Case for support

Several studies have shown a high prevalence of HIV/AIDS (3.6%) in Nigeria translating to 2.32million Nigerians living with AIDS, with over 50% in rural communities. Probable factors include cultural and social values, risky sexual behaviors, gender inequality, and poor access to healthcare services. Consequently, this leads to increase in maternal/child mortality, incidence/prevalence of HIV/STI among at risk persons, and infringement on the right to health.

We see a Nigeria where quality health care is available, affordable and accessible; where patients are treated with dignity and their human rights respected. At CRH, we advocate for the right to health, provide service delivery and promote respect and ethics among vulnerable populations. Our innovative programs has changed women’s lives in the community, advocated for policy changes affecting women’s access to health, upgrade of primary health care centers. Our innovative programs have put smiles on the faces of women and children in rural communities. Now, women and girls in these communities have access to free quality health care delivery through our Health On Wheels. Also we have provided activities that advance their sexual reproductive health and rights. In mitigating the burden of HIV/AIDS, we have scale up uptake of HIV Counseling and Testing among vulnerable groups, and referred HIV positive clients to ART centers and support groups. In communities and across several vulnerable groups we continuously provide intervention activities, advocate for the right to health as a fundamental human right and defend cases on human right violations.

With increased support, we would increase women’s access to reproductive healthcare services, contribute in reducing the vulnerability of at risk persons to HIV/STI, and advocate for policies that support the right to health. We would continuously strengthen the capacity of healthcare providers’ to improve delivery of services and advocate for the transformation of primary healthcare centers to improve access to affordable, accessible and available healthcare services.

You can be part of our work in changing lives through making a donation, leaving a legacy, contributing to our endowment, referrals to funding organizations, and providing In-kind resources.

Health On Wheels.....a mobile health clinic

In developing countries like ours, men are generally regarded as ‘better’ and stronger than women due to socio-cultural and economic issues which ultimately makes them vulnerable and marginalized. This predisposes the women to various economic challenges, diseases and gender inequality.

In our more than eight years of existence, we have found out that health care services and care rural particularly Women, are a herculean task. To turn this around the Center embarked on “health on wheel”, a project that provides health services and education to the rural poor via a mobile clinic. The health on wheels delivers free health care services to vulnerable groups in rural communities. This innovative idea aims to bridge the gap of access, affordability, and availability especially for pro poor and vulnerable groups across rural communities in Nigeria. Thus this project provides free HIV counseling and testing (HCT), referrals to ART centers for positive clients, syndromic management of STIs, health educations, provision of information while serving as outlets for condoms and lubricants. Our unique facility has a medical doctor, nurse, and trained HCT counselors.

With an inbuilt arena for showing documentaries on HIV/AIDS, canopy for focus group discussion, and a bed for medical consultation, we have provided quality healthcare services to women, men, girls and boys in several communities in Abuja, and Lagos state.

Baseline research on Assessing the burden of HIV/AIDS among Men who have Sex with Men (MSM) in Abuja

Ignorance about the extent of male-male sex has led to relative lack of MSM programming. In the past, HIV/AIDS prevention programming in Nigeria has often concentrated on heterosexual sex and minimal public health efforts have focused on homosexual transmission. Many men see sex with women as being an HIV/AIDS risk and male-male sex as a safer option. Also, Criminalisation of male-male sex, Cultural and religious factors have led to the denial of male to male sex which increases their vulnerability.

The rationale behind the research was that many African countries do not acknowledge the existence of MSM and have little HIV prevention programming targeting MSM in Nigeria. Also, the main problem is not much is known about MSM in Nigeria. With funding from amfAR, CRH carried out a baseline study of MSM in Abuja with a view to unearth their HIV burden and challenges faced. The overall goal of the project was to carry out a baseline research to identify the magnitude of HIV burden and challenges faced by MSM in Abuja, Nigeria.

The research serves as a baseline to generate information on the HIV prevalence among MSM in Abuja, allow for policy formulation and further research in mitigating the HIV/AIDS burden among MSM. It is worthy to note that the research provides issues and recommendation based on a public health approach and human right angle. It also serves as a tool for policy formulation and implementation on access of the basic fundamental right to health. This research and advocacy tool provide insights on programmatic activities and interventions in mitigating the HIV/AIDS burden, while providing in-depth analysis on behavioral, sexual and human rights violations among MSM. The project revealed the MSM population is hidden due to several factors and the easiest way to provide information is through peers, influencers, networks and parties.

