How Nigeria is tackling HIV/AIDS scourge
By Azoma Chikwe
As the world marks HIV/AIDS today, stigma and discrimination against members of the People Living With HIV/AIDS (PLWHA) remains the hurdle in efforts by many countries to end the scourge. Patients suffer societal and family isolation even as governments push out policies to alleviate their suffering. For instance, a victim, Gloria Asuquo, who had been living with the disease since 1999 recalled how her mother and even church leader discriminated against her. She said it got to a point that the church leader found out a place in Wuse, Abuja where people were abandoned to die and asked her parent to go and dump her there for fear of infecting other family members. Infact, Asuquo said was the first patient to be tested with antiretroviral in Nigeria.
“I tested positive in 1999, when I was about 12 years old. I contracted HIV through blood transfusion. Each time people come out to say HIV is through sex, I tell them, no, it is not only through sex. You can still get it in so many ways.
“My parents initially hid it from me. They didn’t want me to know I was HIV-positive. But my father revealed it to me a few months later. He asked what I would do if my friend was HIV-positive. I replied that I would not be friends with the person. A few days later, he asked me again, and I gave the same reply. Then, he told me that I was HIV-positive but I did not understand the impact of the revelation. There was no accurate HIV awareness, just stigma.
“Back in 1999, anybody that looked sickly was called ‘AIDS-carrier. Anytime we were talking as kids, we always had negative perception about the issue. My first stigmatization was when the reverend in my church advised my parents to throw me out of the house so I wouldn’t infect my family. He told them to send me to a hospice in Abuja. He showed my family a place in Wuse, Abuja, where people are abandoned to die. Then I was just 12 years old.”
Asuquo said although her father refused the reverend’s advice, her mother was in support, and this led to frequent fights. They finally agreed to create a separate, quarantined room for her in their house. “I ran away to the National Agency for the Control of AIDS (NACA), Nigeria’s coordinating agency that oversees all efforts to combat HIV and AIDS. I ran to them and cried. They took me back to the house and had discussion with my parents. When the situation didn’t improve, I ran away for three years, sleeping on the streets. But soon returned home when a university lecturer told me about access to antiretroviral drugs. I was the first person in Nigeria they tested ARV drugs on,” Asuquo said.
According to reports, “approximately 210,000 people died from AIDS- related illnesses in Nigeria in 2013, which is 14% of the global total.
Recently, Lagos State Governor Akinwunmi Ambode has revealed that about 9,579 cases were recorded between January and June 2016. He SAID that about 616,318 people were counseled, tested and received results during the same period, out of which 9,579 individuals were found to be positive. He advised HIV prevention efforts must be reinvigorated if the world is to stay on the fast-track to end AIDS.
Unprotected heterosexual sex accounts for about 80% of new HIV infections in Nigeria, with the majority of remaining HIV infections among key affected populations.
Sex workers, men who have sex with men and people who inject drugs make up only 1% of the Nigerian population, yet account for around 23% of new HIV infection
Reducing discrimination
The Nigerian National HIV/AIDS Strategic Plan (NSP) was introduced for enhanced behaviour change communication for key affected populations. To deliver this, peer education systems were being scaled-up, alongside social media messaging that aims to reach those populations who tend not to present for HIV services.
This also included increased HIV/AIDS awareness campaigns to teach the citizenry, everything they need to know about HIV/AIDS. This was also aimed at changing their mind sets about PLWHA vis-a-vis decreasing the level of discrimination and stigmatisation.
Despite increased awareness about HIV/ AIDS, stigmatisation in families and communities remains strong. Youths living with HIV said the most painful was discrimination when it comes to education and employment. Most of them who could not find jobs settled to work with non-governmental organisations. It was at this point that the advocacy for the government to pass the anti-discrimination bill to protect the rights of people with HIV and AIDS became even stronger.
Asuquo recounts her experience in seeking admission into a private university in Nigeria.
“The moment you come out on air to say you are positive and look for job, they may deny you. In schools, they have denied so many people admissions because of their status.
“I was denied admission into a private university; I met all the requirements. But after running a HIV test, they said they were sorry, they can’t give me admission because of my HIV status.
“You can imagine as a young person how devastated that is. I don’t have right to work. I don’t have right to freedom. In that case, young people will not like coming out to say this is what they are. Most private institutions require newly admitted students to take an HIV test.”
The bill
In February, 2015, former President Goodluck Jonathan signed HIV/AIDS anti-discrimination bill into law to protect 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 organization from requiring a person to take an HIV test as a precondition for employment or access to services.
The bill received accolades from stakeholders who saw it as a right step towards ending HIV/AIDS by 2030. Victor Omoshehin, National Secretary, Network of People Living with HIV in Nigeria said, “this is good news coming from the government to Nigerians living with HIV. We appreciate this unprecedented development, as it will help halt all HIV-related stigma and discrimination in the country and improve the national response.”
