Helen M Nwaba on transforming the grassroots response to Nigeria’s HIV/AIDS epidemic

helen_nwabaWhen a village in North Western Nigeria, which has one of the highest HIV rates in the state, is effectively cut off from other communities and the rest of the country because it lacks a bridge spanning a turbulent river, it took “STAR” power to tackle the problem. That “STAR” is a community led initiative—Society Tackling AIDS through Rights (STAR)—that aims to help remote communities support themselves. The initiative focuses on finding out the priorities of those who often go unheard (especially rural women and girls), and seeking local solutions.

With a government commissioned bridge abandoned midway through construction, women, and young girls in the village of Ungwan Yanshi who either wanted to go to school or access health clinics (especially when they were pregnant) had to rely on the community’s young men to help carry them across the swollen river. Not only did this limit women and girls’ access to the facilities that they needed, it also led to some cases of the men taking advantage of the situation with high numbers of rape and attacks occurring. But through the STAR initiative, the community came together and have turned things around, raising the approximate £400 required to finish the bridge building work and clearing the bushes on either side of the river (which had previously provided cover for attackers). The result—reports of rape have stopped, safe deliveries have increased, and more people are now able to cross the river to access HIV counselling and testing.

The STAR initiative is part of a larger six year programme, the Enhancing Nigeria’s Response to HIV and AIDS (ENR), a UKAID funded intervention, which supports the government’s efforts to tackle the epidemic. Nigeria has been hard hit by HIV with an adult HIV prevalence of around 3.6%—some 3.9 million Nigerians and 220,000 children under the age of 15 are living with HIV, and an estimated 1.3 million children have been orphaned by the disease.

And the STAR power doesn’t stop at the bridge building. In Uko, Itak Eyulor STAR facilitators, who were trained as part of the ENR programme, engaged the entire community on the issues that were most important to them. This led to the creation of a “Women’s Forum” involving every female over the age of 15—a first in the village’s history. This in turn resulted in the election of women leaders who represented the concerns of females at subsequent community forums, traditional council meetings, and at the village council. One good result is work has begun on a long abandoned primary school project using locally sourced materials to reduce costs and increase the speed of construction. The single block, three classroom school is now being used as a feeder school to the nearest larger primary school five kilometres away. The State Ministry of Education has also been persuaded to adopt the school, which will ensure its future, whilst further STAR efforts with the state government have resulted in the community being linked to the national grid for electricity supplies for the first time.

All these efforts, empowering women, creating links with the wider community, and improving education services will have an undoubted impact in the battle to tackle HIV in the future. That is indeed long lasting “STAR” power.

Competing interests: I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: None.

Helen M Nwaba, Capacity Building Technical Advisor, ENR, Uyo, Akwa Ibom State. 

The Enhancing Nigeria’s Response (ENR) programme is supported by the UK Department for International Development and managed by a consortium led by the Society for Family Health (SFH).