HIV_Prevention_Girls_and_Young_Women_Nigeria by IPPF

RESEARCH REPORT: HIV PREVENTION FOR GIRLS AND YOUNG WOMEN

NIGERIA

This Research Dossier supports the Report Card on HIV Prevention for Girls and Young Women in Nigeria produced by the United Nations Global Coalition on Women and AIDS (GCWA). It documents the detailed research coordinated for the GCWA by the International Planned Parenthood Federation (IPPF), with the support of the United Nations Population Fund (UNFPA), United Nations Program on AIDS (UNAIDS) and Young Positives. The Report Card provides an â&#x20AC;&#x2DC;at a glanceâ&#x20AC;&#x2122; summary of the current status of HIV prevention strategies and services for girls and young women in Nigeria. It focuses on five cross-cutting prevention components: 1. Legal provision 2. Policy context 3. Availability of services 4. Accessibility of services 5. Participation and rights The Report Card also includes background information about the HIV epidemic and key policy and programmatic recommendations to improve and increase action on this issue in Nigeria. This Research Report is divided into two sections: PART 1: DESK RESEARCH: This documents the extensive desk research carried out for the Report Card by IPPF staff and consultants based in the United Kingdom. PART 2: IN-COUNTRY RESEARCH: This documents the participatory in-country research carried out for the Report Card by a local consultant in Nigeria. This involved: o

Two focus group discussions with a total of 19 girls and young women aged 15-24 years. The participants included girls and young women who are: living with HIV; in/outof/school; involved in sex work; living in urban and suburban areas; and working as peer activists. Five one-to-one interviews with representatives of organisations providing services, advocacy and/or funding for HIV prevention for girls and young women. The stakeholders were: a country representative of an international NGO; a nurse at a national NGO focusing on sexual and reproductive health; a counsellor at an NGO/government voluntary counselling and testing centre; a programme officer of a United Nations agency; and a Technical Adviser of an international donor agency. Additional fact-finding to address gaps in the desk research.

Contents: PART 1 - Desk Research Country profile Prevention component 1: Legal Provisions Prevention component 2: Policy Provisions Prevention component 3: Availability of services Prevention component 4: Accessibility of services Prevention component 5: Participation and Rights PART 2 - In-Country Work Focus group discussion with young women and girls aged 16 - 21 Focus group discussion with young women and girls aged 15 â&#x20AC;&#x201C; 21 Interview with Director, local, gender â&#x20AC;&#x201C; based NGO Interview with Director, PLHIV network Interview with Management, International organization Interview with Peer Health Educator Interview with Programme Office, Family Planning Assocation Abbreviations ARVs CEDAW CIA CSO CRC ERNWACA FGM/C IEC IPPF MTCT NACA NDHS NGO OVC PABA PLHIV PLWHA PMTCT SRH STI STD UNAIDS UNDP

Antiretrovirals Convention on the Elimination of All Forms of Discrimination Against Women Central Intelligence Agency Civil society organisation Convention on the Rights of the Child Educational Research Network for West and Central Africa Female Genital Mutilation/Cutting Information, communication and education International Planned Parenthood Federation Mother-to-child-transmission National Action Committee on AIDS - Nigeria Nigeria Demographic and Health Survey Non-governmental organisation Orphans and vulnerable children Person affected by AIDS People living with HIV People living with HIV/AIDS Prevention of mother-to-child-transmission Sexual and Reproductive Health Sexually transmitted infection Sexually transmitted disease United Nations Program on AIDS United Nations Development Program

COUNTRY PROFILE •

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Size of population: 128.77 million (July 2005 estimate) (CIA (2006) The World Factbook – Nigeria, http://www.odci.gov/cia/publications/factbook/geos/ni.html (Date accessed 30/03/06)) Life expectancy at birth: Total population: 46.74 years; male: 46.21 years; female: 47.29 years (2005 estimates) (CIA (2006) The World Factbook – Nigeria, http://www.odci.gov/cia/publications/factbook/geos/ni.html (Date accessed 30/03/06)) % of population under 15 (0 – 14 years): 42.3% (male 27,466,766/female 27,045,092) (CIA – The World Factbook – Nigeria, http://www.odci.gov/cia/publications/factbook/geos/ni.html, last updated January 10, 2006) Population below income poverty line of $1 per day: 70.2% (1990-2003)(UNDP (2005) Human Development Reports 2005: Nigeria, http://hdr.undp.org/statistics/data/indicators.cfm?x=245&y=1&z=1 (Date accessed 30/03/06)) Female youth literacy (ages 15-24 years): 86.5% (UNDP (2005) Human Development Reports 2005: Nigeria, http://hdr.undp.org/statistics/data/indicators.cfm?x=245&y=1&z=1) Health expenditure per capita (2002): $43 (UNAIDS (2005) Country Profile 2005: Nigeria, http://www.unaids.org/en/Regions_Countries/Countries/nigeria.asp) Contraceptive prevalence: 13% (1995-2003) (UNDP (2005) Human Development Reports 2005: Nigeria, http://hdr.undp.org/statistics/data/indicators.cfm?x=99&y=1&z=1 (Date accessed 30/03/06)) Maternal mortality rate: 800 per 100,000 live births (2000) (UNDP (2005) Human Development Reports 2005: Nigeria, http://hdr.undp.org/statistics/data/indicators.cfm?x=99&y=1&z=1 (Date accessed 30/03/06)) Ethnic groups: More than 250 ethnic groups. The most populous and politically influential are: Hausa and Fulani 29%; Yoruba 21%; Igbo (Ibo) 18%; Ijaw 10%; Kanuri 4%; Ibibio 3.5%; Tiv 2.5% (CIA (2006) The World Factbook – Nigeria, http://www.odci.gov/cia/publications/factbook/geos/ni.html (Date accessed 30/03/06)) Religions: Muslim 50%, Christian 40%, indigenous beliefs 10% (CIA (2006) The World Factbook – Nigeria, http://www.odci.gov/cia/publications/factbook/geos/ni.html (Date accessed 30/03/06)) Languages: English (official), Hausa, Yoruba, Igbo (Ibo), Fulani (CIA (2006) The World Factbook – Nigeria, http://www.odci.gov/cia/publications/factbook/geos/ni.html (Date accessed 30/03/06)) Adult (15-49) HIV prevalence rate (end of 2003): 5.4% (range: 3.6% - 8.0%) (UNAIDS (2005) Country Profile 2005: Nigeria, http://www.unaids.org/en/Regions_Countries/Countries/nigeria.asp (Date accessed 30/03/06)) Number of deaths due to AIDS in 2003 (adults and children): 310,000 (range: 200,000 – 490,000) (UNAIDS (2005) Country Profile 2005: Nigeria, http://www.unaids.org/en/Regions_Countries/Countries/nigeria.asp (Date accessed 30/03/06)) Number of women (15-49) living with HIV (end of 2003): 1,900,000 (range: 1,200,000 – 2,700,000) (UNAIDS (2005) Country Profile 2005: Nigeria, http://www.unaids.org/en/Regions_Countries/Countries/nigeria.asp (Date accessed 30/03/06)) Number of children (0-15) living with HIV (ages 0-14 years, 2003): 290,000 (UNICEF (2006) The State of the World’s Children: HIV/AIDS Statistics- Table 4, http://www.unicef.org/aids/files/SOWC06_Table4.pdf (Date accessed 30/03/06)) Estimated number of orphans (as of 2003): 1.8 million (UNICEF (2006) The State of the World’s

Children: HIV/AIDS Statistic- Table 4, http://www.unicef.org/aids/files/SOWC06_Table4.pdf (Date accessed 30/03/06))

PREVENTION COMPONENT 1: LEGAL PROVISION (national laws, regulations, etc) Key questions: 1. What is the minimum legal age for marriage? The population policy put the age of marriage for girls at 18 but in practice girls are married off from age 12 – 20 (provided by in –country consultant) o

“The Child Rights Act, passed in 2003, raised the minimum age of marriage to 18 for girls. However, federal law may be implemented differently at the state level and, to date, only a few of the country’s 36 states have begun developing provisions to execute the law. To further complicate matters, Nigeria has three different legal systems operating simultaneously—civil, customary, and Islamic—and state and federal governments have control only over marriages that take place within the civil system.” (Population Council (2004) Child Marriage Briefing: Nigeria, http://www.popcouncil.org/pdfs/briefingsheets/NIGERIA.pdf#search ='legal%20marriage%20age%20in%20nigeria' (Date accessed 22/04/06))

The Nigerian constitution “endorses child marriage by proclaiming that any woman who is married shall be considered an adult.” (Otive-IGbuzor Ejiro Joyce (2002) HIV/AIDS, Human Rights and Women in Nigeria, Women Empowerment and Reproductive Rights Centre (WERRC), p. 16)

“Nationwide, 20 percent of girls were married by age 15, and 40 percent were married by age 18. Child marriage is extremely prevalent in some regions; in the Northwest region, 48 percent of girls were married by age 15, and 78 percent were married by age 18. Although the practice of polygamy is decreasing in Nigeria, 27 percent of married girls ages 15-19 are in polygamous marriages.” (Population Council (2004) Child Marriage Briefing: Nigeria, http://www.popcouncil.org/pdfs/briefingsheets/NIGERIA.pdf#search ='legal%20marriage%20age%20in%20nigeria' (Date accessed 22/04/06))

“Domestic violence is a widespread problem; some studies report that up to 81 percent of all married women admit experiencing some form of verbal or physical abuse by their husbands. (One study of Demographic and Health Survey data suggests that the lower the age at marriage, the higher the risk of domestic violence.)” (Population Council (2004) Child Marriage Briefing: Nigeria, http://www.popcouncil.org/pdfs/briefingsheets/NIGERIA.pdf#search ='legal%20marriage%20age%20in%20nigeria' (Date accessed 22/04/06))

2. What is the minimum legal age for having an HIV test without parental and partner consent? None restriction is from fear and cultural inhibitions - comment from in country consultant o “Minimum Age: Anyone 18 years of age and above requesting VCT should be considered able to give full, informed consent. Young people under 18 who are married, pregnant, parents, engaged in full behaviour that puts them at risk or are child sex workers should be considered ‘mature minors’ who can give consent for VCT. It is highly recommended that testing of minors under 18 who are not mature minors, especially those under 15, should be done with the knowledge and participation of their parents or guardians.” (OhiriAniche, Chinyere and Dayo Odukoya (2004) Preliminary Report: HIV/AIDS and the Education Sector in Nigeria: Review of Policy and Research Documents, ERNWACA (Educational Research Network for West and Central Africa) – Nigeria, sourced from Federal Ministry of Health (2002) National Guidelines For HIV/AIDS Voluntary Counselling &

Testing, pp. 24-5) 3. What is the minimum legal age for accessing SRH services without parental and partner consent? The respondents did not know of any law restricting them from accessing services, however observed that cultural and other values make the minimum age vary from one group to another, while some think 12 is a ripe age for marriage others allow their daughters to go to school and marry them off between the ages of 18 and 22 (after secondary school or university). Restrictions are more cultural and fear of religious provision for the Muslims. There is a provision that states that a wife needs to seek consent before going out of her house. (provided by in –country consultant) 4. What is the minimum legal age for accessing abortions without parental and partner consent? None, Abortion is restricted, it can only be done to save the life of the mother. (provided by in –country consultant) o

It is illegal to have an abortion. “Any woman who, with intent to procure her own miscarriage, whether she is or is not with child, unlawfully administers to herself any poison or other noxious thing, or uses any force of any kind, or uses any other means whatever, or permits any such thing or means to be administered or used to her, is guilty of a felony, and is liable to imprisonment for seven years.” Note: This code is applicable in the Northern States of Nigeria. (WHO International Digest of Health Legislation: Abortion Laws (2006) Nigeria Law on Abortion – Criminal Code Act. 229, http://www3.who.int/idhlrils/frame.cfm?language=english (Date accessed 13/03/06))

5. Is HIV testing mandatory for any specific groups (e.g. pregnant women, military, migrant workers, and sex workers)? It is mandatory for only pregnant women (provided by in – country consultant) o Summary of the National Response Review (1999-2004), section 3.6.1, recommendations: “In place of mandatory testing, there is need to advocate for integrating VCT into existing health programmes for the uniformed services.” (p. 13) (National Action Committee on AIDS – NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) o

Under the section ‘Ethics and Human Rights’ in the National Policy for HIV/AIDS 2003, the Federal Government of Nigeria affirms that: “Mandatory HIV testing without consent is illegal except in the case of a person charged with any sexual offence that could involve risk of HIV.” (Federal Government of Nigeria (2003) National Policy on HIV/AIDS 2003, sourced from website, Education Research Network for West and Central Africa (ERNWCA), p. 26 http://hivaidsclearinghouse.unesco.org/ev_en.php?ID=4239_201&ID2=DO_TOPIC (Date accessed April 19, 2006))

“Written Results: VCT site should not provide written results. In general, voluntary counselling and Testing Sites and Centres should not be used for mandatory testing, such as for pre-employment, insurance, educational or travel-related testing. The focus on VCT site should be to help persons make better decisions about their sexual behaviour and reduce the risks of HIV transmission.” (Ohiri-Aniche, Chinyere and Dayo Odukoya (2004) Preliminary Report: HIV/AIDS and the Education Sector in Nigeria: Review of Policy and Research Documents, ERNWACA (Educational Research Network for West and Central Africa) – Nigeria: sourced from Federal Ministry of Health (2002): National Guidelines For HIV/AIDS Voluntary Counselling and Testing Methodology, p. 57))

6. Is there any legislation that specifically addresses gender-based violence? Background Information: o “The government of Nigeria commits itself to reviewing existing legislation and enacting

appropriate new laws in the following: Legislation to protect the rights of victims of sexual violence.” (Federal Government of Nigeria (2003) National Policy on HIV/AIDS 2003, sourced from website, Education Research Network for West and Central Africa (ERNWCA), p. 25 http://hivaidsclearinghouse.unesco.org/ev_en.php?ID=4239_201&ID2=DO_TOPIC (Date accessed April 19, 2006)) o

The respondents were certain that violence against women is unacceptable and the fact that there must be a law that prevents it, however they did know the law. “Domesticating CEDAW would have provided the needed protection against violence for women this the government of Nigeria is yet to do”. None is available at the moment. (provided by in –country consultant) 7. Is there an AIDS Law – or equivalent – that legislates on issues such as confidentiality for testing, diagnosis, treatment, care and support? o “The government recognizes the stigma and discrimination facing people infected and affected by HIV/AIDS and realizes that the promotion and protection of human rights for all Nigerians can reduce the negative effects associated with the epidemic; therefore the Federal Government of Nigeria affirms the following: • All persons shall respect the right to privacy and confidentiality of people living with HIV/AIDS and shall not disseminate information on the status without individual’s consent, of that of the individual’s family when the individual is incapable of giving such consent; • Where the dissemination of information is medically indicated, information being imparted shall be assigned the strictest measure of confidentiality on a strictly enforced ‘need-to-know’ basis; • HIV and STI testing shall not be included as part of a routine medical examination without the knowledge and prior consent of the client. • The Government of Nigeria shall monitor human rights abuses and develop enforcement mechanisms for redress.” (Federal Government of Nigeria (2003) National Policy on HIV/AIDS 2003, sourced from website, Education Research Network for West and Central Africa (ERNWCA), pp. 25-26 http://hivaidsclearinghouse.unesco.org/ev_en.php?ID=4239_201&ID2=DO_TOPIC (Date accessed April 19, 2006)) None of the respondents indicated any awareness of a law that ensures confidentiality in relation to issues dealing with testing, diagnosis, treatment, care or support for PLHIV. Some of them indicated that most often people are treated with disrespect and devoid of any consideration of their humanity. Their status is made an issue for public ridicule and they receive limited support from medical staff. They called for a law that will ensure confidentiality in the treatment of PLHIV (provided by in –country consultant) 8. Is there any legislation that protects people living with HIV/AIDS, particularly girls and young women, from stigma and discrimination at home and in the workplace (or anywhere, in general)? o Under the section ‘Ethics and Human Rights’ in the National Policy for HIV/AIDS 2003, the Federal Government of Nigeria affirms that: “Persons living with or affected by HIV shall not be discriminated against on the basis of their health status with respect to education, training, employment, housing, travel, access to health care and other social amenities

and citizenship rights”; “The denial of appropriate care and support for persons living with HIV/AIDS is an abuse of their human rights, unethical and illegal.” (National Policy on HIV/AIDS 2003, Federal Government of Nigeria, p. 25) o

“The government recognizes the stigma and discrimination facing people infected and affected by HIV/AIDS and realizes that the promotion and protection of human rights for all Nigerians can reduce the negative effects associated with the epidemic; therefore the Federal Government of Nigeria affirms the following: o Persons living with or affected by HIV shall not be discriminated against on the basis of their health status with respect to education, training, employment, housing, travel, access to health care and other social amenities and citizenship rights; o The denial of appropriate care and support for persons living with HIV/AIDS is an abuse of their human rights, unethical and illegal; o All persons shall respect the right to privacy and confidentiality of people living with HIV/AIDS and shall not disseminate information on the status without individual’s consent, of that of the individual’s family when the individual is incapable of giving such consent; o The Government of Nigeria shall monitor human rights abuses and develop enforcement mechanisms for redress.” (Federal Government of Nigeria (2003) National Policy on HIV/AIDS 2003, sourced from website, Education Research Network for West and Central Africa (ERNWCA), pp. 25-26 http://hivaidsclearinghouse.unesco.org/ev_en.php?ID=4239_201&ID2=DO_TOPIC (Date accessed April 19, 2006))

All the respondents knows of the law that outlaws discrimination against PLHIV in workplace and the law applies equally to girls and young women just like it does to other groups in society. However, some of them expressed the belief that a law alone may not achieve the objective. The respondent in question indicated the need for sustained awareness campaigns in order to speed the process of collective action in battling HIV/AIDS. (provided by in –country consultant) 9. Are sex workers legally permitted to organise themselves, for example in unions or support groups? Sex work is illegal in Nigeria under Sharia Law and in Lagos state various satues are used to justify the arrest of sex workers. (U.S Department of State, Country Reports on Human Rights Practices 2003.) There is only vague knowledge of the issues relating to the lives and affairs of sex workers among the respondents. However the common understanding is that the issue of rights does not end with the borders of professions and each person is entitled to his rights to life etc. without regard to their profession. As such the rights of sex workers should be respected just like any other person especially if they are PLHIV. The respondents are not aware of any union formed by sex workers. (provided by in –country consultant) 10. Are harm reduction methods for injecting drug users (such as needle exchange) legal? There is no knowledge of the status of harm reduction methods for injection drug users among the respondent. They expressed reservation about helping people use drugs in a safe manner. Their belief is that the government should simply deal with drug users instead of helping them find ‘safer’ methods. They are not aware of any legal backing for the support given to injectable drug users and if the law exists they are in opposition to it. (provided by in –country consultant)

Discussion questions: • Which areas of SRH and HIV/AIDS responses are legislated for? None. The bill to establish a RH institute was stopped by some agitator Only recently (provided by in –country consultant)

• What are the biggest strengths, weaknesses and gaps in legislation in relation to HIV prevention for girls and young women? There are no separate laws for young women (provided by in –country consultant) • Is action taken if laws are broken (e.g. if a girl is married below the legal age)? No (provided by in –country consultant) • Is there any specific legislation for marginalised and vulnerable groups1? If yes, is the legislation supportive or punitive? And what difference does it make to people’s behaviours and risk of HIV infection? None(provided by in –country consultant) • To what extent are ‘qualitative’ issues – such as confidentiality around HIV testing – covered by legislation? Not covered (provided by in –country consultant) • How much do girls and young women know about relevant legislation and how it relates to them? Are there any initiatives to raise awareness about certain laws? Next to nothing (provided by in –country consultant) • Overall, how is relevant legislation applied in practice? What are the ‘real life’ experiences of girls and young women? What difference does it make to their vulnerability to HIV infection? All the various instrument are not know at the grass root level, In practice it does not exist. Young women could use the laws to demand for their right, If they know the content of the legislative provision (provided by in –country consultant) o

From Draft Reproductive Health Strategic Framework and Plan 2002-2006: Adolescent Reproductive Health: “The status of reproductive health care for adolescents is low and inconsistent. Many Nigerian females are married off at a young age as evidenced by the median age at first marriage of 17.9 years ranging from 14.6 in the North West to 20.2 years in the South (1999 NDHS). According to the NDHS, 8.3% of males aged 15 – 19 have had sex by the age of 15 years, while 16.2% of girls in the same age group have had sex by age 15 years. The median age at first sexual intercourse for females was 17.8 years (NPC 2000). Of all women between the ages of 20 and 49 years in 1999, 24.3% were recorded to have had their first intercourse before the age of 15 years and 50.6% by age 18 (NPC 2000). The level of effective contraception among sexually active adolescents is low. Only 23% of all sexually active unmarried females of age 15 – 19 in 1999 were recorded to be using any modern method. In addition, many sexually active Nigerian adolescents are believed to have multiple partners. Consequently, the incidence of teenage pregnancy and childbearing is high, sometimes resulting in severe maternal morbidity such as vesico-vaginal fistula. About two-fifths of teenage pregnancies in Nigeria are estimated to end up in induced abortions with severe morbidity and mortality. Similarly the prevalence of sexually transmitted infections including HIV is high and increasing. Major factor associated with the poor ARH status in Nigeria is lack of awareness and knowledge of relevant RH issues among young people due to lack of access to credible sources of information. Population and family life education, including sexuality education is not taught in most schools despite the fact that relevant curriculum have been designed and approved for use in Nigerian secondary schools. Various stakeholders have negative attitude to the provision of RH information to young people mainly as a result of traditional and socio-cultural beliefs that frown on discussion of sexuality issues with young people. Young people also have a limited access to relevant reproductive health services. Where health services are available, the non-friendly nature of these facilities to young people limits their utilisation. The response of the health care system to the needs of the adolescents have been tepid and ineffective. Any initiative to

Examples include: people living with HIV/AIDS, sex workers, injecting drug users, migrant workers, refugees and displaced people, street children, school drop-outs, lesbians and ethnic minorities.