Former Director-General, National Agency for the Control of AIDS, noted that, “it was a much welcome action in the figh against AIDS, Prof. John Idoko, said, “it will help more Nigerians to seek testing, treatment and care services without fear of facing stigma and discrimination.”
While Bilali Camara, UNAIDS Country Director for Nigeria and UNAIDS Focal Point for the Economic Community of West African States opined that, “by signing the anti-stigma bill into law, the Government of Nigeria has given to all Nigerians living with or affected by HIV a guarantee to access justice and to regain their human rights and dignity in society while enjoying productive lives. Zero discrimination is the only environment conducive to ending the AIDS epidemic by 2030.”
HIV/AIDS today
The Joint United Nations Programme on HIV/AIDS said the world has exceeded the AIDS targets of Millennium Development Goal and is on track to end the epidemic by 2030.
It said the United Nations MDG goal of reversing the spread of HIV has been achieved with 15million people on life-saving HIV treatment by 2015 worldwide.
It said it was achieved nine months ahead of schedule, with new HIV infections fallen by 35 per cent and AIDS-related deaths also fallen by 41 per cent.
The statement reads: “The global response to HIV has averted 30 million new HIV infections and nearly eight million (7.8 million) AIDS- related deaths since 2000, when the MDGs were set.
“The response to HIV has been one of the smartest investments in global health and development, generating measurable results for people and economies.”
Prof. Idoko, announced that cases of new AIDS infection in Nigeria reduced by 35 per cent in the past four years.
He said, Nigeria’s AIDS response has gained steady momentum in the past four
years. This, according to Dr. Camara, has placed Nigeria among countries, which have reversed the HIV trend. “In Nigeria, this effort has to continue until 90 per cent of the 3.2 million people living with HIV in Nigeria are tested and know their results. Ninety per cent of those tested are put on treatment and 90 per cent of those on treatment suppress the virus.”
Prof. Idoko said for AIDS to end by 2030, the country must fund the 90:90:90 strategies in order to eliminate the progression of AIDS, premature death and HIV transmission.
He said the 90-90-90 targets referred to the pathway by which a person was tested, linked and retained in HIV care and the way the anti-retroviral drug was initiated and adhered to.
Dr. Camara said ending AIDS by 2030 was attainable in the country in the same spirit Nigerians fought Ebola. “At the end of 2015, I said with clarity that Nigeria is among the countries which have halted the spread and reversed the trend of the HIV epidemic.
“There is no doubt that with the fast tracking approach being promoted, Nigeria will end
AIDS by 2030.”
In his opinion, Abdulkadir Ibrahim, the National Secretary of Network of People Living with HIV/AIDS in Nigeria, said HIV testing was the first and most important step toward ending AIDS.
Ibrahim said the rate of HIV testing was, however, very low and unless the testing bottleneck was addressed, the potential of so many promising strategies would not be realised.“Placing less than 800,000 people living with HIV on ARV, where less than 50 per cent of those who needed to be placed on Anti retroviral therapy are not having access is totally unacceptable.
“Government needs to own up the interventions, put money on treatment,
prevention, care and support to ensure access to HIV/AIDS, TB and malaria services.”
Ending HIV/AIDS
When THE topic on PLWHA comes to THE fore, many people exempt themselves from it. But the big question is, how many of us know our HIV status. Remember, “AIDS does not show on the face.”
The global aspiration is to achieve zero transmission of HIV, zero stigmatisation of those who are HIV-positive and, more importantly, zero HIV/AIDS-related deaths.“This is possible if we all play our part. Do your bit by screening for HIV today. If you test positive, visit the nearest health centre and let the healing begin from there,” Idoko advised.
Human Immunodeficiency Virus, or HIV, is the virus that causes AIDS (Acquired Immune Deficiency Syndrome.) This virus attacks the body’s immune system and makes it difficult to fight off diseases, bacteria, virus and infections. Generally, HIV transmits through unprotected anal and vaginal sex, sharing injection drug needles, and from mother to child during pregnancy, childbirth and breastfeeding.
However, exactly how this happens is often a mystery to many people. Luckily, there is a simple three-part equation that helps to explain the process of HIV transmission.
First, you need to have someone infected with HIV, and someone to pass it on to. Then, HIV needs three things to pass from one person to another: A body fluid with lots of HIV in it: Sex fluids – semen, pre-ejaculatory fluid (“pre-cum”, the fluid secreted by the penis during sex before ejaculation), vaginal fluids, menstrual blood, and anal secretions (the fluid that is secreted by the lining of the anus). Blood; breast-milk (very small amounts of HIV, but enough to infect a baby); Brain and spinal cord fluid.
