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Country Profiles |
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Community Access to Counseling and Testing Expanded
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FEBRUARY 2007 — The need for HIV counseling and testing services in Nigeria is growing dramatically as efforts intensify to expand access to antiretroviral therapy (ART) and other care and prevention services.
FHI/Nigeria is playing a critical role in meeting that need, particularly through its introduction in May 2006 of a mobile voluntary counseling and testing (MVCT) program that has greatly expanded community access to these critical services. The program is funded by the U.S. President's Emergency Plan for AIDS Relief through USAID. FHI/Nigeria has helped manage and provide technical assistance for the program, in collaboration with the Nigerian government and community organizations, said Cartier Simon, senior voluntary counseling and testing advisor for the USAID-funded, FHI-managed Global HIV/AIDS Initiative Nigeria. FHI/Nigeria established MVCT units in six states and trained a total of 42 care providers to respond to community needs in those states. FHI/Nigeria also partnered with the government and community organizations in building public awareness and usage of the program. Teams at the units have conducted free rapid HIV tests that give clients results before they leave. While this initiative has benefited Nigerians as a whole, it targets groups at greater risk of exposure, such as truck drivers and sex workers. The initiative is making a pivotal contribution to the country's HIV/AIDS program by determining who requires care and treatment: when people know their status, they can access services, including ART and interventions to prevent mother-to-child HIV transmission. The services also help prevent HIV acquisition and transmission. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), counseling and testing services can help produce a reduction in the number of sexual partners, increased condom use, fewer sexually transmitted infections and safer injecting practices. Linkages Established to Care and Support Services In addition to providing counseling and testing, the initiative has linked with other key community care and support services, including ART, home-based care, income-generating activities and support groups. "The knowledge of my HIV status has helped me start treatment on time," said client John Bala. "I possibly would not be alive if I had not learned my status when they [MVCT counselors] came to my community." Approximately 88,000 Nigerians have accessed the care and support services (about 51,000 men and 37,000 women), Simon said. Of that total, only about 2,300 (2.6 percent) have tested positive.
Stigma and Discrimination Reduced The program has reduced stigma and discrimination in communities against those accessing counseling and testing services, Simon said. "We have done this by scaling up other care and support services so the infected will have an opportunity to access these services, especially ART, and community mobilization and sensitization," he said. "We have also made use of people living with HIV/AIDS, who talk freely about HIV in the program." Nonetheless, the program still confronts several major challenges, including the high cost of services, lack of trained personnel, limited availability of test kits, social norms, significant distances between many communities and ART sites, and lack of other care and support services, Simon noted. The initiative builds upon the significant role FHI/Nigeria has played in strengthening counseling and testing services in the country. In 2002 the office assisted the Nigerian government in developing the first national counseling and testing guidelines and curriculum, and recently helped the government review these documents. FHI is also the only organization that has trained non-laboratory personnel to conduct HIV testing in Nigeria, Simon said. The office also helped establish and manage 86 counseling and testing sites in partnership with the Nigerian government. In addition, FHI/Nigeria helped the government scale up counseling and testing services, built care providers' capacity, developed protocols and established four training schools, he said. Challenges to Meeting Counseling and Testing Targets Remain Despite these successes, the program is far from reaching its goal of providing counseling and testing to every Nigerian. Simon said sites have not yet been established in several states, but the government is planning to address that. President Olusegun Obasanjo demonstrated his commitment to these services when he publicly received counseling and testing for HIV in Abuja Dec. 1, World AIDS Day (see photo and story). Counseling and testing as a whole face major challenges, Simon added, including a shortage of trained personnel, a limited number of test kits, difficulty reaching the country's large population and significant distances between many communities and prevention, care and treatment providers. Still, Simon is proud of the number of Nigerians who have received counseling and testing services. "One of the greatest lessons we have learned is that people are willing to take an HIV test if it is available, affordable and accessible." PHOTO (top): Bola Ahmed (right), Federal Capital Territory MVCT team leader, presents a poster promoting counseling and testing to Mohammed Murtala Jibrin, the Sarkin Pada (Head of the Palace) of the Emir of Zuba, Nigeria. The Emir's secretary (left) looks on. (Photo by Cartier Simon, FHI/Nigeria) PHOTO (above): Joy Markus of the MVCT team in Abuja, Nigeria, provides counseling and testing during the national youth services camp orientation in 2006. (Photo by Cartier Simon, FHI/Nigeria) — Alan Goodman |
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A growing number of community groups have also requested the services, including religious organizations, unions and schools. "We have responded to their requests pretty well through careful planning of our activities and creative ways of providing services — beautiful tents, quality services, well-trained personnel, keeping promises and ensuring that infected people receive good care," Simon said.