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respond to the reproductive health needs of adolescents must give due consideration to the following: • Awareness creation on the RH issues and needs of adolescents • Involvement of adolescents and gatekeepers (stakeholders in planning, implementation, monitoring and evaluation of activities) • Establishment of acceptable channels of communication between adolescents and adults • Establishment of functional youth friendly services • Research to update knowledge and information on adolescent RH issues and Services” (Federal Ministry of Health – Nigeria (2002) Draft National Reproductive Health Strategic Framework and Plan 2002-2006, http://www.policyproject.com/pubs/countryreports/NIG_RHStrat.pdf (Date accessed 25/05/06)) From Draft Reproductive Health Strategic Framework and Plan 2002-2006: Adolescent Reproductive Health: Harmful practices, reproductive rights and gender issues: “A number of traditional practices in Nigeria infringe on the reproductive rights of the Nigerian woman and girl-child. The commonest of these include female genital cutting (FGC), forced early marriage, traumatic puberty initiation rites, gender-based violence, wife inheritance with widowhood rites. A national survey in 1998 showed that 32.9% of household in Nigeria practiced FGM. The prevalence among adult women ranged from 0.6% in Yobe in the North East region to 98.7% in Osun state. The most common type in the South West is Type I while Type II is the commonest in the South and Type IV is the commonest in the northern states. The practice of FGC appears however to be on the decrease as a prevalence of less than 1% was recorded among girls aged 10 – 14 compared to almost 50% among women 45 – 49 years (1999 NDHS). Widowhood practices of various types, with cultural bias are widely practiced in Nigeria, while denial of inheritance rights in respect of female children are practiced among some tribes (CGPS, 1998). Preference for male child is widely exhibited, with implications for high number of pregnancies. Harmful birth practices include the use of extremely hot water for bathing of new mothers. Early child marriage is a common harmful practice in this region and is implicated in the high level of occurrence of maternal mortality and vesico-vaginal fistula (V VF) in northern Nigeria. Some of the harmful practices such as wife inheritance and group circumcision could facilitate HIV and Hepatitis B infection. Gender based violence such as rape, sexual exploitation and wife battering are prevalent in Nigeria. So also are food taboos, and poor nutrition amongst females. There are preferences for males to eat first and eat the best portions of food. Reproductive Health has as its integral part sexual and reproductive rights. Reproductive rights concept include “the basic rights of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so without discrimination, coercion and violence, as expressed in human rights documents”. Reproductive and Sexual Rights as part of human rights, are essential for the enjoyment of one’s full human potential, mental, emotional and physical well-being, enhancement of relationships, women empowerment and achievement of gender equality. Current international understanding of sexual and reproductive rights include the right to: • Reproductive and sexual health as a component of overall life long health. • Right to reproductive decision making including choice of marriage, family formation and determination of number, timing and spacing of one’s children and the right to information and means to exercise those choices. • Equality and equity for women and men to enable individuals to make free and informed choices in all spheres of life, free from gender discrimination. • Sexual and reproductive security, including freedom from sexual violence and coercion and the right to privacy. The incidence of various reproductive ill-health conditions, to a great extent, reflects the degree to which individuals or groups have been deprived of their sexual and reproductive rights. The right to life (and survival) is abrogated, for example, by maternal

mortality while denial of reproductive health information and quality services to young people violates the right to non-discrimination on the basis of age. The healthcare system has a critical role to collaborate with other systems such as legal, police, media, social and education sectors and the civil society to develop an action plan that will protect females, support victims and reduce the incidence of gender-related ill-health. Efforts have already begun to articulate ways of exterminating harmful practices and genderbased morbidity in Nigeria. Officially the minimum age of marriage has been set at 18 years and in some states notably Ogun, Edo, Delta and Rivers legislation against FGC have been passed though their enforcement is uncertain. The concept of UBE is designed to ensure that young persons (especially girls) acquire basic education and in so doing attain minimum age for marriage. These efforts need to be broadened, monitored and where necessary enforced. The desired goal can be achieved through the following strategies: • Sensitisation and mobilisation of community support for abolishing harmful practices. • Advocacy for male participation in eradicating gender-based morbidity • Review of laws and legislation to protect against gender violence and enforcement of same • Gender mainstreaming in all health plans, advocacy and sensitisation fora in RH services, strengthen collaboration and coordination between Ministry of Health, Women Affairs, Education, Poverty Alleviation and other relevant programmes, ministries and parastatals.” (p. 18-20) (Federal Ministry of Health – Nigeria (2002) Draft National Reproductive Health Strategic Framework and Plan 2002-2006, http://www.policyproject.com/pubs/countryreports/NIG_RHStrat.pdf (Date accessed 25/05/06)) • How do the effects of legislation vary among different types of girls and young women, such as those in/out of school, married/unmarried, in rural/urban areas, living with HIV/not aware of their HIV status? Services are not divided for any category of girls or young people, unmarried young people, out of school and orphans relates more with NGOs and other private providers of services, while the married and HIV positives have access to available public and private providers. (provided by in –country consultant)

PREVENTION COMPONENT 2: POLICY PROVISION (national policies, protocols, guidelines, etc) Key questions: 11. Does the current National AIDS Plan address the full continuum of HIV/AIDS strategies, including prevention, care, support and treatment? Yes except the specific needs of young women as it relates to violence against women (VAW) SRH rights and choices (provided by in –country consultant) o The National HIV/AIDS Strategic Plan for 2005-09 focuses on the following themes: - Prevention of new infections and universal precaution - Expansion of equitable access to ART, and reduction of laboratory monitoring costs - Effective coordination, resource mobilization, and capacity building - Impact mitigation, care and support of OVC (orphans and vulnerable children) - Psychosocial support and economic empowerment of OVC, PLWAs and PABA (people affected by AIDS) - Research and new technologies - Monitoring and evaluation - Enabling environment

(National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) o Nigeria’s National Policy on HIV/AIDS 2003 (developed in 1997 and sets targets until 2010) emphasizes the full spectrum of HIV/AIDS strategies, including: prevention (promotion of safe sexual behaviour, appropriate use of condoms, prevention of HIV/AIDS transmission through blood and blood products; VCT; early diagnosis and effective treatment of STIs, PMTCT and adolescent and youth-focused interventions); care and support of PLHAs focusing on clinical management, home-based care; and treatment for OIs and ARVs access. (Federal Government of Nigeria (2003) National Policy on HIV/AIDS 2003, sourced from website, Education Research Network for West and Central Africa (ERNWCA), p. 15 http://hivaidsclearinghouse.unesco.org/ev_en.php?ID=4239_201&ID2=DO_TOPIC (Date accessed April 19, 2006)) o The HIV/AIDS Emergency Plan (HEAP) was developed “as a response strategy to the HIV/AIDS epidemic, identifies over two hundred activities which the Federal Government intends to pursue over the period 2001 to 2004. Most activities under the HEAP are conceived as short-term, high impact interventions whose implementation will form the base for a medium term Strategic Plan for HIV/AIDS in Nigeria. The HEAP will therefore serve as an important testing ground for deriving best practices, coordinating strategies and high impact responses and as a bridge to the definition of a longer-term vision for the future…HEAP is intended to serve as an expression of the Government of Nigeria’s interest in and commitment to a dynamic and proactive response to the HIV/AIDS epidemic.” The dual track strategic approach includes: “Preparing the long-term National Strategic Plan through a broad-based participatory process, while undertaking immediate action to build capacity; remove barriers, empower communities and carry out preventive as well as care and support activities.” (National Action Committee on AIDS (NACA) and its various partners (2001) HIV/AIDS Emergency Action Plan (HEAP) – A 3-Year Strategy to Deal with HIV/AIDS in Nigeria, sourced from website, Policy Project Publications, http://www.policyproject.com/pubs/countryreports/HEAP.pdf (Date accessed April 26, 2006)) o From the HIV/AIDS National Strategic Framework 2005-09, under Objective 3: To increase access to comprehensive gender-sensitive prevention, care, treatment and support services for the general population, PLWAs and PABAs, including OVC by 50% in 2009, and mitigate HIV/AIDS impact on the health sector (p. 23): Strategies: - “3.1 Promote development and delivery of sustainable, comprehensive quality approaches to prevention, treatment, care and support services in both public and private sector facilities, including CSOs. - 3.2 Develop a condom policy and strategy to improve access and utilization of condoms. - 3.3 Promote access to safe blood. - 3.4 Promote the practice of universal precautions and infection control (including Medical waste management). - 3.5 Improve accessibility, affordability and quality of STIs/ reproductive health services. - 3.6 Increase equitable access to ART and ensure uninterrupted supply of good quality ARV drugs. - 3.7 Promote access to treatment of opportunistic infections, including TB management. - 3.8 Expand access to gender-focused VCT services, including access to youth-friendly VCT. - 3.9 Promote joint programming between HIV/AIDS /TB, RH, STIs as well as Linkages between sectors and levels of health care delivery. - 3.10 Reduction in mother-to-child transmission of HIV infection. - 3.11 Define, promote and implement gender-sensitive community and home-based care services.” (pp. 23-24) National Action Committee on AIDS – NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009))

12. Does the National AIDS Plan specifically address the HIV prevention and SRH needs of girls and young women? No (provided by in –country consultant) o In relation to the National HIV/AIDS Strategic Plan 2005-09: o Prioritizes four target groups: 1) women; 2) youths; 3) high risk groups (specific groups); 4) orphans and vulnerable children. (p. 19) o Section 4.+2 The National Strategic Framework Goal “Reduce HIV/AIDS incidence and prevalence by at least 25%, and provide equitable prevention, care, treatment and support while mitigating its impact amongst women, children and other vulnerable groups and the general population.” (p. 20) o The Summary of the National Response Review (1999-2000) that informs the National HIV/AIDS Strategic Plan 2005-09 states, “With the rising prevalence, prevention activities became a priority within the National Response with special focus on the youth and females.” (p. 8) o The objectives include a focus on gender-sensitivity: - Objective 3: “To increase access to comprehensive gender-sensitive prevention, care, treatment and support services for the general population, PLWAs and orphans and vulnerable children by 50% in 2009, and mitigate HIV/AIDS impact on the health sector.” (p. 20) - “The need to institutionalize a community oriented social welfare programme that ensures support for the most vulnerable groups e.g. OVC, elderly caregivers, adolescent girls, single and child heads of families etc.” (p. 24) - Objective 4: “To increase gender-sensitive non-health sectoral responses for the mitigation of the impact of HIV/AIDS by 50%.” (p. 21) - Strategy 4.5 Expand agriculture and rural sector response (p. 71) - Strategy 4.5.1 “Develop the capacity of rural PLWAs and PABA on hygiene and nutritional supplements, alternative therapy, and food security. (Gender: 60% female)” (p. 71) - Strategy 4.5.2 “Build capacity of agriculture extension farm workers to educate farm settlement population on HIV/AIDS prevention and impact mitigation. (Gender: 50% of beneficiaries are women; Relevant Vulnerable Group: Women farmers)” (p. 71) - Strategy 4.5.3 “Promote the development of alternative economic activities for PLWAs involved in strenuous farming. (Gender: 60% female; Relevant Vulnerable Group: The poor)” (p. 71) - Objective 8: “To create an enabling social, legal and policy environment by a 50% increase in the number of reviewed and operational gender-sensitive and human rights-friendly policies, legislations and the enforcement of laws that protect the rights of the general population, particularly PLWAs, by the year 2009.” (p. 21) - “To improve the policy environment (policies, guidelines, legislations) that supports safer sex practices, reduces stigma, promotes positive living and rights of women and the general population, particularly PLWAs.” (p. 27) (National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) o The National Policy on HIV/AIDS 2003 states that: - “Women are more vulnerable than men as poverty also decreases their ability to negotiate safe sex.” (p. 10) - “Ensure that prevention programmes are developed and targeted at vulnerable groups such as women and children, adolescents and young adults, sex workers, long distance commercial vehicle drivers, prison inmates, migrant labour, etc.” (p. 15) - “Women shall be empowered, through education and legislation, to protect themselves from unsafe sex.” (p.18) (Federal Government of Nigeria (2003) National Policy on HIV/AIDS 2003, sourced from website, Education Research Network for West and Central Africa (ERNWCA), pp. 10-18

http://hivaidsclearinghouse.unesco.org/ev_en.php?ID=4239_201&ID2=DO_TOPIC (Date accessed April 19, 2006)) 13. Does the National AIDS Plan specifically address the HIV prevention and SRH needs of marginalised and vulnerable groups, including people who are living with HIV/AIDS? Yes to an extent, because the special need of women were not covered such as: Gender based and all violence against women; SRH rights and choices. (provided by in –country consultant) o The National HIV/AIDS Strategic Plan 2005-09 reports: - Under Objective 2: “To have 95% of the general population make the appropriate behavioural changes (safe sex, abstinence etc) social mobilization and greater access to information by 2009.” (p. 22) - These strategies include: “advocacy and community mobilization targeted at policy makers and opinion leaders, behaviour change (like health workers, youth, women and other vulnerable groups), and the continuous development of BCC materials that emphasize abstinence, partner reduction, delay of sexual debut, mutual fidelity, condom use, blood safety and universal precautions.” (p. 23) - “We will also develop and implement BCC (behaviour change communication) youth-focused programmes taking advantage of already existing structures and youth programmes such as youth-friendly centers, AIDS information centers, sporting events, youth-focused television programmes, adverts (billboards), musical concerts, family life education, National Youth Service Corps (NYSC) HIV/AIDS/RH programmes, Citizenship and Leadership Training Center (Man-o-War), National Youth Network on HIV/AIDS (NYNetHA), etc.” (p. 23) - Objective 3: “To increase access to comprehensive gender-sensitive prevention, care, treatment and support services for the general population, PLWAs and orphans and vulnerable children by 50% in 2009, and mitigate HIV/AIDS impact on the health sector.” (p. 20) - Objective 3.8: “Expand access to gender-focused VCT services, including access to youth-friendly VCT.” (p. 24) - Objective 3.10: “Reduction in mother-to-child transmission of HIV infection.” (p. 24) - Objective 3.11: “Define, promote and implement gender-sensitive community and home-based care services.” (p. 24) - Objective 3.12: “Strengthen socio-economic, nutritional and psychosocial support programme at all levels for vulnerable groups, including OVC (orphans and vulnerable children), PABA (people affected by AIDS) and PLWAs.” (p. 24) - “PMTCT is a priority, as a means of markedly reducing the number of children born infected from birth. The community has a responsibility to promote target-specific, culturally, sensitive and innovative approaches to care for PLWAs, increase access to preventive services and address specific cultural challenges that fuel stigma and discrimination, including upholding the rights of PLWAs in their respective communities. The establishment of community and home-based care programmes with national coverage and promotion of male involvement is pivotal for ownership and sustainability. The need to institutionalize a community oriented social welfare programme that ensures support for the most vulnerable groups e.g. OVC (orphans and vulnerable children), elderly caregivers, adolescent girls, single and child heads of families etc.” (p. 24) - Objective 4: “To increase gender-sensitive non-health sectoral responses for the mitigation of the impact of HIV/AIDS by 50%.” (p. 21) - Objective 4.2: “Provide economic empowerment targeting vulnerable groups.” (p. 25) - “Existing public and social sector programmes will be challenged to address the needs of vulnerable groups and the affected. Civil Society, OPS (organized private sector) and NACA (National Action Committee on AIDS) will have to engage in advocacy that will seek to mainstream HIV/AIDS into the activities of institutions such as NDE (National Directorate of Employment) and NAPEP (National Poverty Eradication Programme) for provision of capacity building (jobs, skills training) for older OVCs and NACRB to provide micro-credit. The capacity of micro-credit institutions (specialized

NGOs, various MFIs) would be built. Linkages would be established between them to provide sustainable economic empowerment to OVC, PLWAs and PABA. Poverty reduction initiatives will be scaled to reduce vulnerability.” (p. 25) - Objective 8: “To create an enabling social, legal and policy environment by a 50% increase in the number of reviewed and operational gender-sensitive and human rightsfriendly policies, legislations and the enforcement of laws that protect the rights of the general population, particularly PLWAs, by the year 2009.” (p. 21) - “To improve the policy environment (policies, guidelines, legislations) that supports safer sex practices, reduces stigma, promotes positive living and rights of women and the general population, particularly PLWAs.” (p. 27) - Strategy 8.1 “Create an enabling policy environment for an effective and gendersensitive national HIV and AIDS response.” - Strategy 8.2 “Remove impediments to the attainment of enabling legal environment.” - Strategy 8.3 “Enact new laws to take care of the legal needs of those infected and affected by HIV/AIDS.” - Strategy 8.4 “Create gender-sensitive and human rights-friendly environment for effective management of HIV/AIDS responses.” - Strategy 8.5 “Advocacy targeting policy makers and opinion leaders.” (p. 27) - Objective 5: “To have 95% of groups with special needs make the appropriate behavioural changes (safe sex, abstinence etc) through social mobilization by 2009.” (p. 26) - Strategies 5.1 “Scale up HIV/AIDS response targeted at groups with special needs, such as: Uniformed persons; prison inmates; PESSP (persons engaged in same sex practice); sex workers; IDUs; IDPs (internally displaced persons); transport and migrant workers; trafficked persons; physically and mentally challenged persons; substance abusers; and communities at junction towns.” (p. 26) - “This objective aims to ensure a comprehensive, multi-sectoral response to HIV/AIDS among these groups. This strategy links effective HIV/AIDS communication for behaviour change with increase in access to other treatment, care and support services targeted at the needs of these groups.” (p. 26) (National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) The strategies and objectives of Nigeria’s National Policy on HIV/AIDS 2003 state: o “XII. Ensure that prevention programmes are developed and targeted at vulnerable groups such as women and children, adolescents and young adults, sex workers, long distance commercial vehicle drivers, prison inmates, migrant labour, etc.” (p. 15) o “Peer education shall be undertaken on reducing HIV and STI transmission among susceptible groups including the military, paramilitary and the police force, sex workers, and youths.” (p. 18) o “Nigeria shall place the highest possible priority on ensuring nationwide access to antiretroviral medication for all pregnant women with HIV.” (p. 22) o “Programs will be developed to provide treatment of STI for such high risk groups as sex workers and priority attention will be accorded such initiatives.” (p. 23) o “The Federal Government of Nigeria shall enact, disseminate and enforce legislation focused on protecting the rights of orphans and vulnerable children, as citizens of Nigeria, especially as regards their access to basic housing, education, health care, food, and clothing” o [See also other clauses under ‘Support for the People affected by HIV/AIDS including Orphan and Vulnerable Children Care’ (pp. 32-3)] (Federal Government of Nigeria (2003) National Policy on HIV/AIDS 2003, sourced from website, Education Research Network for West and Central Africa (ERNWCA), pp. 15-32 http://hivaidsclearinghouse.unesco.org/ev_en.php?ID=4239_201&ID2=DO_TOP IC (Date accessed April 19, 2006)) The HIV/AIDS Emergency Plan (HEAP):

Strategy 1: “Under this strategy, the need to sensitize the general public and to support advocacy and activities through the development of legislation and policies centered on human rights of PLWAs and others affected by HIV/AIDS.” Preventive Interventions targeted to special groups: 5.1 Youth (High risk youth population and non-high risk youth population): “Strategy 5.1 deals with developing Nigerian youth’s capacity to define preventive strategies for responding to the HIV/AIDS epidemic. Both in and out-ofschool youths will be incorporated into the program.” “5.2 Empowerment of women to negotiate safer sex: As specified, the thrust of the Strategy 5.2 will be upon empowering women to determine their own standards of sexual behaviour.” “5.4 Prevention of Infection through MTCT. Under substrategy 5.4, NACA and its implementers will focus on developing a strategy to support efforts to prevent HIV/AIDS transmission between mothers and their children. As such, this substrategy calls for the development of IEC materials, the organization of rallies, the training of health workers.” “5.5 Sex Workers. The objective of this is to undertake integrated participatory mapping, peer counselling and promotion of condom use by CSWs.” “5.7 Workplace policies and programs related to HIV/AIDS. Activities under substrategy 57.7 will work towards preventing HIV infection and provide careand support for workers infected and affected through the initiation of workplace policies and programs.” (National Action Committee on AIDS (NACA) and its various partners (2001) HIV/AIDS Emergency Action Plan (HEAP) – A 3-Year Strategy to Deal with HIV/AIDS in Nigeria, sourced from website, Policy Project Publications, http://www.policyproject.com/pubs/countryreports/HEAP.pdf (Date accessed April 26, 2006))

