Dissemination of Findings of the Gede and IHVN Prevalence Study on Depression, Alcohol Use Disorder and Suicidality Among People Living With HIV-AIDS in Nigeria

On January 20, 2017, the Institute of Human Virology in Nigeria (IHVN) and Gede Foundation hosted participants in Nassarawa State to discuss findings and results from the Study that was championed by both organizations in 2015.

The Study was conducted in the Federal Capital Territory (FCT) with 1187 respondents in 3 HIV treatment sites — Asokoro District Hospital, Garki District Hospital and University of Abuja Teaching Hospital Gwagwalada. Using the DSM-IV diagnostic criteria, the lifetime prevalence of major depressive episode was 28.2%; 7.8% engaged in harmful alcohol use; and 14% thought of committing suicide in their lifetime.

 Heads of HIV treatment sites in the FCT, treatment site managers, researchers, interviewers, and members of the press attended the dissemination meeting in Nassarawa. This meeting was the first time the results were made public in order to generate discussion on the integration of mental health services into the HIV/AIDS treatment platform using evidence-based information.

Dr. Ernest Ekong (IHVN Director of Clinical Services and Co-Investigator for the project) introduced the study, its objectives, and major results. Mr. Chidozie Bright Edokwe (Project Field Coordinator) presented the section on research methods, while Mr. Godwin Etim (Performance Director, Resource Mobilization and Partnership Management, and Project Field Supervisor) presented the conclusions and recommendations.

Participants viewed the study results as essential, representing significant evidence that supports the need to integrate mental health services into the HIV treatment and care pathway in Nigeria. IHVN acknowledged and recognized the work of those who were directly involved in field activities. The complete report will be widely published and disseminated in due course.

ADVANCED RESEARCH FOR HEALTH AND DEVELOPMENT: METHODS AND SKILLS FOR ACHIEVING IMPACT TRAINING

Gede Foundation, in collaboration with King’s College London (KCL) and the Nigerian Psychological Association (NPA), held a two day training (24th and 25th January2017) at the Foundation’s headquarters in Abuja on Advanced Research for Health and Development. There were participants from leading organisations such as the National Agency for the Control of AIDS (NACA), Society for Family Health (SFH), Institute of Human Virology in Nigeria (IHVN), Nigeria Centre for Disease Control (NCDC), Excellence Friends Management and Care Centre (EFMC), Society for Community Development (SCD), the Centre for the Right to Health (CRH), Centre for Family Health Initiative (CFHi) and individuals who attended independent of their organisations. 

Dr. Rosie Mayston, a senior researcher from the Centre for Global Mental Health, King’s College London, had this to say about the training, "We had two great days research training- it was very inspiring to be a part of this, alongside Prof. Andrew Zamani and colleagues from Gede Foundation. It was really exciting to see so many people from governmental and non-governmental agencies with enthusiasm for research. I am very much looking forward to taking part in future similar events!” Dr. Mayston included theory as well as practice in her lectures. She began with a seemingly simple question - what is research? and then moved to different types of research methods. 

Professor Andrew Zamani, the President of the Nigerian Psychological Association and also the Dean, Faculty of Social Sciences, Nasarawa State University, was one of the facilitators and covered ethics in research, research in health development in Nigeria and other topics.

The training was fashioned in such a way that it appealed to audiences who had little or no experience in research as well as expert researchers. At the end of the second day of training, there was a panel discussion that included Professor Zamani, Dr. Mayston and Gede’s Managing Director, Mr. John Minto. Among the topics discussed were were challenges and opportunities related to research dissemination, partner engagement and sourcing key information

Participants also asked questions relating to research as well as contributions on how research can be made more effective. One of the participants noted that there is need to generate culturally relevant research. She said that usually, research methods are not adjusted to fit Nigerian standards but instead, carried out as they would in other parts of the world and this may affect the results. Professor Zamani agreed with her and noted that there were gaps in research which are being addressed to ensure better collaboration between organisations.

The training ended with calls from participants for more in depth training. Some organisations wanted personalised training for their staff members. This is definitely an avenue that the Foundation, King’s College London and the Nigerian Psychological Association will explore. The training offered opportunities for participants to recognise the significance ofquality research in adding value to their work and this is reflected in their feedback from the training. If you would like to be offered similar opportunity, please email training@gedefoundation.org

Please come back to the blog for more on further trainings with KCL and NPA.