For a more detailed report on the research, please go to www.crhonline.org

A comprehensive approach to HIV prevention

With funding from the Society for Family Health (SFH), CRH is adopting a comprehensive integrated approach to HIV prevention and care in Shomolu, Lagos state. The goal of the program is to create, strengthen and support the adoption of healthy reproductive and HIV Prevention behavior among the poor and Most At Risk Populations. Our target beneficiaries include MARPs: Female and Male Out of School Youths, Transport workers, Female Commercial Sex Workers and Uniformed service Men.

So far this project has an interesting journey from June 2009 with a one week training at Ota, Ogun state to familiarize program and account staff on the project activities. to a retreat recently held in Osun in October 2009 to share our progress reports. The project adopts several intensive activities to increase behavior conducive to the prevention of HIV/STI transmission among MARPs. By creating an enabling environment for MARPs, we intend to reduce stigma and discrimination through sensitization talks on HIV and health education while increasing the uptake of HIV Counseling and Testing. Beyond this approach, we would also maximize opportunities with our Health on Wheels to provide free health care delivery to pro poor persons in our target community.

At the end of the project, we would have contributed to the reduction of HIV/AIDS in Nigeria through peer education activities, community role plays/dramas/forums, increase uptake of HCT, refer HIV positive persons to ART centers, and creation of community based organisations.

The hidden community

Twenty five years after the first identification of AIDS in Nigeria, there have been few studies on HIV transmission and male-male anal sex. This gap in knowledge has left men and women vulnerable to HIV transmission. Men who have sex with men (MSM) are "one of the high-risk groups vulnerable" to HIV transmission and the cultural and religious factors that lead to the denial of male-to-male sex increases their vulnerability. The criminalization and stigma associated with homosexuality inhibit most men from identifying themselves as gay or bisexual, even though they have sex with other men. Some men who have sex with men and with women don’t identify themselves as gay or bisexual. This results to high prevalence in STIs/HIV/AIDS and hindered access to health care services and treatment options. The main focus has always been on preventing the spread of the HIV virus through heterosexual relationships and MSM are usually forgotten when it comes to AIDS awareness campaigns, educational programme and impact mitigation. They therefore lack information on the risks involved in unprotected sex and how to protect themselves from HIV infection. Thus, reaching out to these ‘hidden community’ and educating them about HIV/AIDS and safer sex is crucial in the fight of AIDS.

Recent studies from Africa and other developing countries shown surging rates of HIV infection among MSM where denial of male-male sex continue to fuel the HIV epidemic. Criminalization, Cultural and religious factors have continuously led an increasing vulnerability of HIV to MSM. Health authorities and institutions had always believed that HIV transmission was mainly through heterosexual transmission. The fact that homosexuality is widely ignored in Nigeria is having a negative impact on the spread of AIDS in the country. There is an urgent need to address all aspects of the HIV/AIDS pandemic without prejudice of social groups.

In an effort to stem the reduction of HIV among MSM, a non profit, non governmental organization Center for the Right to Health based in Nigeria carried out a baseline research to assess the burden of HIV/AIDS in Nigeria’s capital, Abuja. The cornerstone of the project is to provide MSM with HIV Counseling and Testing (HCT), peer education, syndromic management of sexually transmitted infections (STIs), Condom and other prevention (C&OP) messages. The research showed a high prevalence (38%)[1] of HIV/AIDS among MSM. This prevalence is higher than the national average (3.6%) of Nigeria[2] and prevalence of HIV/AIDS among MSM in Lagos state (25%)[3]. There has also been low access to health care services due to fear of stigmatization as result of criminalization of homosexuality in Nigeria. Gradually this yields resistant STIs that further predispose them to higher risk of HIV/AIDS as result of wounds. Affordability and accessibility are factors that play key roles in usage of condom and lubricants. Innovativeness has come to play to substitute expensive lubricants with water, soap, vegetable oil and Vaseline. This comes in handy when lubricants are not accessible and even when accessible not affordable.

Impact mitigation in HIV programming goes beyond heterosexual transmission. Evidence based research provided by the Center for the Right to Health has shown a dire need to advocate for increased access to health care interventions and HIV/STI programming and providing access to accurate information on safer sex and preventing HIV/AIDS. Providing HIV/AIDS education and distribution of condoms/lubricants alone may not be sufficient unless an enabling environment is created for integrated care and support.

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[1] Center for the Right to Health (CRH), Assessing the burden of HIV/AIDS among Men who have Sex with Men iin Abuja, Nigeria. 2009

[2] National HIV/AIDS & Reproductive Health Survey (NARHS), 2007

[3] HIV/STI Integrated Biological and Behavioral Surveillance Survey (IBBSS), 2007