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.