John S. Adakolo: Recipient of Award from IHVN

John Simon Adakolo, received an award from the Institute of Human Virology in Nigeria (IHVN) for his significant contributions to the Study of Mental Health (Depression, Alcohol Use and Suicidality) among HIV Positive Patients in Nigeria in 2015. 

John Jr, as he is called by fellow colleagues at Gede is an energetic and inquisitive young man who is always eager to learn new things. It is his enthusiasm that has seen him through his journey in Gede Foundation where he started as a cleaner in February 2003 to a Programme Officer in 2014.

The Foundation, through this blog would like to recognise and applaud John Jr on this achievement - which is just one of several awards and certificates that he has been given due to his hard work and dedication. 

In his own words, “I am one of the happiest people right now. I was not expecting such an award from such a reputable organisation like IHVN. It is not only a dream come true but also a reminder that hard work pays.”

Congratulations John!

‘The Jungle’

When I first heard the term, I could not contain my laughter. I thought the Community Based Volunteer (CBV) was joking. I’m quite certain a few of you may be wondering why I am not getting to the point already. First of all, this is not your typical jungle. It is not what the dictionary defines as “an area of land overgrown with dense forest and tangled vegetation, typically in the tropics.” That is what came to mind first. Instead of dense forest, this jungle has human beings, in the place of tangled vegetation, there are all sorts of illegal drugs found in this jungle. This is what the CBV was trying to tell me. Even more scary, the jungle has a chairman. The drugs found in the jungle range from marijuana, to cocaine to codeine to other controlled and/or illegal substances. 

Apparently, the jungle is a well known place. There are all kinds of people in the jungle. Some of them have had formal education, others have not. Some have families, others do not. It is a community of one thing and one thing only - illegal drugs. A lot of those that are found in the jungledo not have regular incomes or even any forms of income at all. Most of them are between the ages of 19 and 44 years old. This is worrisome as these are the productive members of society. Needless to say, substance abuse is on a steady rise in the country and the ease with which people can access the drugs is alarming. There are even registered pharmacies that have a backdoor and sell controlled drugs to anyone that would ask and pay. 

The jungle is only one place. There is a myriad of such places all over the capital. Sometimes when you stop at a traffic light, a person may approach slowly and whisper if you want ‘Tuxil C’. It is a legitimate drug for coughs and colds. However, it is abused so much that it is in the same category as Codeine. 

I did a bit of research and discovered there are jungles all over the capital. Sometimes, the police raid them but they still come back. Perhaps people know the dangers of taking illegal drugs, perhaps the dangers are acceptable depending on what the users are trying to get away from or numb. As our regular readers would know, illegal drugs can have dire consequences not just physically but also mentally. There are terms such as drug induced schizophrenia, korsakoff syndrome (alcohol induced), depression and yes, even jail time. 

I recall a story of a lady that seemingly had all it together but was taking illegal drugs to keep up the charade of being the perfect mother, wife, sister, daughter, business woman and friend. One day, she could not take it anymore and ended it all. Other people’s situations may not be as dire as this woman’s, but if you find yourself in the jungle, please do not hesitate to ask for help. You would be surprised at the help that is available. Be a beacon of hope for others - pave the way. 

Written by Zunzika Thole - Okpo.

Musings Of 2016 As 2017 Begins…

2016 was a year of “lessons learned”. And the lessons were many. Mental health has always been a fascination of mine and in my quest for knowledge, I learned so much that I needed to press the brakes and reflect. Below are a few things that came to mind. 

