Mr. Francis Umoh is the Programme Manager, Positive Action for Treatment Access (PATA), Lagos who was in charge of a two-week national mentorship and leadership training programme for Adolescents Living with HIV in Nigeria (ALHIV) with the support of UNICEF in collaboration with the Lagos State AIDS Control Agency (LSACA). In an interview with CHIOMA UMEHA, Umoh discusses the purpose of the just-ended vacation training and how about 196,000 Nigerian adolescents living with HIV can have improved health and quality of life. Excerpts:
Can you give details of the just-ended national mentorship and leadership training programme for Adolescents Living with HIV in Nigeria (ALHIV) organized by PATA?
The event promotes access to HIV treatment education, care and services; advocate for access to affordable, qualitative diagnostic and monitoring tests, drugs and commodities to treat HIV and its attendant problems. Our youth mentorship and leadership programme is for adolescents aged between 10 and 19 living with HIV. It is usually a summer programme and is done during their long vacation. The idea is to bring together adolescents from different states, to promote team bonding. This programme enables them meet with other peers from other states, share experiences and bond as a group. We also seized the opportunity to educate them on sexual reproductive health issues. They were supposed to be 54 from seven states, but, we had 50 adolescents from Kaduna, Federal Capital Territory, Abuja, Akwa Ibom, Benue, Anambra and Lagos in this year’s event. One of the states was unavoidable absent. We also had their care-givers with them; the aim was to ensure that they take their drugs.
Are these adolescents aware of their status?
Most of them are, but not all of them are aware of their status, because not all of them got it from their parents. Some may be positive, but their parents will not tell them. However, part of the criteria for this programme is – knowing your HIV status, because at the camp we mention issues of HIV openly and we don’t want anybody to be embarrassed. But, they are not openly positive because we maintain issues of confidentiality.
What are the challenges of adolescents living with HIV?
One of their challenges is the issue of access to treatment. The drugs are there,though, sometimes we have isolated cases of stock out at the clinic. However, the adolescents lack access to available drugs. Also,we see cases of stigmatisation, for instance, we have seen cases where the children were denied admission because of their status. We have some that have been thrown out of their house because of their status. In some cases, their parents are dead and their relatives tried to take them in, but when they discovered their status, they threw them away.
In PATA, we have home for this type of cases called ‘Mary’s Home’, named after the first adolescent diagnosed with HIV. We have about five adolescents living in the home right now. The home caters for their accommodation, feeding, health and other needs, and ensures that they can live a normal life. So stigma is still strong in Nigeria. The next issue is that of limited access to information on sexual reproductive health and HIV. We did a research some years ago and we found out that many adolescents with HIV have poor knowledge of HIV compared to their negative peers, so some of them don’t have basic information. Also, some of them experience sexual urge, so they need capacity building on issues of sexuality and reproductive health.They also need information on their future careers, so these are some of the issues.
What are the ways to reach out to the unidentified adolescents living with HIV?
Part of the campaign going on is to promote HIV testing and uptake for adolescents. It is only when you test that you can know if the person is positive or negative, so there is a serious campaign to promote testing and then uptake of service for the positive ones. Right now the whole world is talking about 90-90- 90 treatment target by year 2020, and HIV-free generation by 2030. For us to achieve that, about 20 million have to be tested, the 20 million diagnosed people have to be on drugs and the 20 million on drugs should have a suppressed viral load. So for Nigeria to achieve this global target there must be massive HIV testing and uptake for adolescents. The only way to do this is to go out to these adolescents, not expect them to come to you. Most importantly, when they are tested positive, they need to be provided with treatment.
How do you go about the issue of follow-up?
During testing and counselling, of course their basic data are collected and they are linked to service, but, one challenge they have is transiting from paediatric to adult care. This is still a big issue. In Nigeria, once you are 15, you transit to adult clinic but, you know at 15 the child is not yet a full adult. So you have a case of children that is used to paediatric clinic, and instead of transiting the child to adolescent clinic, you move the child straight to adult. This sometimes causes loss to follow-up, because when they get there and see only adults, they get scared and leave. One way to solve this is to have a day or time set aside to attend to the adolescents; there should be that platform for adolescents. On our part, we have tried to solve this case by peer mentorship where the peers counsel their peers on transitioning. Also, we have issue of poor attitude of caregivers. Though, this is improving, but, the caregivers need to know that an adolescent might not react the way an adult does, so you have to be patient with them.
Does poverty affect access to treatment?
Although treatment is free, poverty indirectly affects uptake of treatment, but, this is also related to stigma and discrimination. We have situation where clients have a treatment Centre close to them, but, because of fear of stigma, they go to a far treatment centre. In this case transport fare becomes an issue. Also, when we talk about comprehensive access to treatment, it goes beyond having drugs; you have to have a lab test done, checkups including, viral loads and even nutrition. So, all these involve money. If you are taking your drugs and you are not eating well or in school, this affects the children psychologically. So, yes poverty is still an issue.
Do you think Nigeria is having more cases of adolescents with HIV?
Yes it is increasing. As at 2014, according to UNICEF, 160,000 adolescents aged between 10 and19 were living with HIV/AIDS in Nigeria, in 2013 about 11,000 died, while 17,000 were infected. Although, the issue of mother to child infection is being checked, sometimes, you see some women accessing antenatal care, but when they want to deliver, they drop out and go to a Traditional Birth Attendant (TBA) this leads to more mother-to-child infection. Nigeria needs to improve on our accountability and transparency in implementing the programme, so that service gets down to the people that matter. There is also need for capacity building for adolescents and service-friendly services.