14. Does the National AIDS Plan emphasise consent and confidentiality within HIV/AIDS services? Yes but not well disseminated - (provided by in –country consultant) o In the National HIV/AIDS Strategic Framework 2005-09, there is no mention of consent and confidentiality. (National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) o Under the section ‘Ethics and Human Rights’, the National Policy states that: o “All persons shall respect the right to privacy and confidentiality of people living with HIV/AIDS and shall not disseminate information on HIV status of individuals without the individual’s consent, or that of the individual’s family when the individual is incapable of giving such consent.” o “Where the dissemination of information is medically indicated, information being imparted shall be assigned the strictest measures of confidentiality on a strictly enforced “need-to-know” basis.” o “Confidential pre- and post-test counselling services shall be made available to tested individuals and, if requested by an individual, to his/her family in all places where individuals are tested and/or notified of HIV test results.” (Federal Government of Nigeria (2003) National Policy on HIV/AIDS 2003, sourced from website, Education Research Network for West and Central Africa (ERNWCA), pp. 25-26 http://hivaidsclearinghouse.unesco.org/ev_en.php?ID=4239_201&ID2=DO_TOPIC (Date accessed April 19, 2006)) 15. Does the national policy on VCT address the needs of girls and young women? No (provided by in –country consultant) o The National HIV/AIDS Strategic Framework 2005-09, strategy 3.8 “Expand access to gender focused and youth friendly VCT”: - 3.8.1 “Conduct mapping of existing operational VCT programs.” - 3.8.2 “Establish more gender focused and youth friendly VCT-RH centers” - 3.8.3 “Establish employment of PLWAs as adherence and VCT counsellors.” - 3.8.4 “Develop and disseminate simplified VCT guidelines for counselling, testing and

referring most at risk persons (MARPs”) - 3.8.5 “Provision of rapid testing kits for VCT service delivery centers.”(p. 61) (National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) 16. Does the national protocol for antenatal care include an optional HIV test? No (provided by in –country consultant) o Under the section ‘Prevention of Mother to Child Transmission (PMTCT)’, the National HIV/AIDS Policy 2003 states that: “All antenatal care services shall offer voluntary confidential counselling and testing for all women of childbearing age, including pregnant women as part of existing integrated reproductive health care services and shall include referrals for family planning counselling and services when necessary. Testing will not be mandatory.” (Federal Government of Nigeria (2003) National Policy on HIV/AIDS 2003, sourced from website, Education Research Network for West and Central Africa (ERNWCA), p. 22 http://hivaidsclearinghouse.unesco.org/ev_en.php?ID=4239_201&ID2=DO_TOPIC (Date accessed April 19, 2006)) o Nigeria’s National HIV/AIDS Policy talks about “equipping family planning clinics with STI/HIV/AIDS counselling facilities.” (Strachan, Molly et. al (2004) An Analysis of Family Planning Content in HIV/AIDS, VCT, and PMTCT Policies in 16 Countries, p. 13) 17. Does the national protocol for antenatal care include a commitment that any girl or young woman testing HIV positive should automatically offered PMTCT services? No but there is the National Family Planning/RH service protocol that offers PMTCT services(chapter 12 p217 -247) (provided by in –country consultant) o “National guidelines on PMTCT indicate that women who are identified as HIV positive during pregnancy should have a full clinical examination, syphilis testing, hemoglobin estimation and urinalysis and, if resources permit, full blood count, screening for STIs, CD4 count, and quantitative viral load tests (for HIV-positive women). HIV-positive women should be treated for opportunistic infections and counseled on lifestyle and behavior change (FMOH August 2001).” (Partners for Health Reformplus, Deliver and Policy Project (2004) Nigeria: Rapid Assessment of HIV/AIDS Care in the Public and Private Sectors, http://pdf.dec.org/pdf_docs/PNADA590.pdf (Date accessed 22/04/06) o In the National HIV/AIDS Strategic Framework 2005-09, strategy 3.9 Reduce Mother to Child Transmission of HIV infection: - 3.9.1 “Mapping of all existing PMTCT sites.” - 3.9.2 “Development of management capacity at all sites.” - 3.9.3 “Decentralize and upscale PMTCT service delivery. (Relevant Vulnerable Group: Adolescent, girls, youth, women) - 3.9.4 “Integrate VCT services into all ANC/RH clinics. (Relevant Vulnerable Group: Pregnant adolescent girls, women) - 3.9.5 “Establish use of PLWAs peer counselling and support within PMTCT.” - 3.9.6 “Establish free HIV testing at PMTCT sites.” (Relevant Vulnerable Group: Pregnant Adolescent girls, women) - 3.9.7 “Accelerate implementation of PMTCT + plus (Relevant Vulnerable Group: Pregnant Adolescent girls, women) - 3.9.8 “Produce and widely disseminate revised PMTCT guidelines.” - 3.9.9 “Implement a standard PMTCT MIS in line with existing guidelines.” (p. 61) (National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) o Under the section ‘Prevention of Mother to Child Transmission (PMTCT)’ in the 2003 National HIV/AIDS Policy: “All maternity services shall provide counselling on risks associated with the possible transmission of HIV from mother to child during pregnancy, delivery and breast feeding and the adequate instructions to limit mother to child transmission if the mother’s HIV status is known to be positive, and shall include referrals for family planning services.” (p. 22) Also, “All institutions offering antenatal care or child

health care services shall direct specific attention to maintaining the nutritional status of pregnant women with HIV and the children born to them.” (p. 22) (Federal Government of Nigeria (2003) National Policy on HIV/AIDS 2003, sourced from website, Education Research Network for West and Central Africa (ERNWCA), p. 22 http://hivaidsclearinghouse.unesco.org/ev_en.php?ID=4239_201&ID2=DO_TOPIC (Date accessed April 19, 2006)) 18. Is there a national policy that protects the rights and needs - including HIV prevention, SRH services, employment opportunities and education - of young women or girls at risk or affected by early marriage? No (provided by in –country consultant) o Under Objective 3: “To increase access to comprehensive gender sensitive prevention, care, treatment and support services for the general population, PLWAs and orphans and vulnerable children by 50% in 2009, and mitigate HIV/AIDS impact on the health sector.” - Strategy 3.11 “Strengthen psychosocial support program at all levels for vulnerable groups e.g OVC, PABA and PLWAs.” - Strategy 3.11.1 “Develop and implement policy and guidelines for institutionalized nutritional support and psychosocial care for OVC and PABA. (Relevant Vulnerable Groups: Elderly care givers, Single and child head of families, Girls and married adolescents, Widows/Widowers, OVC, PLWAs, PESSP, IDUs)” - Strategy 3.11.2 “Strengthen the capacity of national social welfare system and that of existing NGOs, CBOs, FBOs, CSOs to provide care and support for OVC and PABA. (Relevant Vulnerable Groups: Elderly care givers, Single and child head of families, Girls and married adolescents, Widows/Widowers)” - Strategy 3.11.5 “Establish more PLWAs support groups and strengthen existing PLWAs networks (Relevant Groups: Married adolescent girls, Women, Youth)” - Strategy 3.11.6 “Establish and ensure sustained nutritional support program for PLWHAs and PABA (Relevant Vulnerable Group: OVC, Married adolescent girls, Elderly care givers, Sing head of families, Indigent Widows and Widowers, etc.)” 19. Is HIV prevention within the official national curriculum for both girls and boys? Yes but most states are not intergrating the national curriculum into the state schools’ work yet (provided by in –country consultant) o Draft Reproductive Health Strategic Framework and Plan 2002-2006: - “Population and family life education, including sexuality education is not taught in most schools despite the fact that relevant curriculum have been designed and approved for use in Nigerian secondary schools.” (p. 17) (Federal Ministry of Health – Nigeria (2002) Draft National Reproductive Health Strategic Framework and Plan 2002-2006, http://www.policyproject.com/pubs/countryreports/NIG_RHStrat.pdf (Date accessed 25/05/06)) o From the HIV/AIDS National Strategic Plan for 2005-09, - Strategy 2.2.4. “Train and re-train facilitators among health workers, teachers, agricultural extension agents, Red Cross staff, etc. to facilitate rural HIV/AIDS education.” (p. 52) Strategy 4.4 “Expand and scale-up educational response.” - Strategy 4.4.1 “Train more school guidance counsellors and social workers to provide psycho social support services.” - Strategy 4.4.2 “Scale up implementation of the approved population/family life and HIV/AIDS curriculum in schools at all levels.” - Strategy 4.4.3 “Integration of HIV/AIDS BCC into orientation and matriculation sessions of all higher institutions NYSC.” (p. 70) (National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) o “One significant response of the education sector to HIV/AIDS is the infusion of Family Life Education and HIV/AIDS issues into the school curricula at the basic and secondary school levels and teacher training institutions as well as the use of non-formal strategies, notably peer education. The latter extends to out-of-school youths.” (p. 2) o “Consequently, at the 46th Session of the National Council on Education in March 1999,

approval was given for the incorporation of Sexuality Education into the national school curriculum. So the Nigerian Educational Research and Development Council [NERDC] collaborated with other government agencies, NGOs and UN agencies to develop a curriculum on Sexuality Education which is considered critical in helping young people with the acquisition of adequate knowledge, skills and responsible attitudes needed to prevent and reduce sexually transmitted infections (STI) including HIV/AIDS.” (p. 10) (OhiriAniche, Chinyere and Dayo Odukoya (2004) Preliminary Report: HIV/AIDS and the Education Sector in Nigeria: Review of Policy and Research Documents, ERNWACA (Educational Research Network for West and Central Africa) – Nigeria: sourced from Federal Ministry of Education (2002): National Sexuality Education Curriculum for Upper Primary School, Junior Secondary School, Senior Secondary School, Tertiary Institutions, pp. 2 &10)) 20. Is key national data about HIV/AIDS, such as HIV prevalence, routinely disaggregated by age and gender? Yes but only when the national surveillance survey is done (provided by in –country consultant) o Data for HIV/AIDS prevalence, knowledge, etc. is disaggregated by gender, age, residence and educational levels. “The HIV/AIDS Survey Indicators Database uses as a foundation the set of indicators jointly adopted with minor variations by UNAIDS and USAID in 2000, and indicators identified to monitor the goals set at the UN General Assembly Special Session (UNGASS) on HIV/AIDS, and the Millennium Development Goals (MDG).” The information is taken from the Demographic Health Surveys from 1990, 1999, 2003. (HIV/AIDS Survey Indicators Database (2006) HIV/AIDS Indicator Country Report for 1990-2003, http://www.measuredhs.com/hivdata/reports/start.cfm?LoadingDisplay=0&Ctry=30&styp e_id=&ShowIndicators=all&Survey_Pop_Based=&char_type=all&char_urban=1&char_age =1&char_ed=1&report_action=view (Date accessed 03/29/06)) Discussion questions: • To what extent are relevant bodies – such as the Ministry of Education, NGO networks, religious organisations, etc – engaged in policy-making around HIV prevention for girls and young women? To what extent do those bodies work in partnership or in isolation? They work largely in isolation only a few collaborations exsist and they are not specifically on young women’s issues (provided by in –country consultant) o From the HIV/AIDS National Strategic Framework for Action 2005-09, Objective 4. To increase gender-sensitive non-health sectoral responses for the mitigation of the impact of HIV/AIDS by 50%: “This objective promotes an engendered and vibrant multi-sectoral response that will mitigate the impact of HIV/AIDS in the country. The expansion of CSO, CBO, NGOs, Private sector and other civil initiatives and involvement in the provision of health, education and micro-credit for impact mitigation, will be pursued. The capacities of key sectoral players will be built for the promotion of impact mitigation. Linkages will be established to minimize waste and duplication and build economies of scale. Existing public and social sector programmes will be challenged to address the needs of vulnerable groups and the affected. Civil Society, OPS and NACA will have to engage in advocacy that will seek to mainstream HIV/AIDS into the activities of institutions such as NDE and NAPEP for provision of capacity building (jobs, skills training) for older OVCs and female headed households, UBE will provide free education to OVCs and NACRB to provide micro-credit. The capacity of micro-credit institutions (specialized NGOs, various MFIs) would be built. Linkages would be established between them to provide sustainable economic empowerment to OVC, PLWAs and PABA. Poverty reduction initiatives will be scaled up to reduce vulnerability. Insurance regulatory agencies - NAICOM and NHIS, and the professional associations (NIA, NCRIB, HMOs etc) will be engaged such that within the life span of this plan, life insurance and comprehensive health insurance (including provision of ART) would be available to PLWAs. The Nigerian insurance industry would be motivated to adopt internationally acceptable best practices. While the

workplace policy is expected to impact all sectors, the critical socio-economic sectors targeted by this objective are agriculture and rural development, education, transport, extractive industries, insurance and tourism. In each sector, both the public and private sectors are included, integrating gender as a cross cutting factor. All sectors will develop sector-specific HIV/AIDS strategies and implementation plans and mainstream HIV/AIDS into their activities. Nigeria will champion the mainstreaming of HIV/AIDS into the activities of regional economic development institutions.” (p. 25) (National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) • What areas of HIV prevention responses (e.g. behaviour change, counselling, treatment, home-based care) have national protocols or guidelines? To what extent do those protocols address the needs of girls and young women, including those that are marginalised and vulnerable? Nigeria have all this ational protocols and guidelines but they don’t address young women separately (provided by in –country consultant) o From the HIV/AIDS National Strategic Framework for Action 2005-09, under Objective 8: To improve the policy environment (policies, guidelines, legislations) that supports safe sex practice, reduces stigma, promote positive living and rights of women and the general population, particularly PLWAs (p. 38): - “Strategy 2.1 Promote the implementation of the Nigerian HIV/AIDS BCC strategy – National BCC Strategy implemented. - Strategy 2.2 Promote behavior change through community outreach – Increased awareness of HIV/AIDS in the community. - Strategy 2.3 Promote BCC through special events and activities– Increased communication on HIV and AIDS. - Strategy 2.4 BCC via mass media – Increased mass media communication on HIV and AIDS. - Strategy 2.5 Expand innovative use of telecom and information technology for BCC – Increaased telecom and IT communications on HIV/AIDS - Strategy 2.6 BCC and the youths – Improved access of youths to HIV BCC messages.” (p. 38-39) (National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) o From the HIV/AIDS National Strategy 2005-09: Under Objective 2: To have 95% of the general population make the appropriate behavioral changes (safe sex, abstinence etc) through social mobilization and greater access to information by 2009 (p. 22): “There is an existing BCC strategy developed in 2004. It is still relevant, as it offers strategic directions for audience segmentation and targeting, and message development… This objective seeks to ensure that available resources are directed towards the implementation of coordinated and contextually appropriate and effective preventive and behaviour change interventions that will improve the knowledge, attitude and practice of the general population, most especially youth and most at risk populations, to embrace abstinence and other safer sexual practice. The BCC Partnership Working Groups composed of key stakeholders from government, media/arts/entertainment industry and civil society organizations especially stakeholders involved in behaviour change interventions, will be formed at all coordination levels. The committee will versee and coordinate the development, production and dissemination of all BCC materials. This is to ensure that all BCC activities benefit from adequate technical oversight, synergies and economics of scale. All avenues that will facilitate the dissemination of correct information will be effectively utilized to ensure that every part of the country is adequately and equitably covered… To this end, a number of strategies are designed to expand advocacy and community mobilization. These are meant to enhance motivation to embrace behaviour change, resulting from increased knowledge about HIV/AIDS transmission and prevention among the general population via the use of multimedia channels of dissemination. These strategies include: advocacy and community mobilization targeted at policy makers and opinion leaders, capacity building to increase knowledge base of implementers of HIV/AIDS prevention and behaviour change (like

health workers, youth, women and other vulnerable groups), and the continuous development of BCC materials that emphasize abstinence, partner reduction, delay of sexual debut, mutual fidelity, condom use, blood safety and universal precautions. Advocacy remains a grey area for most key players requiring guidelines, programming And more capacity development, training, provisions of facilities and funding. The Communities will be mobilized to support the National Blood Transfusion and Injection Safety/Infection Prevention and Control projects and to embrace voluntary blood donation… Other strategies include the implementation of BCC programmes during the special events such as: World AIDS Day, International AIDS Conferences, Sporting events and any other relevant events to reach the target audiences increase involvement of all Media (electronic and print) in HIV/AIDS-related information dissemination and building capacity of media practitioners to improve HIV/AIDS reporting and coverage. The frequency of HIV/AIDS radio and television programme will be increased with particular focus on the rural population… The sub strategies will also include the design and implementation of innovative means of BCC information dissemination through telephone hotline, text messages (SMS), HIV/AIDS-related web sites such as NACA, e-forum and development partner sites… We will also develop and implement BCC youth-focused programmes taking advantage of already existing structures and youth programmes such as youth-friendly centers, AIDS information centers, sporting events, youth-focused television programmes, adverts (billboards), musical concerts, family life education, National Youth Service Corps (NYSC) HIV/AIDS/RH programmes, Citizenship and Leadership Training Center (Man-o-War), National Youth Network on HIV/AIDS (NYNetHA), etc.” (pp. 22-23) National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) • What does school-based sex education cover? Does it help to build young people’s confidence and skills, as well as knowledge? The new sexuality curriculum (Family Life and HIV/AIDS Education) addresses six key areas Human Development; Personal Skills; Sexual Health; Relationships; Sexual behaviour; Society and Culture and it is meant to help build young people’s confidence, skills and knowledge (provided by in – country consultant) • To what extent do policies help to reduce stigma and discrimination? For example, do they encourage people to stop using derogatory language or ‘blaming’ specific groups for HIV/AIDS? It is meant to do exactly that but a lot of the policies and laws are not well disseminated to the local end users where a lot of the stigmatization and discrimination is taking place (provided by in –country consultant) o From Summary of the National Response Review (1999-2004) that informs the HIV/AIDS National Strategy 2005-09, key findings reported: “Widespread stigma and discrimination especially amongst health workers, has continued to fuel the epidemic.” (p. 9) (National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) o Data relating to stigma and discrimination shows that: 1) Accepting attitudes – Willing to care for family member sick with AIDS (pp. 5-6) Definition: The percent of respondents saying they would be willing to care for a family member who became sick with the AIDS virus. Females ages: 15-19 – 42% Males ages: 15-19 – 35% 20-24 – 46% 20-24 – 40% 15-24 – 44% 15-24 – 37% 2) Accepting attitudes – Would buy fresh vegetables from a shopkeeper with AIDS (pp. 6-7) Definition: The percent of respondents who say they would buy fresh vegetables from a vendor whom they knew was HIV positive. Females ages: 15-19 – 19% Males ages: 15-19 – 19% 20-24 – 22% 20-24 – 30%

15-24 – 21% 15-24 – 25% 3) Accepting Attitudes – Female teacher who is HIV positive but not sick should be allowed to continue to teach in school (pp. 7-8) Definition: The percent or respondent who say that a female teacher who is HIV positive but not sick should be allowed to continue to teach in school Females ages: 15-19 – 24% Males ages: 15-19 – 16% 20-24 – 25% 20-24 – 27% 15-24 – 24% 15-24 – 21% 4) Accepting Attitudes – Not secretive about family member’s HIV status (pp. 8-9) Definition: The percent of respondents who say that they would not want to keep the HIV positive status of a family member a secret. Females ages: 15-19 – 54% Males ages: 15-19 – 59% 20-24 – 57% 20-24 – 73% 15-24 – 55% 15-24 – 66% 5) Accepting Attitudes – Approving of food vendors and teachers (p. 9) Definition: The percent of respondents who say they would buy fresh vegetables from an HIV positive food vendor and that they are in favour of having an HIV positive female teacher continue to teach in school Females ages: 15-19 – 10% Males ages: 15-19 – 8% 20-24 – 11% 20-24 – 12% 15-24 – 10% 15-24 – 10% 6) Accepting Attitudes – Caring and approving teachers (p. 10) Definition: The percent of respondents saying they would be willing to care for a family member who became sick with the AIDS virus and that they are in favour of having an HIV positive female teacher continue to teach in school. Females ages: 15-19 – 16% Males ages: 15-19 – 10% 20-24 – 18% 20-24 – 15% 15-24 – 17% 15-24 – 12% (HIV/AIDS Survey Indicators Database (2006) HIV/AIDS Indicator Country Report for 19902003, http://www.measuredhs.com/hivdata/reports/start.cfm?LoadingDisplay=0&Ctry=30&styp e_id=&ShowIndicators=all&Survey_Pop_Based=&char_type=all&char_urban=1&char_age =1&char_ed=1&report_action=view (Date accessed 03/29/06)) • To what extent are different areas of policy provision – such as for HIV/AIDS and antenatal care – integrated or isolated? The services are now intergated since the last 3 years in most major hospitals (provided by in – country consultant) o In the National HIV/AIDS Strategic Framework 2005-09, strategy 3.9: Reduce Mother to Child Transmission of HIV infection: - 3.9.1 “Mapping of all existing PMTCT sites.” - 3.9.2 “Development of management capacity at all sites.” - 3.9.3 “Decentralize and upscale PMTCT service delivery. (Relevant Vulnerable Group: Adolescent, girls, youth, women) - 3.9.4 “Integrate VCT services into all ANC/RH clinics. (Relevant Vulnerable Group: Pregnant adolescent girls, women) - 3.9.5 “Establish use of PLWAs peer counselling and support within PMTCT.” - 3.9.6 “Establish free HIV testing at PMTCT sites.” (Relevant Vulnerable Group: Pregnant Adolescent girls, women) - 3.9.7 “Accelerate implementation of PMTCT + plus (Relevant Vulnerable Group: Pregnant Adolescent girls, women) - 3.9.8 “Produce and widely disseminate revised PMTCT guidelines.” - 3.9.9 “Implement a standard PMTCT MIS in line with existing guidelines.” (p. 61) (National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) o Under the section ‘Prevention of Mother to Child Transmission (PMTCT)’ in the National

HIV/AIDS Policy: “All maternity services shall provide counselling on risks associated with the possible transmission of HIV from mother to child during pregnancy, delivery and breast feeding and the adequate instructions to limit mother to child transmission if the mother’s HIV status is known to be positive, and shall include referrals for family planning services.” (p. 22) Also, “All institutions offering antenatal care or child health care services shall direct specific attention to maintaining the nutritional status of pregnant women with HIV and the children born to them.” (p. 22) (Federal Government of Nigeria (2003) National Policy on HIV/AIDS 2003, sourced from website, Education Research Network for West and Central Africa (ERNWCA), p. 22 http://hivaidsclearinghouse.unesco.org/ev_en.php?ID=4239_201&ID2=DO_TOPIC (Date accessed April 19, 2006)) Nigeria’s National HIV/AIDS Policy talks about “equipping family planning clinics with STI/HIV/AIDS counselling facilities.” (Strachan, Molly et. al (2004) An Analysis of Family Planning Content in HIV/AIDS, VCT, and PMTCT Policies in 16 Countries, p. 13)

• What policy measures exist in relation to consent, approval and confidentiality? For example, can girls and young women access services such as VCT without having to notify their parents and/or partner? And are they informed of their right to confidentiality? There are no specific policy measure in existence (provided by in –country consultant) o “Informed Decisions-Making: In both stand-alone VCT sites and those integrated within health facilities, clients should be helped to understand the importance of HIV-Testing. Even if recommended by the health worker, clients may decline an HIV test.” o “Informed Consent: VCT sites should endeavour to document that all persons being tested have voluntarily and freely consented to being tested.” o “Confidentiality Procedures: VCT sites, especially those located within health centres and hospitals, should ensure that clients requesting VCT services are not readily identified by the public or other patients using the health centres by the fact that they have requested VCT.” o “Disclosure of VCT Result: In general, HIV test results should be disclosed only to the client.” o “Written Results: VCT site should not provide written results. In general, voluntary counselling and Testing Sites and Centres should not be used for mandatory testing, such as for preemployment, insurance, educational or travel-related testing. The focus on VCT site should be to help persons make better decisions about their sexual behaviour and reduce the risks of HIV transmission.” o “Confidential Record-Keeping: Clients’ records must be stored securely. Only personnel with direct responsibility for clients’ medical condition should have access to the records.” o “Partner Notification: All VCT clients, both HIV-positive and HIV-negative, should be strongly encouraged to inform their sexual partners of their test results and the legal implications of infecting their partners.” (pp. 57-8) (Ohiri-Aniche, Chinyere and Dayo Odukoya (2004) Preliminary Report: HIV/AIDS and the Education Sector in Nigeria: Review of Policy and Research Documents, ERNWACA (Educational Research Network for West and Central Africa) – Nigeria: sourced from Federal Ministry of Health (2002): National Guidelines For HIV/AIDS Voluntary Counselling and Testing Methodology, p. 57-58)) • Overall, how are relevant policies applied in practice? What are the ‘real life’ experiences of girls and young women? How much do they know about them and how they relate to them? What difference do these policies make to their vulnerability to HIV infection? The government agencies who are charged with collation of the Nigerian policies have not been able to do extensive dissemination of the instruments so more than 80% of the population do not know of the policies or can not tell what the content of the policies are. Even state government official and operation of services on the field may not tell the content. (provided by in –country consultant) o From Summary of the National Response Review (1999-2004) that informs the HIV/AIDS National Strategy 2005-09, key findings reported the following: - “The young people, especially women below the age of 24 years, are among the most

vulnerable groups with HIV prevalence of 6%.” - “Despite the wide range of prevention programmes targeted at increasing awareness and knowledge, it has not translated into desired behaviour change.” - “Low condom usage amongst the general population particularly the females.” - “Limited access to VCT particularly amongst young people.” - “A wide range of traditional, religious and socio-cultural factors continue to put young women and girls at risk of HIV infection.” - “Poor dissemination and implementation of relevant policy/guidelines for HIV/AIDS, VCT, PMTCT, Blood Safety and Home-Based Care.” - “There is inadequate human, technical and institutional capacity in terms of infrastructure, staff, equipment and supplies for PMTCT services. Services are limited to tertiary facilities in urban centers with no existing stand-alone sites for implementation and poor monitoring of programmes. There is lack of mechanisms for effective follow-up in the community.” - “Limited knowledge and practice of universal safety precautions and Post-Exposure Prophylaxis.” (p. 9) National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) • How do the effects of policies vary among different types of girls and young women, such as those in/out of school, married/unmarried, in rural/urban areas, living with HIV/not aware of their HIV status? The married and the young women living positively have an edge over the in and out of school; unmarried or those not aware of their HIV status, because the married young woman may be able to access FP/RH services without being interrogated, while the unmarried may have to lie about her marital status to avoid being interrogated. (provided by in –country consultant)

PREVENTION COMPONENT 3: AVAILABILITY OF SERVICES2 (number of programmes, scale, range, etc) Key questions: 21. Is there a national database or directory of SRH and HIV/AIDS services for young people? The respondents did not show any awareness of the existence of a directory or data base of SRH and HIV/AIDS services for young people. They are of the view that there must be some form of record that is kept by the government at local government, state and federal government. However, it may not be in a complete and single format or location. The data might be scattered in the custody of a variety of agencies such as Ministries of health, NGOs and CSOs. The ministry of health with the help of PATHS is developing a tool that will be used in capturing data from health facilities for the country’s data base - (provided by in –country consultant)

22. How many SRH clinics or outlets are there in the country? The respondents are not in a position to know the number of SRH clinics or VCT sites in Nigeria. 251 most of these have both SRH and VCT. (provided by in –country consultant) 23. At how many service points is VCT available, including for young women and girls? The respondents are not in a position to know the answer. Could not get accurate figure (provided by in –country consultant) 24. Are male and female condoms available in the country? (Refers to the full range of SRH and HIV/AIDS services relevant to girls and young women. These include antenatal care, STI information and treatment, HIV prevention, condoms, VCT and other counseling, positive prevention, treatment of opportunistic infections, care and support, treatment (including ARVs), skills building, economic development, etc).

