Field Note

Prevent HIV/AIDS among Young Adults?
Involve them from the Start

By Remy Chukwunyere, Executive Director, African Youth Development Foundation, Nigeria

The HIV epidemic in Nigeria is complex and varies widely by region. In some states, it is more concentrated and driven by high-risk groups, while others have more generalized epidemics sustained primarily by multiple sexual partners in the general population.

Currently, the total HIV infections in Nigeria are about 4 million, with more than 200,000 new AIDS cases and 184,000 AIDS deaths already recorded in 2007. Nigeria has about 1.8 million children orphaned by AIDS.

Youth and young adults in Nigeria are particularly vulnerable to HIV. Although information about the number and percentage of youths who have died of AIDS is not available, 2005 estimates from the National HIV/Syphilis Sero prevalence Sentinel Survey by the Federal Ministry of Health indicate an HIV prevalence rate ranging from 3.6 percent to 4.9 percent among people, aged 15-35.

Nigeria Slow to Respond
Since the onset of the epidemic in 1985, Nigeria has been slow to respond. The nearly 30 years of military rule and its legacy - a slow transition to democracy, a weak civil society and a private sector uninterested in public health - have all contributed.

The epidemic has devastated families in Nigeria emotionally, socially and financially. They must bear the psychic costs associated with the illness and death of a family member, the breakdown in family structure, and the stigma associated with HIV. The epidemic and its associated morbidity and mortality rates carry a number of implications, such as reduced non-health consumption expenditures among household members.

Data on the economic impact of HIV/AIDS on Nigeria are limited. But a recently developed model has predicted that the rate of impact on economic growth is potentially larger than that in sub-Saharan Africa. Recent health studies demonstrate that the cost of a fully scaled-up care and prevention program would be as high as US$2 to US$3 per capita or approximately 0.8 percent of GDP. Projections show that if HIV prevalence continues to grow, by 2015, the amount spent on AIDS alone could reach 35 to 45 percent of the health budget.

Young Adults at the Center
Our generation (15-40 years) is being described as the AIDS generation, since we young people have never had a world without the epidemic. It is members of this age group, who are at their most productive age and constitute the major work force in Nigeria. And it is this age group that suffers a major impact, including loss of jobs, denial of admission into some universities, marriage breakups, and denial of participation in politics and other social activities.

The case of Jegede-Ekpe, a nurse, is a typical example. When she publicly declared her HIV status, members of her choir asked her to stop singing with them. The principal of her nursing school tried to expel her and her fellow students shunned her. Another example was the compulsory HIV and pregnancy tests initiated by the Covenant University, Ota in Nigeria, although this recently has been resolved following government and civil society action.

The impact of HIV infection among young girls is the worst. They are not given in marriage. They drop out of schools, and are allowed to die as a way of punishing them for their 'promiscuity.' Where one family member dies of AIDS, another is left with the burden of providing for the needs of the children alone, with little or no assistance from relations because they know the cause of death and fear infection.

Young people face not only the normal challenges of growing into adulthood but peer pressures as well, which may lead them into risky behaviors such as drug and alcohol use, sexual promiscuity, cultism, etc, which indirectly fuel the spread of HIV.

Despite their high level of awareness about HIV/ AIDS in Nigeria, new infections continue to rise among youth, indicating that knowledge does not translate into action - or behavior change. The physical, psychological and social attributes of young people make them particularly vulnerable to HIV and other STIs. Most of the time, they are not able to comprehend fully the extent of their exposure to risk. Our society further compounds this risk by making it difficult for them to learn about HIV/AIDS and sexual reproductive health. Many youths are socially inexperienced and, therefore, depend on others. Peer pressures easily influence them, often in ways that increase their risks to HIV infection.

Moreover, the epidemic among us has remained largely invisible to our political leaders and to ourselves. HIV infection is invisible to youths because they often carry the virus for years without knowing they are infected. As young people, we are yet to come to terms with the fact that "HIV no dey show for face!" Some of us still incorrectly measure one's HIV status on the physical appearance and freshness of the body. The fear of testing for HIV scares some of us and when tested positive, we hide the results out of shame and fear of discrimination.

