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Homelessness spurs HIV epidemic in teenagers: Controlling the epidemic in Rivers State

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Figure1. An interview session with Janet in PortHarcourt

On Thursday, August 11, 2016, I sought to meet teenagers whose lives have been impacted positively by the US President’s Emergency Plan for AIDS Relief (PEPFAR). Supported by the United States Agency for International Development (USAID), the Strengthening Integrated Delivery of HIV/AIDS Services (SIDHAS) project was quick to take me to two of their clients.  Cletus and Janet (not real names) are both teenagers, living with HIV in Port Harcourt Local Government Area of Rivers State. The story of their lives espouses adolescents’ mistakes that manifests immediately or later in the teen ages. It also shows that a lot of adolescents are living with the virus, unknown to their parent or guardians. UNAIDS estimates that in 2013 alone, 3.2 million children under 15 years of age were living with HIV/AIDS. Also, UNICEF asserts that in 2013, nearly 80 percent of all new HIV infections among adolescents in sub-Saharan Africa occurred among girls. In another vein, UNAIDS  alludes that the rate of new HIV infections among girls continues to be disproportionately high, year after year, as compared to their male counterparts. However, the story of Cletus and Janet presents a unique dimension of HIV infection that can be traced to the effects of homelessness. Homelessness is a complex development issue that requires integrated solutions, in order to prevent adverse effects.  This theme emerged clearly in my interview with both Cletus and Janet.

Controlling the HIV epidemic among homeless teenage girls: A case study of Janet

A senior school certificate holder, Janet failed to transition to tertiary institution because she lost her dad at a tender age. The mother does petty trading which could not sustain the family. As an adolescent, Janet had to search for something doing. She left her village for Port Harcourt, and had no place to call her home. A distanced sister, just a little older than her agreed to provide shelter over her. The sister was living with a friend. Both only comes home in the mornings. Every evening, they dress up and go out for work. Janet could not explain what work they were involved in, but says they were consistent in staying out every night. Janet was able to find a job as sales girl. However, the influence of homelessness played out a role in her life. She missed the context that is normally obtainable in a home. As a result, she entered an unguided relationship with an adolescent boy.

Figure1. An interview session with Janet in Port Harcourt

Figure1. An interview session with Janet in PortHarcourt

In December 2015, the SIDHAS HIV epidemic control team mounted a HIV service tent close to her shop. She was mobilized to and took HIV test. The service provider counseled and told her she was HIV positive, but the SIDHAS project will be willing to help her if she provides consent. She agreed to any help from the program. She was then linked to the project case manager who took her to a designated hospital nearby, for further tests and eventual placement on antiretroviral therapy. All services were provided free of charge. As at the time of my interaction with her, she had spent about 7 months on treatment. Narrating her experience with the drugs, she says;

“I experienced general body weakness when I commenced the drugs and wanted to stop, but because the doctor had told me what to expect, I continued taking. Within the first week of treatment, I felt better and continued till today, missing only two doses in July 2016”

In addition to her baseline CD4 test, she took another one last month. Sensitized on viral load testing, Janet happily and immediately presented herself for sample collection. The result was released the following day – Viral Load – 382/ml. This result was interpreted to Janet that for adhering to her treatment regimen, she has achieved viral load suppression. Janet was so excited!

Commenting on her experience with the SIDHAS project, Janet says;

“Before I met the SIDHAS project, I thought nature had cheated me – from the loss of my father, to extreme poverty, homelessness and then HIV positive results.  The project brought back home to my life. If not for this project [SIDHAS], I don’t know what would have become of me today.”

“I was asked to continue taking these drugs for life; but will I ever get cured at some point?” “Can I get married to a man of my choice and have children?”

At this point, I commenced counseling and handed her over to SIDHAS staff based in Port Harcourt, who continued counseling. They agreed to have a follow up session, where she’d be linked to a designated adolescent friendly healthcare provider in the facility, and a support group around her community, for follow up interventions.

Controlling the HIV epidemic among teenage boys: A case study of Cletus

Figure1. An interview session with Cletus in Port Harcourt

Figure1. An interview session with Cletus in Port Harcourt

Also with roots from homelessness, Cletus said he lost his mum when he was 7 years old. His father works for a small local Company in Port Harcourt. Concerned about lost family love, following the demise of his mother, Cletus relocated his siblings to a relation and went out in search of survival. He had no place to call a home, although he benefitted from a free public school program.  He just had his junior school certificate and hopping to go to a public senior school which is also relatively free – thanks to Rivers State Government.

Cletus was squatting with one friend or the other, as opportunity arose and where ever the night met him. Few months after his homeless lifestyle, he came across a friend who introduced him to watching phonographic films. A couple of friends gathered in the boy’s room every time his parents were out to work. There, he learnt to start having sex at a tender age.

How did you meet with the SIDHAS team?

“In June 2016, I was sitting with my friends in a Barbing saloon when they came and mounted their tent beside the saloon. One of them came in and talked to us about our health, and asked us to do some tests. I agreed and had the test. Then, I was told I’m HIV positive. They told me I can be helped to live a normal life. One of the doctors counseled me and asked his colleague [case manager] to accompany me to the hospital. I joined their car and they drove me to hospital.”

So, what happened at the hospital?

“A doctor talked to me about my health. They also did some tests on me and placed me on treatment [ARVs]. Since then and for two months now, I’ve been taking my drugs, and feel better.”

Cletus was supported to find a paid job. He now works in a restaurant and earns a living. However, he still shares concerns about continuation of his education and a place he can call his home. He said he feels concerned about the welfare of his siblings, as well as his future, given his HIV status.  He regrets engaging in risky lifestyle and was happy that he is being assisted out of it. He’ll like to complete his senior school and go to the University:

“They told me I’ll live a normal life so, I’ll like to complete my education and have a good job that will enable me build my own home and take care of my siblings. I thank SIDHAS for the opportunity to know I live with the virus and for commencing me on treatment.”

I counseled him further and asked him to contact the SIDHAS supported facility any time he had any questions regarding his health. During the sixth month of his taking medications, Cletus will be followed up to do viral load test, to determine the outcome of his treatment. Like Janet, Cletus adheres to his treatment regime with hopes for a suppressed viral load upon examination.

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