions aimed at reducing the incidence of

the disease in the region. It will also help raise awareness of the importance of safe

sexual behavior and HIV/AIDS prevention measures among pregnant women,

healthcare providers, and other stakeholders involved in the prevention and control

of the disease.

1.6 Scope of the Study

The scope of this study is limited to pregnant women attending antenatal care in

Bwari Area Council of Federal Capital of Nigeria. The study will focus on

identifying the risk factors associated with HIV/AIDS among pregnant women in

the region and exploring effective preventive measures to reduce the prevalence of

the disease. The study will involve a quantitative research design, and data will be

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collected using a structured questionnaire administered to pregnant women

attending antenatal care in selected health facilities in the BAC.

The study will cover a period of months and will involve a sample size of 200

pregnant women attending antenatal care in selected health facilities in Bwari Area

Council. The selection of the health facilities will be based on their high patient

flow and their representation of the various communities in the BAC. The study

will use a purposive sampling technique to select the participants who meet the

inclusion criteria, which include being pregnant and attending antenatal care in the

selected health facilities.

The study will collect data on socio-demographic characteristics, sources of

information about Hiv/Aids, risk factors, and preventive measures associated with

HIV/AIDS among pregnant women attending antenatal care in the BAC. Data will

be analyzed using appropriate statistical tools, and descriptive statistics. The

findings of the study will be presented in the form of tables, graphs, and charts, and

will be discussed in light of the study objectives and research questions.

Despite these limitations, the study will provide valuable information on the

prevalence, risk factors, and preventive measures associated with HIV/AIDS

among pregnant women attending antenatal care in Kubwa, Bwari Area Council.

The findings of the study may inform public health policies and interventions

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 aimed at reducing the incidence of the disease in the region and improving the

health outcomes of pregnant women and their infants.

1.7 Operational Definition of Terms

This study on risk factors and preventive measures of HIV/AIDS among

pregnant women attending antenatal care in Kubwa, Bwari Area Council may use

some technical terms or concepts that require clarification. The following are some

definitions of key terms used in this study:

1. AIDS: Acquired Immune Deficiency Syndrome is a condition caused by the HIV

virus when the immune system is severely damaged, making the body susceptible

to infections and diseases.

2. Antenatal care: This is the care provided to pregnant women by healthcare

professionals to ensure the health and well-being of both the mother and fetus

during pregnancy.

3. HIV: Human Immunodeficiency Virus is a virus that attacks the immune system

and weakens the body's ability to fight infections and diseases.

4. Prevalence: This is the number of cases of a disease or condition within a

population at a given time.

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5. Preventive measures: These are measures or actions taken to prevent the spread of

a disease or condition. In this study, preventive measures for HIV/AIDS may

include practicing safe sex, using condoms, and regular HIV testing.

6. Risk factors: These are factors that increase the likelihood of a person contracting a

disease or condition. In this study, risk factors associated with HIV/AIDS among

pregnant women may include unprotected sexual intercourse, multiple sexual

partners, and lack of access to healthcare services.

7. Quantitative research: This is a research approach that involves the collection and

analysis of numerical data to draw conclusions and make inferences about a

population or phenomenon.

8. Qualitative research: This is a research approach that involves the collection and

analysis of non-numerical data, such as text or images, to gain insights into the

attitudes, behaviours, and experiences of a population or phenomenon.

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 CHAPTER TWO:

REVIEW OF RELATED LITERATURE

2.1 Concept of HIV/AIDS

Human immunodeficiency virus (HIV) is an infection that attacks the body's

immune system. Acquired immunodeficiency syndrome (AIDS) is the most
advanced stage of the disease. HIV targets the body's white blood cells, weakening
the immune system.

2.2 Stages of HIV /AIDs

If untreated, people living with HIV progress from having no symptoms to

developing illness and eventually late-stage HIV (also known as AIDS).

Left untreated, HIV infection goes through the following stages:

1. Seroconversion illness
Some people experience a short illness soon after they contract HIV. This is known
as seroconversion illness or primary or acute HIV infection.

In some people, seroconversion illness is so mild that it passes without being

noticed. Some people mistake it for the flu, but for others it's more severe and they
may need to see a doctor.

Seroconversion is the period when someone with HIV is at their most infectious.

2. The asymptomatic stage of HIV

Once seroconversion is over, most people feel fine and don’t experience any
symptoms. This is often called the asymptomatic stage and it can last for several
years.
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 Though you might feel well at this stage, the virus is active, infecting new cells,
making copies of itself and damaging your immune system’s ability to fight illness.

3. Symptomatic HIV
The longer you live with HIV without treatment, the greater your risk of
developing infections that your weakened immune system can’t fight:
certain cancers, as well as the direct effects of HIV.
Getting ill in one of these ways means that you now have symptomatic HIV.

4. Late-stage HIV
If HIV has a chance to cause a lot of damage to your immune system, you may
become ill from certain serious opportunistic infections and cancers. These
illnesses are also known as AIDS-defining.
AIDS-defining illnesses:
 cancer
 tuberculosis (TB)
 pneumonia

If diagnosed promptly and go onto treatment straightaway, most people living with
HIV never experience late-stage HIV. Staying healthy is key to living well with
HIV, including exercising regularly, sleeping well and eating well, stopping
smoking, and looking after your mental wellbeing.

2.3 Signs & Symptoms of HIV/AIDS

The symptoms of HIV and AIDS vary depending on the person and the phase of
infection.

Primary infection, also called acute HIV

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Some people infected by HIV get a flu-like illness within 2 to 4 weeks after the
virus enters the body. This stage may last a few days to several weeks. Some
people have no symptoms during this stage.

