Queer Alliance Nigeria
With technical support from
Queer African Youth Networking Center
And financial support of
MTV STAYING ALIVE FOUNDATION
The Helping Ourselves Together (HOT) Project
Peer Educators Training Program
24th to 26th February 2012
The Integrated Biological Behavioural Survey Surveillance (2007) conducted by the Federal Ministry of Health and its partners estimated the prevalence rate of HIV amongst men who have sex with to be 13.5%. Today the prevalence rate of HIV amongst men who have sex with men is put at 17.2%, (IBBS 2010). These figures are alarming and jeopardize the progress that Nigeria has made in the fight against HIV/AIDS.
Discriminatory and repressive laws as found in the statues book of Nigeria, albeit a constitution that protects the basic rights of all citizens, even if not explicit on sexual orientation and gender identity, stigmatizing attitudes of society and health care workers in HIV service provision continues to be the backbone for the continued increase. Furthermore, government quest to further penalize sexual minorities, most especially gays, bisexuals and men who have with other men since 2006 continues to contribute to the upsurge in the prevalence rate. This has also led to several communities of men who have sex with men disenfranchised from service provision in HIV prevention, treatment, and support services.
Since inception in 2009, Queer Alliance has worked to provide the needed interventions as to the HIV and sexual health needs of sexual minorities, especially for young men who have sex with men and also address human rights abuse and violation based on sexual orientation and gender identity. Since 2008, Queer Alliance worked from Lagos, the commercial capital of Nigeria. After a strategic meeting of the organization and sexual minorities’ census conducted in collaboration with the Queer African Youth Networking Center, Queer Alliance’s felt the need to move to the inner cities of Nigeria to address the needs of sexual minorities, most especially men who have sex with men in the South-South geopolitical zone of Nigeria.
By funding the HOT Project, MTV Staying Alive Foundation through Queer Alliance is responding to the HIV and sexual health challenges of the MSM communities in the South-South geopolitical zone of Nigeria, starting from Delta State.
The aims and objectives of the Helping Ourselves Together Project are:
v To increase knowledge of 300 young MSM aged 18-29 in Delta and Anambra states with comprehensive HIV prevention information and services by December 2012 through peer leadership in learning circles.
v To enhance knowledge of 20 health care workers and HIV counselors with knowledge in issues of sexuality, HIV and rights in selected HIV service facilities in Delta and Anambra states. This is to address the gap in service provision, discrimination and stigma of health care workers and HIV counselors towards MSM.
v To use information, education, communication (IEC) and mobile telecommunications strategies in the dissemination of HIV prevention messages to MSM in Delta and Anambra States.
v To distribute 7,000 pieces of condoms/lubricants to MSM in Delta and Anambra States in Nigeria.
REPORT OF THE PEER EDUCATORS TRAINING
From 24th to the 26th February, Queer Alliance trained 15 MSM in issues of HIV Prevention, Treatment and Support Services and to act as peer educators within the gay, bisexual and other men who have sex with men community. The training session was opened by the Executive Director of Queer Alliance with the introduction of Queer Alliance as an organization and its partner organization; Queer African Youth Networking Center and MTV Staying Alive Foundation.
Participants were taken through what the aims and objectives of the HOT Project. Expectations from the training program were collated from the participants. Some of these were:
· To learn more about HIV and how to prevent being infected
· To be able to educate my peers on HIV prevention from the knowledge gained.
The participants were taken through an intensive training that covered the following topics: Introduction to Peer Leadership and Education, Sexuality and Human Rights, HIV/AIDS/STIs, Safer Sex, Managing HIV and Interpersonal and Communication skills. The training session started by administering a Pre-test questionnaire to test the level of knowledge of the participants. The questions were:
