In this report, GRACE OBIKE paints the picture of the horror’s women living with HIV/AIDS are faced with in IDP camps in Borno State

After the Boko Haram attack on Dar-el Jamal, Bama Local Government Area (LGA), Borno State in 2013, Fatima Bulama, a 30-year-old woman, and her husband, Abdullahi Ahmed, made the difficult decision to flee to the safety of the Muna Internally Displaced Persons (IDP) camp in Maiduguri. They brought their five children with them.

However, Fatima’s life took an unexpected turn within the confines of the camp. Her once-loving husband found himself a girlfriend and contemplated marrying her as a second wife but changed his mind at the last moment. Fatima was initially relieved to have Abdullahi back to herself, but her joy was short-lived. Abdullahi fell seriously ill but only sought medical attention with his best friend.

Tragically, he passed away without disclosing the cause of his illness. Fatima refrained from prying into the matter until his funeral, which was held the same day according to Islamic rites, when the best friend shockingly revealed to the gathered crowd that Abdullahi had succumbed to Acquired Immune Deficiency Syndrome (AIDS) and issued a warning for everyone to be cautious.

This revelation marked the beginning of Fatima’s trouble. She found herself ostracised by the community in the camp. Friends distanced themselves, her children were forbidden from playing with others or approaching their homes, and she was instructed to stay away from communal areas and the shanties of fellow camp residents. Consequently, she was compelled to confine her children to their one-room shack for weeks without venturing outside.

Less than two months after her husband’s death, one of her sons stepped out and got into a fight with another child. While she was cooking inside their room, the camp secretary Mallam Ali approached her and demanded that Fatima should gather her belongings and vacate the camp immediately.

Fatima questioned his authority to expel her and her children from a government-established camp and reported to the chairman of the camp, who explained to her that it was for the safety of the entire camp, as other residents were not willing to continue to live in the same camp with individuals like Fatima and her children who are threats to their well-being.

Without allowing Fatima to finish cooking, the chairman forcibly ejected her, along with her underage children and their belongings, with no regard for the fact that her eldest child was just thirteen years old at the time.

Fatima’s ordeal in the Muna camp is not an isolated incident among individuals living with HIV in this region. Discrimination against women based on their health status remains common within the internally displaced persons (IDP) communities in northeastern Nigeria, despite legal prohibitions against such behavior.

A common but negative trend

Sadiya Muhammed, a 35-year-old mother of four, found herself in a similar situation and like Fatima, she was expelled from the camp. Sadiya now resides in the Muna Kumburi informal camp, living under an assumed identity. Not only does she conceal her true identity, Sadiya also pretends to be of Hausa ethnicity rather than her actual Shua Arab background in order to avoid any connection to the Sadiya with HIV who used to reside in the Muna camp. This highlights the profound stigmatisation faced by women living with HIV in these communities.

The camp communities find justification for the expulsion in a way that makes it difficult for the victims to get support even from the relatives.

Sadiya’s situation is particularly complex. While she faced discrimination and eviction from the Muna camp primarily due to her HIV status, she was also accused of sexual exploitation of recruiting young girls within the camp for sexual activities involving male visitors at her residence. Sadiya denies these accusations. This multifaceted situation underscores the challenges faced by individuals like her, who are unfairly stigmatized and accused, making their quest for justice and support even more challenging.

As a result of this stigmatization, many women in IDP camps have become so good at keeping the details of their health conditions secret.

Hauwa Abubakar, a 32-year-old mother of five, lives peacefully at the now informal Dalori camp, as many other camps have closed after residents were encouraged to return to their communities. At her camp, Hauwa and some individuals living with HIV have managed to keep their status a secret even from their own children.

“When we need to get our medications, we simply inform others at the camp that we are going somewhere, and luckily, we receive medications that last for four to six months,” Hauwa explained. “Even when we return, we hide them in a place where no one, including our children, can find them.”

Hauwa, now remarried to another person living with the virus whom she met at the hospital, contracted HIV from her first husband. Unknown to her and her co-wives, he was a fervent member of Boko Haram until the military reclaimed Bama from the insurgents. He fled with his three wives and children into the Sambisa Forest, where he fell ill. After numerous treatments for what they believed to be malaria, he was finally diagnosed with HIV.  All three wives tested positive.

