December 1, is designated world AIDS Day. It is a day dedicated to raising awareness on AIDS pandemic and mourning those who have died of the disease.
The theme for this year’s World AIDS Day is “Know Your Status.”
To mark the Day, a group, 4Youth by Youth, 4YBY, decided to reach out to the adolescents for creative ideas on how to promote HIV self-testing as the fastest way for people to know their status.
The brains behind the group are the Nigerian Institute of Medical Research, NIMR, St Louis University, New York University, University of North Carolina in collaboration with the Lagos State AIDS Control Agency, LSACA, ID Africa, PinPoint Media and SESH Global.
They are funded by the Eunice Shriver National Institute of Child Health and Human Development, USA.
The Next Edition (www.nextedition.com.ng) spoke to some key actors in the project on what it is all about among other issues around HIV/AIDS.
Dr. Juliet Iwelunmor, is a professor at St. Louis University, Missouri, USA, and the organiser of the youth creative contest. According to her, it is important to create advocacy and awareness about AIDS, “the idea being if we don’t continue to create advocacy people will be left behind.”
She explained further: This year’s theme is, “Know Your Status.” People may be wondering why are we still saying know your status, shouldn’t people know their status by now? You’ll be surprised that after every advocacy we’ve been doing since the beginning of World AIDS Day, most people still don’t know their status and in particular in Nigeria.
Iwelunmor noted that a lot of time has been spent talking to pregnant women and adults to know their status but not much attention has been given to the youths. “The one group left behind is our young people. We have not done enough to ensure that they too are carried along. It is not just having knowledge about HIV, which has often been what most people do; go and educate them, but we’re saying take it another step and ensure that they, who are the future of Nigeria also get to know their status now and not when they’re in problem and don’t know where to begin.”
She pointed out that though that globally, there is increased access to treatments, which are reducing the number of people seeing HIV as a death sentence. According to her, people are now living a longer and better life with HIV.
The Prof. also noted that there is now available quick prevention mechanism. “We now even have access to quick prevention mechanism, there is the PREP- the Pre-exposure prophylaxis that you can actually start using to help you ensure that you don’t become positive. There’s access to vector testing like what we’re here for; this whole idea of HIV self testing, is a new strategy that even our youth can key into it because there are not many youth-friendly HIV testing services.
“HIV testing among young people is often undermined by lack of confidentiality, stigma, discrimination, fear and low perceptions of risk, self-testing is a new strategy with the potential to overcome these challenges. It allows an individual to collect his or her own sample, perform the test and interpret the result either in private or with someone they trust.
“So what we are saying is we can finally give young people that power, that autonomy to be empowered to know their result and their status themselves without having to come and stay in long lines or queuing in health facilities,” she added.
She further disclosed that the mandate also includes linking those who are positive to care in order to suppress the virus but stressed that though the care programmes are available people don’t show up, adding, “we can’t link people to care if we don’t know their status so that’s where we are now.”
She explained that their group targets to ensure that at least 90% of all young people in the country know their status, hence the World AIDS Day HIV Self-Testing Contest.
According to her, the group received over 900 entries from young people all over Lagos, suggesting various ways to achieve a HIV free generation in Nigeria.
On the possibility of achieving a HIV free generation by 2030 she said targeting the youths is a sure way of getting there.
“Often, what happens is that the top people, researchers included, dictate what needs to happen to the youths. Now, we are working with them not just as people benefiting from us, but as our partners and our leaders to address this issue. We tap into them, into their creativity, their resources to drive the chain so that no one of them is left behind. Really, no Nigerian child deserves to have HIV given everything else that is going on. And every Nigerian child deserves to be in an AIDS free generation. It is by working with them that we will ultimately ensure that we raise that AIDS free generation that Nigeria deserves,” she said.
Dr. Oliver Ezechi, Deputy Director, Research, NIMR, another key player in project shared his thought on the programmes. “I-Test is aimed at promoting self-testing, teaching the youths how they can do the HIV test by themselves, among themselves. So we organised the contest on strategies to promote self-testing. Once we get the best strategy, we will test it and put it in research mode and see if it will work. We will be doing that until we get the best strategy because our aim is to reach 90% of youths testing for HIV in Lagos and Abuja much later,” he said
According to him, if the strategy works, they will then make a recommendation to the national programme to adopt it as the strategy among the youths.
He explained further: “The world wants to eliminate AIDS by 2030 using the 90-90-90 initiative. As a research institute, we look at where there are gaps. The only way to solve a problem is to see if you can identify the gaps and then try to close them. We have identified that with the youths there’s a gap in terms of HIV programmes that’s why we are trying to close those gaps if we must achieve the target. You know that the youths experiment a lot and have some high risk behaviours that expose them to HIV.”
He explained that after testing, those who are positive will have easy access to treatment pointing out that every general hospital in Lagos has a HIV programme. “What that means is that all of us have a HIV treatment centre within one kilometre radius to our house and we would also be sharing with them (HIV positive youths), the contacts of persons in the hospitals who will attend to them. We are trying to ensure that there is a youth-friendly person in the hospitals. We have a toll free number on for 24 hours that can direct the person to a youth-friendly person in any particular hospital,” he said.