Any activity that shares these fluids: Unprotected anal or vaginal sex (very rarely,
oral sex can also transmit HIV); Sharing needles used for medications, drugs,
tattooing or piercing; From mother-to-child during pregnancy, childbirth and/or breastfeeding. Occupational exposure ( usually in medical and emergency professions, through accidental cuts,/pokes from used needles and scalpels).
HIV can get into the bloodstream through a fresh cut, sore or puncture wound (a needle poke); Through the special cells of sex membranes (the delicate skin that lines the inside of the penis, the vagina, and the anus); From mother to baby through the placenta and umbilical cord, if these organs are damaged during pregnancy or childbirth.
‘97% of Nigerians at risk of malaria’
By Doris Obinna and Ogechukwu Agwu
Malaria is a disease that is easily preventable, treatable and curable, but remains a major public health problem. About 100 million clinical cases of malaria are reported yearly in the country. This situation is due primarily to inadequate and incorrect information for the appropriate use of malaria commodities.
Reports say the disease adversely affects all age groups in rural and urban commodities in Nigeria. Successful control of malaria will reduce poverty, increase productivity, improve health, reduce school absenteeism and facilitate the attainment of the Sustainable Development Goals (SDGs.)
Malaria elimination strategies require lots of compliance and adaptation of behaviours for appropriate use of malaria commodities. However, lack of appropriate information for the correct use of these commodities have hindered attainment of the optimal desired outcome towards the elimination of malaria. As a result, the uptake and utilisation of malaria commodities have remained low. Persistent poor uptake and use of malaria commodities due to inadequate information is a threat towards elimination of malaria in Nigeria.
According to Dr Godwin Ntadom of National Malaria Elimination Programme (NMEP) “Fever is one of the common signs of malaria, which can also be found in other illnesses. Despite this fact, research shows that majority of Nigerians treat all fevers with antimalarial medicines, without consulting a health provider and testing with Rapid Diagnostic Test (RDT) or microscopy to confirm malaria. RDT is an easy, safe and effective way to confirm whether the fever is malaria. This can also prevent clients from wasting time and money.
“Long Lasting Insecticidal Nets (LLINs) are a type of mosquito net that is treated with insecticides that repel and kill mosquitoes. Sleeping inside LLIN every night is an effective means of preventing malaria by protecting yourself and family members from mosquito bites. Additionally, the chemicals used in making LLINs are safe to use and not harmful to human beings.
“LLINs are an effective tool in preventing malaria, and as such, large quantities of LLINs have been distributed across Nigeria. However, despite wide spread of LLINs, there are many cases of low and incorrect usage of LLINs in Nigeria, reducing net’s ability to protect against malaria. For example, the Nigeria Malaria Indicator Survey (NMIS) 2015 shows that while 69% of household own a net, only 37% of individuals – 44% of children under 5 and 49% of pregnant women – sleep inside one. Everyone can sleep inside LLIN indoor and outdoor, however priority should be given to vulnerable population (pregnant women and children under five).
“Nigeria has adopted the use of LLINs as one of its key interventions for malaria prevention, and it is recommended that every person sleep inside a LLIN every night. The National Policy and Guideline on malaria identifies LLINs as a critical element for malaria elimination in the country. This is in agreement with the World Health Organisation’s(WHO) global recommendations to end malaria.”
Antenatal care (ANC) is the special care pregnant women receive from skilled health workers during pregnancy. In Nigeria, pregnant women are given free Long Lasting Insecticidal Nets sand SP as part of ANC to help them prevent malaria.
In Nigeria 97% of the population is at risk of malaria. The pregnant woman and her unborn child are most at risk of dying from the disease. According to the 2015 Nigeria Malaria Indicator Survey ( NMIS), 37% of pregnant women take 2+ doses of SP at least once during an ANC visit. This is significantly low given that malaria during pregnancy affects both the mother and the unborn child.
Early attendance of ANC is very important for pregnant women for a safe pregnancy. Pregnant women should take at least THREE doses of SP for intermittent Preventive Therapy ( IPT) to prevent malaria.WHO says every pregnant woman should go to a health facility for ANC early during her pregnancy.
Ntadom said, “many years of use of a single drug ( monotherapy) for treatment of malaria around the world has led to resistance of the malaria parasite to the these drugs once considered effective against them. As a result,WHO recommended a change to the use of a combination of drugs – artemisinin or its derivatives and one or more other active ingredients. The umbrella term for these combination therapies is ACT, Artemisinin based combination therapy.
“The Artemisinin-based combination Therapy ACTs have been adopted by Nigeria for the treatment of malaria in agreement with WHO recommendation. ACTs are effective in the treatment of malaria. They are the best medicines for malaria all over the world.”
