3.1 Demographics
A total of 44 adolescents (24 males and 20 females) aged 10 – 19 years participated in the FGD. Table 3 presents the demographics of the study participants. The age group 14-17 years (n = 33) comprised many of the adolescents who participated, while many of the adolescents (n = 35) were currently in secondary school.
Table 3: Socio-demographic Characteristics of Study Participants
Socio-demographic Characteristics (n = 44)
|
SOBI
|
UITH
|
CSH
|
Total
|
Gender
|
Male
|
9
|
8
|
7
|
24
|
Female
|
7
|
6
|
7
|
20
|
Age
|
10-13
|
5
|
3
|
3
|
11
|
14-17
|
11
|
11
|
11
|
33
|
Education
|
Completed Primary School
|
5
|
0
|
2
|
7
|
Currently in Secondary School
|
10
|
14
|
11
|
35
|
Completed Secondary School
|
1
|
0
|
1
|
2
|
Tertiary
|
0
|
0
|
0
|
0
|
No formal education
|
0
|
0
|
0
|
0
|
Religion
|
Christianity
|
4
|
2
|
3
|
9
|
Islam
|
12
|
12
|
11
|
35
|
Traditional
|
0
|
0
|
0
|
0
|
Others
|
0
|
0
|
0
|
0
|
Marital Status
|
Single
|
16
|
14
|
14
|
44
|
Married
|
0
|
0
|
0
|
0
|
3.2 Disclosure
The adolescents interviewed in this study, had varying experiences regarding disclosure of their HIV status. Most of the participants were informed at a very young age, primarily by their parents, or guardians. The following quotes speak to this:
“My mum is also infected with the virus, and she takes medications, I was 5 years old when she told me there is a virus in my body and if I failed to take my medications, I will die. I am now 10 years old.” [FGD 1, 10-13 years]
“I was 9 years old when my mum told me about my HIV status and I am currently 14 years old” [FGD 2, 14-17 years]
“My dad told me when I was 8 years old, I asked him the same question and he said because of the virus in my body” [FGD 3, 14-17 years]
“I asked my grandma why I was taking drugs and she told me I have a sickness called HIV, which is why I am taking the drugs, I was 10 years old then. My dad does not know about my status only my grandma knows.” [FGD 4, 10-13 years]
“I was 11 years old when I asked my Grandma why I was taking medication, and she told me it’s because I have HIV, she then explained that I need to continue taking the drugs.” [FGD 5, 14-17 years]
Findings also revealed that only a few participants discovered their status themselves (self-discovery) through independent findings, as shown below:
“I can’t remember vividly if I was told, one day I picked up my drugs and searched the drug name on Google..." [FGD 1, 14-17 years]
The study also revealed most of the participants were already on medication before being informed about their HIV status, indicating delayed disclosure. Find excerpts below:
“I have been using the drugs before I was told I had the virus” [FGD 1, 10-13 years]
“I woke up one morning and asked why I always had to use these drugs, I was then told it was because I had a virus called HIV, adding that I had to be religious with taking the medication, and if I don’t take the medication, I might die My dad told me when I was 7 years old and I am now 14 years old” [FGD 1, 14-17 years]
“I have been using the drugs before my mum told me about my HIV status” [FGD 2, 14-17 years]
Reasons for delayed disclosure included parents wanting to protect their children from stigma and discrimination as well as a lack of awareness about how to approach the topic with the children. In addition, more than 90% of the respondents reported a negative emotional response to their HIV status disclosure, including sadness, unhappiness, and anxiety about the challenges ahead especially for an infection that has no cure.