Since her husband’s demise in Sambisa and her subsequent return to Bama in 2014 followed by illness and resettlement in Maiduguri, first at the Bakassi camp and later Dalori, Fatima has lived in constant fear of exposure. She has taken every precaution to conceal her status, influenced by the harrowing stories of discrimination faced by fellow patients who were exposed.

The acting village head of one of the communities within the Muna IDP camp, Nakil Ahmadu, attributes the discrimination faced by these women to the virus infection.  Ahmadu acknowledged that most women known to have the virus are ostracised from the community.

While he personally claims not to have expelled anyone known to be living with HIV from his part of the camp, he admitted that some other communities within the camp have done so. He did not see anything wrong with these actions, placing the blame for the virus’s spread within the camp squarely on the women.

“Let me clarify something: as far as I’m concerned, in our camp, no man has HIV. It’s only the women. We know most of them and we avoid them.

“They may pretend to be innocent, but they wear trousers and t-shirts, go into town for prostitution, and return with HIV, expecting us to accept them? No way.

“We won’t interact with them or allow them near us. Do you want us to contract the virus? We will only welcome them back when they recover. It’s not our fault that they engage in prostitution,”

Sadly, most of the people that we spoke to at the Muna IDP camp, including the women leader of the camp, Faumata Audu, share his belief, although Audu insisted that women in the camp only prostitute as a result of hunger.

“Well, you can’t blame us for worrying about ourselves. We don’t want to be infected because we touch and interact with them,” she said.

Coordinating Case Manager and Prevention of Mother-to-Child Transmission (PMTCT) at the Maiduguri State Specialist Hospital (MSSH), Mshelia James, said that discrimination against HIV-positive individuals extends beyond the camps and affects patients living within communities as well.

Mshelia highlighted the case of a patient (name withheld) who remarried shortly after her husband’s death. She discovered she had contracted the virus from her late husband, who had not disclosed his HIV status before his death. Her second husband now treats her with disdain, pushing her clothes away with sticks, preventing her from coming near him or sharing utensils. Recently, he even expelled her from their home.

                                                          Women leader of Muna camp Faumata Audu 

                                                                   Acting village head Nakil Ahmadu 

How does the camp know of people’s status?

Mshelia informed us that after visiting camps to test for people living with the virus, the hospital does not report back to the leadership with the results. She said they call patients privately and only break the news to them after confirming that such patients are alone and free to speak because they understand the trauma patients living with the virus face within their communities and try to avoid them.

Bulama Ruma’idu Abubakar, leader of residents from Guna Ward, Marte Local Government Area (LGA) living at the Muna camp corroborates Mshelia’s account of things. He said when the people that wanted to screen for the virus visited the camp, they had met with the Bulama’s and explained their intentions. The Bulama’s in turn convinced their communities to cooperate and after they finished and left, they never returned or contacted the Bulama’s on their findings.

On his part, Ahmadu explained that the hospital did not have to return to reveal the results for the camp to figure things out for themselves. It turned out that after the hospital put the call across to the people, they found to be positive within the camp in private, some of the carriers met some leaders for assistance for transport to enable them get to the hospital while some others met together within the camp and left for the hospital in a group.

This sparked a series of gossip within the camp as people figured out what was going on and began avoiding them.

HIV/AIDS in Nigeria

The 2019 Nigeria National HIV/AIDS Indicator and Impact Survey data estimated that 1.9 million Nigerians were living with HIV and AIDS. By 2019 Nigeria had recorded 74,000 new HIV infections, and 51,000 AIDS-related deaths with 1.7 million people on antiretroviral treatment. As at the time of publication, The Nation tried to look for a more recent data but could not find any.

The Federal Government of Nigeria says it is making all efforts towards the attainment of the United Nations Program on HIV/AIDS (UNAIDS) 95-95-95 targets which is that 95% of people with HIV will know their status, 95% of people with HIV who know their status will be on treatment and 95% of people with HIV on treatment will be virally suppressed by 2025 in order to end AIDS as a public health threat by 2030.

The Society for Family Health (SFH) says it is making efforts to ensure Nigeria meets the said target in Borno State.

State coordinator SFH in Borno, Dr. Timothy Babah, said SFH is currently implementing the Key Population Community HIV Services for Action and Response 2 (SFH-KP-CARE-2) project in Borno State.

