Curbing spread of HIV with youth friendly services

• Over 196,000 Adolescents are infected- UNAID
• Family Planning Will Prevent Unplanned Pregnancies, Infections- NURHI

Sixteen-year-old Oge Sampson is a pregnant teenager, who is living with the dreaded HIV virus, in the Badagry area of Lagos State. Miss Sampson found out about her status when she went for antenatal care (ANC) at the Badagry General Hospital.

“I have never done HIV test before in my life. I only did it because I was asked to do so at the General Hospital, Badagry. It was there that I found out I was HIV positive,” she told The Guardian.

Now overwhelmed by regrets, Sampson claims she was deceived into sex at 13, by a taxi driver, who was helping her out with payment of school fees. Now a school dropout who hawks groundnut, she said, “I never knew the man was HIV positive, and he never used condom when making love to me.”

Despite being sexually active at a very early age, Sampson said she never heard or knew anything about female condom or contraceptives.Her case is similar to that of 15-year-old Rita, who also became sexually active at age 13, and has even undergone an abortion.

“My boyfriend and I use to have sex frequently. So, when I got pregnant, he took me to the place where I aborted it,” she said. Now HIV positive, said she and her boyfriend never used condom, or any form of protection, or even got tested for HIV.

“I only got tested when I went for antenatal care. That was when I found out I have HIV. I learnt in school and church that sex outside marriage is a sin, but nobody told me about protecting myself with condom, or what to do to prevent pregnancy if I have sex,” she lamented.

Like the duo, millions of adolescents in the country begin sex early without any idea of what to do to avoid unplanned pregnancies or sexually transmitted infections. Recent data from the Federal Ministry of Health (FMOH), shos that about 15 per cent of Nigerian youths begin sex as early as 15 years.

Also, an estimated 23 per cent of women aged 15-19 have started childbearing, of which 17 per cent have had their first child and five per cent are pregnant with their first child, according to the Nigeria Demographic and Health Survey (NDHS, 2013).

Reports from the United Nations Children’s Fund (UNICEF) Nigeria, stipulates that this is one factor that is increasing HIV vulnerability among young people, alongside very low HIV testing rates.The report also says that the occurrence of new infections is high among young people aged 15-24 years. About 196, 000 adolescents are living with HIV/AIDS in Nigeria, a recent UNAIDS report said, adding that only 17 per cent of young people know their HIV status.

Recently, over 50 adolescents living with HIV expressed the need for standardised adolescent and youth friendly health services, and the implementation of sexual education at different platforms.They made the appeal at the end of a two-week national mentorship and leadership training programme, held at Ronik Comprehensive Secondary School Ejigbo, Lagos State, and sponsored by the United Nations Children’s Fund (UNICEF).

They also requested for a policy against pre-admission HIV testing and other forms of discrimination against adolescents seeking admission into tertiary institutions, just as they appealed to the Federal Government and all stakeholders to facilitate free, comprehensive HIV treatment without any user fees, for adolescents and young people in all government-owned sites across the country.

Similarly, the Action Health Incorporated (AHI), a non-governmental organisation focused on improving the health of youths, said part of the reason why youths engage in risky sexual behaviours is the lack of information on sexual and reproductive health.

It added that one way this can be addressed is through youth friendly health services, especially at the primary healthcare facilities.According to AHI representative, Mrs. Funsho Bukoye: “Risky sexual behaviours among young people is escalating especially in Lagos State with population of over 20 million people, of which at least 30 per cent are young people aged 10-24 years.  Young people, especially those who are sexually active need access to a variety of reproductive health and HIV services as well as, counseling,” she said.

She pointed out that some youths often avoid using health facilities because of inconvenient hours or location, unfriendly staff, and lack of privacy and confidentiality. Since many young people avoid using these services, she explained that special efforts must be made to attract, serve, and retain young clients, “which is why we have initiated a training programme for health workers in Lagos State on youth friendly services. So far, about 60 healthcare providers from Yaba and Somolu/Bariga local council development areas (LCDA), comprising ward health committee members and health workers, were trained by AHI on youth friendly services,” she noted.

The health workers were also trained on family planning devices and services.One of the health workers trained, Dr. Owoyele Iwasiu, who is the medical officer of Health Bariga LCDA, said youths are faced with so many social health problems hence the need for the training. “Health workers are expected to go back to their respective areas, make changes and integrate this learning in order to make a positive impact in the lives of these youths,” he said.

Fagbemi Titilayo, a nurse with Bariga LCDA, who is in agreement with this, said she has learnt and been exposed to better ways of managing adolescents.“Adolescents are peculiar; they need to be handled in a different manner from adults. At that age, they learn different things from the Internet and friends. So, we need to counsel them about the things they do as they need to know more about their reproductive health. Based on this, we need to relate with them in a way that they can confide in us. For those that are HIV positive among them, you have to make them confide in you; counsel them; manage them; and educate them especially on their medication and the need to take it. I have learnt a lot from this training”, she said.

At the General Hospital Badagry, the Medical and Evaluation Officer (M&E), Jatula Oluwaseyi, described youth friendly services as a new initiative that is just being inculcated into HIV services.

“Before now, all clients were viewed and treated the same way. But now, there is an understanding of the special needs of adolescents,” he said, adding that there’s always counseling and sexual reproductive services at the facility, which can be accessed by the youths any time.

Meanwhile, the Lagos State Team Leader for Nigerian Urban Reproductive Health Initiative, NURHI-2 Project, Dr. Edun Omasanjuwa, has said that family planning knowledge will help prevent unplanned pregnancies, which will in turn reduce maternal deaths and other complications from abortion.

Dr. Edun while speaking during a recent family planning workshop in collaboration with Development Communications Network (DEVCOMS) in Lagos, said there was need to talk more about family planning. Although healthcare providers often do not discuss family planning with adolescents without their parents consent, experts feel that young mothers, who are already having children, or pregnant should be counseled on family planning.

Where family planning becomes a social norm in our community, then everybody is free to talk about it publicly, misconception about family planning are resolved, and Contraceptive Prevalence Rate (CPR) will rise, and at the end of the day, a better family planning will result in improved quality living,” he said.

Evidence from NDHS show that only 15 per cent of Nigerian women particularly those of reproductive age (15 to 49 years) use any method around the country, and only 10 per cent of these women use modern family planning methods. This leaves out 16 per cent of women who want to avoid pregnancy but are not using an effective method of contraception.

“Even though many women are aware of modern family planning methods, religion, culture and misconceptions hinder them from accessing the services,” said Dr. Omasanjuwa.A survey carried out in Lagos in 2015 tagged PMA2014/Lagos, found that over 67 per cent of women in the state are not accessing family planning services in public and private health facilities due to issues of acceptability, accessibility and affordability, as well as, poor state of health facility, “which is why we came up with the 72-Hour Clinic Makeover in some facilities in Lagos State, to ensure that the status of health facilities and utilisation, in relation to family planning is improved. Research has shown that family planning reduces maternal mortality by about 30 to 40 per cent. So for every 10 women that normally would have died of complication of pregnancy, family planning stands or provides opportunity to prevent three to four of those women from dying. So, people need to be aware that family planning is good for them; for the society, and not just the woman.”