“I felt sad and cried a lot, I asked so many questions why it had to be only me who had this disease among my siblings. I refused to speak to my dad because I was angry that he married so many wives and I feel I got the virus as a result of my dad’s numerous escapades. But he told me I should take heart and that’s how God” [FGD 6, 14-17 years]
“When I was first told, I felt like a living dead person because my mum said it and I also read it that HIV is an incurable disease, but when it was explained to me that it can be managed provided, I adhere to my medication and so I feel better now” [FGD 5, 14-17 years]
“When I was told I was not happy, I even wept bitterly” [FGD 4, 14-17 years]
“When I was told I was not happy I was really sad about it because I was told if I disclosed it to anyone, they would make jest of me and run away from me.” [FGD 3, 10-13 years]
“I was very sad and unhappy when I got to know because I don’t like drugs and I was told it is a lifetime drug that I will have to keep using.” [FGD 2, 10-13 years]
“Remember I found out myself and I felt sad because HIV is not a regular disease, even the drugs available is to only prevent the disease from spreading, it’s not the cure yet and this makes me unhappy.” [FGD 1, 14-17 years]
Additionally, few (10%) of the adolescents had a neutral or positive response to their HIV status disclosure, which was largely dependent on their belief in the availability of drugs/medication for the virus. The excerpts from some respondents are stated below:
“I did not feel sad when my HIV status was disclosed to me, because of the drugs available, it gave me a level of assurance that everything will be fine.” [FGD 1, 14-17 years]
“I was not sad about it, specifically because I was told that once I adhere to my medications, nothing would happen to me, in fact, I would live well just like my other counterparts who do not have HIV.” [FGD 4, 14-17 years]
The study also revealed that more than 90% of the participants had not disclosed their status to anyone apart from their immediate family members, especially their parents and siblings, and a few extended family members such as grandparents and aunties, who served as their caregivers. The adolescents affirmed that they were hesitant to disclose their HIV status to others who did not know their status because of fear of stigma and discrimination.
“Only my dad and mum know about my HIV status” [FGD 6, 14-17 years]
“My dad, Mum, and my elder brother are the only ones who know my HIV status”. [FGD 5, 14-17 years]
“My Parents are the only ones who know my status” [FGD 4, 10-13 years]
“My mum, my aunty, and my two siblings” [FGD 3, 14-17 years]
“My grandma is the only one that knows” [FGD 2, 14-17 years]
“I have not disclosed my status to any other person aside from my parents and siblings” [FGD 1, 10-13 years]
When the ALHIV learned their status, some expressed difficulty with disclosure to persons outside their family members, largely because of the fear of stigma or discrimination. Information reportedly received by parents or guardians portrayed HIV as a disease that must be kept as a secret never to be told to anyone and this has made adolescents lose hope for future disclosure.
“People might run away and discriminate against me if I tell them my status." [FGD 1, 14-17 years]
“If I should disclose to another person aside from my family, they might broadcast my status to others” [FGD 3, 14-17 years]
“I don’t want to disclose my HIV status to any other person because I believe it should be kept as a secret” [FGD 4, 10-13 years]
“I don’t want to disclose to anyone because it a sad thing to talk about and also should be kept a secret” [FGD 2, 14-17 years]
3.3 Stigma & Discrimination Experiences
Findings from this study revealedmixed experiences of stigma and discrimination among adolescents. Most adolescents (93%) reported feeling supported and did not experience any discrimination from family members. Some of the extracts from the responses to stigma and discrimination are presented below:
“They have all treated me well, even my school director and principal pamper me well than the other students.” [FGD 4, 14-17 years]
“None of the persons who know my status have ever stigmatized me.” [FGD 3, 10-13 years]
“None of the persons who know my status have ever stigmatized me” [FGD 2, 14-17 years]
“I have never been stigmatized by anyone who knows my status.” [FGD 1, 10-13 years]
“None of those who know about my status have discriminated or stigmatized me” [FGD 5, 14-17 years]
“I have not experienced any form of discrimination or stigmatization whatsoever.” [FGD 6, 10-13 years]
Others expressed concerns about the potential stigma from siblings or extended families if their status was disclosed. Experiences of stigma and discrimination outside the family were largely hypothetical, with adolescents fearing rejection and discrimination from their peers if their status became known.
