Tadaferua Ujorha
16 August 2007
In Kano, one HIV positive couple joyfully adopted a 7 year old positive girl, whose parents died of HIV. Also matchmaking for positive patients is a big activity at a popular hospital in that city. Adoption and matchmaking can play a role in tackling stigma and exclusion, the hallmark of caste systems.
Ladi Abdallah's late parents were HIV positive. One morning her dear father died, and then it was not long before her mother also passed on, leaving Ladi alone. Ladi (not real name) is HIV positive, just as her parents had been.
For a seven year old girl, life became tough in Kano. Sneered at by blood relations, shunned by the same group, and excluded from popular Children's games, young Ladi passed through days of darkness. She was truly alone and became an unwilling introvert. It was as though she were a member of a caste which is forced into cold and unfriendly pathways by a hostile society. At a point she thought her middle name must be stigma, all done in capitals. Then, all of a sudden and in the twinkle of an eye.... radiant sunshine fell upon her life, banishing all darkness.
A heart of gold
This was when Ahmed Usman (not real name) intervened. He is HIV positive as well as his wife, and came across Ladi's relations one afternoon as they were considering putting Ladi in a Children's home in Kano. This was simply on account of her HIV status. He promptly offered to adopt Ladi, an event which has dramatically turned the young girl's life around. His wife embraced his decision without a second thought, and likes Ladi even more than her husband does, as Ahmed confesses to Daily Trust.
He adds that Islam approves of the adoption of Children. His words' Adoption is recommended in Islam Bringing orphans into a family setting is the best way to ennoble them. If you adopt a child, you will then treat him or her like a child of yours. If you adopt and train a child you are training a nation'. On Ladi's education, he says' She is now in the primary school, and the school closes by noon each day. When she comes back, she goes to her Islamic school around 2.00pm. Her parents died of HIV, and her relatives were afraid of taking her into their homes. When she plays with their children, they begin to shun her, saying she should not touch their children, fearing she would infect them. I felt so sad, and decided to adopt the girl. This was early last year. Just because she is HIV positive does not mean that she is by any means less than any other child'.
He tells this reporter that he and his wife are actively engaged in reaching out to people in Villages who are HIV positive, and this is all part of the work of Volunteers within the Aminu Kano Teaching Hospital. In this effort he has a particular strategy. His words' When I meet someone who is positive, maybe he is afraid to tell the wife, I may now send my wife to go and counsel his wife. I target the time my wife takes her drugs, which is around 7.00pm and send her to the house by 6.45 pm. She would then ask the wife for water to take her drugs. This would show that people can be HIV positive and still live a fulfilling life. So we encourage women to come to the hospital, especially when they are pregnant'. Today, Ladi lives happily in Ahmed's house, where she is like a first daughter and is always found exchanging healthy gossip with Ahmed's wife. Ahmed got married last year, and his wife is pregnant with their first child.The golden example of Ahmed and his kind wife ,can go a long way in challenging stigma in society, and extending not a little sunshine into the lives of HIV positive persons.Ladi has, almost single-handedly ,walked down the dark corridor of pain.
Two bold families
This reporter came across two bold families at the Aminu Kano Teaching Hospital Kano. In the first family, the husband, his wife and two children are HIV positive, but the third child is not.This shows the efficacy of mother to child prevention and control that is PMTCT efforts which are gaining currency today. PMTCT can bring about miracles in families where the couple are positive, and also wish to have Children, making them similar to, rather than unlike other families. This reduces the towering stigma which finally creates a caste. The second child of the couple is positively living, and is not yet on drugs. The first two children were born before the couple knew of their status. But after this, effort was made to protect the third child through PMTCT, and it worked, and this has restored hope to positive couples across the country. Then there is the family of Obi James (not real name). Here husband and wife are positive, and the first and second children are negative, while the third child is positive. James says the couple became aware of their status in 1998.The third child is on drugs, and the parents urge her everyday to take her drugs. She goes to a primary school where she is doing quite well.
Rare Children
One of the Volunteers at the hospital mentioned the pathetic story of an HIV positive woman who was abandoned by her own children. According to him'I went on a visit to a community and came across a 45 year old HIV positive woman who had been neglected by her family. They were not willing to look after her. It was only when we brought her to the hospital, she began to take her drugs, and was improving, that they now accepted her.Her own children abandoned her. That was shocking. It was when they were enlightened on the matter that their attitude towards her finally changed.'