For young people to gain critical prevention skills, they need to be at the forefront of every HIV prevention effort - that is to be actively engaged in the design and planning of behavior change communications. But the involvement of youth in HIV prevention efforts is minimal in Nigeria. Youths are not policy makers, nor do they contribute to making policies that affect their lives. They are only at the receiving end. The consequence of this lack of involvement is the design and implementation of HIV and other health programs that are unfriendly to youth, who are worst hit by the epidemic.

The earlier youth are seen as critical stakeholders and engaged in the planning and execution of efforts directed toward them, the better for all of us. If they are properly guided and their synergies harnessed, youth groups all over the world will make the greatest impact in the struggle to stop HIV infections.

Youth Takes the Lead
The African Youth Development Foundation (AFRYDEF) is a Nigerian NGO established in 1999 to cost-effectively empower young people, women and children to choose a better future for themselves in a society that enables positive changes through facilitating sustainable youth and rural development initiatives in Africa. We in AFRYDEF envision such a society where youths, women and children are viewed as assets and encouraged to develop their potentials.

Young people have always been the primary target of our projects, be it in peace building, conflict resolution, poverty reduction or HIV/AIDS programming. As future leaders of society, young people need to be fully informed and empowered before that responsibility falls on them. As upcoming leaders, they are already faced with enormous life challenges, which if not properly met may cause long- lasting negative consequences.

In the past, we launched a "Testing 4 Life" campaign, which sensitized young people to the importance of testing. This campaign was predicated on the importance of early detection in HIV/AIDS treatment and care. We encouraged and provided young people with voluntary HIV counseling and testing and referred HIV-positive youths to the Network of People Living with HIV/AIDS for easy access to ARV drugs and other care services.

This year, we also celebrated the Global Week of Action on AIDS in Owerri from May 20-27. Coincidentally, the weeklong event was kicked off with the Candlelight Memorial on May 20. To mark the week, we organized a street rally, held street interviews, conducted poster campaigns, and the week was wrapped up with a press briefing where we presented the Nigerian Charter of Demands to the state government officials.

The Charter of Demands was jointly prepared by a Coalition of NGOs formed and supported by ActionAid International, Abuja, Nigeria. The document contained demands to the government at all levels to guarantee Nigerians universal access to HIV/AIDS treatment, care and support by 2010. It also reminded the government of its Abuja declaration - a promise to allocate 15 percent of the national budget to the health sector.

The week was a success possibly because we utilized the "street rally" strategy, of mobilizing our audience - which is attractive to young people. We would not have succeeded if we had organized what I call a "closed program," where the adverts for the programs are only aired on radio and television. In Nigeria, if you really want to reach your target audience, you need to go on the street.

Voices that Care! was a follow up to the 2007 International AIDS Candlelight Memorial and the Global Week of Action to get the support of political and religious leaders and to ask the government officials to be committed and respond to the critical issues raised during the two events.

Voices that Care! was held in a university environment and was strategically designed to educate young people about HIV prevention, treatment, care and support using entertainment. In particular, the project used the power of art, drama and music in delivering HIV/AIDS prevention messages to students. HIV/AIDS prevention messages such as condom use, sexual activity and risk- taking were built into drama and songs and then presented to the audience. We used this strategy because important messages are youth-friendly and easily communicated to them.

The target audience, youths themselves participated in every aspect of the program, from planning to execution. AFRYDEF provided the technical and logistical supports and assisted the coalition in designing and implementing the project. We facilitated several needs assessments and consultation meetings, fundraising activities and other such activities that led to the success of the event.

The goals of the Voices that Care! project were numerous, ranging from teaching risk-avoidance skills and discouraging sharing of needles, piercing instruments, blood engagements and oath-taking among cultists, to forming HIV/AIDS support groups on campuses.

So far, some results have indicated that we met many of our expectations. Condom use and delayed sexual debut among students not yet sexually active have increased, as have the number of students who know their HIV status, and the number HIV/AIDS services centers on campuses.

Where used, it is clear that involving young people in peer education and the design and planning of behavior change communication programs is the best, if not the only way to empower them. When youths take part in developing social and group norms that protect against HIV infection, they serve as positive role models for their peers. To better serve youth, health-care providers must do more to make them feel comfortable. Services, including STI treatment, VCT and referrals should be provided confidentially. Even small declines in HIV/AIDS prevalence among youth that are showing up in some countries are the best evidence to support the conviction that they must be at the center of all strategies and programs targeting them.

For further information contact: afrydef@yahoo.com

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