- Integrated Child Health and Social Service Award (ICHSSA) is a – five year, USAID – funded project commenced on December 19, 2019. The project is designed to reduce the impact of Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) on orphans and vulnerable children (OVC) in Akwa Ibom and Cross River states respectively.
- ICHSSA is implemented by Center for Clinical Care and Clinical Research Nigeria (CCCRN) in partnership with Catholic Relief Services CRS), alongside other local resource experts. The ICHSSA will ensure that OVC are cared for and protected by their households, communities, local and state governments. The project will also ensure that communities promote child and family friendly, gender and HIV sensitive cultural norms and practices.
The Nigeria HIV infection rate is beginning to decline same with the states HIV infection rate. States response to HIV and AIDS, as recorded over the years, has experienced reasonable increase in scope and quality. The states HIV programming have been guided by several policy documents and assessments which have been reported to led to an increase in evidence-based response in the states. Some studies to include the 2020 Global Gender Gap report ranks Nigeria at 128 out of 158 countries in bridging the gender gap, and the NAIIS 2018 reported Akwa Ibom prevalence at 5.5%, which is above the national prevalence and target on prevention of new infections and uptake of HIV antiretroviral therapy. Available data also suggest that a growing number of people living with HIV in the states now access antiretroviral therapy (ART). However, much more remains to be done as the number of newly infected people is still high especially among women and youth (AKAIS 2017) and many adults and children who require ART do not have the needed access.
Some factors contributing to the epidemic in the states have been identified to include gender-related issues, stigma and discrimination. These are manifested in many forms; unequal balance of power between men and women, discrimination, denial and violations of rights and dignity. Which are the main reason why people are reluctant to negotiate prevention behaviours, get tested for HIV, disclose their HIV status, take antiretroviral drugs, are denied participate in decision making and ownership to assets. According to the 2018 NDHS report 84% of working women earn less than their husbands while 15% of women who are working are not paid for work compared to 8% of men. Only 11% of women own any assets (house, land) alone or jointly compared to 37% of men, and 31% of women have experienced physical violence since age 15 while more than one-third of women who have ever been married have experienced spousal violence. According to International Centre for Research on Women “The epidemic of fear, stigmatization and discrimination has undermined the ability of individuals, families and societies to protect themselves and provide support and reassurance to those affected with HIV/AIDS. These hinders, in no small way, efforts at stemming the epidemic and impacts negatively on individuals, families, workplace and the community at large.
Men and women are affected differently by HIV/AIDS. The gender disparity in the HIV prevalence was greatest among younger adults with females age 20-24 (13%) having about 4 times the prevalence of males of the same age (0.4%). Gender inequalities in HIV/AIDS are most likely attributable to the differential distribution of the risk factors for women and men. Cultural factors encouraging older men who are likely to be HIV infected to have younger female partners contributes to limiting women’s ability to negotiate safe sex.
Stigma and gender disparity manifests in discriminatory and sometimes violent treatment of people living with HIV, their families and others affected by HIV as well as females and girls. Both stigma and gender disparity can place limit on education, work, housing and health care. They can amongst others trigger verbal or physical violence, isolation or complete ostracism, domestic abuse, spousal abuse and rape contributing to HIV vulnerability among women and children. They may also affect personal and family life, including the opportunity to marry and to bear and raise children.
The purpose of the gender analysis study is to understand the unique needs and HIV vulnerabilities of men and women, boys and girls with a view to tailoring HIV/AIDS responses as focused interventions and dedicate resources where they are most needed. However, the HIV/AIDS Stigma index angle of the study will assess HIV-related stigma experienced among PLHIV. The assessment also aims at exploring stigma and discrimination’s direct and indirect effects on individuals, as well as the opportunities.
The evidence in the gender analysis and stigma index study will be used as an advocacy tool for designing quality HIV programs. The study has six objectives as follows:
- Examine gender roles, harmful gender norms and practices as well as stigma that affect sexual behavior, vulnerability to HIV infection, HIV status disclosure, access to HIV care and support services.
