Following a spell in which the incidence of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome was said to be in decline in Nigeria, the country now faces the grim prospect of a reversal of the gains earlier made, due mainly to lack of sustained and committed funding of the fight against the scourge. A substantial part of the funding for the campaign against the spread of HIV/AIDS comes from international sources. But, while most of the foreign donors have been gradually withdrawing, citing corruption and lack of transparency and accountability in the administration of the funds, among other reasons, the Nigerian government, both at the state and national levels, has failed to step up boldly to fill the emerging gap.
The result has been a rapid reduction in the number of people having access to treatment, which formed the basis of a recent address by the Governor of Rotary International, District 9125, Mike Omotosho. According to him, only 600,000 of the estimated 3.5 million Nigerians living with the deadly virus are covered by the official treatment programme of the government. This is not good enough for a country that is committed to containing the spread of the deadly ailment.
Invariably, those outside government cover are left with no choice but to fund their own treatment personally. The danger in this situation is that, if such people lack the means to fund their own treatment – which is very likely, given the prevalent dire economic situation in the country – then they are left with the option of a resignation to fate, which translates to a rapid deterioration in their condition and an inevitable death. The damage is not limited to that; lack of access to treatment also paves the way for an increase in the rate of HIV transmission.
HIV is the virus that causes AIDS. The virus on its own does not kill, but attacks the human immune system and compromises the ability of an infected person to fight off diseases. By the time the attack on the immune system progresses to the stage of AIDS, the patient becomes a victim of opportunistic diseases that ordinarily could have been fought off by a normal, functional immune system. This natural deterioration is however preventable by administering the anti-retroviral therapy, which keeps down the viral loads and allows a carrier of the virus to live an almost normal life.
Although HIV/AIDS has no known cure yet, access to life saving ART offers a lot of hope to those living with the virus. Apart from slowing down the progression towards AIDS, ART reduces the risk of transmission of the virus by as much as 96 per cent, according to UNAIDS. Administering the therapy also reduces the risk of opportunistic diseases, including tuberculosis, that take advantage of compromised immune system to attack an infected person.
According to figures from UNAIDS, ART averted the death of estimated 5.5 million people in low- and middle-income countries between 1995 and 2012, with most of the survivors accounted for by sub-Saharan Africa. As of 2012, it was estimated that between 23.6 million and 26.8 million people living with HIV were in Africa, with South Africa having the highest burden.
It was because of the positive outlook offered by ART that the United Nations came up with the vision of ending the spread of the disease by 2030. The Federal Government also bought into that vision when it started a programme of free ART at designated facilities across the country in 2006. But, instead of a gradual expansion of the programme to accommodate more patients, lack of funding is now forcing a lot of people out of it.
Most significant has been the inability of the Nigerian health authorities to ensure the prevention of mother-to-child transmission. Despite the fact that this mode of transmission is preventable, Nigeria’s rating in a 2013 UN report was abysmally poor. “Nigeria has the largest number of children acquiring the HIV infection, nearly 60,000 in 2012 – a number that has remained unchanged since 2009,” the report said. In fact, the United States Centres for Disease Control and Prevention also observed in 2014 that the number of those living with HIV/AIDS increased by 500,000 in the three previous years, resulting in 217,000 deaths within the same period.
The Director-General of the National Agency for the Control of AIDS, John Idoko, however, disagrees with the claims of resurgence in HIV/AIDS cases. A report quoting him last year said Nigeria was at a critical stage of eliminating the disease. “The number of new infections is coming down; the number of people dying with HIV is coming down. And one of the big areas we are struggling with: interrupting transmission from HIV women who are positive to their babies is also coming down,” he reportedly said. But with his admission that about 800,000 people were on drugs, out of estimated 3.5 million infected people, it is difficult to see where his optimism is coming from.
Nevertheless, there has to be a new level of commitment from the government at all levels, if the 2030 target is to be met. This has to start by encouraging people to know their status, by voluntarily submitting themselves to HIV tests. This will help in deciding an informed strategic plan. Thereafter, the government has to ensure that treatment is readily available for those that have been infected because of the stated advantages of treatment.
For HIV-infected pregnant women and breastfeeding mothers, experts recommend that ART should be initiated early to prevent mother-to-child transmission during childbirth or during breastfeeding. For a country like Nigeria, manufacturing the drugs locally will also go a long way in ensuring their availability and affordability. Also very important is the need to be faithful with the recommended drugs regimen once treatment starts, as breaking up midway could lead to resistance to drugs and create a more difficult situation.
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