YOUNG PEOPLE AT RISK OF HIV/AIDS IN
EDO STATE: WHAT SHOULD WE DO?
BY
Professor Emeritus
Andrew G. Onokerhoraye,
Executive Director: Centre For Population and
Environmental Development (CPED)Benin City
Outline of the presentation
• Introduction
• The Challenge and Experiences of HIV Prevention
among Youth
• Implications for the reduction of the vulnerability
of young people to HIV/AIDS
• Strategies for Targeting Young people on HIV
prevention
• Perspectives on youth and HIV Prevention in Nigeria
• Youth and HIV Prevention in Edo State
• Some Outcomes of the Action Research
• Some Policy Recommendations
• Summary and Conclusion
Introduction
• According to Joint United Nations Programme on HIV
and AIDS (UNAIDS), there were an estimated 33.3
million people living with HIV in the world in 2009
compared with 26.2 million in 1999, a 27% increase over
the ten year period.
• The annual number of new HIV infections was
2.6 million and overall, 1.7 million people died
of AIDS in 2009.
• Despite the recent efforts, the number of
people living with HIV continues to grow in
sub-Saharan Africa, just as the number of
deaths due to AIDS is also growing.
• Sub-Saharan Africa still bears the greatest share
of the global HIV burden.
• In 2009, that number reached 22.5 million,
68% of the global total.
• However, while the rate of new HIV infections
has decreased, the total number of people
living with HIV continues to rise.
• The negative impact of the HIV/AIDS epidemic
has been a major challenge to developing
countries in general and sub-Saharan Africa
(SSA) in particular.
•
In recent years, promising developments have
taken place in global efforts to address the AIDS
epidemic such as increased access to effective
treatment and increased preventive programmes
•
Youth are defined by the United Nations as people
between the ages of 15-24.
•
Young people aged 15-25 account for 45% of new
cases of HIV infection worldwide.
•
Most of the people infected with HIV/AIDS in subSaharan Africa are within the age bracket of 15 to
35 years.
• It has been estimated that 80% of the infected
group are aged 20-29 years.
• Youth and young adults are therefore a
vulnerable group susceptible to HIV infection.
• The youth is the main work force and potential
leaders of any nation.
• Through its impacts on the labour force,
households and enterprises, AIDS has played a
significant role in slowing down or reversing of
human development in sub-Saharan Africa.
The Challenge and Experiences of
HIV Prevention Among the Youth
• Nearly half the world’s population is under the
age 25, with two thirds of all young people
living in sub-Saharan Africa.
• UNAIDS, estimates that 45 per cent of the 2.6
million new HIV infections in 2009 occurred in
youth of 15-24 years of age.
• Due to social, cultural, economic and biological
reasons, young people are particularly
vulnerable to HIV.
• Young people are more likely to experiment
with dangerous behaviours that favour
HIV/AIDS transmission.
• Young people’s risky behaviours that encourage
HIV transmission include:
a)
Early engagement in pre-marital sexual
relationships,
b) Keeping of multiple sexual partners, drug
abuse and
c) Engaging in sex for money.
• Globally 25% of those living with HIV are under
the age of 25.
• One third of women who are HIV infected are
between the 15-24 years of age.
• In sub-Saharan Africa, youth aged 15-24
constitute between 20 and 25 per cent of the
population.
Implications For the Reduction of
The Vulnerability of Young People
to HIV/AIDS
• Global goals to reduce vulnerability and
prevent HIV in young people highlight the
growing consensus that HIV prevention efforts
must include a focus on young people.
• This has generated considerable interest in the
promotion of HIV prevention among young
people.
• However, in spite of recent calls for increased
attention to the high levels of HIV transmission
to youth, little scientific consensus exists about
how best to prevent HIV infection among them.
• In countries where HIV prevalence has declined
at the population level, sexual behaviour
change among young people has been cited as
an important contributing factor.
• It has been argued that the disease can be
tackled effectively by transforming the social
environment of the youth
• This entails encouraging young people to form
positive relationships between themselves and
their peers, parents, teachers, religious groups
and health services that will contribute to the
prevention of the spread of HIV among the
youth.
•
This is the major way in which young people
can acquire the right type of knowledge, life
skills, and attitude.
• It is only when concerted efforts are directed
towards increasing the knowledge base of youth
on reproductive health issues that the rapid
spread of HIV can be reversed.
