lessons learned in providing reproductive health and hiv prevention program for people who inject...

Lessons Learned in Providing Reproductive Health and HIV Prevention program for People Who Inject Drugs In

Urban Slum in Oyo State South West Nigeria

Bako J. C, Titus M.O, Tijani A.I, Oni F, Atoyebi O, Omoreigie G, Oyedeji D, Tomori O.T, Ademodi T, Fashade A

Society for Family Health Goodworker Ministry International

National HIV Prevention Conference November, 2016

…Creating Change, Enhancing LivesSociety for Family Health, Nigeria

Background• About 3.4million people are living with HIV in Nigeria • Estimated AIDS related deaths in Nigeria moved from

141,225 in 2000 to 233,604 in 2013.

• This is associated with ignorance, poor access to health and social services, poverty, gender issues, stigma and discrimination.

• According to NARHS, 2012, the current HIV prevalence in the general population is 3.4%.

• There was a slight decline from the previous estimates of 2007 which was 3.6%


Background Contd. • HIV prevalence was highest in Oyo state among

the South-west states with prevalence of 5.6% (NARHS 2012)

• According to 2008 mode of transmission studies, majority of the infections in Nigeria are due to HIV transmission within the general population


Background Contd.

• However, the high risk groups who makes up about 1% of the adult populations contribute almost 23% of new HIV infections and with their partners contributes 40% while FSWs and their clients contributes half of the infections.

• MSM, PWID and their partners contributes about 10% and 9% of the new infections


Program with PWID Society for Family Health with Funding support from the Global

Fund implemented HIV Prevention program in Oyo state under the New Funding Model for MARPs (PWID) with the aim to:

• Reduce new HIV infections, and improve the quality of life for the infected and affected

• Provide Nigerians with universal access to high-quality, patient-centred prevention, diagnosis, and treatment services for TB, TB/HIV, and drug-resistant TB by 2020, and

• Contribute to the restoration of public confidence in primary health care services in Nigeria, and thereby reverse declines in the utilization of primary health care facilities

Society for Family Health, Nigeria

…Creating Change, Enhancing LivesSociety for Family Health, Nigeria …Creating Change, Enhancing LivesSociety for Family Health, Nigeria

Program with PWID Contd. • SFH through Partnerships Assessment and Organizational Development Framework worked with

SACA and SMoH to select KAP led/friendly organizations to work with PWID in Oyo State

• GF HIV NFM Prevention Programs among the MARPs aligned with the HCT, Condom Promotion and communication Interventions of the National Strategic Plan (NSP 2010 - 2015) for HIV prevention contributing to 4 indicators

• 80% of sexually active adults accessing HTS in sustainable way.

• 80% MARPs accessing HTS by 2015

• 80% MARPs use condoms in the right way always.

• 80% MARPs reached with group specific interventions and adopt appropriate HIV/AIDS behaviour.


Program with PWID Contd.• SFH adopts Minimum Prevention Package Intervention (MPPI) as the programme strategy for the

MARPs to meet their current HIV prevention needs by reducing new infections

Behavioural Interventiono 40 PWID Recruited and trained as Peer Educators o 320 PWID reached with MPPIo 2,704 IEC materials distributed during sessions o 23,582 condoms and 50 lubricants were distributed

Bio-Medical Intervention o 245 PWID reached with HTSo 4 referred for STI services o Condom forecasting and quantification o 2 PWID referred for TB treatment


Program with PWID Contd. Structural Interventiono Series of meeting with key stakeholders and influencers to address

wide range of issues o Advocacy meeting with the law enforcement agencies o Joint quarterly community town hall meeting with KAPs

…Creating Change, Enhancing LivesSociety for Family Health, Nigeria …Creating Change, Enhancing LivesSociety for Family Health, NigeriaSociety for Family Health, Nigeria …Creating Change, Enhancing Lives

Lessons Learned• Condom use with sexual partners is very low, the same applies to

knowledge and awareness on STIs and HIV prevention among PWID in intervention communities.

• Most sexually active PWID in Oyo state have non-injecting sex partners thereby increasing the potential for STI/HIV infection among non-injecting population

• 95% of PWID who went through the program are poor, they lack social and economic power and often look for cheaper means of taking drugs (selling sex or sharing needles/syringes).

• Sharing of needles/syringes is a common practice among poor PWID in Oyo state.

• Lack of awareness and education about safe injecting is a major reason for sharing needles including PWID’s perception that it is a social and cultural norm, and that it strengthens bonding

•

…Creating Change, Enhancing LivesSociety for Family Health, Nigeria …Creating Change, Enhancing LivesSociety for Family Health, NigeriaSociety for Family Health, Nigeria …Creating Change, Enhancing Lives

Lessons Learned Contd. • PWID are willing and ready to be tested for STI or HIV but are not

ready to spend money on further tests, drugs or treatment• PWID are more comfortable disclosing and discussing their health

issues with trained HCWs after their training on how to provide friendly services to KAP

• Most young women who inject drugs in Oyo state cover up their drug taking behavior and are unwilling to participate in prevention programme because of societal discrimination - limiting their access to medical care and HIV services

• PWID encounters stigma and discrimination from the society since they involve in stealing and lies to support their drug habit. This action contribute to ongoing HIV epidemics as PWID fail to access harm reduction and other health services

Conclusions and Recommendations

• HIV prevention programs should be designed in a more comprehensive way and identify the best venues to reach the largest number of PWID in order to address risk reduction and overlaps.

• It should focus on young PWID to prevent them from starting to inject or help them to end their addiction if they have already started

• Create window of opportunity for drug rehabilitation for drug users


Conclusions and Recommendations Contd. • Engage and train more HCWs on how to provide friendly

services to KAP to reduce stigma/discrimination and provide additional support

• Develop an effective referral & tracking system for PWID who screened and tested positive to STI/HIV

• Empower PWID through capacity building and involve them actively in all advocacy and policy activities

• Set-up needle/syringe distribution and disposal programs - remove legal, social, and funding barriers to Needle and Syringe Programmes (NSPs) in Nigeria.


…Creating Change, Enhancing LivesSociety for Family Health, Nigeria …Creating Change, Enhancing LivesSociety for Family Health, Nigeria…Creating Change, Enhancing LivesSociety for Family Health, Nigeria

…Creating Change, Enhancing Lives

Thank You for your Attention


lessons learned in providing reproductive health and hiv prevention program for people who inject...

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