Addressing Youth vulnerability to HIV/AIDS in Nigeria Presentation by Professor John Idoko Director-General National Agency for the Control of AIDS July 5, 2012

Introduction Epidemiology of HIV in Nigeria Young People – Why vulnerable? Why focus on young people? Taking the lead to protect young people in Nigeria Are we keeping our promise? Voice of young people in Policy formulation/program coordination Conclusion

Why focus on young people? Of the 1.7 billion young people globally, 5.4 million living with HIV 40% new HIV infections among young people Young people have the highest rates of STIs Young people between 15 – 30 years make up to 45 – 50% of Nigerian population In Nigeria 60% of HIV prevalence among young people

National HIV Prevalence Trend 1991 – 2010 (FMOH)

Where we are now with UA?....still far away (2010) No. of PLWIH 3.11 million HCT coverage 18% PMTCT coverage 32% Annual HIV+ Birth 70,000 New infections 339,016 Number on ART 432,000 (30%) Number req ART 1.5 million Total orphaned by AIDS 2.23 million

HIV Prevalence by Age Groups FMOH, 2011

Women and Girls HIV is a leading cause of death and disease among women of reproductive age (15 – 49years) in sub-Saharan Africa. In sub- Saharan African, 60% of the People Living with HIV is female (while women make up 50% of the global epidemic). In Nigeria prevalence among young women aged 15 – 24 years is estimated to be three times higher than among men of the same age. Females constitute 58% (about 1.72 million) of persons living with HIV in Nigeria. Each year, 55% of AIDS deaths in Nigeria occur among women and girls

HIV prevalence among women aged 15-24 years by location, North Central Zone (HSS 2010)

What risk factors...? Early age at sexual initiation Heterosexual transmission Biological vulnerability Lack of recognition of partner’s risk Inequality in relationship Sex with older men (more likely with HIV) Gender norms & Gender violence MSM Less likely to disclose sexual orientation Less likely to have HIV test Likely to have 1 or > female sex partners Infected MSM may transmit to men/women

Halt AIDS, 2006

Halt AIDS, 2006

Age distribution of MSM in Abuja, Nigeria S/N Age group Frequency % 1 15 - 19 15 5.1 2 20 - 24 108 36.6 3 25 - 30 116 39.4 4 30 - 34 45 15.2 5 35 - 39 10 3.4 6 40 - 44 7 45 - 49 0.3 Total 295 100 CRH, 2009

Risk Factors STIs Alcohol, tobacco and drugs Young people have higher prevalence of STIs - increased likelihood of HIV Alcohol, tobacco and drugs Both casual and chronic users more likely to engage in high risk behaviour such as unprotected sex Lack of awareness of risk/vulnerability Low perception of risk among young people Population Effect/Family level vulnerability Generating ever increasing cohort of sexually active susceptible to HIV

Risk Factors Poverty and out of school youths Socio – economic problems associated with poverty can increase risk of HIV: Poor education Poor information on HIV, RH & condoms Lack of high quality health care Poor condom use Coming of age of HIV +ve children Young people who acquired HIV perinatally facing decisions about becoming sexually active Will require counselling

Comprehensive Knowledge about HIV Characteristic Female (%) Male (%) Age: 15 - 19 19.7 28.2 Age: 20 - 24 24.8 37.2 Urban Residence 29.8 39.7 Rural Residence 17.9 Comprehensive Knowledge Consistent use of condoms Having one faithful –ve partner Know that healthy person can have HIV Rejecting 2 common local myths about HIV transmission NDHS, 2008

ZERO NEW HIV INFECTIONS. ZERO DISCRIMINATION. ZERO AIDS-RELATED DEATHS.