3.4 Adherence
This study assessed adolescents’ adherence to antiretroviral therapy, findings revealed that before participating in the OTZ intervention, adolescents faced challenges related to adherence, such as forgetting to take medication or experiencing side effects. Some of the extracts from the responses on adherence are presented below:
“I get sad whenever I want to take my drugs, it is usually difficult for me to take drugs” [FGD 2, 14-17 years]
“I always struggled to take my drugs, the tablet was too big and I had difficulties to swallow it as it always got stucked in my throat” [FGD 6, 14-17 years]
“I logged my complaint to the doctor on how the drugs make me weak and I don’t want to take it anymore. Also Whenever it was time to take my drugs and my mum gives me the drug, I would collect it and throw it behind the chair where she won’t be able to see it to collect” [FGD 6, 14-17 years]
However, after joining the program, the adolescents expressed improved adherence due to increased knowledge and support received through the OTZ sessions. The intervention also provided a sense of community and encouragement to adhere to the treatment, thereby reducing the likelihood of missed doses. Excerpts from some respondents are stated as below:
“The facilitators explained why we take the drugs and also how to use the drugs” [FGD 1, 14-17 years]
“We are told to take our drugs religiously and if we don’t adhere we would be sick” [FGD 1, 10-13 years]
“During our sessions, we are always told to adhere to our medications, and that is what I do” [FGD 3, 10-13 years]
“Before I joined the program I sometimes found it challenging to take my medication, but our facilitators taught us to adhere to our medications and also the best way to take the medication” [FGD 3, 14-17 years]
“I now take my medication religiously, due to the teachings on adherence” [FGD 6, 14-17 years]
3.5 Psychological Trauma
This study explored the traumatic experiences of adolescents living with HIV and found that more than 90% of the adolescents experienced mental health sequelae after they discovered their HIV-positive status. However, 85% of adolescent boys have been able to manage this effectively, especially when they gain more knowledge of how they can effectively manage their HIV status including adherence to medication in order to live a healthy life. Regrettably, however, 40% of the adolescent girls still had active pain, sadness, and trauma expressed with outbursts of emotional responses during the interview. Aside from the pain of living with HIV being felt by adolescent girls, more than 90% of adolescents have been able to manage their mental health effectively. Non-disclosure of HIV status to people beyond their parents and healthcare providers is one of the key reasons for the effective management of their mental health. Hence, they are not exposed to stigma and discrimination, which is a major trigger of mental health problems among PLHIV, especially adolescents and young people. Extracts from the responses are presented below:
“HIV is not a regular disease, even the drugs available is to only prevent the disease from spreading, it’s not the cure yet and this makes me unhappy” [FGD 1, 14-17 years]
“I was very sad and unhappy when I got to know because I don’t like drugs and I was told it is a lifetime drugs that I will have to keep using” [FGD 2, 10-13 years]
“At the point, the nurse told my grandma my HIV Status my parents had died and my siblings too, I was deeply saddened because of this and particularly no one to take care of me. However, my grandma has been taking care of me ever since and she is trying her best. Also, I was sad because I felt if any other person should know my HIV status, they will be afraid of me”. [FGD 2, 10-13 years]
“I felt sad because I was the only one HIV positive in my family and constantly had to use drugs, my parents and siblings don’t have the disease. I however don’t feel sad anymore” [FGD 2, 10-13 years]
“I feel sad because my mum is late and I am the only child of my parents that has the disease, by brother on the other hand does not have” [FGD 2, 10-13 years]
“When I was told I was not happy I was really sad about it because I was told if I disclosed it to anyone, they would make jest of me and run away from me”. [FGD 3, 10-13 years]
“When I was told I was not happy, but with the support I have received this far has made me feel much better” [FGD 3, 10-13 years]
“Anytime my teacher in school teaches us about HIV, I always have this fear that maybe my teacher already knows my HIV Status and I always feel sad whenever it dawns on me that I have HIV and this makes me sometimes withdraw from my friends” [FGD 3, 10-13 years]
“When I was told I was not happy, I even wept bitterly” [FGD 4, 10-13 years]
However, a few shared experiences were healthy for their mental states. Some of the opinions are presented below:
“None of the persons who know my status have ever stigmatized me” [FGD 1, 10-13 years]
“I did not feel sad when my HIV status was disclosed to me, because of the drugs available, it gave me a level of assurance that everything will be fine” [FGD 2, 10-13 years]