- Identify relevant and available policies, laws and legal frameworks in the states, LGAs and communities that promotes and/or impends gender equity and anti- discrimination acts.
- Examine the relationship between gender role and access to assets to increasing HIV infection, vulnerabilities and access to HIV care and support services.
- To conduct a root cause analysis on the nature and drivers of HIV-related stigma in Akwa Ibom State.
- To increase understanding of the burden, consequences of stigma on individuals, and trends regarding HIV-related stigma and discrimination in individual LGAs and across Akwa Ibom.
- Use the findings to develop project specific gender and stigma reduction strategies.
The study will align with the six domains of the Gender Analysis framework developed by USAID’s Interagency Gender Working Group. This framework will provide concrete ways to collect and organize gender differential in health area using the following domains:
- Access – refers to being able to use the resources necessary to be a fully active and productive participant (socially, economically, and politically) in society. It includes access to resources, income, services, employment, information, and benefits.
- Knowledge, Beliefs, and Perception – refers to the types of knowledge that men and women are privy to (who knows what), the beliefs that shape gender identities and behavior, and perceptions that guide how people interpret aspects of their lives differently depending on their gender identity.
- Practices and Participation – refers to peoples’ behaviors and actions in life – what they do – and how this varies by gender. It encompasses not only current patterns of action, but also the way that people engage in development activities. It includes attending meetings, training courses, accepting or seeking out services, and other development activities. Participation can be both active and passive.
- Time and Space – This domain recognizes gender differences in the availability and allocation of time as well as the space in which time is spent. It includes the division of both productive and reproductive labor, identifying how time is spent and committed during the day, week, month, or year, and in different seasons, and determining how people contribute to the maintenance of the family, community, and society. The objective here is to determine how people in different gender categories spend their time and what implications their time commitments have for their respective availability for program activities.
- Legal Rights and Status – Analysis of this domain involves assessing how people are regarded and treated by both the customary and formal legal codes and judicial systems. It encompasses access to legal documentation such as identification cards, voter registration, and property titles as well as rights to inheritance, employment, redress of wrongs, and representation.
- Power and Decision-making – This sphere of social life pertains to the ability of people to decide, to influence, to control, and to enforce. It refers to the capacity to make decisions freely and to exercise power over one’s body and within an individual’s household, community, municipality, and the state. This includes the capacity of adults to decide about the use of household and individual economic resources, income, and their choice of employment as well as to vote, run for office, enter legal contracts, etc.
Relatively, the Stigma Index questionnaire will explore: (1) demographics; (2) experiences with stigma, discrimination, and advocacy; and (3) experiences with testing, disclosure, and access to services. Other areas are experiences with stigma/discrimination from other people; access to health, and education services; internal stigma from homes; rights, laws, and policies relevant to the geographic areas of the study and can add content, as needed, to address local concerns.
Consideration will be given to the unique needs of particular subgroups of women or men (e.g., youths, those living in poverty, people with disabilities, members of minority or ethnic groups, those who live in rural areas, hard to reach and riverine areas) who may face unique barriers or obstacles that prevent them from accessing and utilizing HIV continuum of care and having the same outcomes as other men and women.
Study instruments will be designed as a standardized data collection tool to allow comparison of findings across study sites and within an international context, while at the same time allowing for adaptation to the needs of the local context. As such, while the core questions and content must be retained, researchers can change the wording to the geographic area of the study and can add content, as needed, to address local concerns
The following tasks will be carried out by the Consultants:
Task: Description Task – LOE
Initial Briefing – 1 day:
- Brief senior management on work plan and conceptual framework
Develop work Plan, Gender and Stigma analytical framework – 2 days:
- Using information provided in the SOW develop work plan and conceptual framework to be used to collect and analyze data.
Finalize analysis protocol – 2 days:
- Review initial protocol and adapt. The qualitative methods will be used for data collection and analysis.
