Evidence has shown that a significant proportion of youths for several reasons, tend to practice tattooing, piercing, scarification and others. In the process, scars are formed by cutting or branding the skin using sharp objects. Scarification which occurs on the dermis, far above fatty tissues and muscles is an illegal practice in some countries including Nigeria1. Scarification involves the removal or branding of the skin with sharp objects, therefore, the dangers of getting blood borne infections like HIV, hepatitis and others are likely. The practice of scarification leaves an open wound and good hygiene is incredibly important to prevent other infections 1, 2, 3. This practice of scarification among some youths is very worrisome considering the fact that in 2001, the HIV prevalence was about 5.8% and by 2014 health workers and researchers worked hard to reduce the HIV prevalence to 3.8% thereby minimized the burden of HIV in Nigeria by about 65% 4. This fete of reducing HIV prevalence was mainly achieved by researchers using educational interventions like drama and role plays to sensitize and create positive behaviour changes among youths. As a result of using drama, youths acted as change agents to their peers 5. It was also shown that watching individuals performing drama and role plays on the stage, produced holistic approaches that initiated solutions to problems 5, 6. Therefore, drama and role plays were presumed to be veritable intervention strategies capable of reducing the practice of scarifications among youths in institutions of higher learning. This study used drama and role plays to provide emotional and cognitive experiences that created awareness on the risks of scarification.
Historically, in Nigeria, the practice of tribal marks, or scarifications served the purposes of identifying tribes of one’s origin as well as eternal membership of fraternity bodies6. Tribal marks were also used to identify family members kidnapped during communal conflicts or slave trade. The scars on the faces and other parts of the body of those kidnapped or under slavery helped to identify their heritage. As a result, tribal marks or scarification served as checks on incest and intra marriages among families that are blood related7, 8, 9.
In some developing countries including Nigeria, the practice of having marks on the body has been banned because of the resultant social and health risks. However, public outcry against the decision made the ban in some countries to be slightly upturned 4, 10, 11, 12. For instance, Nigeria's (2003) Child Rights Act section 24(1) declared that no person shall tattoo or make skin marks on any child. The Child Rights further defined “skin marks" as "any ethnic or ritual cuts on the skin which leave permanent marks that could disfigure and expose the child to infections" (Section. 27(7). According to the law, the penalty for violating this provision shall be a fine of 5,000 Nigerian naira (about $15 US) or in the alternative, a prison term of up to a month, or both (Nigeria 2003 Child Rights Act, Section 24(2), but no one has ever been strictly convicted for violating this law, hence, some individuals still indulge in making skin marks 13.
Sources have shown that the continued prevalence of scarifications among youths in higher institutions reflect the view that some youths may lack knowledge of the risks they are exposed to by having marks on the body. It suggests the need to equip youths with feasible intervention strategies capable of enlightening them on the consequences of making scarifications 14, 15, 16, 17. In practice, making tribal marks, and/or incisions are fraught with dangers because most of the instruments used for the cuttings are unsterilized. Such practices that would break the skin and mucus membranes during cutting, suggest likely increase in infections with blood borne pathogens and others including tetanus, Hepatitis B, Hepatitis C, and very importantly, HIV 18, 19, 20. Studies have shown that the healing process of scarifications leaves some scars that producedisfigurements likekeloidson the body21. These disfigurements cause serious psychological, emotional and social problems which sometimes result to attempts by some individuals to commit suicide 22, 23, 24. For instance ,females with disfigurements on the body experience social stigma and discrimination and find it difficult to get suitable suitors 25, 26, 27. As a result of this, thoughts of suicide would emanate 27.
Researchers have noted that the presence of peers influence risk taking among youths because they spend substantial amounts of time with their peers, and as such, their decisions are likely to be influenced by peers 28, 29, 30. The problem is that a good number of youths appear not sensitive to the risks of some of their decisions especially that of making scarifications during fraternal initiations 31, 32, 33. Such youths strongly focus on the anticipated social and material benefits rather than the associated health problems of their actions. They seem to cope well with impulsive situations that are characterized by rapid and unplanned actions that are likely to expose them to negative health consequences34, 35, 36. Realizing that the age range of most of the people infected with HIV and AIDS are between 15 to 35 years 37, 38 and that about 80% of these infected groups are aged 20-29 years 39, 40 makes it imperative to proffer intervention that will reduce the prevalence. It is against the background of reducing HIV and AIDS prevalence among the young people that this research was conceived.
This study investigated the extent to which youths in the universities are aware of the risks associated with scarification. It also examined the likelihood of using drama and role plays to increase the awareness of youths on the risks of scarification.
Ethical Review Committee of the Abia State University approved the project before the commencement of the study. After the approval from the ethical committee, informed consent was sought and obtained from the Deans of Students’ Affair in each university as well as that of the students in the three universities studied .
The study area is Abia State in South East Nigeria. Abia State is made up of 17 local government areas. It has a population of 2.7million (2006 Nigerian census report).
There are 9 tertiary institutions comprising 3 universities( Federal, State and Private) , 2 polytechnics, 2 teacher training institutes and 2 schools of health technology. All the universities in the State, Michael Okpara University of Agriculture (MOUA), representing federal university, Abia State University, representing State university, and Rhema University, representing private university were used for the study.
Abia State has 3 commercial cities Aba, Umuahia and Arochuku. These cities are densely populated. Inhabitants of Abia State are made up of artisans, traders, farmers, civil and public servants. Individuals in Abia State receive health care services from a teaching hospital, four general hospitals, seven primary health care centres and a host of private hospitals.