“My dad told me not to feel sad or disheartened about my status and I try my best not to feel sad”. [FGD 2, 10-13 years]
“I felt bad, but I was still happy that I have people taking care of me and I know that God will do the best for me.” [FGD 4, 10-13 years]
3.6 Experience in Accessing Mental Health and Psycho-social services
Unfortunately, the findings from this study revealed that only the OTZ remains a platform for accessing Mental Health Services for Adolescents living with HIV. There is no other platform known to adolescents where they can access support for their mental health. According to them, the team at the health facility uses different professional methods, classified as psychoeducation and cognitive behavioral therapy, to improve their mental health. Some of the extracts from responses to mental health questions are presented below:
“I benefited from the teachings, we were taught not to segregate ourselves from others, because God created every one of us and we are all the same” [FGD 4, 14-17 years]
“We are always told to adhere to our medications and also we should be free to express ourselves whenever we come for the program” [FGD 4, 14-17 years]
“Before I joined the OTZ meeting, I was always isolating myself even from my siblings and in school, this really affected me. However, after I joined the meeting, we were taught on how to relate with others”. [FGD 5, 14-17 years]
“The OTZ is where they give us detailed information about our medication, need to always adherence to our medication, consequences of not adhering to treatment, how to live with HIV without problems. We are always told to drink enough water and to always avoid getting open wounds and to engage in exercise base on our capacity” [FGD 6, 14-17 years]
“I have learnt not to look down on myself” [FGD 4, 14-17 years]
3.7 Sexual Behavior
This study revealed that 25% of male adolescents at the University of Ilorin Teaching Hospital (UITH) were sexually active, whereas none of the female participants reported being sexually active. Notably, none of the sexually active male participants (100%) consistently used condoms. At Sobi Specialist Hospital, 29% of the interviewed male participants and 40% of the female participants reported being sexually active. Among the sexually active males, 100% reported occasional condom use, whereas none of the sexually active female participants used condoms. This discrepancy may be attributed to intimate partners' reluctance to use condoms or lack of knowledge of their HIV status. Additionally, 43% of the interviewed female participants at the Children Specialist Hospital, were sexually active, whereas none of the male participants reported sexual activity. Of the sexually active female participants, 67% reported using condoms.
The findings indicated that many adolescents, despite knowing their HIV status, continue to engage in risky sexual behaviors, including being sexually active and not consistently using condoms. This low frequency of condom use significantly increased the likelihood of further HIV transmission. The high probability of infection is concerning due to the infectious nature of HIV and the tendency of young people to engage in early sexual experiences. This behavior poses a serious public health threat, as consistent condom use has been proven to protect against HIV and other STIs.
3.8 Influence of Operation Triple Zero (OTZ)
Questions to gain insight into the impacts of OTZ in HIV management revealed that OTZ has played a significant role in coping with their HIV status and the associated treatment demands placed on them. Some of the key benefits itemized include the following:
Treatment literacy and adherence: All respondents across all the health facilities affirmed that OTZ is the most significant platform where they learn about their ART, especially its efficacy, side effects, frequency of use, dosage, and pharmacology. For instance, a few respondents stated the following:
“We are being taught on how to use our drugs, we are provided with moral support and they also teach us games’. All these activities give me more courage to adhere to my medication”. [FGD 1, 14-17 years]
“They tell us to take our drugs religiously and if we don’t adhere we would be sick. And more importantly if we adhere to our medications, we would feel and notice a significant change in our body”. [FGD 1, 10-13 years]
“I have learnt that once we adhere to the medication, the virus in our bodies becomes weak” [FGD 3, 10-13 years]
“We are always told to adhere to our medications and HIV does not just kill provided we use our drugs diligently” [FGD 3, 10-13 years]
OTZ is a Platform for Social Engagement: The respondents also unanimously agreed that the OTZ meetings have remained a significant platform for meeting others, interacting, and learning from their peers about their experience living with HIV and how they cope with the associated stressors. Some of the opinions aired by them include:
