AN HIV/MSD COMMUNITY-BASED INITIATIVE
IN THE KINGDOM OF BLACK GOD
IN THE KINGDOM OF BLACK GOD
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It is 7:00 am in Green's Iwoama, one of the many villages on Bonny Island in the southern part of the Niger Delta. Luke has already started his job, using his old motor boat to ferry around some of the 30,000 locals living on the many scattered islands. The boat belonged to his father before he died of malaria, or was it typhoid? What difference does it make anyway…even the doctors didn't seem to know exactly what it was.
Luke remembers when he used to go fishing with his father in the nearby creeks where the curlew (the emblem of Bonny Kingdom) would nest. The catch was not always huge, but it was usually enough for the family. Now the exploration and drilling platforms light up the sky with their giant flares and the fish have fled the taste of crude oil in these busy waters.
Expansion of the oil and gas multinationals on the island has seen a massive influx of multi-ethnic workers from within Nigeria and other countries. This non-indigenous population can number anywhere between 50,000 and 150,000 people, depending on the development phase of the industrial projects. Nearly all are men, and most of them live here alone, away from their families, from a few weeks to many years. Temptation is great with not much to do on the island after work and many end up in Monkey Village bars, where they are entertained by commercial sex workers.
Preliminary results of a baseline study conducted on Bonny Island in September 2006 by the Society for Family Health show that the adult prevalence of HIV/AIDS is about 7.8% and 16.8% among female commercial sex workers. Thus compares with a rate of 5.4% in Rivers State as a whole. Getting the facts across 
Yesterday Luke went to a meeting in his village organized by the Ibani-se HIV/AIDS Initiative, a not-for-profit NGO based on Bonny Island. The presenters kicked-off by assessing the audience's knowledge of the disease. Like Luke, this was the first most people had heard of HIV/AIDS, or how it is transmitted, or the fact that you need to be tested to protect yourself and your partner from infection. The tone was friendly and full of hope, in sharp contrast to messages on billboards depicting skulls and crossbones with big red slogans shouting "HIV/AIDS kills!"
Luke was reassured to discover that people can live with HIV/AIDS and that there are medicines to treat opportunistic infections, even if there is no actual cure yet. The initiative's members gave the audience practical information on where to go to be tested and to get condoms and antiretroviral drugs (ARVs). Everyone raised their hands to be tested, but Luke wondered how many would actually go for the test or go back to get the results… 
The crowd asked lots of questions: was it true that HIV was transmitted by white men who have sex with cats and dogs? Was HIV invented by Americans to destroy sex? Before the Initiative came along, people didn't know where to get the answers to these questions. Fear of suspicion, stigmatization and discrimination prevented many from asking the local chemist, for example. At last, thought Luke, there is a way we can separate the facts from the rumors. They learnt that they can get confidential Voluntary Counseling and Testing (VCT) services at the Bonny General Hospital, at the Bonny Community Health Centre (especially for pregnant women as part of pre-natal visits), and at several private clinics (whose names were also given to the audience).
Luke had often driven really sick-looking people to Port Harcourt, a one and a half hour boat drive away. Now he realizes why: there is a twice weekly clinic there for getting antiretroviral treatments. But these long trips that add significantly to the costs in terms of absence and fare price should soon end, as ARVs will be available in Bonny within a year, according to the Initiative's members. They have also promised to create a "positive living group" to support people who are infected and affected by HIV/AIDS on Bonny. Recently they converted the public library into an HIV/AIDS information youth center and are also planning a peer education project for commercial sex workers. What's new about the Ibani-se HIV/AIDS Initiative? 
HIV/AIDS and high poverty levels are the key problems on Nigeria's development agenda. Despite its best efforts to respond to the HIV/AIDS crisis, the Nigerian government has seen the national adult prevalence rate of the disease increase from 1.8% in 1991 to over 5% in the last few years. It has spread beyond the usual high-risk groups and is now widespread amongst the general population throughout the federation. Several NGOs have tried to help the government improve its outreach in local areas, but sustaining their efforts has proved difficult.
What makes the Ibani-se HIV/AIDS Initiative unique is its participatory approach based on dialogue with the community. Its organizational structure involves ALL the stakeholders on Bonny Island (see chart below). The community is empowered to get involved in decision-making, as well as in implementing action plans. The Initiative also addresses related problems, such as water supply, electricity, education, health infrastructure and the economic empowerment of young people, women and the people most at-risk from the disease. Along with HIV/AIDS, they also tackle tuberculosis and malaria. In the short term they hope to: (abstinence, partner reduction, and condom usage), The Initiative was launched on World AIDS Day 2006 with the large scale distribution of condoms and the communication of the initial baseline study results to the community.
The program is designed to become financially sustainable through close monitoring and evaluation of accomplishments, in order to build the confidence of international donors. So far the initiative only operates on Bonny Island. But if this sustainable community-based public-private partnership proves successful, they hope to expand it to other parts of the country.
Just as Nigeria was not created overnight, the Initiative team knows that more time and communication of solid results will be needed to make people change their behavior. But for Luke and the many others at that meeting, just having the facts and knowing where to turn is a big step in the right direction. For more information on the Ibani-se HIV/AIDS Initiative, please visit www.ibanise.org and/or contact Ms Ibiba Chidi, Project Manager: ibibachidi@yahoo.com Article by S. d'Aurelle de Paladines, Photos by Frederique Remy, Editor: Fiona Hall Related article published in Nature, January 2007 "A corporate response to AIDS" by Colin Macilwain, Nature , Vol. 445, 125, Issue n° 7124, 11 January 2007. http://www.nature.com/nature/journal/v445/n7124/full/445125a.html "AIDS: On the Brink" by Colin Macilwain, Nature, Vol. 445, 140-143, Issue n° 7124, 11 January 2007. http://www.nature.com/nature/journal/v445/n7124/full/445140a.html | |||||||||||||||||||||