1. What do you understand by the terms (a) Peer Leadership and Education (b) Peer Educator
2. In your opinion who do you think a Peer Educator is?
3. Define the following terms: (a.) Gender (b) Gender Identity(c) Sexual Orientation
4. What do you understand by the term ‘Human Rights’?
5. Define following terms (a) HIV (b) AIDS (c.) STI
6. Give four modes of transmission of HIV and three examples of an STI.
7. How do you think you can prevent HIV/AIDS?
8. What do you understand by the term HIV re-infection?
9. Explain in your own words what you understand by the term Stigma and Discrimination?
10. Why is Voluntary Testing and Counseling important?
11. What do you understand by the term Record Keeping? What is the importance of this in Peer Education
12. What do you understand by the term Communication and Interpersonal Skills?
13. Is there any relationship between peer education and communication? Underline please. If yes, please explain.
INTRODUCTION TO PEER LEADERSHIP AND EDUCATION
The session started with pre-test questions testing the knowledge of the recruited peer educators on issues of HIV prevention, treatment and care alongside basic human rights issues. The first module of the training Introduction to Peer Education and Leadership was facilitated by the Monitoring and Evaluation Program Officer of the Heartland Alliance Nigeria office in Lagos. Participants were asked who they would describe as a “peer”. Participants describe their peers as persons who belong to their age group. The facilitator gave an outline definition of who a peer is and other terminologies as enumerated below:
· A peer refers to person/group that belongs to the same social group as another person or group. The social group may be based on age, sex, sexual orientation, occupation, social group or status, health status or other factors.
· Education refers to the development of a person’s knowledge, attitudes, beliefs or behavior, as a result of the learning process.
· Peer education is the transfer of knowledge and skills to members of a social group by others within the same group.
· HIV Peer Educators are people who are themselves enrolled in HIV prevention, care and/or treatment services; have a good understanding of HIV, care, treatment, PMTCT and adherence;
and have the skills to help other clients with their care and treatment. Usually, Peer Educators are volunteers.
Furthermore the facilitator enumerated on the benefits of being a peer educator. He stated to the
Participants that being a peer educator should not be seen as a waste of time but a period in which one contributes to the development of the community to which one belongs. Emphasis was laid on the illegal status of men having sex with men in Nigeria, making it difficult to reach out to persons with these orientation or those who engage in the act. It was further reiterated to the participants that the best people to reach out to men who have sex with men in Nigeria is to make use of these same people as peer educators and leaders for their community. Peer educators form the pillar upon which education and knowledge for men who have sex with men is built in HIV prevention, treatment and other support services.
The facilitator also enumerated on the role and responsibilities of peer educators, especially as it concerns the HOT Project. The roles and responsibilities for the trained peer educators are as follows:
· Spend at least 6 hours per week working in the community center and 3 days per month working in the community center.
· Participate as an active member of the multidisciplinary care team for MSM living with HIV
· Conduct one-on-one counseling sessions with their peers on the following topics:
1. HIV basics
2. Understanding care and treatment
3. Adherence to care and treatment
5. Positive living and positive prevention
6. Ongoing psychosocial support
7. Others, as decided by the project secretariat
· Help their peers with referrals within the health facility, including walking them to the referral point, explaining why the referral was made and what services will be given at the referral point and making sure their peer is seen in a timely and respectful manner at the referral point
· Act as a link between their peers and the multidisciplinary care team, including presenting common concerns of peers/adherence challenges faced by MSM living with HIV in multidisciplinary team meetings
· Conduct community outreach and education activities to improve community knowledge about HIV and its prevention
· Lead support group meetings and, where none exist, form new support groups
· Keep basic records and compile monthly reports to be submitted to the Project Coordinator
SEXUALITY , SEXUAL ORIENTATION, GENDER IDENTITY AND HUMAN RIGHTS
Knowledge in issues relating to human sexuality, gender, rights were also part of the sessions that were delivered. This was imperative in order that peer educators during their peer education activities could also educate their peers on issues of human rights, gender and sexuality in relation to HIV. The module objectives were as follows:
· Participants will have an understanding of the concept of sexuality
· Have a vivid understanding of sexual orientation and gender identity and be able to educate their peers as regards sexual orientation and gender identity
· Understand what Human Rights are, the relationship between HIV and Human Rights and understand rights within Nigerian society even as LGBTI to self advocate
Sexuality encompasses everything about an individual from the day they were born to the day they die, hence it is an integral part of being a human being and this includes their sexual identity and orientation because they are also a part of an individual’s sexuality. Sexual health considers healthy sexual development, equitable and responsible relationships and sexual fulfillment; it is also freedom from illness, disease, disability, violence and other harmful practices related to sexuality and its expression.
