Spending World AIDS Day in Saki, Oyo State, in Nigeria came with a lot of revelation, reflection and inspiration for me. The event provided an opportunity to think through how relevant the World AIDS day theme was to the people of Saki. The local leadership commitment was an inspiration and provided a rare opportunity to work in this community.
Saki is a very poor area within Oyo State, which borders Benin, and is classified as a hard to reach area, home to around 600,000 inhabitants, mostly Muslim farmers. The region also hosts some nomadic populations from Northern Nigeria. To mark the day, New Initiative for the Enhancement of Life and Health (NELAH) – in partnership with the Local Government Action for the Control of AIDS, Warangari Ward Primary Health Centre (PHC), Keen & Reach Foundation and NELAH Short Stay Centre – organised a community campaign on prevention of parent to child transmission (PPTCT) in Warangari, one of 12 wards within Saki.
The event was in line with the overall World AIDS Day theme of ‘Getting to Zero’ and the focus on the elimination of vertical transmission of HIV particularly resonates with NELAH’s project on Community-based Interventions to Prevent Parent to Child Transmission of HIV in Oyo State, Nigeria (CIPON) which is funded by the Swedish International Development Cooperation Agency (SIDA) through the Alliance’s Africa Regional Programme.
Nigeria is one of 22 focus countries in the global plan to eliminate new infections among children by 2015 and keep their mothers alive and healthy. According to the most recent UNAIDS Global Report on the Epidemic, Nigeria is among the eleven countries which have reported a modest decline of 0-19 % in the number of children newly infected with HIV since 2009. This calls for more efforts if Nigeria is to be on a par with other countries that have recorded much higher decreases in the number of new infections among children.
The day started early at Saki General Hospital where NELAH demonstrated its prowess by mounting a serious community mobilisation session. They had put together a community drama group to act out messages on PPTCT and had hired a truck with a public address system to accompany the entourage to Warangari. Despite the music and the entertainment by the drama group, I could not fail to notice the tough terrain and the poor road conditions. People have to travel long distances to access health centres and schools which explains why it is classified as a hard to reach area and the limited number of service providers targeting this community.
Before entering Warangari, we paid a courtesy call to the Chief, Lateef Abdulahi, and the council of elders who gave us a warm welcome to the community as well as blessing the NELAH project. This experience underscores the importance of the role of community leaders’ participation in programming and of consulting with them before the inception of a project.
The chief was first to take the HIV counselling and testing, followed by the council of elders and the rest of the community. Within the span of three hours, 110 people were tested and counselled for HIV. Two tested positive and they will be accompanied to Saki General Hospital for more care and support.
By the Chief volunteering to take the test first, the villagers were convinced that this was a noble thing to do. This was leadership and male participation in prevention of parent to child transmission in action. Facilitated by the Local Government Action for the Control of AIDS, this partnership is crucial as access to HIV counselling and testing has been identified as one of the major barriers to accessing PPTCT. It also reinforces the relationship between NELAH, the government and service providers.
The drama group, through peer educators, were busy mobilising more people for testing while at the same time communicating messages on HIV prevention and demonstrating the correct and consistent use of condoms, followed by condom distribution.
I could not help noticing the presence of young girls carrying babies or who were pregnant; some of the mothers looked as young as 14. My colleague noticed how young they were to the extent that they were not mature enough to breast feed, and as such their babies were thin and did not look healthy. For this population, exclusive breast feeding is a major challenge. When one of the babies cried, her grandmother who looked to only be in her late 20s was quick to give her water because the mother looked very unsure what to do.
From this, it was clear that NELAH has a lot of work to do educating the women on the importance of breast feeding and also providing adequate information on family planning and family nutrition. A subsequent discussion with, Abbas Baabatunde, project officer with NELAH, confirmed the challenges in the community, particularly as most marriages are polygamous. He pointed out that they were still considering the best strategy to reach young mothers and hoped that this would be achieved through the different services in the project.
The day demonstrated the value of community mobilisation when it comes to prevention of parent to child transmission, the importance of partnership with other organisations including public health structures, and how the community can play a role in executing the four prongs of PPTCT. Messages on family planning and the prevention of unintended pregnancies among women were also disseminated as well as information on prevention of HIV transmission from women living with HIV to their children and access to treatment among people living with HIV.