Yes but not freely used in some parts of the country (provided by in –country consultant) o From the HIV/AIDS National Strategic Framework 2005-09, under Objective 3, Strategy 3.2 “Develop a condom policy and strategy to improve access and utilization of condoms.” - Strategy 3.2.1 – Expand access of vulnerable groups e.g. refugees etc. to prevention commodites (Gender: 50% females accessing; Relevant Vulnerable Group: MARPs, Youths, refugees, migrants) - Strategy 3.2.3 – Expand prevention commodities social marketing (Relevant Vulnerable Group: MARPs, Youths, Sex workers, Migrants) - Promote access to Female condoms – (Gender 30% males accessing; Relevant Vulnerable Group: Adolescent girls, female sex workers)” (p.56) (National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) o Social marketed condoms constitute about 80% of the market. (Federal Republic of Nigeria, Federal Ministry of Health (2003) National HIV/AIDS and Reproductive Health Survey (NARHS): Nigeria 2003, p. 54, http://hivaidsclearinghouse.unesco.org/ev_en.php?ID=4258_201&ID2=DO_TOPIC (Date accessed 22/04/06)) o From a report titled, “Projections for Contraceptives, including Condoms for HIV/AIDS in Nigeria: Determining Needs and Cost of Contraceptives for Nigeria 2003 – 2015”: - “A technical advisory group was set up to use the FAMPLAN model to determine the country’s contraceptive commodity needs for five years (2003 – 2007). The projections showed that in 2004 Nigeria will require about 188 million condoms, 3.7million hormonal injections, 243 thousand intrauterine contraceptive devices (IUD), and 3.5 million cycles of oral contraceptive pills. The study further shows that that about $15 million is needed by the country in 2004 to supply country with reproductive health commodities to effectively space or limit childbearing, and prevent sexually transmitted infections especially HIV/AIDS. Of this amount $9 million will be spent on buying condoms. Four and a half million dollars of the total will be needed to adequately meet the needs of persons who use the public sector for condoms.” (p. 5) - “Commodities are obtained from various sources. Forty three percent of users obtained from the public sector through government hospitals, government health centres, family planning clinics, community health workers and other public sources. Another 43% of users obtain them from the private medical sector including private hospitals, pharmacies and medical stores etc. while others obtain them from other sources including shops, religious institutions and non governmental organisations. (p. 28)…It is important to know the sources of various contraceptive commodities because this will determine the immediate needs and cost to the public sector. Figure 5 shows the usual sources as seen noticed during the 1999 NDHS. it shows that the source of commodities varies with type of commodity. Condoms that are available over the counter and do not need prescriptions are more commonly sourced from the non-public sector – mainly pharmacies. The same is seen for oral pills which once recommended are usually bought in pharmacies. Injectables and IUDs however require medical supervision and a considerable number of users rely on the government to provide these commodities. (p. 29)…When comparing the sources of commodities as seen in the 1990 and 1999 NDHS (table 12), it was evident that contraceptive users were increasingly depending on the public sector for IUD and hormonal injectables. The use of the public sector for condoms and oral pills did not change significantly. It is possible that this trend of increasing dependence on the public sector will continue. There is however anecdotal evidence that there has been a decline in the patronage of the public sector due to a decline in services provided in them including the common place ‘out-of-stock syndrome’. For this forecast the source of supply of commodities was assumed to remain at 1999 levels. (p. 29)…Unfortunately, Nigeria is one of the many countries facing a growing shortage of contraceptives and other reproductive health commodities. The global contraceptive shortage is projected at hundreds of millions of dollars annually in the coming years. The cost of quality contraceptives and condoms needed is projected to rise from $811 million to $1.8 billion between 200 and 2015. While the cost of services to deliver and provide

these commodities are projected to increase from $4 billion to $9 billion over the same period. The main reasons for the short fall in supply of commodities are the increase in number of women of child bearing age opting for family planning/child spacing, the increasing number of women in the reproductive age, the high population growth rate in developing countries, the increased use of condoms for prevention of HIV/AIDS, the declining donor support and dwindling financial resources within countries.” (p. 35) (Policy Project (2003) Projections for Contraceptives, including Condoms for HIV/AIDS in Nigeria, http://www.policyproject.com/pubs/countryreports/NIG_FAMPLAN.pdf (Date accessed 26/04/06)

25. Is a free HIV test available to all pregnant girls and young women who wish to have one? Yes in public hospitals o In the National HIV/AIDS Strategic Framework 2005-09, strategy 3.9 Reduce Mother to Child Transmission of HIV infection: - 3.9.6 “Establish free HIV testing at PMTCT sites.” (Relevant Vulnerable Group: Pregnant Adolescent girls, women)(p. 61) (National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) o Under the section ‘Prevention of Mother to Child Transmission (PMTCT)’, the National HIV/AIDS Policy states that: “All antenatal care services shall offer voluntary confidential counselling and testing for all women of childbearing age, including pregnant women as part of existing integrated reproductive health care services and shall include referrals for family planning counselling and services when necessary. Testing will not be mandatory.” (Federal Government of Nigeria (2003) National Policy on HIV/AIDS 2003, sourced from website, Education Research Network for West and Central Africa (ERNWCA), p. 22 http://hivaidsclearinghouse.unesco.org/ev_en.php?ID=4239_201&ID2=DO_TOPIC (Date accessed April 19, 2006)) o In relation to the usage of services: 1). Pregnant women counseled and tested for HIV (p. 41) Definition: The percent of women who were counseled and offered voluntary HIV testing during ANC for their most recent pregnancy, accepted an offer of testing and received their results, of all women who were pregnant at any time in the two years preceding the survey. Females ages: 15-19 – 0% 20-24 – 1% 15-24 – 0% 2). Pregnant women counseled for HIV during ANC visit (p. 42) Definition: The percent of women who were counseled for HIV during antenatal visit for the most recent birth, of all women who were pregnant at any time in the two years preceding the survey. Females ages: 15-19 – 12% 20-24 – 20% 15-24 – 17% 3). Pregnant women tested for HIV during ANC visit (pp. 42-3) Definition: The percent of women who were offered voluntary HIV testing during ANC for their most recent pregnancy, accepted an offer of testing and received their test results, of all women who were pregnant at any time in the two years preceding the survey Females ages: 15-19 – 0% 20-24 – 1% 15-24 – 1% (Federal Republic of Nigeria, Federal Ministry of Health (2003) National HIV/AIDS and Reproductive Health Survey (NARHS): Nigeria 2003, p. 54, http://hivaidsclearinghouse.unesco.org/ev_en.php?ID=4258_201&ID2=DO_TOPIC (Date accessed 22/04/06))

26. At how many service points are PMTCT services (such as nevirapine) available for pregnant girls or young women who are HIV positive? In general or teaching hospitals (provided by in –country consultant) o

From the HIV/AIDS National Strategic Framework for Action (2005-2009): “A National PMTCT programme was launched, guidelines developed and disseminated, and it has been delivering services at the tertiary level with 12 operation sites in 10 states and the federal capital with an approved scale-up plan.” (p. 9) (National Action Committee on AIDS (NACA) (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) Framework Priority XII. Prevention of the spread of HIV/AIDS, TB and ORID. “PTMCT programmes have expanded in Nigeria and a national team is in place to coordinate its various activities with the Ministry of Health, UNICEF and the Centre for Disease Control. Despite this, most PMTCT sites are at tertiary hospitals and uptake is still low. In Nigeria, there are six or eight pilot sites, all in teaching hospitals. Many of these teaching hospitals operate mandatory (sometimes consensual) HIV testing at antenatal clinics so issue of uptake should not arise.” (ActionAID International (2004) Responding to HIV/AIDS in Africa: A Comparative Analysis of Responses to the Abuja Declaration in Kenya, Malawi, Nigeria and Zimbabwe, http://www.equinetafrica.org/bibl/docs/HESaids.pdf (Date accessed 23/03/06))

27. At how many service points are harm reduction services for injecting drug users available? The respondents are not in a position to know the answer. This is not available in the country at the moment (provided by in –country consultant)

28. Are there any specific national projects (such as camps, conferences, and training courses) for boys/girls and young people living with HIV/AIDS? Apart from the counselling that they receive, young persons are provided with life skills to enable them live productive lives. Some of them are even encouraged to learn new professional skills and are given some money as capital for them to start economic activities. All this is aimed at enabling them generate enough money to cater for their special needs. The respondents could not confirm that any of these projects are taking in every state or simple located in select states but across the country. We are aware that some in Ibadan, Lagos, Kebbi, Sokoto and Abuja are running some skill acquisition and micro credit projects (provided by in –country consultant) 29. At how many service points are ARVs available to people living with HIV/AIDS? It has increase to 91 ARV treatment centres (provided by in –country consultant) o An article titled, “Nigeria has established 74 ARV treatment centres nationwide, Health Minister says Nigeria making progress in ARV distribution”: “Seventy four antiretroviral (ARV) therapy treatment centres have been established across Nigeria to help provide ARV drugs to HIV positive people, Health Minister Eyitayo Lambo said in a statement, AFP/Yahoo! News reports (AFP/Yahoo! News, 3/9). Nigeria in December 2005 announced it would begin a programme that aims to provide ARV drugs at no cost to about 250,000 HIV positive residents. Only about 40,000 of the 3.5 million HIV positive people in the country currently receive subsidized ARV treatment. The programme will be funded by a $250 million grant from the Global Fund To Fight AIDS, Tuberculosis and Malaria, as well as with money made available when the country's international debts were canceled. The U.S. government will provide most of the remaining money needed to implement the programme (Kaiser Daily HIV/AIDS Report, 1/3). Treatment centres currently operate in the capital, Abuja, and in 35 of the country's 36 states. The last state is expected to have a treatment centre by the middle of this year, Lambo said (AFP/Yahoo! News, 3/9).” (Kaiser Network (13/03/06), www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=1&DR_ID=35949 (Date accessed 17/05/06))

Total of 34 listed at JAAIDS website, of which 25 are national ARV Treatment Programs and 9 are PEPFAR Treatment sites (Journalists Against AIDS (JAAIDS) Nigeria, http://www.nigeria-aids.org/print.cfm/3f, website accessed 2006) An assessment of ARV sites reported 25 government ARV centers, and at least 51 private sector sites (35 private sites, 12 faith based and 4 NGOs ARV sites)(Partners for Health Reformplus, Deliver and Policy Project (2004) Nigeria: Rapid Assessment of HIV/AIDS Care in the Public and Private Sectors, http://pdf.dec.org/pdf_docs/PNADA590.pdf (Date accessed 22/04/06)) “Around 520,000 people are estimated to require ART (antiretroviral therapy) and only 17,000 are currently receiving treatment. At present there are 50 treatment sites for HIV/AIDS in Nigeria.” (Vanguard, Ibeneme Ebele (2006) FG receives nine locally manufactured ARVs, source from Journalists Against AIDS (JAAIDS) Nigeria website, http://www.nigeria-aids.org/news/content.cfm/182 (Date accessed 22/04/06))

30. Are there specific positive prevention services, including support groups, for young women and girls living with HIV/AIDS? The respondents are not aware of any prevention services that are specific to young people. However they indicated awareness of a wide range of support groups that could be working with young PLHIV but not necessarily dedicated to serving them. They also stated that young persons usually have difficulties adjusting to their new HIV positive status and the threat, possibility and effects of stigma especially from their peers, family and friends. They are certain that there are no support groups or other services apart from advertisements that are specifically focused on young persons. (provided by in –country consultant) Discussion questions: • What scale and range of HIV prevention services is available for girls and young women? For example, do programmes go beyond ‘ABC’ strategies? Do programmes cover social issues (e.g. early marriage)? NO, it is only new that the Population Council is starting a project in nine states to address specifically HIV/AIDS, married adolescent and early marriage. (provided by in –country consultant) • To what extent are SRH, HIV/AIDS and broader community services integrated and able/willing to provide referrals to each other? For example, could most SRH clinics refer a girl testing HIV positive to a support group for people living with HIV/AIDS? Yes -(provided by in –country consultant) • To what extent are HIV prevention services available through ‘non-traditional’ outlets (e.g. religious organisations, youth clubs)? Some faith based organizations are fully involved in Preventive services, treatment, care and support (provided by in –country consultant) o From the HIV/AIDS National Strategic Framework for Action 2005-09: Under strategy 2.6 BCC and the youth: - Strategy 2.6.4 “Establish gender sensitive youth-friendly centres with access for persons with special needs in rural and urban areas in each LGA of Nigeria.” - Strategy 2.6.6 “Promote the establishment of recreational centres, vocational centres, clubs, etc, for youths to provide a safe and productive engagement for youths.” - Strategy 2.6.7 “Train new and retrain old In and Out of school youths as peer educators on HIV/AIDS” (p. 55) Under strategy 3.4: Improve accessibility, affordability and quality of STIs/reproductive health services: - Strategy 3.4.6 – “Establish youth-friendly STI and RH clinics within health facilities and nonfacility sites.” - Strategy 3.4.7 – “Establish anti-AIDS school clubs and other recreational places with capacity to provide friendly supportive STI and RH services such as counselling.” (p. 58) (National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic

Framework for Action (2005-2009)) The highlights of the Education Sector’s Response to HIV/AIDS in Nigeria are summarised in the UNESCO, Abuja (2003) publication ‘Education in the Context of HIV/AIDS: A Resource Book: o Use of non-formal strategies (peer education, Anti-AIDS Clubs, Drama, Art, Youth Dialogues, Music, Comic Books, Posters, etc). o Periodic sensitisation, mobilisation and awareness raising campaigns. o Establishment of HIV/AIDS desk at parastatals under the Federal Ministry of Education. o Establishment of HIV/AIDS Preventive Education Unit at National Teachers Institute, Kaduna (p. 14). (Ohiri-Aniche, Chinyere and Dayo Odukoya (2004) Preliminary Report: HIV/AIDS and the Education Sector in Nigeria: Review of Policy and Research Documents, ERNWACA (Educational Research Network for West and Central Africa) – Nigeria, p. 14)

• Are there community programmes on gender awareness/dialogue for girls/boys and young women/men? Do they explore power differences and social ‘norms’ for sexual behaviour? Is there mentoring, peer support and economic development that targets females? Yes there are a few (provided by in –country consultant) o ‘Stepping Stones’ - a training package in gender, HIV, communication, relationship skills and life-skills - was conducted in the country. (Stepping Stones (2004) Feedback website, http://www.steppingstonesfeedback.org/index.htm (Date accessed 22/03/06)) • How available is prevention information and support for girls and young women living with HIV/AIDS? There are no special specific services targeting young women, except help which is generated from within their support groupand what ever they can get from the general HIV prevention programs (provided by in –country consultant) o From the HIV/AIDS National Strategic Framework for Action 2005-09, under strategy 2.6 BCC and the youth: - Strategy 2.6.1 “Conduct community outreaches on prevention of HIV/AIDS and drugs among youths, in rural and urban areas of Nigeria (Gender: 50% women and girls; Relevant Vulnerable Group: IDUs, same sex partners)” - Strategy 2.6.2 “Conduct advocacy meetings with Internet Service Providers (ISPs), cyber café operators and Telecom providers on HIV/AIDS prevention and behavioural change.” - Strategy 2.6.3 “Utilize youth oriented events to promote HIV/AIDS prevention (Gender: 50% girls)” (pp. 54-55) - Strategy 2.2.2 “Design and print culturally appropriate and gender sensitive BCC materials in indigenous languages and English for various target populations (youth, specific groups, etc.)” (p. 52) (National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) • How available are HIV prevention ‘commodities’ (e.g. condoms)? How are they distributed? The society for Family Health are the major distributors and it is always available and distributed far and wide in the country. It is the usage that is a problem, as many faith based organization and religious leaders are still preaching against the use of condom. (provided by in –country consultant) • How much do girls and young women know about the availability of services, such as where to get condoms or ARVs? They know but may not get it. Most hospitals do not distribute condom, the girls may need to buy it from shops which they are likely not to go to buy from the shop due to culture of silence. The ARVs are almost always out of stock. (provided by in –country consultant) o Of the 2,698 female respondents who had heard of condoms, 69% of females “agree that condoms are easy to obtain” and 61.2%of females “agree that condoms are affordable”.

These percentages were not broken down into age groups. Compared to 3,687 male respondents, 71.8% “agree that condoms are easy to obtain” and 69.1% “agree that condoms are affordable”. (p. 54) Knowledge of a formal source of condoms among young people (pp. 3-4): o Definition: Percentage of young people age 15-24 who know of at least one formal source of condoms. Numerator: All young people age 15-24 who can name at least one formal source of condoms. Denominator: All young people age 15-24. Females ages: 15-19 – 19% Males ages: 15-19 – 50% 20-24 – 30% 20-24 – 67% 15-24 – 24% 15-24 – 58% o Ever Use of Condoms – Percent Distribution of Sexually Active Respondents who had ever used condoms according to selected characteristics, FMOH, Nigeria 2003. Of the 810 female and male respondents aged 15-19, 10.6% had “ever used condoms” compared to 43.4% of males. Of the 1,430 males and females aged 20-24, 17.8% of females “ever used condoms” compared to 48.1% of males. (p. 56) o Current Use of Condoms – Percent Distribution of Sexually Active Respondents who are current users of condoms according to selected characteristics, FMOH, Nigeria, 2003. o Of the 810, men and women who have ever had sex, ages 15-19, 8.2% of females compared to 35.5% of males are using condoms. Of the 1,430 men and women how have ever had sex, ages 20-24, 12.2% of females compared to 39.7% are currently using condoms. (Federal Republic of Nigeria, Federal Ministry of Health (2003) National HIV/AIDS and Reproductive Health Survey (NARHS): Nigeria 2003, pp. 54-56, http://hivaidsclearinghouse.unesco.org/ev_en.php?ID=4258_201&ID2=DO_TOPIC (Date accessed 22/04/06))

• Overall, what does the availability of HIV prevention services mean in practice? What are the ‘real life’ experiences of girls and young women? What difference do these services make to their vulnerability to HIV infection? This means having information and education that will enable the woman make an informed choice; Have means that will enable her to access available services; The common young woman on the street still suffers from lack of information and education which is key to any decision making. The reality is that HIV and poverty have now been feminized. (provided by in – country consultant) o From Summary of the National Response Review (1999-2004) that informs the HIV/AIDS National Strategy 2005-09, key findings reported the following: - “ART guidelines have been developed and fairly disseminated with some capacity built amongst programme implementers.” - “A Health Sector Response Plan and an ART scale-up plan have been developed.” - “There is high demand for ART and the existing sites are thus overwhelmed.” - “As a result of the increasing demand for services, there is still inadequate human, technical and institutional capacity in terms of infrastructure, staff, equipment and supplies for ART services.” - “The existing treatment centers are located mainly in urban centres within tertiary institutions thereby limiting access.” - “Pediatric ART is yet to commence.” - “Non-availability of standardized guidelines/protocols for Opportunistic Infections Management.” - “Treatment, care and support including VCT, TB and STI management services, are not integrated.” - “Increasing numbers of OVC (orphans and vulnerable children) and deepening poverty is overburdening the traditional support systems of the extended families and communities.” - “There is also weak human, technical and institutional capacity to effectively respond to OVC issues.” (p. 11) National Action Committee on AIDS - NACA (2005) HIV/AIDS

•

National Strategic Framework for Action (2005-2009)) From a newspaper article titled, “Nigeria: Condom Ads Stir Passionate Debate: ““LAGOS, 27 March (PLUSNEWS) - Efforts to promote condom use in Nigeria could be threatened when the Nigerian Code of Advertising Practice starts being more strictly enforced on 1 July this year. Unhappy with current condom awareness campaigns, the Advertising Practitioners Council of Nigeria (APCON), the statutory body charged with vetting and approving advertisements, has begun cracking down on advertisers. Citing the code, Panel Chairman Emmanuel Ekuno warned against condom advertisements that might encourage indecency, or which in any way dramatised, depicted or insinuated a sexual act by use of word, graphics, sound or action. All condom advertisements are required to carry health warnings, may not be aired on children's programmes, before 8.00 pm on radio and television, or displayed on billboards near places of worship, schools and hospitals. APCON's directive on stricter enforcement has not gone down well with HIV/AIDS activists, who argue that it could be counterproductive to the success achieved in promoting the use of condoms. The National Action Committee on AIDS (NACA), the Society for Family Health (SFH) and other NGOs have all advertised condom use on billboards and in print and broadcast media as part of their prevention efforts. Activists have slammed the APCON decision, saying it was wrong and hypocritical of APCON to suggest that advertising condoms could promote promiscuity, especially when a large number of young people were finding it difficult to abstain from sex. HIV-positive activist Ibrahim Umoru, who is also a peer educator for the medical humanitarian organisation, Medecins Sans Frontieres, (MSF) in the port city of Lagos, told PlusNews that the directive would negatively effect ongoing campaigns. "Our society is full of deceit and denial. Whether we like it or not, there is an explosion of sexual [activity] ... among the youths, who have refused to zip up. Unless we have the key to their zips it will be wrong to curtail the advertisement of condoms in any way," he commented. "There is acute information deficiency in the country about HIV/AIDS, and we should not take any action that will deny people, irrespective of their age, the information they need to take the right decision about their lives," Umoru warned. In Nigeria schools and places of worship can be situated anywhere - in houses, shops and even in the open air - so banning billboards near such institutions might amount to a total ban. "What APCON must realise is that billboards are not only meant for students alone but [also for] the general public who either live or work near such institutions" he pointed out. Executive Director of Media Concern for Women and Children, Princess Olufemi Kayode, also found fault with the directive, noting that as much as there was a need not to promote sexual promiscuity, the level of sexual activity among the youth was alarming. "We go around giving sexuality education to students and what we find is mind boggling, concerning how early young people are either getting involved in sex or have been abused by their elders, who take advantage of their ignorance. Bisi Aborishade, Editor-in-Chief of HIV/AIDS information portal NigeriaHIVinfo.com, argued that the rate of HIV infection did not justify any limitation on promoting the use of condoms. "Everywhere you turn - on radio, television and music - there is sex, so what can be achieved by regulating condom adverts?" Aborishade wondered. NACA communication specialist Sam Archibong admitted that APCON's directive might affect those involved in the production and sale of condoms, but said his agency would comply with the directive to avoid being labelled as an organisation that promoted promiscuity. "We cannot afford to be involved in debating a matter like this, considering that we are also promoting abstinence and mutual fidelity," he explained. "It is a sensitive issue and we want to respect everybody's view on the matter." (Integrated Regional Information Networks (IRIN) (March 2006) Nigeria: Condom ads stir passionate debate, http://www.plusnews.org/AIDSreport.asp?ReportID=5807&SelectRegion=West_Africa (Date accessed 25/05/06))

• How do the effects of availability vary among different types of girls and young women, such as those in/out of school, married/unmarried, in rural/urban areas, living with HIV/not aware of their HIV status?