Strategies for Targeting Young
People on HIV Prevention
• An examination of experiences across the world
shows that there are key unanswered questions
regarding how to achieve and sustain the
individual-level behavioural changes needed to
reduce HIV incidence among the youth.
• Three major types of interventions in the
context of Nigeria and indeed sub-Sharan Africa
can be identified.
• The first focuses on schools which are regarded
as the most appropriate setting for targeted HIV
prevention intervention in young people.
• Schools play a significant role in HIV prevention
among young people, both while they are
within the young person’s age group (10-24
years) and thereafter.
•
A considerable number of interventions in
schools show that this type of intervention can
be effective at increasing sexual and
reproductive health knowledge.
• The second type of intervention to prevent HIV
among youth focuses on improving health
services which play a vital role in the
prevention, care and treatment of HIV/AIDS in
young people.
• Access to high-quality health care is a basic aim
of all national health services.
• There is now strong evidence of the potential
efficacy of several HIV prevention interventions
that can be delivered by health services, such
as:
i. male circumcision,
ii. condom use, and
iii. possibly HIV testing and couselling.
• However, these specific interventions cannot
have any direct population-level effect on the
HIV epidemic among young people unless they
are made accessible and acceptable to, and
therefore used by, young people.
• The most common type of interventions
reported in the literature focus on training
service providers, including taking actions to
make the improved health facility more youthfriendly as well as activities in the community
to link or refer young people to health
services.
• The third type of interventions focuses on
geographically-defined communities or what
can be described as community-based
interventions.
• Community level interventions have the
potential to change established norms, values
and traditions that may impede HIV prevention
and care.
• In addition, community-based interventions
may increase the support young people need,
and increase access to necessary information
and services.
• Despite their potential, community-based
interventions face a number of challenges,
including
i.
the inherent difficulty in changing established
norms,
ii. community diversity, sustainability and
iii. difficulty with monitoring and evaluation of these
interventions.
• Interventions
in
geographically-defined
communities can be categorized into two broad
categoiries;
.
• Those that focus on providing information, skills
building and behavior change targeting young
people; and
• Those that target the entire community in which
various traditional kinship networks and community
activities are used to deliver the intervention
Perspectives on Youth and HIV
Prevention in Nigeria
• A key component of the present policy
framework in Nigeria in terms of containing the
spread of HIV/AIDS relates to reaching at least
80 percent of sexually active most at-risk adults
with HIV counseling.
• The young persons in different parts of the
country fall in this category of people that need
to be reached.
•
It is only when concerted efforts are directed towards
increasing the knowledge base of youth on sexual and
reproductive health (SRH) issues that the rapid spread
of HIV can be reversed.
•
A primary reason for targeting young persons with
sexuality education is the fact that adolescents reach
sexual maturity before they develop mental/emotional
maturity and the social skills needed to appreciate the
consequences of their sexual activity.
• Secondly, in Nigeria it is a fact that the sexuality
education needs of this age group is largely unmet.
• Evidence of unmet need is reflected in research
that confirms that some young people have a
poor understanding of the reproductive process,
others harbour misconceptions.
• Research in Nigeria also confirms that many
young persons participate in risky sexual
activities, including early debut in sexual
activities, sex with many partners, low and
inconsistent use of condoms.
• The data from the National HIV/AIDS and
Reproductive Health Survey (NARHS) reveals that
among the sexually active 15 to 19 year olds only
34.4% used condoms at their most recent sexual
encounter.
• Another survey found that by the age of 13 years
over a quarter of a sample of secondary school
students in some parts of the country had had
sexual intercourse.
• The explanation for these behaviors includes
earlier sexual maturity, the effect of media that
glamorize sex, and an increasing weakness of
traditional control of the family system in Nigeria
• Another justification for targeting young persons
is that many are in their most impressionist years
when behaviors and character traits have not
been fully formed.
• Therefore,
sexuality
education
during
adolescence is likely to foster positive attitudes
and healthy behaviors in adult years
• Despite the benefits of sexual education for the
control of HIV among young people, several
challenges undermine implementation of
comprehensive sexuality education for young
persons in Nigeria.
• In the first place, sex is traditionally a very
private subject in Nigeria and the discussion of
sex with teenagers is often seen as
inappropriate.
• Attempts at providing sex education for young
people have been hampered by religious and
cultural objections.
• Secondly, there is the difficulty of coping with
the large population of young people in Nigeria.
• Apart from the difficulty of accessing funds for
programmes, the lack of political will by
appropriate government ministries to mobilize
programmes in schools and out-of-schools in
different parts of the country is a major
challenge.
