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
Introduction
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.
Objectives
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
4. Disclosure
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.
HIV/AIDS/STIs
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.
MANAGING
HIV/AIDS 
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.
Challenges
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.
Reflections
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.
Recommendation
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.
Conclusion
The training was an eye opener to MSM in Delta State and Queer
Alliance hope (is sure) to experience success as the project continues.
