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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

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young people at risk of hiv aids in edo state what should we do

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
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
slide3

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
Introduction
  • According to Joint United Nations Programmeon 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.
slide5

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.
slide6

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 sub-Saharan Africa are within the age bracket of 15 to 35 years.
slide7

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
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.
slide9

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:
  • Early engagement in pre-marital sexual relationships,
  • Keeping of multiple sexual partners, drug abuse and
  • Engaging in sex for money.
slide10

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
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.  
slide12

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
slide13

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
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.
slide15

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.
slide16

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:
slide17

male circumcision,

  • condom use, and
  • 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.
slide18

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 youth-friendly 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.
slide19

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
slide20

the inherent difficulty in changing established norms,

  • community diversity, sustainability and
  • difficulty with monitoring and evaluation of these interventions.
  • Interventions in geographically-defined communities can be categorized into two broad categoiries;

.

slide21

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
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.

slide23

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.
slide24

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.
slide25

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.
slide26

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.
slide27

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.
slide28

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.
slide29

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
slide30

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.
slide31

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 extra-curricular methods, leaving many children not exposed to sexuality education.
slide32

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
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.
slide34

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.

slide35

“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:

  • University of Windsor, Canada
  • York University, Canada
slide36

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:
slide37

Mrs. AdenikeEsien

  • Dr. UzoAnucha
  • Dr. Robert Arnold
  • Dr. NombusoDlamini
  • Prof. KokunreAgbontean-Eghafona
  • Dr. Isaac Luginaah
  • Prof. Felicia Okoro
  • Dr. Francisca Omorodion
  • Dr. Uyi Oni Ekhosuehi
  • Prof. Friday Okonofua
slide38

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.  
slide39

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.
slide40

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?
slide41

To what degree can school- and community-based 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:
slide42

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.

  • Second, these results become the baseline against which results from later waves were compared.
slide43

 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.
slide44

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
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.
slide46

Out-of-school youth became conscious of the presence of AIDS in their community and now take some precautions including:

  • Endorsement of HIV testing;
  • 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;
  • Accepted they were not yet ready for sex;
  • Have better knowledge about condom use as a preventive strategy against HIV/AIDS
slide47

In terms of specific results, there was evidence that in response to the school and/or community programming at least some students:

  • Were aware of the presence of FLHE programming in their schools;
  • Talked to teachers and peer educators about HIV/AIDS and related issues;
  • Were able to reject common myths about HIV transmission;
  • Attitudes became more accepting of abstinence;
slide48

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.

slide49

With respect to the trained teachers, a variety of gains from their FLHE training were noted.

  • 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%.
  • Teachers were more competent in delivering guidance and counseling to students who came with problems in the area of sexuality.
slide50

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
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.
slide52

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.
slide53

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.
slide54

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
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.
slide56

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.
slide57

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.
slide58

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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