1. In my eight months as Media Officer of Gede Foundation, I have learned a lot. There have been a lot of challenges and even more lessons. No disrespect to mental health professionals who obviously know more than I do, but I have learned a little in the past eight months that I find myself diagnosing people - in my head. I have to consciously stop myself from diagnosing people’s mental illnesses. Most importantly because I am unqualified and I suppose even more important, I AM NOT A DOCTOR. 
2. Going into the job, I was worried. I thought mentally challenged people were definitely violent (I blame TV, especially American Horror Story - Asylum). I have probably crossed paths with mentally challenged persons before but not the way I did working in the field with Gede Foundation. My first encounter, which most of our regular readers know about, is the lady that was chained to a pole in a church - for over a year. Even after I learned her condition, I was scared. My main concern was MY OWN SAFETY. My fear was that a lady chained to a pole would somehow break free and attack me. Is that even rational? Thinking back, I am quite ashamed. It was HER SAFETY that should have concerned me more. She has been unchained now and is back with her family. To me, that is one person reached, one person helped, one voice that can speak. Note to self: It is not about you. 
3. There have been others of course. Others riddled with so much pain, disdain and heartache in their lives yet they still soldier on. One girl that has seizures so bad but she doesn’t let that restrict her actions. HOPE AND COURAGE
4. “So what?” One might ask. Well, people suffer. More than I have ever been exposed to. There is an 8 year old boy who has no less than 5 seizures in a day. He is bruised and battered and ridiculed because of his condition. Also because of his condition, he cannot go to school. His family is so poor they can’t afford his medication. The young boy is doing better now. We did not do much for him but the little we did was enough for the father to understand that his son’s condition is medical and there are people willing to HELP.
5. Then there is a young bubbly lady who is bipolar (I did not diagnose her). First time I met her, she seemed OK. She was bubbly, happy and saw no reason why she had to be at the mental health camp. I dug deeper and discovered she was in a manic phase and when this happens, she loses all her inhibitions. This includes sexual inhibitions. For this reason, many men take advantage of her. It was recommended that she take an HIV test as well as a pregnancy test as it had been a few months and she hadn’t had her period. Some members of her community look down on her because of the aforementioned encounters with men. With a little more enlightenment, perhaps they will show a little COMPASSION. 
6. Then there was a man, just 31, shouting and screaming at something/someone we could not see. His reality is apparently as real to him as mine is to me. There are a lot of productive things he could be doing with his life but he can’t because he had (at that time) had no access to medication. Not everyone can understand mental illnesses, but that does not make them any less real. Furthermore, not everyone understands malaria but because its a physical illness, it is accepted. 
7. Last but definitely not the least is the substance abuse. I learned that there is a place in Mararaba, Nassarawa State, called the ‘jungle’. This is where all kinds of illegal drugs can be found. Even more interesting, the ‘jungle’ has a chairman. When I first heard this story of the ‘jungle’ I broke into fits of laughter. For that reaction, I am ashamed. It saddens me that it is so easy to get illegal drugs.
   
   
   It is my hope that 2017 leads us closer to “No Shame” and “Zero Stigma” for those who have mental illnesses. HAPPY 2017!

The Christmas Festive Season With Its Peculiar Stressor

By Ekaette Udoekong

The holiday season should be a time to relax, rest from the stress from work, unwind with family and friends. During the festive season in Calabar, the streets are flooded with children adorned in colourful attire to perform traditional folk dramas and masquerades. Others mask themselves with coloured raffia or hide their faces under heavy makeup as they pass in groups to showcasethe best masquerade in a combination of song, dance, and drumming. Unfortunately, this tradition is slowly dying out as fewer children participates but rather are enrolled in the largest street party – the Calabar Carnival. However, this tradition still remains a major way of celebrating Christmas in most remote villages in the south-south. 

During this period there is a common trend; A throng of young adults and a few elderly people at bars and clubs. There is an increase in alcohol consumption, bandits and pickpockets at bus stations, religious activities, loud music and a hike in the prices of commodities. So far, these difficulties and stressors have not stopped Nigerians from celebrating Christmas with gifts and family reunions.

Before the actual day of Christmas, preparations and commitments are made and these could be overwhelming stress for some persons. Shopping, financial strains, traffic on major routes, crowded marketplaces, and unwelcome guests, late night harassment by hoodlums, hike in the prices of commodities and the fear of commitments in January the next year. Typically, I would say that we live in a Christmas culture where spending of money in the last month of the year equals love, charity, kindness and relaxation for a ‘fulfilled’ year.

Typically, for families and individual who are unable to follow the Christmas season trend, it becomes depressive and for those who lose loved ones during the season celebration is done in sadness or no celebration at all.

In general terms the holiday season come with a lot of stress and anxiety that could be managed by:

• Early preparation including early shopping and budget trimming (to accommodate needs not wants)
• Keeping certain aspects of home life constant and maintaining usual routines to avoid stress throughout the season. 
• Doing things in moderation; Food and drink are a big part of Christmas festivities for most people overindulging in drinking, other overeating which may constitute a health issue.