Services are not divided for any category of girls or young people. Unmarried young people, out of school and orphans relate more with NGOs and other private providers of services, while the married and HIV positives have access to available public and private service providers. Most of the rural young women may always travel to some peri urban centres to access services. (provided by in –country consultant)

PREVENTION COMPONENT 4: ACCESSIBILITY OF SERVICES (location, user-friendliness, affordability, etc) Key questions: 31. Are all government HIV prevention and SRH services equally open to married and unmarried girls and young women? o From the HIV/AIDS National Strategic Framework 2005-09, under Objective 3: To increase access to comprehensive gender-sensitive prevention, care, treatment and support services for the general population, PLWAs and PABAs, including OVC by 50% in 2009, and mitigate HIV/AIDS impact on the health sector (p. 23): Strategies: - “3.1 Promote development and delivery of sustainable, comprehensive quality approaches to prevention, treatment, care and support services in both public and private sector facilities, including CSOs. - 3.5 Improve accessibility, affordability and quality of STIs/ reproductive health services. - 3.8 Expand access to gender-focused VCT services, including access to youth-friendly VCT. - 3.11 Define, promote and implement gender-sensitive community and home-based care services.” (pp. 23-24) National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) The services provided by government and NGOs in relation to HIV prevention, SRH services are available to all citizens. According to the respondents these services can be accessed by young persons, married or unmarried and even to young men who are either married or unmarried. Some of them even indicated that married women get more attention in view of the services that are available at antenatal and other child birth services. Married and pregnant women are also attended to because of the need to prevent mother to child transmission. The unmarried girl usually lie about the marital status as to avoid being reprimanded. (provided by in –country consultant) 32. Are all government HIV prevention and SRH services equally open to girls and young women who are HIV positive, negative or untested? o From the HIV/AIDS National Strategic Framework 2005-09, under Objective 3: To increase access to comprehensive gender-sensitive prevention, care, treatment and support services for the general population, PLWAs and PABAs, including OVC by 50% in 2009, and mitigate HIV/AIDS impact on the health sector (p. 23): Strategies: - “3.1 Promote development and delivery of sustainable, comprehensive quality Approaches to prevention, treatment, care and support services in both public and private sector facilities, including CSOs. - 3.2 Develop a condom policy and strategy to improve access and utilization of condoms. - 3.3 Promote access to safe blood. - 3.4 Promote the practice of universal precautions and infection control (including Medical waste management). - 3.5 Improve accessibility, affordability and quality of STIs/ reproductive health services. - 3.6 Increase equitable access to ART and ensure uninterrupted supply of good quality ARV drugs. - 3.7 Promote access to treatment of opportunistic infections, including TB management.

- 3.8 Expand access to gender-focused VCT services, including access to youth-friendly VCT. - 3.9 Promote joint programming between HIV/AIDS /TB, RH, STIs as well as linkages between sectors and levels of health care delivery. - 3.10 Reduction in mother-to-child transmission of HIV infection. - 3.11 Define, promote and implement gender-sensitive community and home-based care services.” (pp. 23-24) (National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) The HIV prevention and SRH services provided by government and NGOs are easily accessible to all citizens. However, one of the respondents observed that these services are not available in all societies with rural communities at a disadvantage when compared to urban communities which have been the main focus of prevention interventions. Where they have the courage to go and access the services. (provided by in –country consultant) 33. Are VCT services free for girls and young women? o From the HIV/AIDS National Strategic Framework 2005-09, under Objective 3, Strategy 3.8 “Expand access to gender-focused VCT services, including access to youth-friendly VCT.” (p. 24) (National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) VCT services are free for girls and young persons when they are available though due to the fact that they are spread too widely many of them go through some hardships before they get to the service centres or even get the services. (provided by in –country consultant) 34. Are approximately equal numbers of females and males accessing VCT services? o Population requesting an HIV test, receiving a test and receiving test results (p. 38) Definition: The percent of respondents who have ever voluntarily requested an HIV test, received the test and received their results. Females ages: 15-19 – 2% Males ages: 15-19 – 2% 20-24 – 4% 20-24 – 7% 15-24 – 3% 15-24 – 4% o Population receiving an HIV test (pp. 38-9) Definition: The percent of respondents who have ever received an HIV test. Females ages: 15-19 – 3% Males ages: 15-19 – 4% 20-24 – 7% 20-24 – 11% 15-24 – 5% 15-24 – 8% o Population receiving a test and receiving test results within the last 12 months (pp. 39-40) Definition: Percent of the general population aged 15-49 receiving HIV test results within the last 12 months. Females ages: 15-19 – 2% Males ages: 15-19 – 1% 20-24 – 3% 20-24 – 7% 15-24 – 2% 15-24 – 4% o Population receiving a test and receiving test results in the last 12 months (pp. 40-1) Definition: Percent of the general population aged 15-49 receiving HIV test results in the last 12 months. Females ages: 15-19 – 3% Males ages: 15-19 – 4% 20-24 – 4% 20-24 – 11% 15-24 – 3% 15-24 – 9% (Federal Republic of Nigeria, Federal Ministry of Health (2003) National HIV/AIDS and Reproductive Health Survey (NARHS): Nigeria 2003, p. 54, http://hivaidsclearinghouse.unesco.org/ev_en.php?ID=4258_201&ID2=DO_TOPIC (Date accessed 22/04/06)) 35. Are STI treatment and counseling services free for all girls and young women? o From the HIV/AIDS National Strategic Framework 2005-09, under Objective 3, - Strategy 3.5 “Improve accessibility, affordability and quality of STIs/reproductive

health service.” (p. 23) Strategy 3.9 “Promote joint programming between HIV/AIDS/TB. RH, STIs as well as linkages between sectors and levels of health care delivery.” (p. 24) (National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) STI and counselling services are free for girls and young persons when they are available though the sources are too few and spread out which poses challenges to them. That is when they have the courage to even seek help. (provided by in –country consultant) -

36. Are condoms free for girls and young women within government SRH services? o From the HIV/AIDS National Strategic Framework 2005-09, under Objective 3, Strategy 3.2 “Develop a condom policy and strategy to improve access and utilization of condoms.” (p. 23) (National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) Condoms are not commonly issued in government hospitals but how to use them is usually discussed and explained to the young persons including women. Some of the service centres that are managed by NGOs and other donor groups may provide such condoms but they are in the minority and not adequately patronised due to cultural and other values which focus more on abstinence. (provided by in –country consultant) 37. Are ARVs free for all girls and young women living with HIV/AIDS? If they get into the program in any of the government hospitals (provided by in –country consultant) o From the HIV/AIDS National Strategic Framework 2005-09, under Objective 3, Strategy 3.6 “Increase equitable access to ART and ensure uninterrupted supply of good quality ARV drugs.” (p. 24) (National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) o From a newspaper article titled, “Nigeria says it will provide free AIDS drugs”, LAGOS, Nigeria (Reuters): “Nigeria will start providing AIDS drugs for free next year, the government agency in charge of fighting AIDS said, scrapping fees that aid workers say deny access to treatment for poor patients. Nigeria has 3.5 million people living with HIV/AIDS, the third-highest number in the world after India and South Africa, and at the moment it has an estimated 40,000 people on subsidized anti-retroviral drugs, or ARVs. "Up until now we provided ARVs at a subsidized rate, and patients had to pay 1,000 naira [$8] per month. They will not have to pay that anymore," said Babatunde Osotimehin, chairman of the National Action Committee on HIV/AIDS, on Saturday. Nigeria's goal is to get 250,000 people on ARVs by the end of next year, and Osotimehin said providing the drugs for free would help meet that target by encouraging more people to come forward for treatment. Two-thirds of Nigeria's 140 million people live on less than a dollar a day, and aid groups say many HIV-positive people are too poor to pay for drugs. Relief organization Medecins Sans Frontieres, which has campaigned for Nigeria to provide free AIDS treatment, said the announcement of free ARVs was a step in the right direction but it did not go far enough. Francois Giddey, head of mission in Nigeria for the Dutch section of MSF that runs an HIV/AIDS clinic in Lagos, said medical care for HIV victims does not consist only of ARVs. He said patients have to treat frequent opportunistic infections and take a battery of medical tests monthly for ARVs to be administered correctly. The cost of these treatments, which patients have to pay for themselves, is 3,000 to 7,000 naira per month in addition to the cost of ARVs, he said. Asked about this, Osotimehin said Nigeria would provide tests and treatment at a subsidized rate for adult patients, but details were still being worked out. Medecins Sans Frontieres said earlier this month that it was dangerous to require HIV victims to pay for care because the cost meant they often interrupted treatment or took insufficient doses of drugs. This enables the virus to build up resistance to ARVs.” Osotimehin said all care would be free for HIV-positive pregnant women and children. The U.N. Children's Fund warned in November that Nigerian children were increasingly at risk of contracting HIV/AIDS and called for ARVs to be given to more pregnant women to avoid a catastrophic rise in infections. UNICEF said fewer

than 1 percent of HIV-positive pregnant women in Nigeria were getting proper drugs.” (Reuters (December 2005) Nigeria says it will provide free AIDS drugs, http://nm.onlinenigeria.com/templates/?a=6524&z=17 (Date accessed 25/05/06)) o From Summary of the National Response Review (1999-2004) that informs the HIV/AIDS National Strategy 2005-09, key findings reported the following: - “There is high demand for ART and the existing sites are thus overwhelmed.” - “As a result of the increasing demand for services, there is still inadequate human, technical and institutional capacity in terms of infrastructure, staff, equipment and supplies for ART services.” - “The existing treatment centers are located mainly in urban centres within tertiary institutions thereby limiting access.” - “Treatment, care and support including VCT, TB and STI management services, are not integrated.” (p. 11) (National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) 38. Are issues relating to HIV/AIDS stigma and discrimination included in the training curriculum of key health care workers at SRH clinics? According to the respondents the training curriculum of key SRH and health care workers clinics include training on managing HIV/AIDS stigma and discrimination. These aspects are necessary in providing service to HIV and AIDS affected people. This started not more than two years ago so, there is a need for reorientation of all the health worker who got trained before the last 2 years. . (provided by in –country consultant) 39. Are issues relating to young people included in the training curriculum of key health care workers at SRH clinics? The respondents believed that the training content of key health care workers contain aspects relating to HIV/AIDS and the stigma and discrimination that is associated with it. Yes in the Last 2 years. (provided by in –country consultant) 40. Are there any government media campaigns (e.g. television commercials and newspaper advertisements) about HIV/AIDS that specifically address prevention among girls and young women? The respondents are aware of government sponsored campaigns that specifically address prevention among girls and young women. Some of them even called for the campaign to be sustained in view of its immense benefits. According to them, the HIV virus is so devastating and young people are so vulnerable that there is no effort that can be considered as too much. None specifically addressing prevention among girls and young women. (provided by in – country consultant) Discussion questions: • Are HIV prevention services truly accessible to girls and young women, including those that are marginalised and vulnerable? For example, are they: safe? affordable? reachable by public transport? in appropriate languages? non-stigmatising? open at convenient times? • What are the cultural norms around prioritizing females and males for health care? Culturally people do not have effective health seeking behaviours. (provided by in –country consultant) • To what extent are informed and supportive SRH services accessible for girls or young women living with HIV/AIDS? Very limited due to lack of awareness of the availability of the service and cultural inhibitions even when they are aware.(provided by in –country consultant)

• What are the client/service provider ratios in different types of HIV prevention services? What is the gender ratio for staff in those services? Apart from those providers who are linked to antenatal and family planning most of the other providers are male. (provided by in –country consultant) • Do services make proactive efforts to attract girls and young women? For example, do SRH clinics have separate rooms for young women so that they do not risk seeing family members or familiar adults? No (provided by in –country consultant) • What are the attitudes of service providers to girls and young women, including those who are marginalised and vulnerable? Are they kind, non-judgemental and realistic (for example about young people’s sexual pressures and desires)? Can they encourage girls/boys to assess their risks of HIV infection and change their behaviour? Are attitudes generally getting better or worse? Health workers are sometimes insensitive while providing the services. Parents and fiends are not always supportive. Access to HIV prevention services are easier for HIV positive and married girls and young women while unmarried, in and out of school may find it harder to access services because of moralization and stigma. (provided by in –country consultant) • Do HIV prevention information campaigns, etc, target girls and young women? For example, are they culturally and linguistically appropriate? Are materials distributed through appropriate media and outlets? Not appropriate (provided by in –country consultant) • Is there a national monitoring and evaluation framework? Does it encourage data to be disaggregated (according to gender and age) – to help assess the extent to which girls and young women are accessing programmes and services? Not effectively (provided by in –country consultant) o From the Summary of the National Response Review that informs the HIV/AIDS National Strategic Framework 2005-09, under section 3.7 Monitoring and Evaluation, Surveillance and Research: “The launch of the Nigeria National Response Information Management System (NNRIMS) is one of the key achievements in Nigeria. The system was designed in alignment with global monitoring and evaluation needs, and has been agreed upon by major stakeholders as the core monitoring and evaluation system for the country. The review revealed that Nigeria had accomplished some of the HEAP-set objectives for M&E, which included periodic update of data through HIV/AIDS and syphilis sero-prevalence, conducting a situational analysis of OVC and establishing the NNRIMS. The major challenges in this area included: the lack of gender sensitivity in the system, failure of NNRIMS to address programme evaluation. NNRIMS though a good structure, is still in its early stages of implementation. NNRIMS was based on the HEAP, which had a narrow focus on HIV/AIDS responses and thus needs to be reviewed to be in harmony with the emerging objectives in the NSF. Though the National Response Review (NRR) does not evidence the researches carried out in the country during the period of implementing the HEAP, however, the recommendation in the NRR goes on to suggest action in the following areas.” (p. 14) (National Action Committee on AIDS - NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) o Framework Priority X. Monitoring and evaluation (M&E) “In Nigeria, the National Action Committee on AIDS has worked with stakeholders to develop the Nigeria National Response Information Management Systems to monitor HIV/AIDS prevention and control activities in the country and evaluate their impact...Further, there is a draft national M&E framework in Nigeria, and some reasonable amount of training has been done both locally and internationally on this.” (ActionAID International (2004) Responding to HIV/AIDS in Africa: A Comparative Analysis of Responses to the Abuja Declaration in Kenya, Malawi, Nigeria and Zimbabwe, http://www.equinetafrica.org/bibl/docs/HESaids.pdf (Date accessed 22/03/06))

• Are referrals and follow-up provided during HIV/AIDS, SRH and antenatal care services for young women and girls? Yes (provided by in –country consultant) Overall, what difference does accessibility to services mean in practice? What are the ‘real life’ experiences of girls and young women? What difference is made to their vulnerability to HIV infection? The reality of girls is that they do not have required education nor information to make informed decisions about their lives; they are poorest of the poor; they have the highest prevalence rate and the reality is that HIV and poverty have now been feminized. (provided by in –country consultant)

How do the effects of accessibility vary among different types of girls and young women, such as those in/out of school, married/unmarried, in rural/urban areas, living with HIV/not aware of their HIV status? In theory young people of all categories are free to access services freely, the reality is girls or young people who are unmarried, out of school and orphans to not patronize services of the public hospitals but relate more with NGOs and other private providers of services, this means that they may never access any services as they almost always do not have money of their own. While the married and HIV positives have access to available public and private service providers. Most of the rural young women may always travel to some peri urban centres to access services. (provided by in –country consultant)

PREVENTION COMPONENT 5: PARTICIPATION AND RIGHTS (human rights, representation, advocacy, participation in decision-making, etc) Key questions: 41. Has the country signed the Convention on the Rights of the Child (CRC)? o The CRC was signed on January 26, 1990 and ratified on April 19, 1991. (Office of the United Nations High Commissioner for Human Rights (2006) Convention on the Rights of the Child New York - 20 November 1989, http://www.ohchr.org/english/countries/ratification/11.htm (Date accessed 30/03/06)) 42. Has the country signed the Convention on the Elimination of all Forms of Discrimination against Women (CEDAW) and the Convention on Consent Marriage, Minimum Age of Marriage and Registration of Marriages (CCM)? o CEDAW was signed on 26 January 1990 and ratified 19 April 1991. (Office of the United Nations High Commissioner for Human Rights (2006) Convention on the Elimination of All Forms of Discrimination against Women New York - 18 December 1979, http://www.ohchr.org/english/countries/ratification/8.htm (Date accessed 30/03/06)) o The Optional Protocol to the Convention on the Elimination of All Forms of Discrimination against Women was signed on September 8, 2000 and ratified on November 22, 2004. (Office of the United Nations High Commissioner for Human Rights (2006) Optional Protocol to the Convention on the Elimination of All Forms of Discrimination against Women New York - 6 October 1999, http://www.ohchr.org/english/countries/ratification/8.htm (Date accessed 30/03/06)) The respondents did not show any awareness of Nigeria signing the CCM convention though they are aware of the various efforts at reducing incidences of early marriage We are aware that it was signed but not domesticated yet. (provided by in –country consultant)

