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Communities Make The Difference

Communities Make The Difference

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In 2018, UNAIDS estimated that, 250,000 young people (15-24 years) were living with HIV, making up 13% of the total number of people with HIV in Nigeria. 64 % of the infected young people were female compared to 36% of males within the 15-24 years of age range. 

Females in age groups from 15-64 years have a higher HIV prevalence and are infected earlier in life than men of the same age group. The highest prevalence of 3.3% is among 35-39 years age group among females while among the males the highest prevalence of 2.3% is among the 50-54 years age group.

Adolescents and young people face distinct challenges in accessing HIV testing and treatment services. Some of these challenges include cultural barriers in accessing HIV testing and counselling and SRH services, concerns about confidentiality, stigma and discrimination, discriminatory (and contradictory) age-related legislature and policies on consent to HIV Testing and Counselling, lack of youth-friendly services, judgmental attitude of health care workers and payment of user fees for accessing HIV services. 

Low HIV and sexual health knowledge and risk perception is a key factor  that  reduces the likelihood of  young people who are more sexually active and engage in Unprotected sex from accessing services.

The location of treatment-linked facilities is not always strategic and may not be central enough to facilitate easy access by adolescents and young people living with HIV. Although antiretrovirals is provided for free, there are other costs associated with availing transport to the centre in order to receive the medications and for some, these costs are prohibitive as most of them are dependent on their parents for transport fare. 

Stigma is the foremost overwhelming reason why young people are lost to follow up more than any other age group and plays a key role in non-adherence to medication. Most of these young people living with HIV are in school and would not want to look or behave differently from their peers.

Although the age of consent to testing has been lowered so that more adolescents can have access to HIV testing and counselling services without additional parental/caregiver consent, this requires systematic implementation across the country. 

The complexity of needs and challenges faced by adolescents and young people living with HIV require a holistic approach which takes account of factors at all levels of the health and social system they are part of, including their family, a broader community and policy environment which can facilitate their wellbeing.

Scaling up of Youth and Adolescent-Friendly Services (YAFS) is crucial as it helps retain adolescents and young people in care, reducing attrition among youth after ART initiation. Co-location of services can also help integrate HIV care into other sexual and reproductive health services for young people. 

Mobile clinics can help to reach and provide diagnosis to AYP. Appointment reminders delivered through SMS, phone-calls or face-to-face meetings can help increase adolescents’ uptake of repeat testing. Hotlines specifically for AYP can allow AYP to engage with a professional and youth-friendly counsellor confidentiality at flexible times. Home-based, community-level universal test and treat approaches interventions may help de-stigmatise and normalise HIV testing and care especially if targeted testing for AYP is provided in combination.

Targeted education and training sessions on stigma (e.g. through workshops and computer-based resources) for adults who work with AYP can significantly reduce their levels of stigma. Mass media interventions for stigma reduction may be more effective for young people than older people, where young people living with HIV can tell stories about their everyday lives. 

Self-Care Innovations

In Nigeria, HIV testing rates are relatively low with 70% of young people lack the comprehensive knowledge on how to protect themselves from infection. For young people, it is noted that the distance to clinics and the reluctance to seek testing because of the stigma associated with HIV are some of the deterrents on testing.  

To meet the UNAIDS target –that 90 percent of people living with HIV know their status by 2020–we must move beyond conventional testing and invest in strategies such as self-testing. HIV self-testing is a way to reach more first-time testers and make it easy to retest often, which is particularly valuable for those at high risk of contracting the virus. HIV self-testing (HIVST) can increase coverage of essential HIV services.

The adoption of HIV self-testing has several benefits for young people as it is accessible, convenient and confidential. Self-testing allows people to test on their own without having to go to the clinics or health facilities. It can also facilitate linkage and treatment for individuals who test positive. Young people could also be empowered through peer to peer conversations on HIV prevention services, distribution of HIV self-test kits for those who are sexually active and at risk of HIV exposure. 

We have the NANI project, which is Led by NACA, and implemented by Nigeria Business Coalition Against AIDS (NiBUCAA), – a business membership organization established to have collective leadership roles to play in the multi-sectoral response to HIV/AIDS. The NANI project aims to empower young people and deliver a high impact HIV/AIDS program for young people in Nigeria, while also leveraging on media and technology tools to sustain and accelerate the impact of the intervention.   

While some of these things are taking place now there has been no deliberate evaluation on HIV self-testing.