The project currently operating in four Local Government Areas of Maiduguri, Jere, Biu, and Konduga is aimed at increasing the demand for and access to comprehensive HIV prevention, treatment, and care services for Key Populations (Female Sex Workers (FSW), People Who Inject Drugs (PWID), Men who have Sex with Men (MSM) and the Transgender (TG) people.

“So far, SFH KPCARE2 Project in Borno state has served KPs, their sexual partners, social network, and children inclusive with HIV Testing Services (HTS_TST) on the 1st 95 by deploying various HIV Testing Modalities such as HIV Self Testing (HIVST) for hard-to-reach areas, Index Client Testing (ICT), Social Network Testing (SNT), Genealogy Testing for the children of KPs and Intensive Outreaches at KP hotspots within the state to optimise the testing coverage.”

With all of these efforts being put in place to curb the spread of the virus, the question is does this stop the discrimination that women face within their communities?

Site enhancement officer, MSSH (Maiduguri State Specialist Hospital), Honesty Iwenya, explained that the hospital assists 3,412 patients living with the virus to access treatment within the facility with IDPs accounting for 415. He said at present, the number of IDPs has reduced to 115 due to the relocation of the IDPs to their various LGAs.

However, despite efforts to prevent discrimination against HIV-infected women, Iwenya said most patients still experience discrimination.  He explained that discrimination arises because certain community members lack a proper understanding of the virus.

He added that their interactions with patients revealed that some individuals who are aware of someone’s HIV status inadvertently and unknowingly share this information, causing others to avoid those individuals.

Does the law allow discrimination against people living with HIV/AIDS in Nigeria?

Nigeria law forbids any form of discrimination against people living with HIV/AIDS. Former President Goodluck Jonathan, in 2014 signed the anti-discrimination bill into law that protects the rights and dignity of people living with HIV. The HIV/AIDS Anti-Discrimination Act 2014 makes it illegal to discriminate against people based on their HIV status. It also prohibits any employer, individual or organisation from requiring a person to take an HIV test as a precondition for employment or access to services. Despite the enactment of the law, many believe that the law is a mere paper tiger that roars but does not bite.

An analysis carried out by the Nigeria Demographic and Health Survey (NDHS) in 2013, which unfortunately seems to be the latest, showed that about half of Nigerians still exhibited stigmatising attitudes against People Living with HIV (PLHIV).  This discriminatory behavior was notably associated with factors such as younger age, urban residence, limited formal education, and economic vulnerability.

The study also showed that stigmatising behaviour was worst against women and was a reflection of the subsisting power imbalance that exists in patriarchal societies such as Nigeria.

Society for Family Health (SFH) Borno said although the Anti-Stigma Bill has been passed into law in Borno State, stigmatisation is still considered a major barrier, as there are still pockets of stigma and discrimination targeted at persons living with the virus, especially at the IDP camps, workplace settings, schools, and so on.

This may be attributed to socio-cultural practices, beliefs, and negative attitudes towards people living with the virus which stems from misconceptions about the disease amongst others, SFH said.

                                                                    A section of the Muna IDP camp

How Borno State deals with the problem

Representative of the Monitoring and Evaluation team of the Borno State Agency for the Control of HIV/AIDS & Malaria (BOSACAM) who work on the Prevention of Mother To Child Transmission (PMTCT),  Saraya Danladi, told us that before her agency carries out screenings in communities and camps, they always ensure they create awareness of the virus to the leadership and its people, but unfortunately in Borno State, most of the people discriminating against people living with HIV/AIDS are illiterates, especially those living within the different camps.

She said they always have difficulties convincing people to visit facilities within the camp to collect their medications because they are always worried that people would see them and tell on them.

She said: “When I worked with the Saving One Million Lives Programme for Results (SOML-PforR) at the Teacher’s village camp, we realised that some people simply resumed in front of our clinics every day just so see those going in so as to go spread the news. So, most of our patients refused to visit the clinic and we had to take their medications to them in secret.”

Saraya explained that they educate women living with HIV that this is not the end of life

“We realise that those discriminating against the carriers of the virus are just ignorant,” she said.

• This report was produced with the support of the Women Radio Centre through the MacArthur Foundation.