43. In the National AIDS Council (or equivalent), is there an individual or organisation that represents the interests of girls and young women? There is enough representation on the National Aids Council for girls and young women though the respondents indicated that there is no organisation that specifically represents them. There are many women groups that are in the council and they also represent the interest of young women and girls. Some of these organisations do this in a wide range of areas apart from the National Aids Council. They did not know specifically if there is representation on the council. We now know that there are representation of all groups especially male and female PLHIV from the national association of Positive people. But special attention is not given to girls and young women. (provided by in –country consultant) 44. In the National AIDS Council, is there an individual or organisation that represents the interests of people living with HIV/AIDS? Yes. The respondents indicated that the council was established to provide support to PLHIV as such it will be unthinkable that the council should lack representation for PLHIV. Therefore they are certain that the core support groups are members and part of the stakeholders. However, the respondents did not know in specific terms if this representation has been done. (provided by in – country consultant) 45. Was the current National AIDS Plan developed through a participatory process, including input from girls and young women? They had representations from young people but there was no special interest focused on girls and young women (provided by in –country consultant) o The HIV/AIDS National Strategic Framework for Action (2005-2009): “The process of NSF (National Strategic Framework) 2005 – 2009 development was inclusive and participatory and for the first time ever identified and involved the Constituency coordinating entities of the Civil Society, such as Women, Youths, Faith based, Private sector, PLWAs, Media & Art, Public Sector and International Stakeholders at all levels from the six geo-political zones in the country…NACA acknowledges with thanks the important role played by membersof the Gender Technical Committee (GTC) for ensuring that gender was mainstreamed into both the NRR (National Response Review) and NSF.” (National Action Committee on AIDS NACA (2005) HIV/AIDS National Strategic Framework for Action (2005-2009)) o The National Policy on HIV/AIDS from 2003 was developed through a larger collaborative process, including the following: “Federal and state government line ministries and parastatals, developmental partners, donor agencies, civil society organizations including professional bodies, non-governmental organizations, faith-based organizations, community-based organizations, women’s organizations, and networks for people living with HIV/AIDS.” Also mentioned were, representatives of youths and youth serving organizations as well as the National Network of People Living with HIV/AIDS. (Federal Government of Nigeria (2003) National Policy on HIV/AIDS 2003, sourced from website, Education Research Network for West and Central Africa (ERNWCA), Acknowledgements, pp. X-XI http://hivaidsclearinghouse.unesco.org/ev_en.php?ID=4239_201&ID2=DO_TOPIC (Date accessed April 19, 2006)) 46. Is there any type of group/coalition actively promoting the HIV prevention and SRH needs and rights of girls and young women? o AfriHealth Optonet Association “…seeks to implement its programs using research, intervention, education, information and advocacy. The organisation focuses on the disadvantaged and most vulnerable groups in society, especially women, youth, children, and the elderly in poor urban and rural communities.” o Benue Network of PLWHA (BNPPLUS) – “Networking in the state among PLWHA groups with other NGOs and CBOs with similar aims and objectives; advocacy, care, and support; home-based activities; creation of an enabling environment for effective implementation of activities through 14 support groups in 10 local government areas. Prevention activities include awareness, peer education for in-school youth, education (seminars, rallies,

workshops) for PLWHA, persons affected by HIV/AIDS, and community members.” Members include youths, men, women, orphans, vulnerable children. Adolescent Health Vanguard – “Mobilization, seminars, outreach programs for out-ofschool youth.” (United States Agency for International Development (USAID), Global Network of People Living with HIV/AIDS (GNP+) and International Coalition of Women (ICW) (2004) Directory of Associations of People Living with HIV/AIDS, http://www.usaid.gov/our_work/global_health/aids/Publications/docs/hivaidsdirectory.pdf, pp. 30-43) Action E3 on AIDS Nigeria (E3 stands for Education, Enlightenment and Eradication); Action E3 trains adolescent peer health educators, their parents and care givers in the area of adolescent reproductive health. The organization was founded with great emphasis on reproductive health, HIV/AIDS prevention and mitigation. Action E3 provides ways for people to communicate with each other about reproductive health and HIV/AIDS information and personal experience fighting AIDS. (Action E3 on AIDS Nigeria, http://orgs.takingitglobal.org/6671 (Date accessed April 26, 2006)) Action Health Incorporated (AHI) is a “pioneering non-profit, non-governmental organisation dedicated to improving the health of Nigerian adolescents. AHI is a non-governmental organization dedicated to the promotion of adolescent health and development. We serve as a leading advocate and catalyst for change in the present poor health status of Nigeria's adolescents by increasing public awareness and implementing innovative education, healthcare and youth development programs. Our conviction is that adolescents need to be aware of the various factors that influence the experiences they have at this stage of their lives and that providing them with this knowledge and life planning skills will empower them to make informed and responsible decisions concerning their sexuality and life directions.” (Action Health Incorporated (AHI) http://orgs.takingitglobal.org/2639 (Date accessed April 26, 2006)) Adolescent Action Pact. “Our mission is the complete systemic attainment of mental, physical and social wellbeing of adolescent, women and children. We are into adolescent reproductive health issues, prevention of HIV/AIDS, sexually transmitted infections, teen pregnancy, building the capacity of the adolescents through peer education, mentoring, sensitisation meetings, managing puberty changes through life building skills education.” (Adolescent Action Pact http://orgs.takingitglobal.org/10441(Date accessed April 26, 2006)) Centre for Gender and Social. “The Centre for Gender and Social Policy Studies, Obafemi Awolowo University was established in 1997 with a central focus on issues relating to gender studies; women's issues, especially sexual and reproductive health among others. The mandates of the Centre include: i. teaching; research; training; and outreach programmes.” (Centre for Gender and Social, http://orgs.takingitglobal.org/9946 (Date accessed April 26, 2006))

The respondents indicated awareness of a number of groups and coalitions which are actively involved in promoting HIV prevention but could not specifically name them. They were able to mention some NGOs that work on such issues which include GHAIN, SWAN and AHIP. Most NGOs are involved in education and information disseminations, only a few are involved in care and support. Some faith based organizations are also doing care and support with distribution of ARVs. (provided by in –country consultant) 47. Is there any type of national group/coalition advocating for HIV prevention (including positive prevention) for girls and young women? Most of the network for PLHIV are involved in mostly advocacy work but not specifically for girls and women. (provided by in –country consultant) o Centre for Adolescent Research Evaluation (CARES) has a nationwide focus. CARES provides “Multi disciplinary research into social and medical problems facing adolescent; community based reproductive health information; training; advocacy and reproductive health care for youth; documentation centre; risk reduction programmes at oil locations and surrounding communities.” (Africa Now! (2000) Inventory of HIV and AIDS Programs in

Sub-Saharan Africa, pp. 129-138) Benue Network of PLWHA (BNPPLUS) – “Networking in the state among PLWHA groups with other NGOs and CBOs with similar aims and objectives; advocacy, care, and support; home-based activities; creation of an enabling environment for effective implementation of activities through 14 support groups in 10 local government areas. Prevention activities include awareness, peer education for in-school youth, education (seminars, rallies, workshops) for PLWHA, persons affected by HIV/AIDS, and community members.” Members include youths, men, women, orphans, vulnerable children. (United States Agency for International Development (USAID), Global Network of People Living with HIV/AIDS (GNP+) and International Coalition of Women (ICW) (2004) Directory of Associations of People Living with HIV/AIDS, http://www.usaid.gov/our_work/global_health/aids/Publications/docs/hivaidsdirectory.pdf, pp. 30-43) Planned Parenthood Federation of Nigeria (PPFN) – Young Adult Reproductive Health Force (YARHF) STD/HIV Management Project. Membership profile has 216 young men and 87 young women. Clinic services such as counselling on family planning, syndromic management of STIs; advocacy meetings with community leaders; workshops for community-based organizations on the basic facts about STIs, HIV/AIDS, and modes of prevention and care; training of prison officers on HIV prevention and care, syndromic management, counselling; training for community birth attendants; training for out-ofschool youth peer educators; supporting PLWHA and vulnerable orphans; HIV/AIDS awareness in rural areas; income-generating activities for sustainability; essay/quiz competition for adolescents; radio program. (United States Agency for International Development (USAID), Global Network of People Living with HIV/AIDS (GNP+) and International Coalition of Women (ICW) (2004) Directory of Associations of People Living with HIV/AIDS, http://www.usaid.gov/our_work/global_health/aids/Publications/docs/hivaidsdirectory.pdf, pp. 30-43) Society for Women and AIDS in Africa, Nigeria Chapter (SWAAN) – “Counselling services, support centers for PLWHA in three local government areas, home visits with PLWHA, quarterly meetings with collaborating health care providers to strengthen linkages and referrals, community involvement through regular outreach-worker meetings, education and awareness-raising, female condom distribution, sex workers project, in-school youth project. Members are men, women, teenagers and adults.” (United States Agency for International Development (USAID), Global Network of People Living with HIV/AIDS (GNP+) and International Coalition of Women (ICW) (2004) Directory of Associations of People Living with HIV/AIDS, http://www.usaid.gov/our_work/global_health/aids/Publications/docs/hivaidsdirectory.pdf, pp. 30-43) Action E3 on AIDS Nigeria: “E3 stands for Education, Enlightenment and Eradication); Action E3 trains adolescent peer health educators, their parents and care givers in the area of adolescent reproductive health. The organization was founded with great emphasis on reproductive health, HIV/AIDS prevention and mitigation. Action E3 provides ways for people to communicate with each other about reproductive health and HIV/AIDS information and personal experience fighting AIDS.”(Action E3 on AIDS Nigeria, http://orgs.takingitglobal.org/6671 (Date accessed April 26, 2006)) Adolescent Action Pact. “Our mission is the complete systemic attainment of mental, physical and social wellbeing of adolescent, women and children. We are into adolescent reproductive health issues, prevention of HIV/AIDS, Sexually transmitted infections, teen pregnancy, building the capacity of the adolescents through peer education, mentoring, sensitisation meetings, managing puberty changes through life building skills education.” (Adolescent Action Pact http://orgs.takingitglobal.org/10441(Date accessed April 26, 2006)) Care givers Organization. “To undertake advocacy on HIV/AIDS related issues in Nigeria; To advocate for the mobilization, at all levels, of the necessary resources to address the issues of the epidemic especially amongst the youths; Equipping youths with skill for components

on HIV/AIDS Issues; To promote and sustain behavior changes to reduce stigma and discrimination; To establish understanding, encouragement and support for people living with HIV/AIDS and their families; To maintain emotional, physical and social support to the infected and those who care for them; To discourage risk behaviors that will enhance the spread of HIV infections; Care for Orphans and Vulnerable Children; Promoting youth involvement in coordinating and monitoring; Promoting ownership of the youth component by the youth.” (Care givers Organization, http://orgs.takingitglobal.org/12717(Date accessed April 26, 2006)) Caring Youth Organisation. “Our vision is to save our generation from extinction by HIV/AIDS through equipping young people and the society with scientifically correct information and promoting programs that will foster behavioral change. We organize HIV/AIDS Reproductive health training for students in schools, Inter-school presentation/workshop, Music Concert (where HIV is preached against), Books to help people with basic knowledge and prevention methods of HIV/AIDS.” (Caring Youth Organisation, http://orgs.takingitglobal.org/4453 (Date accessed April 26, 2006)) Community AIDS Care Rescue Team. “To completely eradicate the spread of the deadly pandemic - HIV/AIDS and other sexually transmitted infections through massive awareness and sex education by the year 2012. Training of peer health educators to spread the message not the virus; advocating against obnoxious practices - female genital mutilation, child labour/trafficking, gender inequality/male preference; organising roadshows and workshops to inform sex workers(csws) and other individuals who are more proned to contract the virus and other stds e.G motor workers, tanker drivers, soldiers at the nation's border towns, on the dangers and consequences of contracting the diseases; caring for aids orphans and widows through fund raising and donations from individuals and corporate bodies etc..” (Community AIDS Care Rescure Team, http://orgs.takingitglobal.org/5829 (Date accessed April 26, 2006)) Community Development Support (CDS). “Recognizing Voluntary counseling and Testing (VCT), as a very important entry point for HIV prevention, treatment, care and support for PLWHA. CDS through Advocacies, community rallies and IEC materials mobilizes communities especially at the districts for the up take of VCT for PMTCT, prevention, care and support. In school HIV/AIDS awareness and peer education; HIVAIDS counseling training for youths” (Community Development Support (CDS), http://orgs.takingitglobal.org/9954 (Date accessed April 26, 2006))

48. Is the membership of the main network(s) for people living with HIV/AIDS open to young people, including girls and young women? o “The Network of People Living with HIV/AIDS in Nigeria (NEPWHAN) is the umbrella organization that coordinates all support groups and special interest groups of people living with HIV/AIDS in Nigeria. The mission of NEPWHAN is to empower, strengthen and coordinate all support groups and constituents of people living with HIV/AIDS in Nigeria to contribute to meaningfully to the national response.” (Journalists Against AIDS (JAAIDS) Nigeria (2006) National PLWHA Forum 2006, Forum Message, http://www.nigeria-aids.org/ (Date accessed 05/04/06)) The group was of the view that being coalitions, their membership is often based on groups coming together as such individuals are expected to join individual groups which will then join the coalition. Despite this the respondents indicated that young women and girls are free to join to any of the groups that form the coalition. (provided by in –country consultant) 49. Are there any programmes to build the capacity of people living with HIV/AIDS (e.g. in networking, advocacy, etc)? there are a few and some mentioned here are actually running such programs o The Coalition of Support Groups in Northern Nigeria (COSGINON) was developed as an advocacy initiative in northern Nigeria due to the stigma and discrimination of PLP (people living positively). It has 20 support groups. The goals are to: (1) build alliances with other key

institutions towards enhancing the activities of support groups in Northern Nigeria; (2) To build a functional network (COSGINON) with a dynamic institutional structures; (3) To advocate for increased support accessibility, affordability, availability for ARV, access to information and care and support for people living positively; (4) To advocate for the fundamental human rights of PLP. (Journalists Against AIDS (JAAIDS) Nigeria (2005) Forum Message, Introducing ....Coalition of Support Groups in Northern Nigeria, http://www.nigeria-aids.org/ (Date accessed 05/04/06)) AIDS Alliance in Nigeria – “Advocacy and sensitisatization, microcredit for PLWHA, HIV/AIDS telephone help lines, counselling and support groups, face-to-face counselling, referral services, home-based care and support for PLWHA, media outreach, training of people living with HIV/AIDS and volunteers, research/documentation, production of newsletters and journals, radio/TV program. Compiling a comprehensive treatment guidelines handbook for health care workers and every PLWHA in Nigeria; planning a nationwide treatment advocacy campaign; live phone-in program on radio and TV called AIDS Online; pushing the visibility of PLWHA on the Global Fund CCM in Nigeria and the GIPA principals.” Members are both men and women, with more than 55% women, average age is 34. (United States Agency for International Development (USAID), Global Network of People Living with HIV/AIDS (GNP+) and International Coalition of Women (ICW) (2004) Directory of Associations of People Living with HIV/AIDS, http://www.usaid.gov/our_work/global_health/aids/Publications/docs/hivaidsdirectory.pdf, pp. 30-43) Benue Network of PLWHA (BNPPLUS) – “Networking in the state among PLWHA groups with other NGOs and CBOs with similar aims and objectives; advocacy, care, and support; home-based activities; creation of an enabling environment for effective implementation of activities through 14 support groups in 10 local government areas. Prevention activities include awareness, peer education for in-school youth, education (seminars, rallies, workshops) for PLWHA, persons affected by HIV/AIDS, and community members.” Members include youths, men, women, orphans and vulnerable children. (United States Agency for International Development (USAID), Global Network of People Living with HIV/AIDS (GNP+) and International Coalition of Women (ICW) (2004) Directory of Associations of People Living with HIV/AIDS, http://www.usaid.gov/our_work/global_health/aids/Publications/docs/hivaidsdirectory.pdf, pp. 30-43) Association for Positive Care (ASPOCA) – Home-based care for members; weekly health talk at Federal Medical Centre, Owerri, Imo State; monthly meeting of support group; participation in World AIDS Day activities for 2003 and in first NACA-SACA Forum in September 2003 in Abuja. Members include HIV positive people, men and women age 18 or older. Members include men and women age 18 or older. (United States Agency for International Development (USAID), Global Network of People Living with HIV/AIDS (GNP+) and International Coalition of Women (ICW) (2004) Directory of Associations of People Living with HIV/AIDS, http://www.usaid.gov/our_work/global_health/aids/Publications/docs/hivaidsdirectory.pdf, pp. 30-43) Centre for Positive Development – “Home-based care; mobilization and formation of support groups; education for PLWHA on care and management of their condition; advocacy to prevent the spread of HIV; peer counselling, especially in schools and faithbased organizations; pre-test and post-test counselling; capacity-building for PLWHA.” (United States Agency for International Development (USAID), Global Network of People Living with HIV/AIDS (GNP+) and International Coalition of Women (ICW) (2004) Directory of Associations of People Living with HIV/AIDS, http://www.usaid.gov/our_work/global_health/aids/Publications/docs/hivaidsdirectory.pdf, pp. 30-43) Save the World Organization – “Advocacy sensitization, formation of other support groups for PLWHA, community mobilization, home-based care and support training, counselling.” Members are all ages, genders and religions.” (United States Agency for International Development (USAID), Global Network of People Living with HIV/AIDS (GNP+) and

International Coalition of Women (ICW) (2004) Directory of Associations of People Living with HIV/AIDS, http://www.usaid.gov/our_work/global_health/aids/Publications/docs/hivaidsdirectory.pdf, pp. 30-43) Simple Practical Informed Network (SPIN) – “Capacity-building, home-based care for people living with and affected by HIV/AIDS, counselling services, advocacy, awareness campaigns, sharing experiences to encourage members, regular group meetings.” Members are all ages. (United States Agency for International Development (USAID), Global Network of People Living with HIV/AIDS (GNP+) and International Coalition of Women (ICW) (2004) Directory of Associations of People Living with HIV/AIDS, http://www.usaid.gov/our_work/global_health/aids/Publications/docs/hivaidsdirectory.pdf, pp. 30-43) Unique AIDS Control Organization (UACO) – “Grassroots HIV/AIDS intervention (the CARI Project), PLWHA monthly support group meetings, food and drug supplementation, advocacy, home-based care, educating PLWHA on care and management techniques, advocacy on the further spread of HIV, mobilizing people living with HIV into various support groups, counselling, capacity-building.” Members are all religions, ages and genders. (United States Agency for International Development (USAID), Global Network of People Living with HIV/AIDS (GNP+) and International Coalition of Women (ICW) (2004) Directory of Associations of People Living with HIV/AIDS, http://www.usaid.gov/our_work/global_health/aids/Publications/docs/hivaidsdirectory.pdf, pp. 30-43)

50. Are there any girls or young women living with HIV/AIDS who speak openly about their HIV status (e.g. on television or at conferences)? o One woman, Ms. Rolake Odetoyinbo Nwagwu, a newspaper journalist, received the award for Breaker of Silence “for her role in promoting visibility and acceptance of people living with HIV in Nigeria. Her newspaper column, In Moments Like This, is the first by an openly HIV-positive person and has helped to convince many Nigerians about the human impact of living with HIV.” (Journalists Against AIDS (JAAIDS) Nigeria (2005)Journalists, PLHA, others honoured at Red Ribbon Awards 2005, http://www.nigeria-aids.org/ (Date accessed 05/04/06)) A few young infected persons speak in public about their HIV status but the most common are older persons because the young persons often have difficulty adjusting to their positive status and struggle to fit among their peers. So it is not common for young persons to speak publicly about their positive status or discuss such issues. Cultural reasons and fear of stigma and discrimination also prevent young women who are positive from going public with their status and campaigning against HIV. Culturally it is not common for young women to appear on TV which prevents them from doing that for HIV. (provided by in –country consultant)

Discussion questions: • How are international commitments (e.g. CRC, CEDAW, and CCM) applied within the country? These instruments are not domesticated. NGOs have worked relentlessly to have them domesticated but have not succeeded to date. (provided by in –country consultant) • Is the national response to HIV/AIDS rights-based? For example, does it recognise the SRH rights of women living with HIV/AIDS? No, the issue of violence against women, SRH rights and choices are missing (provided by in – country consultant) o Adoption of other international and regional commitments, including the Declaration on Sexual and Reproductive Health for Anglophone West African Countries (adopted at the sub-regional ministerial meeting) by the Minister of Health on June 9, 2005 in Abuja. (WHO Nigeria, http://www.who-nigeria.org/news/SRH_Conference_Ends/ (Date accessed by 12/04/06)) o Nigeria received accession on the International Covenant on Civil and Political Rights on

July 29, 1993. (Office of the United Nations High Commissioner for Human Rights (2006) Status by Country: Nigeria, http://www.ohchr.org/english/countries/ratification/4.htm (Date accessed by 12/04/06)) Nigeria received accession status for the International Covenant on Economic, Social and Cultural Rights on July 29, 1993. (Office of the United Nations High Commissioner for Human Rights (2006) Status by Country: Nigeria, http://www.ohchr.org/english/countries/ratification/4.htm (Date accessed by 12/04/06)) Framework Priority III – Protection of Human Rights. “In Nigeria, the government is currently reviewing existing legislation in order to inform the enactment of new and appropriate laws relating to various human rights issues, such as HIV/AIDS legislation in the workplace; legal rights and property ownership, and improving access to legal services for people infected and affected by HIV/AIDS.” (ActionAID International (2004) Responding to HIV/AIDS in Africa: A Comparative Analysis of Responses to the Abuja Declaration in Kenya, Malawi, Nigeria and Zimbabwe, http://www.equinetafrica.org/bibl/docs/HESaids.pdf, (Date accessed 22/03/06)) “The government recognizes the stigma and discrimination facing people infected and affected by HIV/AIDS and realizes that the promotion and protection of human rights for all Nigerians can reduce the negative effects associated with the epidemic; therefore the Federal Government of Nigeria affirms the following: • Persons living with or affected by HIV shall not be discriminated against on the basis of their health status with respect to education, training, employment, housing, travel, access to health care and other social amenities and citizenship rights; • The denial of appropriate care and support for persons living with HIV/AIDS is an abuse of their human rights, unethical and illegal; • All persons shall respect the right to privacy and confidentiality of people living with HIV/AIDS and shall not disseminate information on the status without individual’s consent, of that of the individual’s family when the individual is incapable of giving such consent; • The Government of Nigeria shall monitor human rights abuses and develop enforcement mechanisms for redress.” (Federal Government of Nigeria (2003) National Policy on HIV/AIDS 2003, sourced from website, Education Research Network for West and Central Africa (ERNWCA), pp. 25-26 http://hivaidsclearinghouse.unesco.org/ev_en.php?ID=4239_201&ID2=DO_TOPIC (Date accessed April 19, 2006))

• Do key decision-making bodies (e.g. the Country Coordinating Mechanism of the Global Fund to Fight AIDS, TB and Malaria) have a set number of seats for civil society? Are any of them specifically for representatives of girls and young women or people living with HIV/AIDS? Yes they have seats for civil society but do not have a seat for a representative of girls and women. (provided by in –country consultant) • Are HIV prevention programmes generally developed ‘for’ or ‘with’ girls and young women, including those who are marginalised and vulnerable? Are girls and young women seen as ‘implementers’ as well as ‘receivers’ of services? No (provided by in –country consultant) • To what extent are girls and young women aware of decision-making processes? Are they encouraged to have a voice? Are they seen as an important constituency within committees, management groups, etc? Not young women (provided by in –country consultant) • How high are issues relating to HIV prevention for girls and young women (e.g. early marriage and stigma) on the agendas of local leaders and decision-making groups (e.g. district AIDS committees)? To what extent do girls and young women participate in those type of bodies? Women are included those committees to represent women but not because of the special needs

of Girls and young women. (provided by in –country consultant) • To what extent are people living with HIV/AIDS organised, for example in networks? Are girls and young women involved in those bodies? Those that have accepted their status are well organized some young women are also involved in those networks. (provided by in –country consultant) • How are issues of participation affected by stigma? For example, is it safe for people living with HIV to speak openly about their HIV status? It will be safe in a meeting circle where people who know about the issues are I attendance but not in any public place. (provided by in –country consultant) • Overall, how are participation and rights applied in practice? What are the ‘real life’ experiences of girls and young women? What difference is made to their vulnerability to HIV infection? Its only young people who are in school that get to participate actively in most programs. The chances of the out of school getting any information or sex education is slim and that increases their vulnerability to HIV infection. (provided by in –country consultant) • How do the effects of participation and rights vary among different types of girls and young women, such as those in/out of school, married/unmarried, in rural/urban areas, living with HIV/not aware of their HIV status? Participation of in-school girls and young women in HIV program is very high but all other groups have low participation in HIV prevention programs. The implementers of any program for girls and young women who are out of school; married; in rural or urban; or not aware of their status have to put in extra effort into reaching them in their locations and choose times that are suitable for them. (provided by in –country consultant)

Focus Group Discussions

Focus group discussion 1 Age group: 16 - 21 Profile of participants: Girls and young women living with HIV Place: Kano, Nigera

Prevention component 1: Legal provision Respondents were aware of the law that provides protection to PLHIV against discrimination especially in the workplace or loss of job, housing and other benefits due to their HIV status. However, the law cannot provide privacy and confidentiality as well as protection against social stigma which leads to divorce and other social losses. Forming groups gives them a sense of security and their offer of support to each other especially as most of them are unable to access the drugs that are supposed to be provided free by the government. The respondents are of the opinion that the laws are no different for all girls except some considerations are given to the married girls, but they are unaware of any laws against gender-based violence but they believe that the law courts can provide protection when required but non of them have seek protection from the law. They have no awareness of the lives of sex workers and how they organize themselves. The respondents argued that most medical health workers are not aware of laws protecting HIV infected persons. Respect for the laws is more evident in Teaching Hospitals, while other hospitals have been known to discriminate against PLHIV. The federal government should make it compulsory for states to introduce Family life Education in government schools and all Quranic schools. There are no laws stipulating the legal age of marriage, it is only population policies which recommends 18 years as age of marriage for girls. The group have different opinion on the age of marriage ranging from 15 â&#x20AC;&#x201C; 20 years and abortion is illegal accept to save the life of the mother. There is no known state laws prevent girls and women from using services but tradition and some cultural practices requires that the woman must obtain permission from the parent and if she is married get permission from the husband to access any service or even go out of the house. Prevention component 2: Policy provision: The federal government has a policy on adolescent health and a curriculum for Family live and HIV/AIDS Education (sexuality education) which has been approved for use in the schools but only Lagos states is fully using it while the different state are not using it in their schools yet. This group have never been thought any thing about HIV prevention. The federal government must make sexuality education compulsory in schools and Quranic Schools in Nigeria. The only knowledge they have is from advertisements of condoms from the media, have never been in any educational sessions for the prevention of HIV; are not encouraged to use condoms and some have never heard of a female condom while others have never seen it. The respondent does not have information on sexually transmitted infections but know that they are treated in hospitals.