It’s been reported that 1 in 20 people find Christmas to be more stressful, the holiday season does present certain challenges and stressors which can become overwhelming. If unmanaged all positives pleasure that come at Christmas time can be undermined although certain level of stress is almost unavoidable at this time of year. As this is December, many towns and cities would be empty as most Nigerians will move from the cities to their ancestral villages to be with family and friends. It is needful to be aware of your bodily responses to stress and focus on what’s really important for you at this time of year.

Choices, Genetics or Circumstances?

“Is alcoholism genetic?” he mumbles. 

“I’m not sure, I can’t say I know for certain,” I answer. Or at all, I think to myself, I am, after all, not a mental health expert. 

I met Stephen through a mutual friend. Stephen is 33 years old. He began drinking at a young age, around 13 years old. His parents were divorced and so he thinks they did not really pay much attention at the time. In addition, they were mostly drunk.

He has this quiet and calm demeanour about him when sober, almost shy. He begins by telling me drinking alcohol is something that is done regularly in his family house. All his relatives drink. He recalls one time though, when his mother took him to a native doctor to see how his drinking could be curbed. She had given up drinking and wanted the same for him. He was given animal blood to drink and for a while, even the smell of alcohol made him throw up but after some time, he continued. He has a steady job which he is actually very good at. The only concern his bosses have is that he doesn’t seem to be taking care of himself in terms of hygiene. He scoffs as he says this. He does look somewhat disheveled and its past 2pm. He also looks thin and not in the way fashion tabloids depict. I ask him if he eats regularly and he shakes his head. He would rather drink. His hair is light brown - almost like one who has spent too much time riding on an okada during the harmattan. 

Stephen says he was in the hospital a few weeks back. “Something to do with my liver,” he says. I’m not sure what to ask, so I just let him tell his story. Drinking alcohol for him was a rite of passage. Like most people in his family, he thought that it was something he could control. Even as he went to classes drunk, forgot to eat, drank more alcohol than water, he did not realise the grip that alcohol already had on him. Without it, he recalls, he was withdrawn and bitter. After a few, he was the life of the party. Soon, people figured that was the real him. Little did they know that the real sober him was a calm, considerate and loving brother and son. As time went on and he got in university, he drank more, missed classes and barely passed his final year exams. But it was not only him, he says. It is the same with his siblings. Only a few do not drink. At least not as much as him. He says that sometimes he goes for a drink with his uncles and brothers and one drink turns to two then five then 8 until they lose count.  

He keeps fidgeting and twirling his fingers. I ask him if he is drunk right now. He laughs and says no. He has been trying to stop but it has not been easy. Yes, he had a few drinks two days ago and he is itching for more. He has not been to work in a while as he is too weak. He says even just one bottle will make him feel alive. Even talking to me seems to be weakening him more. 

As I get up to leave, I offer him some food. He smiles and takes it. He looks so forlorn that I am scared to leave him. He jokes about getting a wife, perhaps that would straighten him out. His question lingers on my mind though, is alcoholism genetic? Does that mean Stephen stood no chance at all? Are some people more prone to addiction than others? Like I told Stephen, I do not know, but I intend to find out more. 

Written by Zunzika, with Stephen's permission

Gede's OVC Programme In the News

http://leadership.ng/news/563732/ngo-empowers-94-graduands-of-skills-acquisition-programme

Please visit the above link to read more about Gede's OVC programme with Addax Oryx Foundation. 

How Long Can One Grieve The Loss Of A Loved One?

By Ekaette Udoekong

A few months ago I was at the beach market – Esuk Atu to buy fresh fish and shrimps. Euk Atu is small seaside beach with few fish traders and fishermen. Business happens here more in the morning and a little in the evening depending on the weather and tides. The beach is usually deserted in the afternoon. At the beach you can see women and young children crossing from one end of the river to another with goods, and of course fishermen returning with fish, shrimps and sometimes oysters. 

