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HIV self-testing, breaking stigma, discrimination barriers in Nigeria

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It is 7pm as I step into a minibar, in an average neighbourhood to speak with madam Ifeoma but as I made to settle into a chair, she frantically signals me not to seat.

I walk up to her and she whispers, ”Madam, you be wan siddon, we can’t talk about ‘that thing’ here now”.

”My customers may hear us, I no want wahala o”.

I smile and follow her outside as she bellows instructions to her service girl. I make a mental note to remind her she had asked we meet in the shop.

‘But you are not positive now I quip, she smiles and says ‘e no matter o, dem no dey discuss that thing for public‘.

You are wondering what ‘that thing is, right?

Ifeoma, (not real name), a 35 years old businesswoman is scared of discussing HIV/ AIDS in public.

She is worried her story could be distorted if overheard; she only agreed to the interview only if I do not use her real name in the story.

Despite being negative of the virus, Ifeoma’s reservation is not out of place.

Millions of educated Nigerians fear stigmatisation and would not take a test or discuss HIV in public or with strangers.

She said the fear of discrimination and shame from a possible positive result kept her from checking her status for eight years, until a recent nasty STD infection.

Now sitting in the privacy of her car for the interview, Ifeoma tells me an HIV self-test kit saved her the anxiety of testing at a public facility.

”I had a very bad STD; I was too ashamed to go to the hospital at first. I went to a big pharmacy in town, they gave me drugs, I used them but I didn’t get better.

”When it got worse I was afraid and went to the hospital. The doctor treated me and recommended an HIV test but I left because my neighbour works in that hospital.

‘‘I went back to the pharmacist and told him, he asked me to buy a self-test kit, plus the drugs the doctor recommended. He taught me how to use the kit. That’s how I bought it and used oo. Thank God I was negative sha, Ifeoma narrates.

In 2019 the federal government introduced the HIV self-testing kit to the Nigerian public; hoping it could reduce the stigma faced by individuals and encourage more young persons to test.

HIV self-testing is an innovation that allows people take a test using a rapid test kit in the privacy of their homes.

In self-testing, a person is expected to run a swab along their gums to collect oral fluid, which is placed in a liquid solution that provides accurate reading in 20 minutes.

‘‘A non-reactive (negative) self-test result is considered negative and all reactive (positive) results must be confirmed in a hospital,’’ according to medical experts.

Clinical Microbiologist, Dr Philip Nwajiobi-Princewill, explains that the self-test kit is not conclusive but is mostly a guide as individuals still need to visit the hospital if their results return positive.

‘‘Self-test kits were developed to test more persons for HIV, it is just for you to be guided to take steps in visiting the hospital for confirmation, as some may still test negative in the hospital, even after testing positive while using the test kit,” he said.

Asides the benefit of allowing people test privately, experts say HIV self-testing promotes anonymity; it is easy to use, helps to link people to treatment, has a quick turnaround time for results and increases the number of people who test for the virus to break transmissions’.

‘‘We had the challenge of stigmatization with regards to HIV testing, people were afraid of coming forward to test, says Dr. Philip, but now you can test yourself without going to queue in a hospital or heart to heart facility’’

The stigma and discrimination attached to HIV testing or fear of a positive result is the reason my respondent spent eight years in between her first and second test.

She is not alone; millions of Nigerians do not know their HIV status and have no plans of finding out.

This is despite the warning by the National Agency for the Control of AIDS, NACA that people in high-risk groups need to test every three to six months.

The World Health Organization recently revealed that 8.1 million persons, that is, 21% of the global population living with HIV are unaware of their infection.

In Nigeria, only about 73% of the population knows their status as estimated by the United Nations Programme on AIDS, UNAIDS.

Meanwhile, experts, warn that there are downsides to self-testing, though minimal.

Dr. Phillip explains that there are situations where some collect the kit but never use it for fear of the outcome, while others may use it, test positive but never revert to the health facility for treatment.

”There is the possibility that someone could perform the test incorrectly and get a false positive. Sometimes we don’t know how couples will react if a partner tests positive using the kit’’

Despite these downsides, the federal government has provided a range of options on where the home-test kits can be obtained.

An HIV counsellor and caregiver at the Institute of Human Virology Nigeria, IHVN, stationed at the National hospital Abuja, Vitalis Offor, says the self-test kits are available at the Specialist hospital Gwagwalada, Karshi General hospital and the Federal Medical Centre, Jabi.

This is outside the many private pharmacies that sell the kits to their clients.

”There are functional places established by government where HIV test can be procured, says Vitalis, we have the government clinics, which offer free services; private facilities or through home-test kits’’

‘‘People come in to pick the self-test kits, it’s really no big deal anymore. We counsel them, teach them how to use it and encourage them to come back if they test positive.

Dr Princewill, however, explained that 11 health facilities in the FCT have now been listed to pilot the self-testing services, including some military and paramilitary hospitals

Self-testing has come as a solution, it is also helping to overcome the challenge imposed by the COVID-19 pandemic.

Counsellor Offor says because of COVID, people found it difficult to go to for screening at hospitals, coupled with the long waiting time.

”So for young people who want to know their status, COVID and queues were a fitting excuse not to go ahead but that changed with the introduction of self-testing

Dr Princewill who participated in a baseline study that informed the rollout of self-testing in Nigeria agrees with Offor that the approach is changing the attitude of young persons to HIV test.

Although there is not much awareness in the public domain on HIV self-testing, medical experts argue that the innovation may have contributed to the decline in prevalence in Nigeria.

Yet the UNAIDS in 2019 revealed that two-thirds of new HIV infections in West and Central Africa occur in Nigeria despite the 13% reduction in new infections.

22,000 Nigerian children get infected with HIV yearly – UN

HIV self-testing, breaking stigma, discrimination barriers in Nigeria

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