“They keep pushing us so that we won’t feel like we having HIV makes us less than every other person. We are reminded that we can make it in the future”. [FGD 1, 10-13 years]
“they teach us on how to love ourselves and not feel less of ourselves” {FGD 3, 14-17 years]
“before I got to know my status I was very free with my friends, however when I got to know I started isolating myself, but I learnt from the meeting that we should learn to interact with friends and families, and we should be care not to have open wound so the virus does not spread to another”. [FGD 6, 14-17 years]
“What I gained a lot from was the last topic we treated on disclosure and trust in relationships, because I also isolate myself a lot even in school, they emphasized the need to identify at least one person we can always talk to and disclose how we feel”. [FGD 6, 14-17 years]
“We were told to have at least one person we can always talk to and confined in and we should not bottle up how we feel. We are also told to always eat well”. [FGD 6, 14-17 years]
“I have learnt that being HIV positive does not stop me from playing with my friends or even hugging them, also it is important that we adhere to our medications else we can die” [FGD 3, 14-17 years]
“We are provided with moral support and they also teach us games. All these activities give me more courage to adhere to my medication”. [FGD 5, 14-17 years]
“Before I joined this meeting I always isolating myself even from my siblings and in school, this really affected me. However, after I joined the meeting, we were taught on how to relate with others”. [FGD 3, 14-17 years]
“whenever we come for the OTZ meeting, they give us money and food and this serve as motivation for us” [FGD 4, 10-13 years]
OTZ is a Platform to discuss positive living and personal hygiene: OTZ as a platform to discuss positive living and personal hygiene was assessed. The respondents in this study confirmed that the OTZ is a platform for extensive discussion of positive living and personal hygiene.
“We have been taught to take balanced diet, rest, take enough water and a good personal hygiene. We have been taught on the need to take balanced diet and keep clean” [FGD 1, 10-13 years]
“We have been taught to take balanced diet, rest, take enough water and a good personal hygiene”. [FGD 3, 10-13 years]
“We were told to eat fruits which will help with our overall health, and we should take time out to exercise as well”. [FGD 5, 14-17 years]
“We are told to eat fruits which will help with our overall health and we should take time out to exercise as well Games should be included in our activities” [FGD 5, 14-17 years]
“We were told to keep ourselves away from harm and unpleasant situations and be responsible individuals” [FGD 6, 14-17 years]
Additional supports required for more impacts: Adolescents identified several areas where additional support could further enhance the effectiveness of interventions, including the provision of educational and financial support to facilitate access to healthcare and reduce economic barriers. Some of the excerpts from the responses on mental health are presented below:
“I want support to pay my school fees, as I have been unable to pay my school fees educational support” [FGD 2, 10-13 years]
“I want to write my WAEC examination and I need financial support to procure the form, my parents have not been able to get the money to support me” [FGD 2, 14-17 years]
“I want to ask that the refreshment and money we are given be increased” [FGD 3, 10 -13 years]
“More financial assistance should be provided to support those who want to go to school, but his/her parents cannot afford this” [FGD 4, 14-17 years]
“More financial support should be provided to support us who need help with our academics. There was a time I wrote my WAEC exams and after I needed to write my NECO exams but my mum had no money to support me at that time, I mentioned this to one of our facilitators, however, I was unable to write the exam due to financial instability should be provided to support those who want to go to school, but his/her parents cannot afford this. Furthermore, they emphasized the importance of ongoing mental health and psychosocial support tailored to their specific needs, as well as access to youth-friendly services to address broader health and social issues” [FGD 5, 14-17 years]
“I want to ask that you continue to provide us with moral support which will continue to make us happy” [FGD 1, 14-17 years]
“Continue to sustain what you have been doing, the monthly OTZ meetings should continue to hold” [FGD 5, 14-17 years]
“I want physical activity to be included in our activities, particularly sport activities” [FGD 4, 14-17 years]
“I want to suggest different game be included in our OTZ activities” [FGD 5, 14-17 years]
“There is need to increase awareness, because a lot of people still don’t know about the free drugs available for HIV. Because I have a friend in school who is always sick and something like rashes has appeared on her skin. I asked her to go to tell her parent to take her to the hospital, but I doubt she took me serious” [FGD 6, 14-17 years]