In a small home tucked away on a side street in the city of Kaduna in northern Nigeria, Aisha Yakubu watches her son take out three bottles of prescribed medications from a dresser in his bedroom. The eight-year-old boy ignores the kittens meandering around his legs as he twists open the caps of each of the white bottles.
Every day he takes anti-viral drugs: 200 miligrams of Aluvia, 150 miligrams of Truvada and half a tablet of Septrin. "I think he contracted the HIV from his mother," Yakubu says.
About six years ago, she found the boy lying in a heap of rubbish in an abandoned building. She picked him up, took him home and has been raising him as her son ever since. Together, they strive to overcome the challenges and stigmas surrounding those infected with HIV.
"After seven [in the evening] you couldn't even say HIV then because people were so afraid," she says. She explains that the word to describe HIV or AIDS in the local Hausa language, kanjamau, refers to a sickly, skeleton-like person with scabby skin.
In 2005, after several months of losing weight and being accused of possessing an evil spirit that was making her sick, Yakubu said she became depressed and her relatives, some Christians and others Muslims, did not offer her enough support. "The Christians were saying I need deliverance and the Muslims were saying I was a sinner," she said.
She finally visited a medical doctor who told her she was HIV-positive. She said the news "completely threw her off balance". She suspected her second, now former, husband had given her the virus.
From that moment, Yakubu became aware that she was part of a much larger community. An estimated 3.5 million Nigerians are infected with HIV. The National Agency for the Control of AIDS says Nigeria has the world's second-largest number of people living with the virus after South Africa. Nigeria also carries about one-third of the global burden of new HIV infections among children, according to The Joint United Nations Programme on HIV and AIDS.
|HIV funding shortage threatens Senegal gains
In places like Kaduna where Yakubu lives, the rate of HIV infection is higher than the national average of five percent.
The federal government has allocated more than $12.4m to the state to finance HIV and AIDS reduction initiatives from 2014-15, according to the head of the Kaduna State Agency for the Control of AIDS. This agency, in partnership with Enhancing Nigeria's Response to HIV and AIDS (ENR) - a programme funded by the United Kingdom's Department of International Development, aims to fight the epidemic by boosting awareness.
Yakubu says her involvement with local advocacy groups has helped her to accept her status. She is said to be the first woman openly living with HIV in Kaduna. "I have already told the world my status," she says.
"There was a lot of scepticism. It's a huge amount of money with a lot of expected deliverables," says Olanipekun Oluwasola, who helps to monitor and evaluate ENR's activities. "In the past five years we have proved that we have been able to manage such money - not just manage but to make a huge difference on ground."
Although ENR has prescribed certain strategies, it has also tailored its approach to the needs of certain communities. Kaduna is the only state in Nigeria where ENR trainings have targeted physically handicapped persons.
Under a tree near a cluster of markets, about 20 people - some blind, some lame and others mute or deaf - gather in a circle to talk about HIV. They agree that rape is the biggest problem facing handicapped people in Kaduna, especially blind and mute, and that this causes the virus to spread.
"Imagine a blind woman who comes outside not knowing she is inappropriately dressed. Men will take advantage of her," says Risikat Toyin Muhammed, the Kaduna state coordinator of the Network of Persons With Disabilities Against HIV and AIDS.
Thirty-nine-year-old Muhammed walks with a metal set of crutches to support her limbs, which were crippled by a bout of childhood polio. ENR gave her training as a field worker to educate others about HIV. She chose to use her experience to reach out to those with physical and mental disabilities.
This is the land of God. It cannot be rubbished by HIV. Everyone's hand is on deck to make sure the virus is completely eradicated in this state.
Meanwhile, in the small farming village of Uko Itak Eyulor in southern Nigeria, chiefs and elders say they know more about the virus after an ENR community facilitator began conducting regular learning sessions with residents in the village.
Akwa Ibom state, where Uko Itak Eyulor is located, has the second-highest HIV prevalence rate in the country. A survey on sexual and reproductive attitudes conducted by ENR's Akwa Ibom team found that practices such as wife sharing and avoidance of condom use have led to the high rate of infection.
Dr Frances Udoikpong, the head of the Akwa Ibom State Agency for the Control of AIDS, emphasises his commitment to lowering the rate. "This is the land of God. It cannot be rubbished by HIV," he said. "Everyone's hand is on deck to make sure the virus is completely eradicated in this state."
Despite Nigeria's localised approach, foreign entities provide a bulk of the funding. The United States President's Emergency Plan for AIDS relief (PEPFAR), the landmark effort begun in 2004 which has been acclaimed for providing free antiretroviral drugs to millions of people around the world, has given $2.5bn to Nigeria to fight the virus, according to the US diplomatic mission to Nigeria. The mission reports that PEPFAR funds in Nigeria have made it possible for more than 3.4 million pregnant women to access health services for the prevention of mother-to-child transmission of HIV, and that nearly 415,000 people have received anti-retroviral therapy.
Nigeria's largest health-oriented NGO, the Society for Family Health, receives money from international donors including the Bill and Melinda Gates Foundation, the World Health Organization, and the Global Fund to fight HIV and AIDS, Tuberculosis and Malaria to maintain a number of HIV and AIDS-related programmes.
Some Nigerians are calling for more anti-HIV efforts backed by the Nigerian federal government. Local media recently reported claims from a state official who claimed that the federal government has not adequately funded HIV and AIDS programmes on the state level.
Meanwhile, HIV-positive Nigerians like Yakubu are focusing less on federal government aid, instead hoping to strengthen local community support groups and become more financially self-reliant. Yakubu depends on per diems from HIV and AIDS advocacy and awareness workshops that she runs, and hopes the money will continue to provide a livelihood for her two adopted sons and husband.
She closely monitors the health of her HIV-positive adopted son and that of her own, offering herself as an example of the success of localised strategies to reducing Nigeria's HIV epidemic. "I am making an impact right here," she says.
Follow Chika Oduah on Twittter: @chikaoduah