Recent reports have it that Nigeria ranks topmost in terms of latest figures on HIV infected babies around the world. According to the Director General, National Agency for the Control of AIDS (NACA) Dr. Sani Aliyu, the challenge posed by stigmatisation of people living with HIV/AIDS, access to care services, busy nature of youths, and lack of comprehensive knowledge of the dreaded disease are among the factors encouraging the increase of HIV/AIDS among the youth in the country. In this cover story, PharmaTimes Editor, MORGAN NWANGUMA x-rays the predominant factors responsible for the appalling statistical tag hanging on Nigeria in the global ranking of nations with the highest prevalence rate of HIV/AIDS epidemic, after South Africa.
The United Nations Organisation’s latest report says half of new infections of HIV/AIDS in the West African sub region come from Nigeria! When this revelation is juxtaposed with another recent report that Nigeria also accounts for more HIV-infected new-borns – more than any nation in the world, it becomes easier to understand why the country still has about 3 million Nigerians who are living with the infection.
The pandemic, unknown to many has had, and continues to have destructive effects on the socio-economic fabrics of the country.
Need for education
Commentators in health are unanimous in their view that many people living with HIV in the country are unaware of their status. According to them, Nigeria has inadequate provision of the recommended number of HIV testing and counselling sites and this has given rise to escalating figures in the number of people living with HIV/AIDS.
To buttress this point, a medical expert, Dr. Aliyu in a recent interview on Channels TV monitored in Lagos, disclosed that over one million people are on treatment in the country while at the same time, it costs the country about N50,000 to keep a patient on treatment annually.
It would be recalled that many years back the general notion was that once you’re diagnosed with HIV it was a one way ticket to death; and in the early days it was actually so for most victims of the dreaded disease especially for those in less developed climes. But with improvement in social awareness and medication such as the antiretroviral drugs coupled with early detection, it has become evident that the victims can still lead a healthy life.
Obviously most of the victims of the disease are young people, hence the need for a coalition of young people who are living with the virus in the country. The Association of Positive Youths Living with HIV/AIDS in Nigeria (APYIN) was eventually brought to birth in order to make care and support readily available to adolescents and youths living with the disease. It also seeks to empower them with sufficient knowledge on sexual reproductive health as well as rights issues and Positive health, dignity and Prevention.
In a recent forum the National Coordinator of APYIN, Mr. Isah Mohammed emphasised the need to remove stigma and encourage fellowship and bonding with fellow citizens living with the virus, while encouraging them to go for counselling. Mohammed stated that people living with the condition urgently require the requisite knowledge vis-à-vis the general populace regarding the need to check contracting the virus as well as re-infection.
The following information is also important to appreciate why Nigeria needs to re-double efforts in the renewed campaign against the dreaded disease.
Nigeria ranks second in HIV epidemic in the world, and also has one of the highest rates of new infection in sub-Saharan Africa.
Many still die of AIDS-related causes due to inadequate access to antiretroviral treatment in Nigeria.
Also, the country ranks fourth largest tuberculosis epidemic area in the world; HIV and TB co-infection is a growing source of worry for people living with HIV.
Available statistics show that just six states in the country (Kaduna, Akwa Ibom, Benue, Lagos, Oyo, and Kano) are responsible for 41% of people living with HIV. The South-South zone of the country is known to have the highest prevalence of HIV – at 5.5% while the South-East zone comes with the lowest prevalence rate of 1.8%. Generally, the disease occurs at a higher rate in rural areas which is 4%, than in urban settings being 3%.
In 2016 about 160,000 people died from AIDS-related illnesses in Nigeria. Since 2005, there has only been a minimal decline in the number of annual AIDS-related deaths, which goes to show that only 30% of those with the virus in the country are accessing antiretroviral treatment (ART).
Since its inception in June of 2005, APYIN through the years has been coordinating efforts in sensitising the public and especially its members towards preventing further spread of HIV among young people and the general public. Its programmes touch on the social, economic, religious, and political challenges that have to do with sexuality and reproduction particularly as it concerns the youth.
