WorldAIDSDay: Does The Call To ‘Equalise’ Efforts Reach Displaced Women In Nigeria?

As the globe marks the 34th annual AIDS day, there are questions about equitable access to treatment and preventive measures amongst internally displaced women in Nigeria.

“It remains a big challenge,” Gloria Asuquo, the Regional Coordinator of International Community of Women Living with HIV (ICW), told HumAngle. Keeping track of women who contract the disease in conflict situations and are living with it in displacement camps is very hard, she says.

AIDS (Acquired immunodeficiency syndrome) is a chronic condition caused by the Human Immunodeficiency Virus (HIV) — the sexually transmitted infection that can also be spread through contact with infected blood or other bodily fluids.

‘Equalise’ is this year’s theme for World Aids Day. According to the United Nations Programme on HIV/AIDS (UNAIDS), it is a prompt calling for a strengthening of policies and laws to tackle stigmatisation and exclusion faced by people living with the disease so that everyone is shown respect.

“The world is not on track to end the AIDS pandemic,” Winnie Byanyima, the executive director of UNAIDS said during the events to mark World Aids Day on Dec. 1. Inequality causes progress against the disease to stumble, she added.

The experiences of those living with the disease and who have been forced from their homes by conflict show that in practice, to “equalise” is no simple matter.

Are displaced women part of the plan?

The international community aims to end the AIDS pandemic by 2030, but Gloria Asuquo says the reasons that make tackling the disease difficult around conflicts like those occurring in Nigeria, could compromise these goals. 

The campaigner, who has been open about her own personal struggle with the disease after testing positive at aged 12, noted health workers find it difficult to keep up with displaced people, especially women and girls, who are living with the disease across the country.

“Sometimes we gather data of displaced women, some of them even pregnant without knowing they are HIV positive, and try to give assistance and follow up with them,” she explains, “but most times they move to other camps or communities, or they lose their contact numbers. This alone has made it difficult to keep track.”

Asuquo also noted that equitable access to antiretroviral medications has been severely disrupted due to the insecurity and the COVID-19 pandemic. “Some of the hospitals we used to distribute drugs were turned into isolation centres for COVID patients. The insecurity too has generally disrupted health systems.”

Unjust cultural norms further compromise women’s health. Husbands, or the paternal head of the household, decide whether or not women and girls should get tested. “This plays a major role in the area of women, adolescents and girls speaking out about their symptoms and their health.”

The government needs to take responsibility for ensuring these vulnerable groups have access to medication, Asuquo says. She explains that the National Agency For The Control Of AIDS (NACA) should ensure that practices that aid the spread of the disease are countered.

The World Health Organisation (WHO) agrees the global HIV response is in danger. In a statement to mark World Aids day, it said: “Over the last few years progress towards HIV goals has stalled, resources have shrunk, and millions of lives are at risk as a result.

“Division, disparity and disregard for human rights are among the failures that allowed HIV to become and remain a global health crisis.”

Prevalence of HIV/AIDS amongst IDPs in Borno.

In Nigeria, the first case of HIV/AIDS was diagnosed in 1985. It was first reported in Lagos, southwestern Nigeria. The disease was soon found in all parts of the country.

Currently, over 1.9 million people are known to be living with the disease in Nigeria. It affects more women and girls yearly.

The widespread presence of HIV/AIDS tends to exacerbate during conflict situations and humanitarian emergencies. According to a study published last year on International Journal of HIV/AIDS Prevention, Education and Behavioral Science, the breaking down in social structures, the increase in sexual and gender-based violence (SGBV) during conflict, and inadequate education and awareness increases the spread of the virus. 

Due to the decade-long insurgency in the northeastern part of Nigeria, women and girls living in worst-hit villages have been subjected to harsher outcomes. This includes rape committed by terror groups, soldiers, and even male counterparts who are also victims of the violence.

Insurgent groups abduct women and girls to serve as wives or servants of Boko Haram fighters. Sexual abuse also occurs in overcrowded displacement camps. Some camp officials have been known to exploit vulnerable women for sex before they distribute relief materials. This practice even has its own name: “survival sex”.

The study assessed and tested 26,712 displaced persons across three displacement camps in Ngala, Banki, and Dikwa Local Government Area (LGA). It found that a lack of coordinated effort is fueling the increase of infections amongst the displaced populations.

In Ngala IDP camp alone, there was a prevalence rate of 1.98 percent which is higher than the national average, the study found. “This is a major concern,’ the report added, “especially with its geographical location as a border town having boundaries with Cameroon and Chad where there is a constant movement of people across both sides of the border.”

Stigma faced while displaced.

In 2021, HumAngle chronicled the lives of Hajiya and Maryam, displaced women living in Maiduguri who contracted HIV/AIDS while surviving the insurgency. 

Hajiya told HumAngle how she surrendered herself to them in a bid to rescue her children from Boko Haram after an attack on their community in Bama LGA. She was held in their den for over two years, forcefully “married” to three different commanders. This is where she said she was infected.

It was after her eventual fleeing from terrorist enclave that Hajiya was tested and found to be positive of the disease. Both Hajiya and Maryam are laying low about their condition due to the fear of being stigmatised and excluded.

Stigma and discrimination against IDPs living with HIV/AIDS in camp and camp-like setting have grave consequences for women. It could result in general exclusion from other members of the community and can even worsen their chances of getting relief materials.

“They don’t know and I don’t want them to know,” Maryam told HumAngle. “If people know about those that are affected, they will keep away from them.” She added how she wakes up very early in the morning to take her medications for fear of being ‘caught’. 

Maryam also narrated how when a man in their camp died of the virus, his widow faced great neglect. This led to the widow relocating to another camp where her status would remain unknown.

Apart from the stigma. Because of the insurgency, more than half of the antiretroviral centres in the state, where displaced women could access HIV treatment, had been shut down leaving only a smaller portion of people living with the disease with access to drugs.

Displaced persons living in other parts of the state especially in smaller communities have it more difficult because access to antiretroviral treatment being far away from their location. HumAngle’s report noted that, “those in the garrison towns have to constantly visit health facilities outside their displacement camps to access essential services.”