Under human rights, participants were made to understand why the burden of HIV is greater amongst most at risk populations, most especially amongst gays, bisexual and other men who have sex with men. The need for the campaign of rights and the holistic inclusion of MSM in HIV programming throughout Nigeria was underscored to the participants with emphasis laid on the Universal Declaration of Human Rights and other international treaties and covenants that protects from the discrimination on the basis of sexual orientation and gender identity, most especially those to which Nigeria as a country is signatory to.
The module on HIV/AIDS/STIs began with a values and values clarification. The module consisted of the following sessions: STIs, Voluntary Counseling and Testing, Stigma and Discrimination and Risk and Vulnerability.
The session on sexually transmitted diseases was incorporated into the training module to enable participants get the relationship between STIs and HIV. Taking the participants through the session, emphasis was on a person’s sexual behaviour which puts them at risk of acquiring and spreading sexually transmitted infections. Emphasis was also laid on untreated STIs which further put people at a risk of HIV infection. The different kind of STIs that MSM were prone to was enumerated to the participants, together with their signs, symptoms and available treatment. Participants were made to understand that it is important to be tested if one thinks that he/she has been exposed to an STI. It is important to note that counseling plays an important role in the management of STIs.
Partner notification of STIs was pointed out to participants as good practice in STI management Early notification of partners of an STI provides the other partner the opportunity to ascertain their own infection status; where an infection has been diagnosed the partner commences treatment immediately, this helps prevent re-infection for both parties. And where the partner has not been infected by the STI, then preventive measures are put in place to ensure that they are not infected with the STI. STIs easily predispose an individual and most especially MSM to HIV infection. The essence of preventing or making sure an acquired STI infection is treated properly before one engages in sex again in other to reduce the percentage of acquiring HIV.
The module on HIV took the participants through the basic facts and stages in the progression of the disease. The following stages in the progression of HIV were outlined and explained to the participants.
§ Window Stage: This is the period between when HIV infection occurs and the body’s response by producing anti-bodies to fight the infection. At this stage, there are no signs and symptoms of infection and the person appears negative when tested. The infected person is capable of transmitting the virus also at this stage. This period is usually between 3 to 6 months.
§ Dormant Stage: At this stage, there are also no signs and symptoms. However, the person if tested appears positive.
§ AIDS Related Complex: This is the stage when clinical symptoms with non-specific illness begin to show. These symptoms include swelling of the lymph nodes, nausea, chronic diarrhea, weight loss, fever and fatigue.
§ Full Blown AIDS: This is the stage when the infected person begins to show signs and symptoms related to AIDS. These signs and symptoms are those of the opportunistic infections that occur as a result of the damaged immune system. This stage is also the last and fatal stage of infection.
The mode of transmission of HIV were also spelt out to the participants as follows:
· By sexual intercourse- vaginal, anal or oral with an infected person
· By transfusion with HIV infected blood (often with blood that was not screened)
· By sharing needles, razors and other sharp objects with an infected person; and
· From an infected mother to her unborn baby, before, during or after birth
Factors that increased the vulnerability of MSM to HIV infection were also enumerated upon:
· Discriminatory and repressive laws as found in the statues book of Nigeria
· Stigma and discrimination
· Inadequate healthcare service provision
· Hetero-normative culture compelling sexual minorities to engage in heterosexual unions
· Hostile policy environment
Participants were also taken through Risk and Vulnerability, HIV Testing and Counseling and Stigma and Discrimination. Participants were made to understand the risks and factors that contributes to MSM being prone to HIV infection. Some of these risks and vulnerability pointed were:
· Unprotected sexual intercourse (anal, oral and vaginal)
· Multiple sexual partners
· Discriminatory and Repressive Laws
· Human Rights Violation
· Lack of access to information relating to issues on HIV/AIDS
· Untreated Sexually Transmitted Infections
Taking the participants through HIV Testing and Counseling, HIV/AIDS treatment and care, the facilitator reiterated that counseling forms an important foundation in helping people resolve internal conflicts in relation to HIV and also gain the inner courage to move on with their lives positively irrespective of the outcomes of their test results. The possible outcomes of an HIV test results were also elucidated on:
· Positive: If the test detects antibodies for HIV, we know that HIV has entered the body. When antibodies are found, we say the blood is HIV-positive, or sero-positive. Blood tests are 99% accurate in most places. This means there is a 1% chance the test will not be accurate, and may show a “false positive.” For this reason, most positive or indeterminate results are confirmed with a second test.