I got very concerned about the women and children who travel by water in a small canoes and are not afraid of the tides and the water.  One of the women told me that she focuses on an object or thinks of something beautiful and not on the waves when traveling on water. She does not listen to the tossing of the canoe or battering by the water, she busies her mind on how to sell off her fish and how to get her creditors to pay their debt. Then I turned to one of the fishermen, a boat owner and asked how he manages if the tidal waves caught up with him at sea. He laughed and said he has not experienced it yet though because he had learnt over time to understand the tides (every fisherman knows!). 

Most weekends when I get to the beach the fishermen had already washed off the nets and are on-shore in a make-shift bar to take ofop-ofop or combine, or have breakfast, or are selling off fish to middlemen. I observed a few times that a particular fisherman does not celebrate at the bar with others but just exchanges pleasantries, sells to a particular middleman and leaves with his two boys. It’s obvious he does that so that he does not have to stay at the beach longer than necessary. Then I began to asked questions and for more than two months I have frequented the beach market to winthe friendship of some of the fishermen and the middle-women. This weekend I got my story.

The fisherman I have been observing lost his oldest son and the loss caused a deep grief that had taken him off social life including sharing a drink with fellow fishermen. It has been over 2 years since his son died. According to the middle-woman I spoke with, he has not overcome his grief. My source said he only greets and sells only to one middleman. According to my source he used to be a jolly fellow participated actively at the beach but is very withdrawn now. 

How long can one grieve the loss of a loved one? There is a link between grief and substance abuse problem but in this case could grief cause one to stop drinking? Are there other stressors that could trigger such a change in a person for over 2 years? 

NATIONAL HIV PREVENTION CONFERENCE 2016

Government agencies and Not-For-Profit Organisations came together for a conference at Nicon- Hilton Hotel in Abuja for the first National HIV Prevention Conference that lasted 3 days - November 28 - 30h 2016. The conference provided an opportunity for all those involved in the prevention of HIV at the national as well as sub-national level. 

In his welcoming remarks, Dr. Sani Aliyu, the Director General of the National Agency for the Control of AIDS (NACA) said “Nigeria bears a significant portion of the global HIV burden. Through this conference, Nigeria is leading the way for fostering reflections, galvanising knowledge that are geared to bridge the prevention gap in Nigeria.” 

The conference attracted scores of supporters and sponsors. The first day was dedicated to youths and was organised by the Society for Family Health. There was an overview of HIV response amongst young people in Nigeria (presented by NACA). The youth summit also had a capacity building session as well as a skills building workshop. 

 After the Youth Summit, the next day was filled with numerous programmes that were running concurrently. There were professionals and experts from sponsors and supporters of the conference. Among them was the Federal Ministry of Health, United Nations, Management Sciences for Health, Institute of Human Virology, The World Bank, USAID, UNAIDS, Silver Lining Initiative, Network of People Living with HIV and AIDS, The Presidents Emergency Plan for AIDS Relief, Society for Family Health and a lot more. 

In one of the sessions themed “Towards the First 90: Leaving No One Behind”, Dr. Sani urged everyone to move from policy to practice. He mentioned that most people only test and there is a big problem with adherence to drugs. He encouraged health practitioners to support their patients and form self care groups for those living with HIV. Ms. Assumpta Reginald, National Coordinator of ASHWAN (Association of Women with HIV and AIDS), shared her experience with Abia/Taraba Mentor Mother experience. The project was focused on leaving no mother behind. She noted that the project was focused on prevention of mother to child transmission of HIV and AIDS. 

In another session, targeted at key populations showed research done in Ibadan on poverty, sexual practices and vulnerability of female sex workers to HIV/AIDS. This was particularly interesting as some of the sex workers may use alcohol or other addictive substances to ‘cope’. The presenter explained that while their mental health is not the primary concern, the former sex workers have psycho-social activities and other relaxing techniques. 

Overall, the conference was very informative and it is important to note that the supporters and sponsors present recognise the link between HIV/AIDS and Mental Health. In one of their presentations they noted that some of the people living with HIV/AIDS are prone to depression, alcohol/substance abuse and even suicidal ideation. It is therefore imperative to not only continue to treat the physical BUT the mental health aspect so as to have a more holistic approach. As Dr. Han Kang from USAID said, “In as much as we should test and treat, we should also test and prevent.” This includes those found negative and prevention of any mental health issues that may come up due to the diagnosis. This is indeed a reaffirmation of Gede’s work towards the integration of mental health and HIV/AIDS.