• To successfully provide sex education for young
people, there is need for massive training of
teachers, primary health care personnel and
community youth leaders, among others, in
order to have a meaningful impact
• In some localities in Nigeria girls marry relatively
young, often to much older men. It has been found
that those who are married at a younger age have
less knowledge about HIV and AIDS and are more
likely to believe they are low-risk for becoming
infected with HIV.
• The large population of young people coupled with
the lack of adequate funds and political will have
contributed to the neglect of rural communities in
sex education programmes in different parts of
Nigeria.
• Consequently, youth in rural areas are particularly
disadvantaged since educational and prevention
programming does not reach them, leaving them
more vulnerable to infection than their urban peers.
• Where sexuality education is available, the bulk of
the school programmes continue to use extracurricular methods, leaving many children not
exposed to sexuality education.
• Whereas out-of-school adolescents are
generally less informed about reproductive
health and participate more in risky sexual
activity than students, virtually all sexuality
education programmes for young persons are
school-based.
• Consequently the reproductive health needs of
the out-of-school youth are not being fully
addressed in Nigeria.
Youth and HIV Prevention in Edo
State
• The 2008 National HIV Sero-Prevalence
Sentinel Survey indicated that the HIV
prevalent rate for Edo State was 6.2% making
the State the 14th among the 36 States of
Nigeria.
• The report also showed that the prevalence
rate among the youth was also higher than any
age group in Edo State.
• This indicated then that something urgent
needed to be done to address young people’s
vulnerability.
It was within this context that an action research
programme titled “HIV Prevention for Rural
Youth” was conceived and implemented in Edo
State.
• “HIV Prevention for Rural Youth” was a 4-year
programme funded by a grant from the Global
Health Research Initiative, Canada to a team of
Canadians and Nigerians from the following
institutions participated in the project:
i.
University of Windsor, Canada
ii. York University, Canada
iii University of Benin, Nigeria
iv Centre for Population and Environmental Development (CPED),
Nigeria
v Women’s Health and Action Research Centre (WHARC), Nigeria
vi Action Health Incorporated, Nigeria
•
The Project Team was led by Professor Eleanor Maticka‐Tyndale of
the University of Windsor and my self (Andrew G. Onokerhoraye)
as Principal Investigators.
•
The other members of the Project Team are:
•
•
•
•
•
•
•
•
•
•
Mrs. Adenike Esien
Dr. Uzo Anucha
Dr. Robert Arnold
Dr. Nombuso Dlamini
Prof. Kokunre Agbontean-Eghafona
Dr. Isaac Luginaah
Prof. Felicia Okoro
Dr. Francisca Omorodion
Dr. Uyi Oni Ekhosuehi
Prof. Friday Okonofua
• The goal of HIV Prevention for Rural Youth
(HP4RY) was to develop and use research
evidence to build and evaluate HIV prevention
for youth delivered through schools and
communities.
• The programme took a social ecological
approach to prevention that placed individual
risk of acquiring HIV within the context of
interpersonal networks, community and larger
social and cultural contexts.
• Thirty rural communities and thirty junior
secondary schools located in them constituted
the locus of the research with results were used
in consultation with communities to establish
strategies to reduce youth vulnerability to HIV
infection.
• Youth participating in the National Youth Service
Corps were used to train and located in the
target communities in the implementation of
the various community-based strategies.
• The research and evaluation of the school and
community programming tried to answer two
questions:
• How was youth vulnerability and risk situated
within individual, interpersonal and
community dynamics?
i.
To what degree can school- and communitybased interventions separately, and in
combination, contribute to reducing youth risk
and vulnerability?
• All thirty schools participated in three waves of
data collection. In each wave, all students in
the Junior Secondary School and 3-5 teachers
were invited to complete surveys.
• The first wave of data collection was completed
in early February 2009. Results from this wave
served two purposes:
i.
They were used to improve the Family Life and
HIV Education (FLHE) programme of Edo State,
teacher
training,
and
community
programming, insuring that their content
addresses locally relevant issues and
vulnerabilities.
ii. Second, these results become the baseline
against which results from later waves were
compared.
•
Thus after baseline data collection, teachers as
well as Guidance Counselors were trained in
FLHE to teach students in 20 of the 30 schools
participating in the project.
• In ten of the communities where the project
took place, Youth Corpers were trained in
community programming around HIV/AIDS and
introduced into the communities to work with
out-of- schools youth.
