Friday, July 6, 2018 3:44 pm
By Steve Aborisade
One remarkable manifestation of the enormity of the HIV situation in Nigeria today would be the expansive population of adolescents who have known nothing but HIV all their lives. Talking of a generation whose existence has been defined and moulded with confronting and conforming to the demands and dictates (social, medical and psychological) of a disease the nation is struggling to tame, which also now, certainly,inspires the texture of a future they can ever hope to have.
Adolescence as a stage of development comes with its peculiarities. These peculiarities remain the same all over the world. As a stage and as an experience, no individual should be denied of its intense immersion, given it does not repeat itself and because it connects the other important developmental phases of life. Without doubt, it is a vital experience that is not to be missed.
Adolescence is that stage of discovery, of making mistakes and learning from it, a stage to dare and dream, a period to hope and to dare; of massive self love and, of appreciating the essence of things. It is that period of imaginary knowledge – you just seem to know it all, with no one coming close, not by an inch, but then, it is also that period of understanding the limits of illusions and the necessity of embracing realities. No one needs to be denied of this lifetime experience.
For adolescents living with HIV however, the above experience is what is largely denied. With that deprivation also comes a responsibility,foisted,that is beyond the scope of their age, but which they are expected to assume with pride. For anyone, coping and dealing with the realities of being HIV positive comes with tremendous responsibility,first to the self and, to others. Usually, several people are overwhelmed by what these entails. Expecting adolescents to get a grip of what these requires and to be responsible about it, even to themselves remain a herculian task, a challenge which the nation’s HIV intervention is perhaps poorly equipped to deal with, due to many factors,of which availability of needed resources leads the pack.
To be sure, our focus as a nation has strictly been to get the highest number on ARVs to halt the stride of HIV and to prolong life. This is commendable and cannot be faulted given our peculiar circumstances. In reality, we are far from getting enough people needing life saving ARVs to access them. Meanwhile, there is also no denying the fact that what is needed, which is crucial to the well being of this group goes beyond just the drugs. Irrespective of the challenges being faced, giving one while leaving out the other has not proved to be a prudent decision as far as the condition of adolescents on treatment suggests.
In contemplating this, it might be wise to consider the 2013 WHO guideline for the care of adolescents living with HIV/AIDS.As a precursor, the WHO guideline argues for the active engagement and involvement of HIV-positive adolescents in the delivery of care for this population. Through their active engagement, it can be taken for granted that whatever intervention is being adopted would have been fed by their peculiar needs and aspirations, which could then shape what is being delivered.
For the majority of these adolescents, priority consideration is first and foremost learning and adapting to live with a daily medication dosing that is for life. That in itself poses several challenges. The challenges here have resulted in countless adolescents on treatment opting out, to the detriment of their health,for various reasons; including difficulties dealing with initial side effects of the drugs,the non youth friendly nature of majority of our facilities, to predominantly pervasive environment of stigma, unresolved internal conflicts with accepting an HIV positive status, the restrictions that is treatment – as it is for adolescents at a phase of exploration, to the more pathetic – poverty. Several have little to eat, some find it difficult to transport themselves to health facilities and so on.
The need to moderate the impact of these realities for this group of adolescents, while warehousing their voices to feed program design and implementation was what informed the 2018 edition of AIDS Healthcare Foundation (AHF) Safe Space Program. Traditionally, AHF’s Safe Space Program supports young women and girls including boys, through empowering them with leadership skills, providing needed education to negotiate safe sex and to imbibe safer sexual practices or to embrace abstinence. It provides menstrual hygiene best practices awareness,as well as the opportunity for life skills and access to HIV Counselling and Testing Services.
AHF Nigeria Country Programme Director, Dr. Echey Ijezie, had contextualised the goal of the effort as an avenue to engage the challenges confronting adolescent girls and young women from the ages of 14 to 24 years in various communities.These challenges according to him include: components of social intelligence and networking, gaps in psycho-social support generally, menstrual hygiene awareness and provision of free sanitary towels, confidence deficits, and lack of skills to negotiate safe sex and the need to lay a foundation for needed mentoring for this group. The overriding consideration according to Ijezie, is the need to ensure that this group is empowered, able to build their self-confidence, have self-esteem, with the capacity to confront their future productively.
For several participants,their emotiion oscillates from blaming themselves,to their parents, who they blame for their situation. Some habour strong hatred for those who should be their loved ones. Others have accepted their situation, while several remain in denial,self isolation and,are depressed. The tendency to seek self help is high, resulting in inadequate care, but worsened by the larger societal reaction of social exclusion, stigma and discrimination that majority has experienced.
To be sure, what is needed are interventions that can moderate the various influences on their emotions and that can support their resilience and adjustment capabilities.Practical recommendations coming from the experience of the group include: the need to have a supportive policy in place that allows those in school easy access to leave school whenever they have clinic appointments,implementation of a school feeding program that guarantees indigent adolescents being fed while on treatment, setting up and incorporating mental health services into adolescent support groups,commencement of stress management skills alongside life skill during workshops as a preventive measure, and the integration of mental health services with Anti-retroviral Theraphy (ART) as well as renewed effort to eliminate mother to child transmission of HIV/AIDS. We have no choice as a nation but to keep the promise on AIDS by committing resources to halt its stride.
• Aborisade is the Advocacy and Marketing Manager at AIDS Healthcare Foundation (AHF) Nigeria