· Negative: A “negative” result means that antibodies were not found, indicating either that the person has not been infected with HIV, or, it may be too early to tell. In the 2-3 month period after infection, it is too early for antibodies to have formed. This period is called the window period. To be absolutely accurate, the test should be taken twice in three months giving HIV antibodies time to appear in the bloodstream after the time of infection.
It is noted that within the MSM communities across Nigeria, stigma and discrimination remains a challenge in HIV prevention work for MSM. With a soaring prevalence rate of HIV amongst MSM in Nigeria, the session on stigma and discrimination was imperative so that participants could educate their peers and also have adequate understanding of the relationship between HIV transmission and stigma and discrimination. The session was opened with experience sharing relating to stigma and discrimination on the grounds of sexual orientation, gender identity and HIV status.
In closing the session, the facilitator shed light on the “SAVE” approach as a medium of prevention, treatment and support services.
S - Safe Practices: Safe Practices means that individuals, families, communities and organizations are encouraged to adopt practices that reduce their chances of getting infected and adopting the best and appropriate approach in particular to their situation. These will be different for different groups of people.
A – Accessing Appropriate Interventions: Accessing appropriate information requires that organizations are informed with up-date information on ways in which those with HIV can better increase their quality of life and actively encourage people to make use of these services. This will include access to anti-retroviral drugs, clinics, access to improved nutrition, rapid referral to health services for HIV infected and non-HIV infected people. It would also include encouraging communities and families not to reject HIV infected people.
V – Verification: Verification encourages all at risk to, however small to seek and access testing facilities available. It also encourages organizations not to attach stigma to the process of testing and to see it as a responsible action.
E – Education: Education recognizes the importance of accurate information on a whole range of issues relating to HIV/AIDS and also opportunities to discuss and engage with these as part of the process of individuals, families and communities making informed decisions.
SAFER SEX (CONDOM AND LUBRICANTS USE)
The session took participants through the use of condoms and lubricants and their role in the prevention of HIV and re-infection with HIV. There was a short discussion amongst the participants on the reasons why young people complain about the efficacy or effectiveness of a condom in preventing sexually transmitted infections. Alongside this was also a short discussion on why MSM find the use of condoms difficult. One prominent question that was an outcome of the discussion centered on the efficacy and effectiveness of condoms. A participant raised the question of condoms have pores and with the size of the virus, there was bound to be transmission.
Furthermore, the facilitator took the participants through the anatomy of the anus, explaining to participants the reason why MSM are more vulnerable to HIV prevention. Condom preservation was also touched upon. It was interesting to note that during the sessions, participants with condoms in their wallet brought them out. Light was also shed on the expiry date of condoms, which in a way determines the effectiveness and efficacy of the condom. In addition, light was shed on the different sizes of condoms that would be available for distribution during the literacy session and the field work of the peer educators.
Knowledge of participants on lubricants was tested. It was not surprising to find out that most participants had little or no knowledge of water based lubricants. To test the difference between water based lubricants and oil based lubricant, the facilitator took the participants through a practical session on condom wearing and the difference in using oil based lubricant and a water-based lubricant.
During the session, participants raised questions on frequency of the incidence of HIV infection in relation to oral sex when there are microscopic sores in the mouth in lieu with anal rimming amongst MSM in relation to acquiring HIV or other STIs. Issues relating to sexual satisfaction in relation to condom use were discussed too. This led to a discussion between the participants. It was explained to the participants there were chances of becoming infected with HIV through oral sex if there were sores in the mouth. Ejaculating in the mouth also contributes to increasing the rate of becoming infected with HIV via oral sex. This was explained to the participants as a risky behaviour which should be avoided. Emphasis was laid on other sexually transmitted infections which can be easily contracted through the oral medium .For safety; participants were introduced to falvoured condoms for oral sex and dental dam for rimming. Also introduced to the participants as another form og prevention was the female condom which could also be improvised for anal sex either with a female or a male partner.