APYIN highly considers in its activities the prevailing current of thoughts among the different genders as it networks with them within young people living with HIV/AIDS in the country. Its core values are centred on, encouraging adolescents and youths living with HIV (aged between 10-35 years) to get involved, and rubbing of minds on issues and programmes relating to young people living with HIV and AIDS in Nigeria.
In further ensuring the prevention of the dreaded killer virus, we need to fully understand as well the nature of the disease and the factors of environment and social behaviours that could make or mar the situation at hand.
Facts on Nigeria include that it has a mixed epidemic; this implies that although HIV prevalence among the general population is high, some groups still bear a far heavier load of HIV in contrast to the rest of the population. For example, prostitutes, homosexual men and people who inject drugs constitute merely 3.4% of the people; nevertheless they form approximately 32% of new HIV cases.
Homosexuality amongst men
The strange phenomenon of men having sex with men is one that is creating another growing concern in the bid to curtail and stamp out the infection, especially with the practice being regarded as unlawful. It is only in this case that we see a steady rise in HIV prevalence in Nigeria according to expert survey.
This group overtook prostitutes in 2016 as the most affected by the disease in the country, then with a prevalence rate of 23%. And most recent available statistics shows that 10% of all new HIV infections in the country occur among homosexual men.
But since such social behaviours as this have been outlawed it makes it more difficult for civil society organisations to work with LGBT communities thereby forcing men who have sex with But after all said and done, it is gladdening to hear from NACA that the law prohibiting the practice in Nigeria does not in any way stand to deny anybody in the country access to HIV treatment and other medical services.
Meanwhile the fact remains that unprotected heterosexual sex is responsible for 80% of new HIV infections in Nigeria, with the greater part of other HIV infections taking place in seriously affected groups like prostitutes.
Mr. Mohammed said recently that APYIN has continued to advise people in his category to come out of their shells and interface with like members of the public so as to draw strength for living. In a recent programme he called for more enlightenment and mass education especially regarding how to avoid contacting the virus, as well as how to prevent the spread of the infection by those already living with the virus. He advised people living with HIV/AIDS to come out and seek counselling.
HIV Counselling and Testing (HCT) is done in three distinct components: pre-test counselling before the blood is taken; taking of blood sample and test by using rapid test kits; and disclosure of result, counselling and referrals, depending on what the result shows. Provider Initiative HCT strategy is available to majority of government hospitals and patients are supposed to access the services free of charge! Thus HCT will help many know their status, aid in preventing HIV spread, accessibility to medical care if positive, get education for positive living, and it provides information and educates members of the public on prevention.
An overview of the general situation reveals that the world has made tremendous progress since the early 1980s when the disease first broke out. The human toll worldwide has been grievous loss, with nearly 80 million infections and 35.4 million lives lost since the first cases were identified. But in the very recent past a greater achievement has been scored by the WHO and its allied agencies in the various regions – in arresting new infections and deaths. Also, According to Michel Sidibe – Executive Director United Nations HIV/AIDS agency (UNAIDS), Nigeria enrolled 1.3m HIV/AIDS victims on antiretroviral drugs in first quarter of 2017.
The Executive Director said, “Some countries continue to concern us, such as Nigeria which accounts for about half of all new infections in West Africa.” The report said almost three in five people infected with HIV, or 21.7 million globally, took antiretroviral therapy in 2017, a new record for anti-AIDS drug access. But recently there are still concerns owing to a number of factors. Last year for instance, there were about 36.9 million people living with the immune system-attacking virus, but of this number about 15.2 million were not able to access the drugs they needed, and according to UNAIDS report, this is the lowest number since the epidemic broke out.
The snag as situation stands now is that this progress may be under threat if funding is inadequate to meet the urgent needs as required. The agency thus warned that, “We are short $7 billion per year to maintain our results and to achieve our objectives for 2020.” For instance, only 40 percent of people living with HIV/AIDS in West and Central Africa have access to antiretroviral drugs (ARV). And very importantly, the authorities confirm that antiretroviral drugs are supposed to be given out FREE in Nigeria!