Love at first sight
The story of Ado and Baba (not real names) is an unforgettable one. Both men live in Kano.One is a local politician and a community worker, and the other is an ACTION trained home based care-giver and volunteer. Between July and September 2006 both men got married to two women they met and fell in love with while on regular visits to receive treatment at AKTH.Some years ago Ado fell ill and had to be rushed to a hospital in Kano, because for two days, he was vomiting and stooling.Soon he was diagnosed with HIV. Baba, on the other hand, did not fall ill before discovering his status. He went for a test after his wife died of HIV. The test revealed that he had the Virus. His words'I quickly got enrolled for counselling, and subsequently began to receive appropriate medication because my CDA4 count was low then'. Baba says that with the amount of information he receives at AKTH On HIV/AIDS, he is waiting for his college of Education Graduate wife to raise a family, to signify that there's life beyond the virus.
Volunteers in Kano
Within the Kano area are a crop of willing volunteers, who help in sensitising the community on HIV, and this plays a role in checking forms of stigma. The group was formed in 2006 and Volunteers are given a stipend to assist their good work. Today, there are 35 Volunteers working with the Home Based Care Team based at AKTH.The group sensitises family members on HIV by constantly giving health talks in communities, which show how HIV is transmitted.Effort is made to show that if care is given to positive persons ,this will improve the clients general well being.
The President of the Volunteer group tells Daily Trust that the work requires detailed information on the patient. His words 'Before he is discharged from the ward or before he is discharged from the clinic, we try to find out his full address, and later make sure we follow him there. When we follow him there we take our home based care kit along with us. Then we try to see if the relatives are looking after him, and whether he has clean water to drink. So we constantly check on him, and make him feel happy, encouraging him to take his drugs'. He also shows that the Volunteers face many challenges in the course of doing their work. One of which is the very low support from individuals to assist the noble work. Contributions in terms of clothes, food and money could assist the work handsomely. He adds that more Volunteers are needed to assist the work in the community. His words 'We face many challenges here in Kano.We need additional money, clothes and food for the patients. Also we need more Volunteers. We also have a radio programme through which we try to reach out to the patients in Kano. The number of patients in the clinic is higher than it was a year ago, that was before the beginning of Volunteer work. Now, it is high. People come voluntarily, especially after our sensitisation effort'.
He also sheds light on stigma, and shows that today people still believe that HIV originates only through sexual contact, and not by any other means. His words' so if people are infected, others instantly think such a one is sexually reckless or promiscuous.People still regard HIV as the end of the road. We work freely with our infected colleagues. We eat with them, and do everything freely and easily, because we know how the infection spreads. Now people are becoming more enlightened and things are changing'.
Good Work
Dr. Patrick Dakum is Country Representative of the Institute of Human Virology. The effort of the AIDS care and Treatment in Nigeria (ACTION) project of the Institute of Human Virology, is to provide antiretroviral medication to people living with HIV. According to him the situation in respect of HIV/AIDS in the country, is truly an emergency, and he provides statistics to make this point. His words'We have about 3 or 4 million people that are carrying the Virus already. Out of this, the group that will need to be on treatment is estimated at some 600,000.Out of this number only 120,000 are being treated today. We need to declare a state of emergency, as far as HIV is concerned, and then tackle it as an emergency right down to every village.'
To the villages
He argues that we need a national Aids control agency at the state and local government levels, and that this should be replicated at Ward and Village levels.' In fact people have advocated that we should go down as far as families to be able to ensure that we address these issues squarely'. He compares HIV with Tuberculosis, and adds that in respect of the latter after treatment, the patient gets well. But in HIV' you remain in therapy till your days are over. It means that we have a unique public health challenge here, which is similar to hypertension. The difference is in the magnitude and the number of patients, and in the fact that it has the potential to affect thousands of persons'. He also makes the formidable point about a country's mark of development. According to him'The mark of development of any country is in its ability to take care of those citizens who cannot look after themselves. A community's' development is measured directly by how much it can take care of the weak, not by the number of structures you build or schools, not by the number of hospitals, but by how much you care for those who cannot take care of themselves'.