The session was introduced into the training module to build knowledge of the participants on how HIV/AIDS can be managed. Participants were taken through HIV treatment, prevention and treatment of opportunistic infections, anti-retroviral therapy and positive living.
The session started with an introduction to HIV treatment. Light was shed on the essence of HIV treatment and why the knowing of one’s status was a very integral part of a holistic sexual health profile. Participants were made to understand that, though HIV is still a life threatening illness, it is no longer a death sentence with the availability of life saving drugs.
Emphasis was also laid on the opportunistic infections to which HIV positive people were prone to due to a depressed immune system and viral replication. Prevention of opportunistic infections and treatment were explained to the participants. As stigma and discrimination continues to be a challenged within the Nigerian society, with homosexuality being illegal and criminal, the need for positive living was also touched on so as to enable the participants understand the relationship between good health and an HIV positive status.
COMMUNICATION AND INTERPERSONAL SKILLS
The session on Communication and Interpersonal skills started with an exercise. The facilitator asked participants to define communication. Some of the definition given were:
· Act of transferring information
· Sharing ideas
· Passing of vital information to another persons
· Passing message across
The facilitator then defined communication as follows: This is defined as the activity or process of expressing ideas and feelings or of giving people information. It also deals with method of sending information, especially through the electronic media e.g. Telephone, radio, computer, television, e.t.c. or by words of mouth. At this juncture the facilitator asked the participants what the fastest form of communication was. There was disagreement as to which the fastest medium was. Arguments were centered on the television, radio.
Communication falls within two ranges: inter personal and intra-personal. The module on communication was to educate the participants on how to communicate messages in HIV prevention at any given environment. Participants were taken through the 4 Cs of communications. This are:
· CREDIBILITY: The audience needs to believe who is saying it, what is being said, and how it is being said.
· COMPREHENSION: The audience must understand the message. Message should be clear, concise and repeated.
· CONNECTION: The audience must relate to the message. Facts, stories, or pictures can help the audience to connect.
· CONTAGIOUSNESS: The messenger, message and mode should motivate the audience to share the message with others.
Barriers to passing quality HIV prevention to one’s peer groups were also spelt out to the peer educators. The facilitator elucidated on the barrier of language, culture, religion and educational background.
Punctuality as to the starting time of the program was a main challenge to the project secretariat, especially in the first day of the day. Queer Alliance felt this was due the fact of the project being the first in Delta State. Some participants also felt uneasy as to security and safety.
This was managed with the project Rashid Williams shedding more, light on his personal journey as an advocate and an open gay man and the reason why the project was brought to Delta States.
Queer Alliance is particularly thrilled with the commencement of the HIV prevention programme targeting men who have sex with men in the inner cities of Nigeria, beginning from Delta state. This has resulted in the gradual building of the capacity of men who are being discriminated on the basis of sexual orientation and gender identity in HIV prevention. The mobilization visits and FGDs conducted by Queer Alliance informed the content of the training curriculum as well as the selection of the peer educators. In addition, the training presented a very good learning and working experience for our organization, facilitators and participants alike. The training drew hands on experienced resource persons with expertise in Human Rights, Sexual Health and HIV and Project Monitoring and Evaluation.
The availability of the Staying Alive Foundation grant has enabled us to respond to the unmet needs and capacity of gays, bisexuals and other men who have sex with men in HIV prevention, treatment and support services.
FEED BACK FROM PARTICIPANTS
“I will recommend that we have more of these training to help build our capacity as peer educators in Delta state. and increase knowledge in issues of human rights”
“I was secure in the Queer Alliance community centre in the area of expressing my identity, orientation, values and thought about my rights and sexual health during the trainings.”
“I will ensure that I apply what I have learnt on the field amongst my peers”
“We are extremely grateful to Staying Alive foundation for supporting the HOT program with funds; words can’t express our appreciation as gays and bisexuals in Delta State”. We have waited this long for a program such as this and we thank Queer Alliance and Queer African Youth Networking Center for coming to Delta State.
As with other projects that have been conducted in Nigeria for men who have sex with men, Queer Alliance recommends quarterly refresher sessions with the peer educators so as to constantly update them on information in HIV prevention, care and treatment. The key challenge here would be funding.
The training was an eye opener to MSM in Delta State and Queer Alliance hope (is sure) to experience success as the project continues.