Possible symptoms include:

 Fever.

 Headache.

 Muscle aches and joint pain.

 Rash.

 Sore throat and painful mouth sores.

 Swollen lymph glands, also called nodes, mainly on the neck.

 Diarrhea.

 Weight loss.

 Cough.

 Night sweats.

These symptoms can be so mild that you might not notice them. However, the
amount of virus in your bloodstream, called viral load, is high at this time. As a
result, the infection spreads to others more easily during primary infection than
during the next stage.

Clinical latent infection, also called chronic HIV

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In this stage of infection, HIV is still in the body and cells of the immune system,
called white blood cells. But during this time, many people don't have symptoms
or the infections that HIV can cause.

This stage can last for many years for people who aren't getting antiretroviral
therapy, also called ART. Some people get more-severe disease much sooner.

Symptomatic HIV infection

As the virus continues to multiply and destroy immune cells, you may get mild
infections or long-term symptoms such as:

 Fever.

 Fatigue.

 Swollen lymph glands, which are often one of the first symptoms
of HIV infection.

 Diarrhea.

 Weight loss.

 Oral yeast infection, also called thrush.

 Shingles, also called herpes zoster.

 Pneumonia.

Progression to AIDS

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Better antiviral treatments have greatly decreased deaths from AIDS worldwide.
Thanks to these lifesaving treatments, most people with HIV in the U.S. today
don't get AIDS. Untreated, HIV most often turns into AIDS in about 8 to 10 years.

Having AIDS means your immune system is very damaged. People with AIDS are
more likely to develop diseases they wouldn't get if they had healthy immune
systems. These are called opportunistic infections or opportunistic cancers. Some
people get opportunistic infections during the acute stage of the disease.

The symptoms of some of these infections may include:

 Sweats.

 Chills.

 Fever that keeps coming back.

 Ongoing diarrhea.

 Swollen lymph glands.

 Constant white spots or lesions on the tongue or in the mouth.

 Constant fatigue.

 Weakness.

 Rapid weight loss.

 Skin rashes or bumps.

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2.4 Management of HIV/AIDS

The management of HIV/AIDS normally includes the use of

multiple antiretroviral drugs as a strategy to control HIV infection. There are
several classes of antiretroviral agents that act on different stages of the HIV life-
cycle. The use of multiple drugs that act on different viral targets is known
as highly active antiretroviral therapy (HAART). HAART decreases the
patient's total burden of HIV, maintains function of the immune system, and
prevents opportunistic infections that often lead to death. HAART also prevents
the transmission of HIV between serodiscordant same-sex and opposite-sex
partners so long as the HIV-positive partner maintains an undetectable viral load.

Treatment has been so successful that in many parts of the world, HIV has become
a chronic condition in which progression to AIDS is increasingly rare. Anthony
Fauci, former head of the Nigerian National Institute of Allergy and Infectious
Diseases, has written, "With collective and resolute action now and a steadfast
commitment for years to come, an AIDS-free generation is indeed within reach."
In the same paper, he noted that an estimated 700,000 lives were saved in 2010
alone by antiretroviral therapy. As another commentary in The Lancet noted,
"Rather than dealing with acute and potentially life-threatening complications,
clinicians are now confronted with managing a chronic disease that in the absence
of a cure will persist for many decades."

The United States Department of Health and Human Services and the World
Health Organization (WHO) recommend offering antiretroviral treatment to all
patients with HIV. Because of the complexity of selecting and following a
regimen, the potential for side effects, and the importance of taking medications
regularly to prevent viral resistance, such organizations emphasize the importance
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of involving patients in therapy choices and recommend analyzing the risks and the
potential benefits.

The WHO has defined health as more than the absence of disease. For this reason,
many researchers have dedicated their work to better understanding the effects of
HIV-related stigma, the barriers it creates for treatment interventions, and the ways
in which those barriers can be circumvented.
Classes of medication

Schematic description of the mechanism of the four classes of available

antiretroviral drugs against HIV

There are six classes of drugs, which are usually used in combination, to treat HIV
infection. Antiretroviral (ARV) drugs are broadly classified by the phase of
the retrovirus life-cycle that the drug inhibits. Typical combinations include two
nucleoside reverse-transcriptase inhibitors (NRTI) as a "backbone" along with one
non-nucleoside reverse-transcriptase inhibitor (NNRTI), protease inhibitor (PI) or

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integrase inhibitors (also known as integrase nuclear strand transfer inhibitors or
INSTIs) as a "base".

Entry inhibitors

Entry inhibitors (or fusion inhibitors) interfere with binding, fusion and entry of
HIV-1 to the host cell by blocking one of several
targets. Maraviroc, enfuvirtide and Ibalizumab are available agents in this class.
Maraviroc works by targeting CCR5, a co-receptor located on human helper T-
cells. Caution should be used when administering this drug, however, due to a
possible shift in tropism which allows HIV to target an alternative co-receptor such
as CXCR4. Ibalizumab is effective against both CCR5 and CXCR4 tropic HIV
viruses.

In rare cases, individuals may have a mutation in the CCR5 delta gene which
results in a nonfunctional CCR5 co-receptor and in turn, a means of resistance or
slow progression of the disease. However, as mentioned previously, this can be
overcome if an HIV variant that targets CXCR4 becomes dominant. To prevent
fusion of the virus with the host membrane, enfuvirtide can be used. Enfuvirtide is
a peptide drug that must be injected and acts by interacting with the N-terminal
heptad repeat of gp41 of HIV to form an inactive hetero six-helix bundle, therefore
preventing infection of host cells.

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