Young people constitute more than half of the Nigerian population. Nigeria has no option but to create opportunities to strengthen the health of the young people. With the huge youth bulge, the country first needs to ensure that the young people are educated, and healthy and health care settings are supportive of young people. Investments in health, education and job creation are therefore vital. By so doing, young people will be able to talk to their peers, shifting people’s mindset. Mainstreaming youth friendly services into existing primary health care facilities, expanding young people’s access to services, targeted messaging through peer to peer kind of approach, engaging young people as Community health workers , building synergies across different youth related programmes and youth led programmes leveraging on platforms in social media are some of the ways by which Nigeria can offer health services that are more youth centred. 

We will need to enhance the capacity of health care workers to offer youth friendly services and eliminate all forms of  stigma in health facilities. This will significantly scale up the utilisation and access to HIV related  services

The Nigerian national youth alliance formed under the ACT 2015! campaign has called for youth friendly services in post 2015 agenda focussing its efforts to work with national decision-makers and development partners to ensure the priorities of young people are adequately addressed in intergovernmental negotiations. 

The implementation of Family Life and HIV Education Initiative of the government of Nigeria across some schools had positive effects in the states and among schools where young people in such places now receive adequate preparation for their sexual lives. However, a lot more school children are yet to be reached with effective FLHE instruction.

Nigeria has well-articulated AYP relevant policies however awareness of the content of the policies, lack of funding and lack of implementation are the major gaps. There are pockets of initiatives targeting young people in school and out of school, but they are disjointed and working in silos.

We need to continue to invest in young people by empowering and involving them in decision making bodies, building their capacities and leadership skills, enabling them to be meaningfully engaged in the design and delivery of integrated SRHR and HIV programmes, promising them that they are able to exercise their rights on health in order to protect their own health and wellbeing and encouraging them to advocate for the needs of young people. 

Social media and associated technologies are already substantially integrated into the lives of young people. These platforms should be used for more interventions that fit into the already complex and challenging lives of young people to strengthen young people’s ability to respond more effectively to HIV.  Nigeria is part of the ACT!2030, which is a youth-led social action initiative aimed at inspiring a new wave of activism in the HIV response using social media and online technology to advance young people’s Sexual Reproductive Health and Rights. 

There are several strategies to address stigma among youth. Building young people’s self-esteem by using youth development principles and leadership training; encouraging youth to seek knowledge and tools to stay educated about HIV prevention, transmission, and care; Peer level support, Mass media campaigns, use of digital media, implementation of the policies and anti-stigma law are some of the ways that can help reduce stigma. 

Misconceptions Concerning HIV/AIDS

There are lots of myths and misconceptions about how one can get HIV. Here we debunk those myths and give you the facts about how HIV is transmitted.

There is no cure for HIV

There is no cure for HIV. However, there are effective treatments, which, if started promptly and taken regularly, results in a quality and stable life for someone living with HIV which is similar to that expected in the absence of infection. 

I can get HIV from casual contact (shaking hands, hugging, using a toilet, drinking from the same glass as someone who is living with HIV or being close to an infected person who is sneezing or coughing)

HIV is not transmitted by day-to-day contact in social settings, schools or the workplace. You cannot be infected by shaking someone’s hand, hugging someone, using the same toilet or drinking from the same glass as someone living with HIV or by being exposed to coughing or sneezing by an infected person.

You can tell if someone has HIV just by looking at them

You cannot tell if someone has HIV by just looking at them. A person infected with HIV may look healthy and feel good, but they can still pass the virus to you. An HIV test is the only way a person can find out if he or she is infected with HIV

HIV only affect homosexuals and drug users

Anyone who has condom-less sex, shares injecting equipment or has a transfusion with contaminated blood can become infected with HIV. Infants can be infected with HIV from their mothers during pregnancy, during labour or after delivery through breastfeeding.

I cannot have more than one sexually transmitted infection at a time

You can have more than one sexually transmitted infection at the same time. Each infection requires its own treatment. You cannot become immune to sexually transmitted infections. You can catch the same infection over and over again. Many men and women do not see or feel any early symptoms when they first become infected with a sexually transmitted infection; however, they can still infect their sexual partner.

When you are on antiretroviral therapy, you cannot transmit HIV to others

If antiretroviral therapy is effective and the virus is fully suppressed, you cannot transmit HIV to others. For this reason, monitoring of the suppression of the viral load is recommended as part of ongoing care for people living with HIV.

‘Youth Focus Programmes and Interventions’ that need to be scaled up or implemented to reach more youth in Nigeria

  • It would be good to see more innovative approaches and increased use of the multiple channels and platforms offered by social media, SMS, face-to-face meetings and peer engagements
  • Greater involvement and engagement of the AYP and availing them resources to develop and implement programmes.  Mentorship programs that support purposeful leadership by AYP activists, professionals, students and with incentives for them to evolve, be more creative and impactful will be able to reach more young people in Nigeria.
  • Finally, programs that increase the knowledge base among adolescents and young people in schools, community and religious institutions should also be encouraged.
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