LAGOS, Nigeria – They arrive in small brightly colored packages, having been ferried through the notorious gridlock of Nigeria’s huge cities. What’s inside could be anyone’s guess, and that’s the point.
The contents of the packages, HIV self-testing kits, are helping save lives amid the world’s second-largest epidemic – but many of the people receiving them would face stigma and rejection if anyone found out.
While almost 3 percent of Nigeria’s population of 186 million has HIV, only 10 percent of the population has been tested for the virus. The Nigerian National Agency for the Control of HIV/AIDS recommends testing every three to six months for people in high-risk groups (sex workers, gay men and people who inject drugs) and Nigerians have a range of options of where to get tested: government clinics, which offer free services; private facilities; or through home-test kits available at pharmacies.
Today, women constitute more than half of all people living with HIV. AIDS-related illnesses remain the leading cause of death for women of reproductive age (15-44). In Nigeria, young women are at greater risk of contracting HIV than young men. last year, 46,000 young women were infected with HIV, compared to 33,900 young men.
But all of those options require a person to reveal to someone else that they are taking the test. That’s the problem the brightly colored, anonymous packages are trying to address.
A health startup, Slide Safe, allows customers to get their kits sent straight to them so they can use them in private and, if they want, keep the results secret. It’s the only company in Nigeria delivering HIV home-test kits directly to customers – others send their products to pharmacies.
To protect the identity of her customers, the delivery company’s drivers don’t know what’s inside the packages and don’t have copies of the order invoices. To date, Slide Safe has delivered more than 720 packages, mostly to offices, but also homes and hotels.
Stigmatized for Fighting HIV
Florida Uzoaru, a former nonprofit health worker, launched Slide Safe in Abuja and Lagos at the beginning of 2017. She is one of the 40 percent of Nigerian women who are entrepreneurs, a rate far higher than the U.S. or U.K.
She grew up in a conservative family with five siblings, and came up with the idea when her sister, who is 13 years younger and lives in the U.K., asked her for advice on birth control.
“It really got me thinking. If she is having issues like that, how can I help people who are like her in Nigeria?” Uzoaru says. After a year of market research, she saw there was a need for confidential HIV testing and came up with the kits. The company also delivers boxes of condoms and lubricants.
But by highlighting the issue of HIV testing in public, Uzoaru has become the target of insult and abuse herself. Strangers on Facebook have called her “crass” and said she has “no class.” One of her uncles was “really, really nasty” after she founded the company, she says.
“He kind of feels it’s embarrassing the family.”
Some hotels have refused to carry the kits to sell to their guests. “[They] just flat-out said that they feared they would be telling their guests they are whores,” she says.
Uzoaru won’t let the fear and prejudice surrounding HIV stop her from her plans to expand to the city of Port Harcourt in December and eventually lower the cost of the kits. Her goal is to give everyone in Nigeria the chance to find out their HIV status, to get help if they need it and find peace of mind if they don’t.
She says many of her customers were too frightened to get tested until they found out about her kits. “Some people feel that just [because] they want to test, they are to some degree accepting the chance that they may be positive,” she says.
Testing At Home
The Slide Safe kits, which also include self-testing tools for Hepatitis B and syphilis, contain an illustrated manual explaining to customers how to test themselves using blood from a fingerprick.
The company says the kits, which start at 4,000 Nigerian Naira ($11), give accurate results in less than 15 minutes. But it encourages anyone who tests positive to get a second opinion from a doctor.
Daniel Ndukwe of NACA’s Program Coordination Department says the organization sees several benefits to testing at home. As well as allowing people to test confidentially, it cuts down on lines in health clinics, where people can wait “sometimes for hours” to be tested. And self-test kits could make it easier to reach people in remote parts of the country, where there are no clinics or hospitals.
But Ndukwe also stresses the downside to self-testing, including the risk that someone could perform the test incorrectly and get a false positive.
Slide Safe also offers free pre- and post-testing counselling, mainly by phone and WhatsApp, to help people get through what can be a traumatic process. But the company leaves it up to the customer to decide whether or not they divulge their results to Slide Safe.
“We try not to ask so that it doesn’t seem as if we’re trying to encroach on their privacy, but more often than not they volunteer the information,” Uzoaru says.
“We say, ‘Whatever your result, we want you to feel free enough to talk to us, because we’re going to help you whatever it is.’”
“You have that piece of mind. You don’t have to share your results, it’s up to you,” says Princess*, a Slide Safe customer living in the capital Abuja, who ordered a kit so she could test herself after before trying for another child.
In Lagos, Hope* found out about Slide Safe on Facebook, but after she received the kit, she says, “I couldn’t bring myself to do the test” for two or three weeks.
Finally, “I said, ‘Why don’t I do this test now and if it is positive I can look for solutions, immediately?’”
In the end, she says, it was not a big deal. “It’s all about your health.”
*Names have been changed to protect identities.