Catalysing the next phase Advancing human rights & gender equality 3 Strategic Directions Revolutionising HIV prevention Political commitment to why people are getting infected and reduce new infections Mobilize communities to demand transformative change Resources directed to hotspots and what works Catalysing the next phase of treatment, care & support Access to effective treatment when people need it Strong national & community systems to deliver services Access to care, support & nutrition and social protection Linkages with maternal and child health, SRH, TB… Advancing human rights & gender equality Protective social & legal environments enable access Equitable service provision reaches people most in need HIV-related needs and rights women and girls addressed

Reducing Youth Vulnerability Education on sexuality and RH School Attendance esp Girl child Cultural norms/values Virginity and Abstinence before marriage – values for girls & boys Sexual behaviour tolerating multiple sex partners Access to condoms Migrants are vulnerable Alcohol & Drugs

Prevention Strategies Making HIV testing a mature part of medical care (PIT) & Implementing new models of diagnosing HIV infection outside medical settings Prevention of new infections by working with HIV infected persons and their partners Decreasing Perinatal infections (eMTCT) COMBINATION PREVENTION + NPT PrEP and Treatment as Prevention Role of Parents, Schools, Churches & communities Prevention programs Awareness for responsible sex behaviour

Contribution of the 20 countries with the largest numbers of women needing antiretrovirals for preventing the mother-to-child transmission of HIV to the global gap to reach 80% of those in need, 2008

Role of Government Role of Federal Ministry of Education & Youths line Ministries supporting multi-sectoral response Role of State Ministries of Education Role of NACA, SACAs & LACAs FL& HIV education (curriculum) NYSC HIV project AIDS & RH clubs in secondary schools GS curriculum in Universities & expanded curriculum in medical & nursing schools Youth Friendly Centres in Universities

Commissioning of Youth Friendly Centre, OOU, Ago- Iwoye

National Call Centre Update The centre is set to harness the vast potential of telephone through public-private partnerships Airtel has provided an E1 line with capacity for 30 toll free voice calls + 2 data lines ETISALAT already key in to provide free services NACA procured office space in Central Area close to NACA office in Abuja Skye and Access Banks have supported furniture and hardware respectively NACA sourced robust user friendly software from India and installation of E1 hardware completed Access Code – 6322 ONLY ON AIRTEL FOR NOW

National Reproductive Health, HIV & AIDS Prevention and Care Project through the NYSC Project Goal Increase RH/HIV knowledge among corpers Provide life skills & promote peer education Support protective behaviour in communities of primary assignment

Sensitization of Students in Schools

Project Achievement 1,157,571 77,325 29.8 million <1,800 185 222 Activity Beneficiaries No. reached Duration Orientation Seminar Corps members/ NYSC staff 1,157,571 2002 to 2011 Training Peer Educator Trainers (PETs) Corps members 77,325 2002 to 2010 Training Peer Educators (PEs) Secondary School Students 29.8 million HCR Corps Members <1,800 2003 to 2008 HCT 185 2010 to 2011 Training of Peer Influencers (PIs) Staff 222 2007 Project Management and Supervision Sch. Officers/ Zonal Inspectors <1,000 2003 to 2005

Are we keeping our promise? Importance of preventing HIV in young people has been a consistent message: ICPD +5, MDG, UNGASS, Political commitment of UN General Assembly in 2006 Calls on Governments to ensure HIV rates in persons 15-24 should be reduced by 25% in the most affected countries by 2005 and by 25% globally by 2010. Young people’s voices in policy and programs in Nigeria Youth HIV network – NYNETHA, APYN Role in NACA, CCM, CCEs Regional networks & UN meetings

Conclusion Various prevention strategies have proven effective to address youth vulnerability; they include HIV counseling and testing Condom us Reduction in sexual partners Raising the age of first sexual activity Education – attending school especially for GIRL CHILD education RH education including FLE & HIV education

Success is determined by.......... Political support for HIV prevention Active role of communities and grass roots initiatives Involvement of PLWHV Communication & information including on SRH Creating enabling environment for youths to protect themselves and others Combating and reducing stigma, discrimination, denials and taboos Protecting and promoting HR including the rights of women & children Increased access to ART Integrating comprehensive HIV services with SRH

THANK YOU