Ezechi restated that HIV treatment in the country was free though some health facilities might charge a user fee. He was emphatic, however, that at the Nigerian Institute of Medical Research, pregnant women, the elderly and children do not pay for treatment and drugs.
On the availability and affordability of the self testing kits, he said government would determine the cost but assured it would be affordable.
Dr. Sule Omolola, Lead Advocacy & Strategy, Lagos State AIDS Control Agency, LSACA, said a lot of progress has been made within the last one year in the areas of AIDS awareness, reduction and treatment in the state.
According to her, the agency took the HIV self testing to all the nooks and crannies of the state. “We did a lot of tests for the artisans, market women, and a lot of them really came out to know their status. We also organised trainings for the Traditional Birth Attendants (TBAs) where we taught them on healthy and safe practices and how to refer pregnant women who are HIV positive to centres where they can access care. We trained them to know that they should not take deliveries of women who are HIV positive and also the importance of testing for HIV in their facilities.
“We trained counsellor testers and put them in most of the TBCs so that as pregnant women come in to register, they test them to know their status and if they are positive, they are referred to centres where they are cared for, to prevent mother-to-child transmission. That has actually helped between last year and now to reduce the prevalence rate and most people are actually coming out now to test,” she disclosed.
She explained further: “With regards to the 90-90-90 initiative, we are at 43% for the first 90. Between last year and now, we have been able to take HIV testing to about 2 million people in Lagos state and they have been able to come out to assess their tests and some positive people have been linked to care as well and are already assessing care. This would also help to improve the second 90, which is that 90% of those who know their status are actually linked to care.
“The 90-90-90 target is the global initiative of the UNAIDS launched in 2014, aimed at eradicating HIV/AIDS come the year 2030. The first 90 means that 90% of those living with HIV/AIDS should know their status. The second 90 says that out of these 90% who know their status, 90 % should be linked to care and be accessing care. That means they should be on treatment. The third 90 says that out of the 90% who are accessing care, 90% of them should have achieved viral suppression meaning that they are not able to transmit HIV/AIDS to anybody.”
Dr. Omolola pointed out that a lot of countries have achieved the target already. “Rwanda right now has achieved 98% of the first and second 90 and if Rwanda can do it, I believe Nigeria can do it.
“For Nigeria, we have not really gotten anywhere in the second 90, but I believe that we will get there, that’s why we are doing all we can, collaborating with our partners for the I-Test,” she said.
She spoke on the impact involving the youths in the programme will have on Nigeria achieving the world target on AIDS: “The youths have been left out in a lot of HIV programmes. But now that we are inculcating them in what we are doing, that will boost the first 90 and once we achieve that, we are on the road to achieving the second and third 90s.
“With the self-test kit, it’s easier for people to know their status within the four walls of their homes and nobody knows your status. We also have national toll lines, 9222. Once you know your status, you can call the number and they will answer all the questions you have about HIV/AIDS and also link you up to care. You can actually do everything yourself without anybody knowing.
“Right now, there’s a campaign going on at the national level in collaboration with UNICEF, it’s called the ‘I sabi’ HIV/AIDS campaign for the adolescents and young persons. One of the key areas of the campaign is to increase awareness of HIV/AIDS, Gender based violence, knowledge of HIV/AIDS and utilisation of condoms. So we are actually promoting all these so that they can be aware. We have been talking to secondary school students.”
Prof. Collins Airhihenbuwa, Professor of Public health, Georgia State University, in his contribution noted that it was possible to have an AIDS free generation by 2030, stressing; “but for us to achieve it, the youths have to be the ones helping to frame the solution. The way we typically address the problems that affected the youths is we design the solution and expect the youths to just adopt it. It doesn’t work that way. We topically say for Africa to grow, it has to be by Africans, for the youths to enjoy an AIDS free generation, the solution has to come from the youths.
“It doesn’t mean that the adults can not provide input and guidance, it simply means that we can’t just expect the youths to stand by and accept a solution designed that they don’t have an input in. But AIDS free generation is quite achievable.”
Prof. Airhihenbuwa noted that when it comes to HIV/AIDS, no group is seen as contributor but rather, what is looked at is how it affects them because no group created it. “This is a condition that we all find ourselves living with. It’s a question of how we develop programme that is going to benefit the youths the most because there has been child survival programme focused on the child, then we skip a whole generation and focus on the adult.
“So part of what we want to do is to say that the youth is a part of us. We all went through that process. We know that it matters to us when someone listens to us.”
He said advocacy on HIV/AIDS must continue: “The message about HIV/AIDS that we are all either infected or affected has to continue. We almost slowed down with the message in the belief that there was enough awareness. We forget that every day children are born. They are going to grow and get into that population. We can’t rely on messages that were sent out 10 years ago thinking that we have addressed the youth population. There are new people that move into that category of youths everyday so whatever information we share, it has to be intensified and sustained and that has not been the case.”