In a period of 12 months, particularly in year 2005, only 1200 people agreed to HIV testing during a campaign for free testing with focus on Lagos and Ogun State of Nigeria. Lagos State alone has a population of over 14 million people.
Mrs. Falana, Executive Director of CHEDCOM, a Lagos-based NGO revealed that people are still scared to subject themselves to test because of the fear of stigma and discrimination.
Q: If you do a review of your program so far, what is your opinion on the attitude of Nigerians to Voluntary Counseling and Testing (VCT)?
A: The experience we have had, chedcomparticularly with the generality of the public, is that a lot of people are still very much afraid to go for HIV test. Even though quite a considerable number have HIV information, taking the bold step to know their HIV status is a big problem for a lot of people and from our own experience running the free VCT project for one year, we find out that there are various reason why people would not want to determine their status.
Basically, the issue of stigma and discrimination and the fear of the unknown have been the twin reason why people shy away from testing. The impression given is that you are going for a death sentence, you know, people still equate HIV testing to tying a noose on your own neck. A lot of people say they will just jump into the lagoon if they test positive. It is the fear — the feeling that if I test positive I am doomed — that is responsible for the unwillingness of our people not wanting to know their HIV status.
Q: How many people participated in the program while it lasted?
A: Almost 1,200.
Q: Within the course of a year? You said the focus of the program was in Lagos and Ogun State (Nigeria)?
A: Yes, within the course of a year. That’s the figure we have, though it can be explained. We found out that another major factor responsible for the low response is the issue of poverty. When you attach a prize to it, people will not test. After some time, what we did was to announce a free testing service, but we realized that in spite of the free testing, peoples’ response particularly at our centre still remained low. So what we did was to go (offer) mobile testing. We had a project to execute, so we decided to go meet our people at their workplace, meet students in their universities. Not only in their universities but in their departments, because we realized that the one (program) we did in some higher institutions in a more or less central location received low patronage. And it worked; we got more people coming to be tested. But the bottom line is that stigmatization is still very much within our environment.
Q: But you said you only recorded just 1,200 people for the entire program with a focus on two states (Lagos and Ogun), and in a 12-month period?
A: Yes. In fact, of that figure, we had 583 people testing within just one week.
Q: Within a week?
A: Within a week.
Q: So, for over 11 months you had just a little over 600 people that tested?
Q: Initially, what was it costing to test?
A: Between N300 and N500. And why we charged was to be able to make something so that we could sustain the program. Since we know that our funding ends in December, we won’t say we would stop working because we ran out of funding. People will still keep coming and we need to attend to them and that is why we charge this thing.
Q: From the clients you’ve had, what social level would you say the majority belong to?
A: The impression that is created is that people at the top still feel they are safe, or maybe it’s just that they don’t want to come out. It is also our belief that “big people” will not want to be seen in a public facility. What has been achieved with the attitude of our elite is to make HIV/AIDS look like the disease of the poor. You will agree with me that 95% of the people who have put a face to HIV in Nigeria are not from the other side of the ladder, whereas the reality indicates that everyone is affected when it comes to HIV. We are the one discriminating, HIV/AIDS does not.
Q: You see, I am troubled by the figure that you have, just 1,200 in two states. Lagos alone has over 14 million people.
A: Well, we consider it very low too. But what can we do? We ran jingles in the local language both on Radio Nigeria and Paramount FM in Ogun state. People listened to it, people saw our advert in the papers, and we conducted interviews. We produced handbills and went as far as distributing them on the streets, in banks, etc. but look at the response. Like I always say, it takes people with guts to come and say I want to know my HIV status.
Q: From your experience, do people embrace treatment when they test positive?
A: It varies. There are those who, after testing positive, will begin looking for religious miracles but when their condition worsens in the church where they are and we get to know, we usually persuade them that please, don’t kill yourselves. Even there was a case of a couple, the wife’s relation took her to the church and she was there until the situation got beyond redemption. And some people will not even show up again after testing positive.
Q: But for those who are ready to embrace treatment, how do you ensure that they access treatment?
A: We refer them. We usually refer them to the Nigeria Institute of Medical Research (NIMR) for confirmatory test and TB. We also refer them to treatment sites in Lagos, especially the Doctors without Borders (MSF) program.
Q: What is the structure of the counseling system here?
A: We follow the prescribed guidelines. There is a training manual which we all went through before we started, even the cleaner, we all went through the training and we follow the guidelines. After taking the information from the client we pass it to the counselor for pre-test counseling and thereafter it will be the turn of the lab scientist so that they can take sample of the blood and run the test. And when the result is out we invite the person for post-test counseling, whether the test is positive or otherwise, and then we do follow-up in case it is a positive result.
Q: From your clients, what is the gender percentage (with HIV)? How many are men and how many are women? How many of the women are nursing mothers?
A: We don’t test children. But women are in the majority. I can say 60% women, men 40%.
Q: Will you say most of your clients are self-employed?
A: Majority are really employed. But you find out that people who are employed will not come for test at centers like ours. They patronize private clinics, (although) we have one who came and said her parent buy N25,000 drugs each month and when they saw our banner “Know your HIV status”, they came here and they found out that they can test for N300 and then we referred them to where they can get treatment for N1000.
Q: Probably they are not coming because of the issue of confidentiality?
A: What we do here is strictly confidential.
Q: What did you study?
A: I am a social scientist, I studied psychology.
Q: What is your staff strength?
A: We are 10, and two are living openly positive with HIV.