Conduct desk review – 2 days:
- Review of literature will include survey and reports, policies, and guidelines relevant to the study.
- Recommended documents: National Demographic and Health Survey, Violence Against Children Survey, National Gender Analysis Report, Strategies for Integrating Gender in HIV/AIDS, HIV Related Stigma, Discrimination and Shame in Nigerian Faith Communities, HIV-related stigma across contexts: common at its core, Measuring AIDS stigmas in people living with HIV/AIDS: the Internalized AIDS-Related Stigma Scale” AIDS Care, HIV-Stigma in Nigeria: Review of Research Studies, Policies, and Programmes, The Akwa Ibom AIDS Indicator Survey, The Nigerian HIV/AIDs Indicator and Impact Survey
- The review will also include a systematic electronic database search for published peer reviewed journal articles and reports on gender, HIV/AIDS and, gender inequalities, norms, stigma and discrimination as well as other related areas. Key search terms include HIV, AIDS, Gender, Nigeria, Inequality, stigma, discrimination, Akwa Ibom state and Cross River state. Share findings of desk review.
Develop data collection tools – 3 days:
- Develop interview guides and questions as well as questionnaires for different categories of respondents for In-depth Interviews, Focus Group Discussion, key informant interviews and questionnaires admiration for the different stakeholder groups and respondents.
Conduct data collection exercise – 15 days:
- Collection of data via key informant interviews, Inept interviews, focus group discussions and questionnaires.
Document findings and recommendation – 5 days:
- Analyze data collected and document findings and recommendations
- Recommend issues for inclusion in a Barrier Analysis for gender.
Preliminary report – 2days:
- Develop and share preliminary report
Debrief – 1 day:
- Present assessment findings and recommendation to Project senior management.
Final report – 5 days:
- Submission of final report, factsheet, infographics, tables and slide deck.
Total number of days 38 days
- Protocol that includes sample plan, timeline for fieldwork, data analysis, data management plan, data security etc.
- Desk review report
- Gender and stigma analytical frameworks
- Study instruments/tools (Discussion Guide, questionnaires for the different categories of respondents)
- Presentation slides and training tools/materials for field teams
- Gender and Stigma hotspots Geo-spatial map
- Study questionnaires and encrypted responses (as exports)
- Preliminary report including findings and recommendations
- Final report and information products (factsheets, infographics and slide deck)
- The Gender and Stigma Analysis will require a period of 38 days including weekends and public holidays, executed within a period of 2 consecutive months.
- All travel arrangements will be provided by the CCCRN-ICHSSA 1. A technical support team made up of program specialists and other field staff will assist the consultants (where required) in the fieldwork. However, the research team will consider conducting and collecting data using android mobile phones and other virtual means while observing all precautions necessary for prevention of COVID-19 pandemic.
Required Qualification and Skills for the Consultants (Lead and Associates)
- Advanced degree in Sociology, Public Health, Research / Monitoring and Evaluation, International Development, and other relevant fields.
- Minimum of 7 years of experience in international development and gender.
- Experience working on gender and health projects, including HIV projects.
- Experience in conducting similar HIV/AIDS surveys e.g. NARHS. NDHS, NAIIS etc
- Familiarity with Nigerian socio-cultural norms and structures
- Knowledge of USAID and PEPFAR gender policies and strategies
- Demonstrated skills in qualitative and quantitative research methods required.
- Demonstrated capacity to analyze complex issues, draw relevant conclusions and produce a comprehensive technical report.
- Should speak and read English language fluently with strong writing skills.
- Excellent interpersonal skills, including experience successfully interacting with USAID, implementing partners, government officials, civil society partners, and other stakeholders
- Must demonstrate cultural sensitivity, particularly in multi – ethnic and multi – religious contexts.
- Must be available for the entire duration of the study.
- Understanding of local languages in Akwa Ibom and Cross River is an added advantage.