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My Dance With HIV

My Dance With HIV

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“Nothing I have come to know or learnt prepared me for the journey I was to embark on. I wasn’t really keen to travel for Christmas, but my family had relocated and ‘big girl’ like me, a working class person had to stay behind in the city of Ibadan. Jobs are not so easy to get. I was privileged to have a good and prospective one. I left Ibadan a little late and arrived Benin at about 11pm due to horrible roads and the breakdown of the bus I was conveying in. Not very familiar with the location, I thought I could still get a night bus to Warri. I decide its either I go to a Police station to spend the night or the bus garage. I had heard that the garage in Benin never shuts down, so I decided to take a bike to the garage. I was not familiar with the terrain. On the route, we passed a police checkpoint where I informed them I was going to the bus garage.  Finally, I realized that the bike man had his own destination planned. He threw me into a pit and I couldn’t  see a way out. I was beaten to a pulp, tied up, and had my  ATM card stolen from me. After what seemed like hours, he returned and raped me. I was a virgin at 26. To garnish the violation, he gave me N2000 so that I can find my way according to him. I found my way to a police station. I did not know that I was at risk of anything that could affect my health post rape other than pregnancy”. The call from this lady came on January 2nd about 8 days post rape. She just wanted to know where she could confirm that she wasn’t pregnant. 

Atinuke had a delightsome Christmas with family. What with a new baby, she delivered the second week of December — the 14th to be precise. This bundle of joy added to the festive joy. Danger struck on the last day of December few hours to exchanging Happy New Year pleasantries. Armed robbers struck their compound and she was raped. Her call messed my up New Year’s celebration. 

10-year-old Ngozi has been sexually molested by a neighbor for over 4 years. She finally spoke up while in horrible pain because according to her, if she is going to die, she might as well “spill the beans”. Her molester and abuser had told her he will kill her if she spoke about the abuse. It was a secret. The fear of death, she assumed not by him, broke the secret. ‘Pin’ worm had migrated to reproduce in her vaginal passage. She was infected.  

Most women, no matter their education level and clout cannot negotiate condom usage with their spouse, knowing very well he is philandering.  Antenatal surveys were the best way to test for HIV. Most women were tested without their knowledge and those discovered to have HIV infection faced another dilemma. How to get their partners to come for testing, and manage the infection with safe delivery options due to stigma were some of the challenges facing these women. 

Sexual and Domestic violence is playing a major role in the spread of HIV/ AIDS. Certain factors have contributed to this epidemic: poverty, bodily autonomy, forced sex in marriage, rape, sexual abuse of children, obstructed access to HIV/AIDS information and treatment, lack of  sexual and reproductive health /rights (Not being able to negotiate number of children  and spacing), polygamy, traditional practices, widow inheritance, child marriage, economic independence amongst a few.  

As far back as 2000, the then director general of the World Health Organisation (WHO) said that we will not achieve progress against HIV until women gain control of their sexuality. Gender inequalities surface in this dance with HIV. 

Far back in 2007, we handled a case of child sexual abuse of various girls aged between 8 -10 by a man of 39 who knew he was HIV positive and using antiretroviral drugs. The cohabitation of Sexual / domestic violence and HIV has long existed; in recent years, the world is finally catching up. 

Violent or forced sex can increase the risk of transmission of HIV infection. This is due to abrasions and cuts which commonly occur, thus facilitating the entry of the virus into the bloodstream. A woman who is facing domestic violence is beaten by her spouse and then perceived to be ready for a sexual relationship. She is raped by her own spouse or partner. 

Being a victim of sexual violence makes one susceptible to HIV – for example childhood sexual abuse, those in intimate relationship and sexual coercion among adolescents and some adults. Stigma predisposes some population, having someone infected in your family as well as children orphaned by HIV. Nevertheless, factoring these into HIV prevention and treatment has taken decades. 

Now, starting off a rape crisis center that will address cases across the country in 2005, opened us as an organisation to the dangers a child victim or an adult survivor had to face beyond seeking justice – mental health issues, pregnancy, HIV infection, sexually transmitted infections (STIs), stigma, blame, etc. traumatic as the situation is, it was difficult discovering that one had been infected with HIV. Then we delved into HIV prevention and could see the gap therein. Post Exposure Prophylaxis (PEP) was available in the national ARV programme.  Our investigation revealed it was accessible only to medical personnel for occupational exposure. MediaCon began advocacy and education on the availability and requested for access to victims of sexual violence. About the same time, a Joint WHO/ILO expert consultation for the development of policy and guidelines on occupational and non-occupational exposure held in Geneva. 

Post Exposure Prophylaxis (PEP) according to World Health Organisation (WHO) is, a short-term antiretroviral treatment to reduce the likelihood of HIV infection after potential exposure, either occupationally, or through sexual intercourse. 

What are the benefits of accessing this combination prevention treatment? 

Some are:

  • Antiretroviral (ARVs) have been used to prevent infections in case of accidental exposure for many years. It involves taking a 28-day course of ARVs. 
  • PEP should be offered and initiated as early as possible, for all individuals with an exposure that has the potential for HIV transmission, and ideally within 72 hours
  • It offers a single opportunity to prevent HIV after exposure ( You have to adhere to and complete the 28 days treatment)
  • Adherence support is also offered to improve adherence and completion rates through counselling. 
  • Simplified prescription approaches have been continually improved upon by WHO and other partners

What is our status as a country in addressing violence against women and preventing new HIV infection?

Finally in 2015, Nigeria signed into law Violence Against Person Prohibition (VAPP) Act. However, great as this feat is, it’s only applicable in the Federal Capital Territory (FCT), Abuja. Except for a few states that have their own criminal laws reviewed like Lagos and Ekiti. Definitions of certain crimes still suffer the criminal code and of course the penal code. Many states are yet to domesticate the VAPP Act into laws.  The fight against domestic and sexual violence still has a long way to go. 

As for accessibility to PEP, Nigeria has made giant strides – Utilising and integrating into existing programmes and structure has assisted in wide availability of Post Exposure Prophylaxis (PEP), such as reaching out through Primary health care (PHC) centers, existing ARV centers and increasing rape crisis centers and sexual assault referral centers. 

Recommendations

This is everyone’s problem. It affects manpower, productivity and waste of medical resources. Thereby prevention is better than cure. Every sector is affected. Government, corporate, nollywood, entertainment, professional bodies, civil society, traditional and religious bodies have to get involved more than ever. As they make their own contributions to:

  • Massive awareness and education of the populace is highly required. 
  • Victims Funds to help women receive mental health and other psychosocial support
  • Review of laws as well as enactment of VAPP at state levels
  • More Sexual assault referral and rape crisis centers
  • Trained and equipped police force
  • Enhance multi-sectoral response to Sexual and Domestic violence
  • Owning our problem, accepting responsibility and taking steps to protection children (both girl and boy child), women and men. 

Facts are, new infections are increasing and the battle that was once thought to be a winning one is facing us like we haven’t even started. Yet, as the theme for this year states ‘Communities can make the difference.’ It behoves us as Nigerians to step back and look deep within us. With reduced funding and a shrinking space for civil society, returning to the old ways to mobilize and address the barriers hindering communities delivery of services and maintaining HIV/AIDS on the political agenda, that human rights are respected, and our decision-makers and implementers are held accountable to reduce and eliminate violence of all forms against women.

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