Providing Care in the Shadows of HIV

Kemi spent her life savings on her son, who is HIV positive. Now, she’s raising his children on her own, in the Shomolu area of Lagos, Nigeria.

The children’s mother died of HIV, and their father left shortly after. Kemi doesn’t have a job but sometimes takes on work as a cleaner to be able to provide for her grandchildren.

“Their mother, who was also HIV positive, eventually died of the illness,” Kemi says. “So I am left alone to care for their children.”

Putting food on the table has been Kemi’s biggest challenge. So when she heard from neighbors that the local government was giving out food, she went to see for herself. But by the time she got there, she was too late.

“The HIV epidemic has a multi-factorial effect on children…They often must deal with psychological stress, reduced parenting capacity, stigma, discrimination, poor school performance, and malnutrition.”

“That day we had no food to cook for the children, but as I got there, there were too many people so I was not able to get any food,” she says. “I went home dejected.”

Days later, she got a call to go collect food — staples like rice, beans, and garri (cassava flour) — distributions that were supported by Project HOPE assessments as part of the Integrated Child Health and Social Services Award (ICHSSA), a USAID and PEPFAR-funded project.

“I was very happy because the food really came in good time,” Kemi says.

Kemi’s grandchildren are just two of hundreds of thousands of children in Nigeria whose lives have been upended by HIV/AIDS. Nigeria has one of the world’s highest populations living with HIV: An estimated 1.9 million people are living with the virus, most of them women. The country also has the highest number of annual HIV infections among children. In 2020, almost 1 in 3 AIDS-related deaths occurred in children.

In December 2019, Project HOPE began supporting ICHSSA, a five-year project created to help mitigate the impact of HIV/AIDS on vulnerable children and their households in Edo, Kwara, and Lagos states.

“The HIV epidemic has a multi-factorial effect on children as it increases the vulnerability of children who are living with ill adults,” says Dr. Uche Ralph-Opara, Deputy Regional Director and Africa/Country Representative for Project HOPE Nigeria. “They often must deal with psychological stress, reduced parenting capacity, stigma, discrimination, poor school performance, and malnutrition.”

One of several ICHSSA consortium partners, Project HOPE’s focus has been on strengthening the abilities of local and state governments to detect and respond to child rights violations and deliver basic services. This includes the provision of necessities like the food given to Kemi.

“The food lasted me and my two grandchildren for three weeks,” Kemi shares. “I pray God will continue to help those who provided this food to us.”

Over the past five years, Project HOPE has helped governments support hundreds of caregivers in providing for orphans and vulnerable children (OVC) by assisting community leaders in planning for, financing, and delivering high-quality services and then collecting and analyzing the data needed to continually improve those services.

“As a result of ICHSSA, there’s greater advocacy for capacity building for caregivers,” says Adeola Seweje-Chimunda, a senior program officer for Project HOPE. “There’s a new budget line for OVC in Lagos, caregivers are registering for government social insurance, there’s better  retention in schools, and there’s greater recognition of OVC programs by local governments and civil society organizations.”

“The dedication and passion of our team led to great achievements. Strengthening the system and collaborating with the government and private sectors enabled a lot of opportunities and support for the project and its beneficiaries.”

Major achievements include the development of assessment tools for capacity strengthening, improved monitoring and evaluation procedures, the formulation of policy documents, support for birth certification, and trained social workers.

“The dedication and passion of our team led to great achievements,” says Oluwatosin Badmos, a program officer for Project HOPE. “Strengthening the system and collaborating with the government and private sectors enabled a lot of opportunities and support for the project and its beneficiaries.”

The rate of HIV infections in Nigeria is steadily declining, thanks to community outreach efforts, but critical gaps remain. Even though 90% of people living with HIV are receiving treatment, only about 3.5% of them are children, despite the fact that children make up about 30% of AIDS-related deaths in Nigeria. Less than half of pregnant women who are HIV positive are being treated, risking mother-to-child transmission. Gender inequality and stigma are some of the top barriers to HIV services. Despite the prevalence of the virus, around 60% of Nigerians have discriminatory attitudes toward people with HIV, underlining a need for continued support and advocacy.

“The impact of system strengthening cannot be understated in the provision of quality and collaborative OVC care and support in Nigeria,” Seweje-Chimunda says. “The sustainability of OVC programs depends on building and strengthening adequate structures in the communities and state.”