Figure Above: A health care provider, Mr Solomon discusses with Mary in her community in Abuja.
According to the 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS), the prevalence of HIV among female sex workers is between 13 to 15% according to. Female sex workers are considered key populations in addressing HIV globally because of their exposure to high risk sexual behaviors. Other key populations are men who have sex with men, transgender people and people who inject drugs.
Mary, a female sex worker living in Abuja, identifies stigmatization, confidentiality and transportation costs as challenges that affect access to HIV treatment in health facilities. However, as a person living with HIV since 2013, her relief is the one-stop shop HIV center that Institute of Human Virology Nigeria (IHVN) is supporting in her community.
The IHVN supported center run by DIADEM Consults with funding from the US Centers for Disease Control and Prevention (CDC). At the center, Mary and other female sex workers receive prevention, care, and treatment services to reduce the transmission of HIV.
The center located close to Mary’s residence her the worry of transportation costs.
“The staff treat us well, there are no long queues and HIV medications are always available. I meet my peers during support group meetings and the staff there encourage us to adhere to our HIV treatment,” she said.
“They teach us that if we stop taking drugs, our viral levels will go up but if we adhere to treatment, we will stay healthy. They also teach us how to prevent re-infection. We do not always know the HIV status of our clients so it helps when we get condoms at the center. There, we are taught how to use condoms and given lubricants as well. They tell us to be careful when using needles and sharp objects” she said.
“I take my drugs well and I feel strong. Treatment is free too,” she said.
What attracted another female sex worker, Victory, to the center is the friendly way in which she was told about her HIV positive status when a friend recommended the center to her last year.
“The people working here are friendly. They educated me about HIV. I asked them if I was going to die immediately but they assured me that HIV is not a death sentence. I started taking antiretroviral treatment and it is really helping,” Victory said.
IHVN Prevention Lead, Mrs Comfort Ochigbo, said that with more people on treatment, the likelihood of people living with HIV transmitting the virus is reduced.
“Key populations need these services to stay healthy and also to reduce HIV transmission. When we interrupt HIV transmission in these populations, we will go a long way in reducing the spread of HIV in the larger community.”
She explained that IHVN supported One Stop Shops also reach out to men who have sex with men, transgender people and people who inject drugs.
”We provide not only HIV treatment but pre-exposure prophylaxis (PrEP) to those who are not yet infected to prevent transmission,” she said.
Amira, a transgender woman, attests to the availability of free pre-exposure prophylaxis at the center where she accesses HIV medications in Abuja. She has even introduced a friend to the center.
“When I told my friend about pre-exposure prophylaxis available in the one stop shop, she followed me to access the services. When she came, she was tested for HIV and given PrEP after she tested negative,” Amira said.
Amira added that she is willing to introduce others to the one stop community center where she accesses HIV medications because they are like family to her.
“As a member of the key population community, going to a regular hospital is not safe. Even if I go, some people will start preaching to me about my gender identity and personality. Here, they just accept me as family and I feel at home.”
Amira also gets free treatment for sexually transmitted infections as well as transportation support.
Apart from easy access to HIV services, Mary is also encouraged to remain in treatment through follow up calls from the center.
Another transgender woman, Godiya, added that viral load tests are free at the IHVN supported center.
“They really care a lot about their clients. I started taking HIV medications in December 2019 and I always get free drug refills and viral load tests here at the One Stop Shop.”
An additional service that Emmanuel, a member of the Men who have Sex with Men (MSM) community, receives is delivery of drugs at his door step when he is unable to go to the center.
“When we are unable to go to the facility for treatment, they send it to our doorsteps. I take my HIV medications daily. The last viral load test I did here shows that I am doing well and the virus is undetectable,” he said happily.
“I see the facility as my second home, whenever I have issues, I run to them. Any time I have challenges with my treatment, they guide me on what to do,” he added.
Emmanuel now refers other community members to the center. “Recently, I encouraged some to go there for cryotherapy treatment for anal warts. Many of them turned up, though at first, they were shy,” he said.
Constant encouragement from staff at the center is what has kept Chidi, another member of the MSM community, motivated to remain on treatment.
“The staff talk to me and counsel me. Taking drugs every day is not easy. They give me hope,” he said.
IHVN Prevention Lead, Mrs. Comfort Ochigbo, said that the community centers are also supported by the Institute to conduct community outreaches to settlements with high numbers of key population.
Dalhatu, a person who injects drugs says that he first learned PrEP after one of such outreaches to his community in Kpaduma by IHVN supported Reach Care Foundation. Since then, Dalhatu has continued to access PrEP services to prevent HIV.
“I access PrEP services, treatment for sexually transmitted infections and regular HIV testing at the Reach Care Foundation One Stop Shop,” he said.
Mr. Solomon, a counselor at one of the One Stop Shops in Abuja, said that PrEP is only given to clients who are HIV negative.
“For clients who are living with HIV, we give them free condoms and lubricants, teach them condom negotiation skills, and organize support group meetings to encourage them to live healthy lives. Currently, 1,500 key population members and their partners access HIV prevention and treatment services at our center,” he said.
According to IHVN Prevention Lead, Mrs Ochigbo, these one stop shop community centers have continued to improve access to health services to female sex workers, MSM, transgender women and other key populations community members.
“We have 17 one stop shops in the Federal Capital Territory, Nasarawa, Katsina and Rivers States. Combination prevention package of services are offered at these centers include HIV testing services, PrEP, HIV antiretroviral treatment, viral load testing, mental health, gender-based violence services amongst others” she said.