In summary the respondent believe that if 1. the federal government encourage that existing laws and policies of Nigeria are enforced and adhered to in the states and local government 2. community leaders and their communities buy into girlsâ&#x20AC;&#x2122; education, marriages are delayed and partners tested before marriage

3. 4.

donors to fund programs to do mass campaign to eliminate stigmatization of People Living With HIV federal government makes it compulsory for states to introduce Family life Education in government schools and all Quranic schools.

Prevention component 3: Availability of service This group have the impression that the general situation of HIV/AIDS among girls and young women is getting worst because new members are introduced to their group every month and most of them are married or divorced young women and usually from first marriages. Respondent: “ most of us don’t know of our status until we are pregnant or have a baby” Most communities do not have VCT or HIV service centres, these are located in big hospitals and some NGO centres who provide drugs for infected persons as well as other Family Planning services, though they discuss and explain the use of condoms they do not provide any. The user will have to purchase what they need. Other services include counselling at ante-natal and postnatal stages of child birth to avoid mother to child infections; part of the counselling also cover managing risky behaviour especially among PLHIV who are unmarried. STIs can be treated in most hospitals even though patients might have to buy their own medication. HIV tests are carried out in Teaching Hospital and other general hospitals. The boys and young me also do not have HIV prevention services in the communities, what they have is no different from what is available for girls and women. The difference is they go about with girls more freely and spread the infections.. Boys and Young men are also encouraged to abstain in response to their religious values which do not encourage promiscuity. Those who cannot abstain are encouraged to use condoms which can break if not used properly and most of the massages are from NGOs. Respondent “I want to make a comment on what my colleague said that it is the youth that spread HIV/AIDS most. I want to say even the old people do spread it because I was talking to one old man about HIV/AIDS but he replied to me that “He can not forfeit enjoyment because any difficulty” so I surprised because the was very old with white hairs yet he was saying that because of HIV/AIDS he can not stop having sexual intercourse. The man was so old to be my grand father but look at what he was saying”. Another Response: Yes it is true that some old men do because they usually go after young girl and seduce her, sometimes marry her. Another Response: And another thing with these old people is even if they went to VCCT and were found positive they don’t reveal it to their wives at home. So they will be going to the hospital secretly and will be taking the ARVs but the wives will be left suffering with one disease or the other since they are not tested. So I will like to advice the old people that whenever they went for VCCT and were found positive, they should go and send their wives to be tested too even if the person has 4 wives because after they were tested they will be counsel and advice on what to do and what not to do, and for youth that picks on a girl friend and abandon her. I will say youth nowadays are so stubborn you can only advice them to go for VCCT because there are some youth that don’t go for it even though it is free. So the best way is for the married to be faithful and remain with their partners only and for the unmarried youth to abstain or get married or rather go for VCCT and know what to do and what no to and how to go about it. All communities must work towards delaying marriage so that girls can get full education at least to secondary school level so that they can make their own decisions, have some skill in generating income and don’t be over dependant o husbands.

Prevention component 4: Accessibility of services These services are given to all irrespective of marital or gender status and VCT services are free in government hospitals. Service centres are not available in many places; confidentiality is not always assured; services are available at the offices hours of work 8am – 5pm; the local language of the area is used, health workers are sometimes insensitive while providing the services. Parents and fiends are not always supportive. Access to HIV prevention services are easier for HIV positive and married girls and young women while unmarried, in and out of school may find it harder to access services because of moralisation and stigma. Reducing the stigmatization of people living with the virus will help HIV prevention services and make it more accessible. Prevention component 5: Participation and rights The only time women and men came together was in the support groups and respondents have not any HIV prevent meets or training.

most of the

Focus group discussion 2 Age group: 15 - 21 Profile of participants: Single girls, married and divorced girls and young women Place: Kano, Nigera

Prevention component 1: Legal provision The group suggested a wide range of ages from 15 to as high as 30 and there is no consistency as some ages were suggested by only one person or a few people as such there is no decision possible. There are many factors that are responsible for these variations some of them might be education, marital status, the trauma of divorce, income levels or level of exposure to legal and other social issues. The respondents are fully aware of gender based violence and were unequivocal in the condemnation of such violence. They were unanimous in admitting that there is a law against gender-based violence. “Violence against women is condemnable and any man who does that should be ashamed of himself. I know it is not allowed and even the court can take measures against a person who does that but I am not sure if there is any law that specifically prohibits it” The respondents were not certain of the existence of a law legislating on issues tat relate to HIV/AIDS. They even indicated that many VCT centres do not have enough provisions for privacy as such people are often exposed, ridiculed and stigmatised as a result of the open manner in which tests, diagnosis and counselling takes place. While some of the respondents indicated that they have heard of such a law, none of them was definite about it. Some of them actually had no idea what such a law is even after they were given an example of job loss and other aspects of discrimination. Some of them even misunderstood the law to mean counselling as provided in hospitals and life management. On the other hand they are aware of the media effort on raising the awareness of the society against the prevailing discrimination suffered by PLHIV especially aspects of stigma and rejection. They are equally aware that stigmatization is attended by a series of problems for the PLHIV. “….they enlighten people through radio that people should not stigmatize the PLHIV because Stigma worsens the condition.”

Some of them also hinted that rich people are constantly being sensitized towards providing support and help to PLHIV. While others indicated awareness that the government provides drugs to infected persons. This group are aware that abortion is rampant and that even mother take their daughter to secure abortion and the respondent know that there is no law that supports abortion. There are no laws that prevents girls and young women from using services, however the culture requires girls and women to ask for permission from parents or husbands before going out or accessing services Prevention component 2: Policy provision: Some of the respondent have never been to school and those that have attended some form of education did not receive any education on issues of relationships, sex and AIDS neither have they been educated on sexual and reproductive health and rights. Not in school and definitely they are not thought out of school.

In summary the 1. community leaders must support girl child education 2. protect her rights 3. delay marriage. Prevention component 3: Availability of service The most common services in the community are counselling towards abstinence, Young girls and young women can go to any family health clinic or general hospital and they can be able to access the services. As regards treatment for STIs the respondents are of the view that treatment is available in any government clinic or hospital. HIV test is also available in all the selected locations and girls and young women can access those services the same as any other person. The problem with the services is that they are only available in urban cities and some peri urban areas and they are far in between, they do not give condoms and most hospitals do not have friendly health providers. In addition to all these some support groups and NGOs like AHIP and SWAN provide a range of service such as counselling, information on HIV, STIs and also attend to other needs of young persons. The respondents are not aware of any prevention services that are specific to young women. However they indicated awareness of a wide range of support groups that could be working with young female PLHIV but not necessarily dedicated to serving them. They also stated that girls and young women usually have difficulties adjusting to their new HIV positive status and the threat, possibility and effects of stigma especially from their peers, family and friends. They are certain that there are no support groups or other services apart from advertisements that are specifically focused on young persons and sometimes put down females. Boys and Young men are more informed on issues such as HIV though the respondents were of the view that urban youths know more than rural persons in response to the varied life styles and access to information as well as differing literacy levels. The awareness of preventive methods has increased in the recent past though young persons still engage in risky behaviour and they often do not believe how dangerous some of the behaviour can be. The respondents were of the view that young men have a major role to play in preventing the spread of HIV.

Prevention component 4: Accessibility of services Are all government HIV prevention and SRH services equally open to married and unmarried girls and young women?

HIV preventive services are difficult for girls to use because some that live near VCT centres may not want to use the near by services and they may not get another centre within 100 kilometre from the available one. So they have no choice is ether they use the community center or learn to live with the uncertainty surrounding their status. The services provided by government and NGOs in relation to HIV prevention, SRH services are available to all citizens. According to the respondents these services can be accessed by young persons, married or unmarried and even to young men who are either married or unmarried. Some of them even indicated that married women get more attention in view of the services that are available at antenatal and other child birth services. Married and pregnant women are also attended to because of the need to prevent mother to child transmission. It was observed that pregnant women are usually targeted for VCT in most hospitals but more especially in teaching Hospitals. The women are usually informed that they will be tested and when they are found positive then effort is made to guide and counsel them for safe delivery and safe child care. However, some of the respondents observed that sometimes couples who want to marry go for tests more often at the instance of the girl but only if the man agrees. “Sometimes if couples are about to marry they do go for test if the boyfriend agrees but if he doesn’t agree then he might be a positive” “Zip up” and other advertisements were given as examples of media campaigns that the respondents are aware of and they believe that such adverts are actually targeting young women and men who need as much influence and convincing as can be managed. “If you recall the “Zip up” advertisement which is encouraging youths to abstain from premarital sex and by extension other risky behaviour is a very good one and it has young actors and the message is clearly aimed at youths” There are also many other media campaigns including talk shows and other forms of jingles that are sometimes sponsored by NGOs and other donor agencies with a view to working with young persons so that they can reach other young persons.

Prevention component 5: Participation and rights Yes there are many project that have brought girls and boys together to talk about HIV prevention in the community. The program involved lectures and seminar king presentation. Some community members did not believe that they could be at risk and hence did not accept the program while those who believed continue to talk to others about the infection and how it can be prevented.

Interviews Profile of interviewee Position: Director, local, gender – based NGO Title: President, Girls Vanguard (Network of divorced girls) Sex: Female

General What is your impression about the general situation of HIV prevention for girls and young women in Nigeria? Are things getting better or worse … and why? There are a lot of programs for girls and young women but the issue of low self esteem; girls being poorly educated and/or the lack of life skills in an aggressive pro male society place the girls and women in a vulnerable position and makes the HIV/AIDS situation worse . She also observed that there are many girls and women who are exploited by men in pretence of testing for compatibility while they only want sexual pleasure meanwhile they do not have any protection or believe in safe sex.

Prevention component 1: Legal provision In your opinion, what laws in Nigeria are making HIV prevention for girls and young women better or worse? There are no specific laws protecting girls and women or making HIV prevention better for them. The law dose not prevent gender discrimination or gender based violence. How does legislation affect different types of girls and young women and their vulnerability to HIV? Legislations affect different girls and women differently. The sexual rights and/or choice of the married girls and women are not recognized, they can not allowed to negotiate and rape in marriage is not recognized, the sex workers have mostly been driven to operate underground hence it reduced their negotiating power and makes them more vulnerable. Overall, what laws could the government change, abolish or introduce to bring the greatest improvements to HIV prevention for girls and young women? The country needs a whole social reorientation to make every person gender conscious, domesticate laws on sexual and reproductive rights and choices Prevention component 2: Policy provision What type of government policies or protocols – for example in relation to antenatal care, condoms or voluntary counseling and testing – make HIV prevention for girls and young people in Nigeria better or worse? The Nigerian RH policy and the protocol on antenatal care are two instruments that should promote HIV prevention for girls and women but , they are not widely disseminated. The wider population do not know about this instruments and some health practitioner are ignorant about them. Do girls and young women – and also boys and young men - receive any type of official sex education? For example, what are they taught about their sexual and reproductive health and rights while in school? The federal government have developed a national curriculum for teaching sexuality education, but the various states are yet to integrate it into schools curriculum, hence only Lagos and Oyo states are using the curriculum to teach in schools. Overall, what policies or protocols could the government change, abolish or introduce to bring the greatest improvements to HIV prevention for girls and young women? The introductions of Laws that protects women’s rights as human rights, laws that recognize the rights to bodily integrity of girls and women, abolish early marriage and criminalizing gender based violence will bring the greatest improvements to HIV prevention for girls and women in Nigeria. Prevention component 3: Availability of services

What type and scale of HIV prevention services are available for girls and young women in Nigeria? voluntary counselling and testing are available in hospitals, ARV services are scare only available in a few major hospital and some Faith Based health facilities, STD treatment are available in most health units but male condom distribution service are not encouraged. Female condoms are not available. What type and scale of HIV prevention services are available for particular types of girls and young women? For example what services are there for those who are: Unmarried? Out of school? Involved in sex work? Orphaned? Injecting drug users? Migrants? Refugees? HIV positive*? There are no special services for any particular type of girls, but married girls and women have a better advantage of accessing services better that all other types of girls. What type and extent of HIV prevention services and information are available for boys and young men? How does this affect the situation for girls and young women? There are no specific services for boys and young men. The health care system is designed for both women and men, but more women seek the services than men. Most buts and men may not disclose their status to their female partners, they will rather die. “I know a man that refused to sleep with his three wives for more than four years and never disclosed the reason for doing so, until he was sick and at the point of dying, when a few days before his death, the doctor counseled the wives and encouraged them to test and one of the wives tested positive. This one of the very few honorable men. I know some families where the husband know and never disclosed it to the wives. The dies and the wives follow one after the other with in very short intervals.” Overall, what type of services most urgently need to be increased to improve HIV prevention for girls and young women? National Action committee on AIDS must as a matter of urgency, work with the health ministry to provide STD treatment, ARVs, and VCT In every health facility. Sexual and reproductive education and services made widely available for girls, women, boys and men Prevention component 4: Accessibility of services What are the main barriers to girls and young women using HIV prevention services in Nigeria? The distance of the appropriate health facilities, the cost of transporting the individual to the facility even when the VCT is free, ARVs are not free. Control of other significant others over the female folks in the society. Lack of youth friendly services that young people can use. The attitude of the health worker, the fear of disclosure and the unfriendly attitude of health workers all cumulates to be factors that promotes the barriers to girls and women in using HIV prevention services in Nigeria. Are HIV prevention services easier or harder for particular types of girls and young women to access? For example, is it easier or harder if they are: Married or unmarried? In school or out of school? HIV positive? It is easier for married women who are allowed to access the services in the hospitals or when they are pregnant and go for antenatal and married women that work. Girls who are not married may not have the confidence to seek for such services, unless she lies about her marital status. What role do boys and young men have in making HIV prevention services easier and better for girls and young women? “If boys and men become gender sensitive and respect girls and women and have comprehensive knowledge of HIV/AIDS and how to protect themselves and the partners, then half the problems of HIV infections will be solved.”

Overall, what priority actions could be taken to make HIV prevention services more accessible to girls and young women? Massive sensitization drive for health workers; providing VCT services in every community; support for women focused organizations. Massive education for women on how to negotiate for their rights and to protect themselves, and for boys and men to respect women and their rights. Prevention component 5: Participation and rights How are international commitments (such as the Convention on the Rights of the Child and the Convention on the Elimination of all Forms of Discrimination against Women) applied in Nigeria? Those conventions are not applied in Nigeria. It still remains international not local To what extent is the national response to AIDS ‘rights-based’? No. because not many people know their rights so they can not ask for what they do not know about. To what extent are girls and young women – including those that are living with HIV - involved in decision-making about AIDS at the national level? There are some attempts to involve more girls and young women, drawn from different networks and youth programs Overall, what priority actions could be taken to support girls and young women to be more involved in national level decision-making about AIDS? Deliberate efforts must be made to ensure gender balance in participations in all decision making level of the nation. Summary In summary, what are the 3-4 key actions – for example by the government, donors or community leaders - that would bring the biggest improvements to HIV prevention for girls and young women in Nigeria? Empower girls and women to access information and servises Massive social reorientation to make every person gender conscious, Domesticate laws on sexual and reproductive rights and choices Ensure gender equity in participations at all decision making levels especially those that will effect wellbeing of the girls and women

Profile of interviewee Position: Director, PLHIV network Title: President, People Living with HIV/AIDS in Nigeria - WAZOBIA Sex: Male

General What is your impression about the general situation of HIV prevention for girls and young women in Nigeria? Are things getting better or worse … and why? The entire situation works against females because there is more focus and preference on the male in Nigeria than on females as such the girls are always at a disadvantage in all aspects.

The different initiatives have tried to promote gender equity in services but the facts still remains that it is the males the have the power to dictates what happens in relationships and seek help in sensitive situations like that of persons infected with the HIV virus. Not many programs are specifically target at girls and women. Mostly NGOs, states that have very high prevalence rate and faith based organization providing service for HIV prevention and support for positive persons can be said to be making some effort to provide girls and women specific programs, even that is a tip on the iceberg considering the magnitude of the problem in Nigeria. Prevention component 1: Legal provision In your opinion, what laws in Nigeria are making HIV prevention for girls and young women better or worse? There are policies that sit on government shelves but no clear cut laws that makes HIV prevention easy. Laws on Violence against women or rape are weak and not enforced. Most of the Nigerian laws that affect women rights are those from the colonial masters and have not been reviewed to reflect the present day rights of the women. Most people do not know the provisions in the existing policies. How does legislation affect different types of girls and young women and their vulnerability to HIV? “There is no law preventing early marriage, all that we usually do is to seek the intervention of some NGOs or some organisation that focuses on human rights. There’s nothing in the real practical sense of it” “there is no law that make VCT mandatory before marriage, so girls and women face a lot of Dangers of HIV infection. One of the major problems discovered which has been aggravating the situation, is poverty in our community. Poverty leads them to do what they don’t want to do just to survive” Overall, what laws could the government change, abolish or introduce to bring the greatest improvements to HIV prevention for girls and young women? Law to protect women’s right in all matters, not only sexual and reproductive matters must be put in place and strict compliance ensured. Prevention component 2: Policy provision What type of government policies or protocols – for example in relation to antenatal care, condoms or voluntary counseling and testing – make HIV prevention for girls and young people in Nigeria better or worse? The policy and protocol on antenatal care was designed to make prevention better, but not many health providers or their clients know about its content or what to practice. Do girls and young women – and also boys and young men - receive any type of official sex education? For example, what are they taught about their sexual and reproductive health and rights while in school? The adolescent Health Policy, the National Reproductive health policy, The approval of sexuality curriculum for secondary school, The HIV/AIDS policy, the Nigeria HIV/AIDS plan of action, are all aimed at making HIV prevention girls and young people better. However implementation of the existing policies have been a problem. The policies are not fully implemented in the various states. UNFPA for the past three years have trained teachers in 15 states to teach Family Life Education in public schools. Overall, what policies or protocols could the government change, abolish or introduce to bring the greatest improvements to HIV prevention for girls and young women? Nigeria have all the necessary policies but dissemination is the problem. All policies and protocol on government shelves must as a matter of urgency be disseminated to every person in Nigerian.

Prevention component 3: Availability of services What type and scale of HIV prevention services are available for girls and young women in Nigeria? The most common services in the community are the media campaigns which are rolled out on a regular and sustained basis. Other services include campaigns directed at youths to abstain from risky behaviour and sexual activities. Some NGOs and donor groups do provide a wide range of services to young persons which include counselling, SRH advise and even access to condoms. UNAIDS have 15 VCT centres in Bauchi State alone. The GHAIN project concentrates on treatment, care and support for people living with HIV. The various teaching hospitals in the in the country provides VCT, treatment for opportunistic infection, antiretroviral drugs and encourage support groups to be formed and maintained. The National Action Committee on AIDS give small grants to NGOs and CBOs to carry out interventions in local communities. NGOs provide information and education at all levels. Volunteers from VSOs recruited from Africa and Asian countrys to contribute their technical expertise in the work of various NGOs and faith based organizations towards HIV prevention. What type and scale of HIV prevention services are available for particular types of girls and young women? For example what services are there for those who are: Unmarried? Out of school? Involved in sex work? Orphaned? Injecting drug users? Migrants? Refugees? HIV positive*? Services are not divided for any category of girls or women, unmarried young people, out of school and orphans relate more with NGOs and other private providers of services, while the married and HIV positives have access to available public and private providers. Most of the rural girls and women may have to always travel to some peri urban centres to access services. What type and extent of HIV prevention services and information are available for boys and young men? How does this affect the situation for girls and young women? Young men and boys of urban disposition are more aware of STIs and HIV than previously. Rural youths do not have as much access to information as their urban counterparts. Young persons have a major role to play in preventing the spread of HIV as they have more freedom to experiment with sexual activities than girls. Overall, what type of services most urgently need to be increased to improve HIV prevention for girls and young women? There is an urgent need for comprehensive services, with STD treatment, ARVs, and VCT centers to be widely spread and education on the issues of stigma stepped up. Sexuality education, which includes sexual and reproductive health rights and choices are integrated into schools. Massive training for health workers to respect rights and confidentiality of client. Prevention component 4: Accessibility of services What are the main barriers to girls and young women using HIV prevention services in Nigeria? Distance of available services, fear of stigmatization, lack of financial means, lack of confidentiality by providers, attitude of health workers and lack of community support for girl or women who declare their status openly. Are HIV prevention services easier or harder for particular types of girls and young women to access? For example, is it easier or harder if they are: Married or unmarried? In school or out of school? HIV positive? It is easier for married girls and women to access the services offered by the government than it is for unmarried girls. In-school and out of school girl uses service of private clinics and NGOs.