But he adds that Nigeria is on the right course, but that the country needs 'to expand the budget for HIV/AIDS, and we need to also ensure that each state also goes in the direction the Federal Government has done, by establishing agencies rather than committees. We all need to move towards communities accepting the fact that HIV/AIDS is like any other disease, and that people that are infected or affected, should be accepted in normal duties in the community. For instance, if a chief is going to set up a committee to carry out a task, somebody who is known to be HIV positive should be on that committee, as long as he qualifies for the position.' He adds with insight' If the leaders of that community see HIV as an issue they are ready to talk about and accept, and encourage people to accept, you will find that stigma would go down. If government is proactive in promoting services that would ensure that they live normal lives, then it would reduce stigma'.
According to him the intervention in Nigeria in respect of HIV started a little later than other countries, probably because Nigeria did not see the scope of the devastation, unlike countries such as Uganda and Botswana. Nigeria has since done very well in the campaign against HIV, and can compare very well with other countries. For instance, there are just a few countries that have set up a committee at the presidential level in respect of HIV. Nigeria also took the Bull by the horns recently by convening a summit on HIV/AIDS. He shows that there are more women among those that are currently on therapy. His words' The reason is because more women are coming out to be tested than the men. If you look at hospital seeking behaviour, you find more women than men. If you go to any typical hospital, or any primary health care facility, you will find more women and children. A lot of men wait until they cannot walk before they go to the hospital. They would rather brave it or take panadol. Because of pregnancy, we have a lot of women coming to the hospital for ante -natal care. That is why we have a programme called prevention of mother to child transmission, to enable women that come for a check up, to be tested .For those that are found positive, we begin therapy to reduce the risk for the child. His words'I believe that's a major public health success. In the US the risk has been reduced to almost 0%.So you have many women that are positive, currently having normal children'.
Adherence to drugs
Dr.Jibreel Jumare, Regional Manager, Kano speaks on the adherence of patients to their drugs. He explains that the level of education among the patients is low, and therefore such patients are quite vulnerable to persons who operate in the traditional arena, and this is seen as a challenge. His words'We have had instances where patients would become quite moribund, and after treatment they get well. Because of the difficulty of having to take a drug sometimes twice a day, you and I know that taking a course of anti-biotics for five days is sometimes a challenge. If somebody offers you an option saying take this and you are cured, some people are vulnerable to that kind of abuse, and this affects the adherence level to some degree. By and large, even if the patients that we see try some of these things, eventually they come back. He adds that the level of adherence has not been quantified, in terms of figures ,but it is quite appreciable. His words' Some studies have shown that the level of adherence in the third world is higher than what obtains in the developed world. Our patients tend to present late, and that might be a reason. For somebody who presents late is naturally not doing well,and is more likely to comply to treatment, than somebody who is detected early, and who is relatively still well preserved'.
Season of Matchmaking
A season of happy matchmaking has begun at AKTH.This revolves around single HIV positive persons who are seeking partners. According to Maimuna Saad,the Programme Officer, Adherence, of the hospital 'When clients come in for Adherence counselling, they talk to us about their private social issues, like the need for a partner. We arrange for them to meet each other, under a conducive atmosphere. When they get to know each other and are comfortable with themselves, then we allow them to bring in their families'. Matchmaking at AKTH actually began at the Adherence unit which 'deals with the social aspect of a client and their social needs to prevent him from going astray. Their sexual drive would make them go out to satisfy heir needs, but if married they would not spread it'. So far, a total of ten HIV positive couples got married owing to the matchmaking team at the hospital.
Dr. Jibreel Jumare tells this reporter that matchmaking in the hospital started with the support groups where people get together on a weekly basis.' Along the line some of our programme officers felt that because of high cases of some people being discordant, that is, a husband being positive and the wife negative, or vice versa, with there being some incidents of divorce. So an option was thought of to tackle the problem. Also members of the support groups sometimes approach the medical personnel, requesting that if they find a compatible person, they should also let them know.' He argues that the possibility of couples using the matchmakers would be a relief' in terms of getting someone who will not only be a partner, but also be a fellow client. She also takes the same drugs and there would be mutual encouragement by the couple for each other. That would go a long way in boosting adherence'. In Kano, HIV positive persons may not wait long, if they are single and in need of a partner.
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