•
• Subsequent waves of data collection were
carried out to track the outcomes of the
intervention in FLHE and Youth Corpers
programming in the schools and communities.
Some Outcomes of the Action
Research
• Young people in schools with FLHE, compared
to those in schools that do not yet have FLHE
programming reported increased exposure to
information about HIV and AIDS.
• Through various school sources such as texts,
teachers, school friends, communication with
diverse others (parents, teachers, friends, peer
educators) on various sexuality issues young
people in these target schools are now able to
respond to factual questions about HIV/AIDS
correctly and reject myths.
• Out-of-school youth became conscious of the
presence of AIDS in their community and now
take some precautions including:
i. Endorsement of HIV testing;
ii. Using strategies to avoid sexual activity such as
helping friends to avoid situations or
themselves avoiding situations or places
where they knew sex was likely to occur;
iii. Accepted they were not yet ready for sex;
iv. Have better knowledge about condom use as a
preventive strategy against HIV/AIDS
• In terms of specific results, there was evidence
that in response to the school and/or
community programming at least some
students:
i.
Were aware of the presence of FLHE
programming in their schools;
ii. Talked to teachers and peer educators about
HIV/AIDS and related issues;
iii. Were able to reject common myths about HIV
transmission;
iv. Attitudes became more accepting of
abstinence;
v Attitudes became more supportive of the
rights of girls to refuse sex;
vi Attitudes became more accepting of
condoms;
vii Students reported fewer sources of pressure
to engage in sex;
Viii Greater Knowledge in HIV/AIDS related
issues
ix Sexual debut was delayed;
x Those who were sexually experienced
reduced recent sexual activity.
• With respect to the trained teachers, a variety
of gains from their FLHE training were noted.
i.
Teachers’ knowledge related to FLHE topics
was high before training and improved further
over the course of training. After training, the
average grade on the knowledge examination
was 92%.
ii. Teachers were more competent in delivering
guidance and counseling to students who
came with problems in the area of sexuality.
iii Improved access to resource materials such as
texts and schemes of work for teaching
iv Increased use of classroom instruction,
school assemblies and school displays for
teaching about HIV and AIDS;
v Increased discussion of FLHE teaching
strategies in staff meetings;
vi Teachers’ desires to teach about HIV and
AIDS and talking about sexuality grew after
their training in FLHE.
Some Policy Recommendations
• Nigeria must continue to seek for international
partners in the fight against HIV/AIDS.
• The government in conjunction with the
international bodies concern should ensure
that more projects focusing on reducing youth
vulnerability are funded especially in order to
get to the grassroots.
• Continue expanding delivery of the FLHE
programme to all secondary schools in Edo
State including those in rural areas.
• Mobilization towards delivery of programming
in communities targeted at young persons.
• Nigeria must increase funding for the HIV/AIDS
response especially for the young people.
• Public-private partnerships are essential to
bring HIV/AIDS interventions to more young
people in rural communities
• Deployment of Youth Corpers to rural
communities specifically to deal with HIV/AIDS
programming since youth are more at home
with them
• Edo State must recognize the role of the
community structures in the fight against
HIV/AIDS by using a Bottom –up approach
rather than a top-down syndrome.
• All teachers should be made to mainstream
HIV/AIDS teaching into all subjects in all
primary and secondary schools in Edo State.
• Develop a policy shift that recognizes condom
education as part of the FLHE curriculum
Summary and Conclusion
• Young people are generally more vulnerable to
HIV and AIDS compared with adults because
they are disadvantaged with respect to the key
tools necessary to combat the epidemic.
• The youth in most cases lack the knowledge, life
skills, financial resources and access to needed
health care services to help protect themselves
against early sexual debut, sexual coercion, and
unprotected sex.
• Although young people are major victims of the
HIV epidemic, they have not, over the years,
been given the required attention in actions
designed to control its spread.
• It is in this context that young people have
been acknowledged as a special risk population
at the global level for attention in efforts to
control the spread of HIV/AIDS.
• Both the Millennium Development Goals and
the global goals endorsed by the UN General
Assembly’s Special Session on HIV/AIDS have
explicitly focused on the unique vulnerability of
young people.
• In Nigeria the needed attention on young
people must start from the rural communities
where young people are greatly disadvantaged
compared with those in urban areas.
• The action research findings reported in this
address reflect the concern for the challenges
facing young people in rural communities in
Nigeria with respect to combating the HIV
epidemic in the country.
• Nigeria and Edo State must also respond to
this challenge
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