What role do boys and young men have in making HIV prevention services easier and better for girls and young women? They have a role of getting themselves educated and respecting the right of their partners Overall, what priority actions could be taken to make HIV prevention services more accessible to girls and young women? More support for programs targeting girls and women, orientation for networks of PLP to give women more attention and orientation for health workers to be more responsive to the needs of young women. Prevention component 5: Participation and rights How are international commitments (such as the Convention on the Rights of the Child and the Convention on the Elimination of all Forms of Discrimination against Women) applied in Nigeria? They have not been domesticated and are not applied To what extent is the national response to AIDS ‘rights-based’? They are not right base “The responsibility of the government if not the natural laws that is human laws, we don’t have any law that guides human practices that you can not go and reveal some body’s status just like that.” “Any law that will be enacted should be a law that will protect our rights nobody should just see you on the road and say this man is HIV positive and abuse you and go away if he should do that there should be a law that will punish him for what he has done.” To what extent are girls and young women – including those that are living with HIV - involved in decision-making about AIDS at the national level? There are some attempts to involve more girls and young women, but, because they are not prepared, their contributions are weak. Overall, what priority actions could be taken to support girls and young women to be more involved in national level decision-making about AIDS? The support to girls should be given through the associations they belong to. Give them tasks and responsibilities that prepare them to talk openly and with confidence. The hours the youth have their meetings should also change to suit women’s needs. Summary In summary, what are the 3-4 key actions – for example by the government, donors or community leaders - that would bring the biggest improvements to HIV prevention for girls and young women in Nigeria? Make ARV and other services free for girls and women Institute laws that will make discrimination against PLP punishable Promote Girls education

Profile of interviewee Position: Management, International organisation Title: Assistant representative, UNFPA, Nigeria Sex: Female

General What is your impression about the general situation of HIV prevention for girls and young women in Nigeria? Are things getting better or worse â&#x20AC;Ś and why? I think that the country has made tremendous strides in the HIV for the general population particularly in the areas of ART and stigma reduction in the last few years. However, I believe that more could have been done with the opportunities available. For instance, young people particularly girls and young women have had the list benefits in terms of access to preventive information and services. This is due to various institutional, cultural and resource barriers. Overall, while things are not getting worse, they need to improve rapidly if we are to make any meaningful progress in tackling the HIV epidemic in the country. Prevention component 1: Legal provision In your opinion, what laws in Nigeria are making HIV prevention for girls and young women better or worse? Whether girls can get married at an early age? There is no law prohibiting early marriage, however, various policy documents (the Population Policy, the National RH policy) do state the 18years as the minimum age for marriage for girls, implementation of these policies has been limited. Early marriage is pervasive, particularly in the northern states due to poverty and the gender inequality. * Sex work is illegal and as such sex workers have no voice, and are often exploited even by law enforcement agents. This status of affair often hinder sex workers from using appropriate prevention services. * Safe abortion is allowed only for medical conditions, as such girls and young women resort to unsafe abortions, with dire consequences. Unsafe abortion is a major cause of maternal death in Nigeria. * While there is no legal barrier for girls and women to accessing RH services, the socio-cultural, institutional factors and attitude of the providers in public facilities prevents them using available services. Efforts to increase access to youth friendly health services has had very limited success in reaching girls, as the peculiar needs of girls and young women are not taken into consideration in the definition of youth friendliness. How does legislation affect different types of girls and young women and their vulnerability to HIV?

* In/out of school? While in-school girls benefit from the Family-Life and HIV/AIDS Education (FLHE), those girls who are out of school (and majority of girls particularly in rural areas) are not reached except through some NGO programmes which are limited in coverage. In addition, young women in tertiary institutions and urban slums are not effectively reached. Girls who are not in education, employment and training(NEET) are particularly disadvantaged. * Married/unmarried? Legally, married girls and young women should access to RH information and services, but this is often not the case particularly with this group due to ignorance and the fact that available services do not take their peculiar needs. * In rural/urban areas? Generally, those in urban areas have better access due to availability, through public, private and NGO outlets. * Living with HIV? The HIV and AIDS policy promotes equal access to existing services, however, due to stigma, status of women, socio-cultural barriers and costs, girls and young women living with HIV have limited access to services. * From marginalised groups (such as sex workers, migrants or orphans)? While there are ot legal barriers, the special circumstances of these group in general and that of girls and young women in particular severely limit their capacity. Overall, what laws could the government change, abolish or introduce to bring the greatest improvements to HIV prevention for girls and young women? Laws that will make institutional changes to promote/support the utilization of HIV prevention services by girls and young women-girls friendly services Prevention component 2: Policy provision What type of government policies or protocols â&#x20AC;&#x201C; for example in relation to antenatal care, condoms or voluntary counseling and testing â&#x20AC;&#x201C; make HIV prevention for girls and young people in Nigeria better or worse? All the existing polices and protocols are to improve HIV prevention in general, however, the peculiar needs/circumstances of this group are not taken into considerationDo girls and young women â&#x20AC;&#x201C; and also boys and young men - receive any type of official sex education? For example, what are they taught about their sexual and reproductive health and rights while in school? Those in school receive appropriate education on sexuality-Government has developed a comprehensive curriculum-the National Family Life and HIV Education (FLHE) for all levels. However, implementation has been slow-due to inadequate number of trained teachers, poor funding, and resistance from gatekeepers. Overall, what policies or protocols could the government change, abolish or introduce to bring the greatest improvements to HIV prevention for girls and young women? Government should make institutional changes(location, cost, hours of services, etc) to make available services more girls- friendly and provide the required resources. Prevention component 3: Availability of services What type and scale of HIV prevention services are available for girls and young women in Nigeria?

For example, to what extent is it possible for them to get: * Male and female condoms? While some progress has been made mainly by NGOs to provide information and services for girls and young women, this is still very limited to urban areas. Access to male condoms is improving, through both public facilities and social marketing but girls are constraints by socio-cultural barriers and attitude of health workers in public health facilities and by costs. Female condom is still not readily available, because the necessary capacity development has not fully taken off. * Information and treatment for sexually transmitted infections (STIs)? Information is available to in school group through the Family Life and HIV and AID Education (FLHE), but treatment is very limited by costs. * Voluntary counseling and testing? Most HIV testing and counseling facilities particularly targeting youth, have no provision for attracting girls and young women. Some of such facilities in an attempt to make them youth friendly provide only-male friendly recreational facilities such as snookers and the like. Cost of transportation to such centres even when they are free may be unaffordable. * Antiretroviral drugs (for infants, children and adults)? Access to ARVs has increased with the support of PEPFAR and the GF, but bringing this to scale has been a challenge and infants children and women have been most excluded. * Services and antiretroviral drugs to prevent transmission of HIV from an HIV positive mother to her children PMTCT services are available and are currently limited, efforts are being made to increase coverage, access for girls and young women are limited by costs, socio-cultural barriers. In some instances these young women due to fear of stigma may not follow through with care. What type and scale of HIV prevention services are available for particular types of girls and young women? For example what services are there for those who are: Unmarried? Out of school? Involved in sex work? Orphaned? Injecting drug users? Migrants? Refugees? HIV positive*? * Such services for the unmarried are limited to NGO initiatives and is not available to many of those who need them particularly those in the rural areas and NEET What type and extent of HIV prevention services and information are available for boys and young men? How does this affect the situation for girls and young women? All services designed for young people are available to boys and young men and they access the services more than the girls. Overall, what type of services most urgently need to be increased to improve HIV prevention for girls and young women? The need to go to scale with existing prevetion services can not be overemphasized. VCT services should be expanded and the special circumstances of young women taken into consideration. Prevention component 4: Accessibility of services What are the main barriers to girls and young women using HIV prevention services in Nigeria?

The cost, location of services; lack of privacy at the services; hours that the services are open; language that the services use; attitudes of the staff that run the services; fear that confidentiality will be breached by the services; attitudes of parents or friends; Cultural norms, for example that prioritize the health of boys over the health of girls all are factors that act as barriers to some extent, depending of the context of the young women and varies for different parts of the county Are HIV prevention services easier or harder for particular types of girls and young women to access? For example, is it easier or harder if they are: Married or unmarried? In school or out of school? HIV positive? It is harder for unmarried, rural and urban poor girls and young women, because it is not accessible nor affordable for these group. What role do boys and young men have in making HIV prevention services easier and better for girls and young women? I think that they have an important role to play in sharing information with these girls whom they associate with, because the boys are empowered in terms of access to information generally and related to available services in particular. They can also support them to create the necessary time to enable them use existing services Overall, what priority actions could be taken to make HIV prevention services more accessible to girls and young women? Expand programmes for the empowerment of girls and young women focusing on those NEET and in the rural areas. Making information and services related to post abortion care readily available to all those who need them Prevention component 5: Participation and rights How are international commitments (such as the Convention on the Rights of the Child and the Convention on the Elimination of all Forms of Discrimination against Women) applied in Nigeria? They are yet to be applied in Nigeria To what extent is the national response to AIDS ‘rights-based’? The National AIDS Policy does not recognize and address the sexual and reproductive health rights of women living with HIV? The national HIV and AIDS Strategic plan does recognize the reproductive health rights of people leaving with HIVTo what extent are girls and young women – including those that are living with HIV - involved in decision-making about AIDS at the national level? The participation of women in very limited in the National Action Committee on AlDS, * Developing the National AIDS Plan? While there was a wide participation by the stake holders in the development of the NSF, women representation in the groups was limited as their member ship of the various stakeholder group is generally limited. * Participating in the National AIDS Committee or the Country Coordinating Mechanism for the Global Fund to Fight AIDS, Tuberculosis and Malaria? The participation of women and particularly young women is very limited in these committees. The CCM for instance has been

democratized and the various stakeholders representatives are elected, young women are very few in the decision making levels in these stakeholder groups

Overall, what priority actions could be taken to support girls and young women to be more involved in national level decision-making about AIDS? Efforts to empower more young girls to participate effectively in youth networks and organizations representing youth so that they can put their peculiar needs on the agenda. Policy makers should be proactive in promoting/supporting changes that take the needs of this group into consideration in the overall efforts to improve HIV services. Summary In summary, what are the 3-4 key actions â&#x20AC;&#x201C; for example by the government, donors or community leaders - that would bring the biggest improvements to HIV prevention for girls and young women in Nigeria?

Make institutional changes to promote/support the utilization of HIV prevention services by girls and young women-girls friendly services Expand programmes for the empowerment of girls and young women focusing on those NEET and in the rural areas. Making information and services related to post abortion care readily available to all those who need them Since we do not have legal provision against early marriage, we should establish services and mechanism to ensure that married adolescents are empowered to derive maximum benefits from such services

Profile of interviewee Position: Peer Educator Title: Peer Health Educator Sex: Male

General What is your impression about the general situation of HIV prevention for girls and young women in Nigeria? Are things getting better or worse â&#x20AC;Ś and why? Things have not changed much, because even though efforts are made by Organisations and government bodies to make people aware of the virus, people affected or infected with the virus are still hiding for fear of stigmatization and public reaction towards them. Though people now know that it exists know how it can be transmitted. Prevention component 1: Legal provision

In your opinion, what laws in Nigeria are making HIV prevention for girls and young women better or worse? The existence of bodies like national action committee on aids, saca, and laca including the national policy against trafficking in persons as well as other polices giving the girl child right to go to school, prohibition of abortion and sex activities, equality for women in the presence of the law are trying to make HIV prevention for girls better because the existence of this bodies and policies have helped lots of young girls from being forced into early marriage with older sexually active men who are usually infected with the virus or from being trafficked for prostitution. How does legislation affect different types of girls and young women and their vulnerability to HIV? It should provide protections for them from harmful practices and cultural inclinations that are bad for the girl child as well as women be them in rural areas or urban centers , in or out of school, married or unmarried but the execution of the provisions of the policies in Nigeria is very poor. Overall, what laws could the government change, abolish or introduce to bring the greatest improvements to HIV prevention for girls and young women? From passed researches the percentage of females having the virus are more so the Government can enforce a law backing the rights of the people living with HIV/AIDS ensuring that they are treated with respect and love this way more women can speak about their experiences which will motivate others to move in the right direction away from discrimination and AIDS. The government can also put to an end all those practices in the rural areas that lead to the spread of HIV virus like the mutilation of the female genitalia and the TAKE OVERS of late brothers wife as practiced in the eastern part of Nigeria, and forcing the girl child into marriage most importantly ensure that the subject matter is thought in primary, secondary and tertiary institutions all over the country. Prevention component 2: Policy provision What type of government policies or protocols â&#x20AC;&#x201C; for example in relation to antenatal care, condoms or voluntary counselling and testing â&#x20AC;&#x201C; make HIV prevention for girls and young people in Nigeria better or worse? In relation to antenatal care the government can provide free treatment for pregnant women and their babies to ensure safe motherhood. Concerning the use of condoms laws should be made that condoms be shared to sex workers and if possible be made free for individuals with risky behaviour to have access to them. For voluntary counselling and testing many Nigerians do not know that such service exist the government should establish VCT centres in every settlement and advertise its existence and importance make it free as well. Do girls and young women â&#x20AC;&#x201C; and also boys and young men - receive any type of official sex education? For example, what are they taught about their sexual and reproductive health and rights while in school? None. Overall, what policies or protocols could the government change, abolish or introduce to bring the greatest improvements to HIV prevention for girls and young women? Sex and Sexuality education should be thought in schools and on air (media) should be introduced and funded by the government Prevention component 3: Availability of services What type and scale of HIV prevention services are available for girls and young women in Nigeria?

The use of contraceptives, like the male and female condom though the knowledge of the female condom is on the low side but abstinence is more pronounce as it is taught as good morals in homes and religious places though it is not really practiced and recently introduced VCT for those who are homeless and vulnerable. What type and scale of HIV prevention services are available for particular types of girls and young women? For example what services are there for those who are: Unmarried? Out of school? Involved in sex work? Orphaned? Injecting drug users? Migrants? Refugees? HIV positive*? The VCT is the only service available to all. What type and extent of HIV prevention services and information are available for boys and young men? How does this affect the situation for girls and young women? The use of the male condom which is put the girl and young women expose to the dangers of having HIV because if the boys or young men do not use this condoms or use it wrongly the women may get infected by the virus or other infections Overall, what type of services most urgently needs to be increased to improve HIV prevention for girls and young women? The vct centres and other proper medical equipments and facilities. Prevention component 4: Accessibility of services What are the main barriers to girls and young women using HIV prevention services in Nigeria? Culture , Religion, Beliefs, Misconceptions Gender Inequality should be wide spread. Are HIV prevention services easier or harder for particular types of girls and young women to access? For example, is it easier or harder if they are: Married or unmarried? In school or out of school? HIV positive? It is relatively easy for all to get this services depending on the situation they find them selves some married couples go to seek this services together others are not in agreement to do so some girls can learn about it in school while others on the street so it just the situation that they find them selves that determines their access to the services in question. What role do boys and young men have in making HIV prevention services easier and better for girls and young women? If they accept to use the condoms they do not only protect them selves, they save the girls from spreading the virus if the carrier is a female and when it a male carrying the virus they protect the girls by using condoms. Overall, what priority actions could be taken to make HIV prevention services more accessible to girls and young women? Open women clinics where they can go and get these services for free. Prevention component 5: Participation and rights How are international commitments (such as the Convention on the Rights of the Child and the Convention on the Elimination of all Forms of Discrimination against Women) applied in Nigeria? So far in Nigeria every thing is moving slowly sometime it seem like nothing happened outside the country we only get to hear the story but never get to see actions geared towards achieving the aims of such conventions. To what extent is the national response to AIDS â&#x20AC;&#x2DC;rights-basedâ&#x20AC;&#x2122;? It is not

To what extent are girls and young women – including those that are living with HIV - involved in decision-making about AIDS at the national level? Very poor. Overall, what priority actions could be taken to support girls and young women to be more involved in national level decision-making about AIDS? Introduce a policy protecting the girl and women from violation of their fundamental rights and make services and facilities available to them. Summary In summary, what are the 3-4 key actions – for example by the government, donors or community leaders - that would bring the biggest improvements to HIV prevention for girls and young women in Nigeria? •

Enforcing existing laws against abortion, activities in relation to the sex trade. Introduce a policy protecting the girl child from passed violation of her fundamental rights especially being forced into marriage at a tender ages and make reproductive health services and facilities available to her and introduction to the school curriculum and the use of media to keep all aware.

•

Open women clinics and facilities where they can go and get these services for free.

•

Establish VCT centres in every settlement and advertise its existence and importance make it free as well.

•

All these should be backed and supported by the government.

Profile of interviewee Position: Programme Office, Family Planning Assocation Title: Programme Manager - Research Evaluation, Planned Parenthood Federation of Nigeria Sex: Male

General What is your impression about the general situation of HIV prevention for girls and young women in Nigeria? Are things getting better or worse … and why? General speaking, HIV and AIDS prevention for girls and indeed for everybody in Nigeria is getting better. A lot of awareness is being created. However, haven said this; the rate of behaviour change on HIV and AIDS prevention is very slow. That is why girls are still very vulnerable in Nigeria. Prevention component 1: Legal provision In your opinion, what laws in Nigeria are making HIV prevention for girls and young women better or worse? Like I said above, HIV prevention for girls is getting better. The first reason for this is government commitment on gender issues. In Nigeria, the law or policy prohibiting sex trade and sexual trafficking of young girls is in force. Also, the adolescent reproductive health policy in Nigeria emphasizes safer sex among young people especially girls to protect them from HIV and other STIS. This policy is currently being implemented. Sex work remains an aberration of the law in Nigeria. However, efforts are on my NGOs to take service to them on safer sex. Government

efforts at alleviating poverty among women and young girls through NEPEP is a factor that is empowering women and young girls not to engage in high risk sexual activity for economic gain. These are some reasons why HIV protection among girls is getting better. How does legislation affect different types of girls and young women and their vulnerability to HIV? The legislation directed at protecting young girls who are vulnerable to HIV infection does not seems to address all categories of young girls in Nigeria. For example, while the law prohibit rape and other forms of sexual harassment, it very silent on young married girls who are faced with marital rape and domestic sexual violence. The issue of young girls hawking in the street is an influencing factor for sexual harassment, yet the law on child rights (policy) is only on paper and therefore these categories of young girls are still very vulnerable. Overall, what laws could the government change, abolish or introduce to bring the greatest improvements to HIV prevention for girls and young women? The government can introduce law that will ban street hawking were it is not promulgated and enforced it where is promulgated. Also, the government can also introduce law against marital rape and domestic sexual violence against young women and girls. Customary and religions law eroding thee dignity and rights of young girls in Nigeria should be abolished. Prevention component 2: Policy provision What type of government policies or protocols – for example in relation to antenatal care, condoms or voluntary counseling and testing – make HIV prevention for girls and young people in Nigeria better or worse? The adolescent reproductive health policy, Policy on Female Genital mutilation and Policy on International sexual Trafficking all helps to improve and better HIV prevention among young women and girls in Nigeria. Do girls and young women – and also boys and young men - receive any type of official sex education? For example, what are they taught about their sexual and reproductive health and rights while in school? The adolescent reproductive health policy clearly states that young women and girls as well as boy and young girls are taught family life and HIV education. The FLHE education includes sex education. Overall, what policies or protocols could the government change, abolish or introduce to bring the greatest improvements to HIV prevention for girls and young women? The government can improve on the rights of young women and girls by liberalising abortion laws in Nigeria. This will not only reduce morbidity and mortality among young women and girls but it will also reduce HIV infection among children whose mothers are HIV positive.

Prevention component 3: Availability of services What type and scale of HIV prevention services are available for girls and young women in Nigeria? The HIV and Policy in Nigeria clearly spells out government commitment to HIV prevention through establishment of VCT centres, condom distribution through the supply and logistic chain mechanism, treatment of people living with HIV for adults and limited scale for children and PMTCT. What type and scale of HIV prevention services are available for particular types of girls and young women? For example what services are there for those who are: Unmarried? Out of school? Involved in sex work? Orphaned? Injecting drug users? Migrants? Refugees? HIV positive*?

The types of HIV prevention among young girls which are on comparatively high in scale are: Condom distribution for all the categories of persons the question refer to above with the exception of injecting drug users, VCT centre and HIV treatment, care and support. What type and extent of HIV prevention services and information are available for boys and young men? How does this affect the situation for girls and young women? Condom distribution for all the categories of persons the question refer to above with the exception of injecting drug users, VCT centre and HIV treatment, care and support. These also includes family life and HIV education among in and out of school young men and boys. Overall, what type of services most urgently need to be increased to improve HIV prevention for girls and young women? Scaling up health information, increased access to VCT and school health programme Prevention component 4: Accessibility of services What are the main barriers to girls and young women using HIV prevention services in Nigeria? Presently in Nigeria, the greatest obstacles young women and girls are facing is parental barriers to access to RH and HIV services. Are HIV prevention services easier or harder for particular types of girls and young women to access? For example, is it easier or harder if they are: Married or unmarried? In school or out of school? HIV positive? HIV prevention services are more difficult to provide to young women and girls whether in or out of school because of parental and cultural barriers. What role do boys and young men have in making HIV prevention services easier and better for girls and young women? Young men involvement in peer education and interpersonal communication will make HIV prevention easier and better for young women and girls. Overall, what priority actions could be taken to make HIV prevention services more accessible to girls and young women? Breaking the parental barrier of access to services through increase parent-child communication, parents respecting the rights of young women and girls and intervention targeting parents on SRH and HIV information. Prevention component 5: Participation and rights How are international commitments (such as the Convention on the Rights of the Child and the Convention on the Elimination of all Forms of Discrimination against Women) applied in Nigeria? Nigeria is a signatory to these conventions and therefore are bound by its term. To what extent is the national response to AIDS ‘rights-based’? The policy recognizes the rights of women living with HIV and they are well protected against the violation their rights through judicial procedures in Nigeria. To what extent are girls and young women – including those that are living with HIV - involved in decision-making about AIDS at the national level? Young women and girls are involved in decision making about HIV at the national level during the process of HIV and AIDS policy formulations and finalisation. Young women and girls are always invited to contribute to the formation of the policy. Also, there are also on the various committee of the National action Committee on HIV and AIDS. Overall, what priority actions could be taken to support girls and young women to be more involved in national level decision-making about AIDS? Scaling up health information, increased access to VCT and school health programme

Summary In summary, what are the 3-4 key actions – for example by the government, donors or community leaders - that would bring the biggest improvements to HIV prevention for girls and young women in Nigeria? • introduce law against marital rape and domestic sexual violence against young women and girls. • The government can improve on the rights of young women and girls by liberalising abortion laws in Nigeria. • Breaking the parental barrier of access to services through increase parent-child communication, parents respecting the rights of young women and girls and intervention targeting parents on SRH and HIV information.