IAS 2011: Assessing Nigeria’s position in the global fight against AIDS

By Kemi Yesufu,
Nigeria is one of the countries with the biggest Acquired Immune Deficiency Syndrome (AIDS) burden in the world. According to statistics, despite, the reduction to 4.4 from an over six percent national prevalence rate, Nigeria is only second to South Africa on the continent as per recorded cases of the disease. This makes Nigeria’s success in the control of AIDS pivotal to the global fight to curtail the spread of HIV.

It therefore was pertinent for Nigeria to attend the 6th International AIDS Society (IAS) Conference. The summit took place in Rome, Italy from 17th -20th July. Though Nigeria has made progress in management of the disease with the National Agency for the Control of AIDS (NACA) making head way with the national response on AIDS, the consensus is there is still a lot of work to be done. Since its inception, the IAS Conference has provided a platform for scientists, health equipment manufacturers, pharmaceutical companies, government agencies, public healthcare officials and the academia to exchange ideas on the management of the disease. The IAS conference 2011 theme, “HIV Pathogenesis Treatment and Prevention” has been described as timely and most appropriate, as it came a little after the world marked 30 years of the disease in human though scientists at the conference reminded attendees that SIV, (HIV in humans) had long existed in Monkeys and Apes.

Scientists at the conference equally stated that there is still no agreement on how SIV was transmitted to human from apes and why these primates never come down with AIDS like their close relatives, the humans, it is worthy of note, that scientists and health administrators were more concerned with using treatment as a veritable tool for prevention of AIDS. Notwithstanding the show of indifference shown by the absence of the Federal Ministry of Health which implements 85 percent of the HIV/AIDS treatment and prevention programs of government and that of the Women Affairs and Social Development ministry which oversees a large chunk of programs on infant and maternal survival, it is important to say that Nigeria stands to gain a lot by improving on its treatment model. Nigeria has placed 400 thousand Persons Living with HIV/AIDS (PLWHAs) on Anti-Retroviral; the number falls short of the country’s target of no less than one million persons. This much was acknowledged by the Director General of NACA, Professor John Idoko who led the Nigerian team to the conference. He said all efforts were being put in place to increase access to treatment especially for expectant mothers. Indeed, for experts at the conference the sure route to an AIDS free generation is for countries like Nigeria to stop pediatric AIDS. Idoko said, “treatment has helped a great deal in reducing new infections in Nigeria. When a person uses ARVs it reduces the viral load and this makes it less possible for the person to infect someone else. It is this principle that is used in reducing transmission of the virus. We have also adopted the principle that we will not restrict treatment for pregnant women whose CD4 count is less than 350. We use the HAART option, we give three drugs from the pregnancy, to delivery and to when the woman weans the baby, so you protect the woman and she will not transmit the disease during pregnancy, delivery or during breast feeding. The second option is to use two drugs from the time of pregnancy any time from 24 weeks to one week after delivery but in addition you will give the baby Neverapine syrup. All of these are to prevent transmission through treatment and we have recorded success though we are working towards doubling the number of success stories”.

Government has struggled with interventions in the health sector largely due to corruption, dilapidated structures and lopsided distribution of skilled personnel. However, NACA has pledged to continue with action aimed at stopping new infections by targeting hitherto overlooked groups. This much, Idoko disclosed. “There are two things recent studies have come up with. First you have the pre-exposure prophylaxis. These drugs work to break transmission of the virus from a HIV positive person to an HIV negative person when the latter is exposed to the virus either through sex or other means. Studies have shown that this drugs work for both Men who have Sex with Men (MSM) and heterosexual sero-discordant couples. I am part of a chore team set up globally to work on the use of prophylaxis and Nigeria has been chosen as one of the countries in which demonstration studies will be carried out to see how it works in certain environments. If we are successful, then, we will scale up the program”, he said.

He argued that it was not a case of misplaced priorities for Nigeria to take up use of prophylaxis. Hear him, “for a country like Nigeria where people might ask why we should be using resources on prophylaxis for uninfected persons when we need to double the number of sick people on ARVs, I would like to say that prevention should be the starting point for treatment. For us, we must prevent new infections among sero-discordant couples; the fact is that couples have the desire to live a normal life and to have children. So, once we send our proposal to this committee and we get the funds, we will commence the study in states with high prevalence rates”.

A major complaint among PLWHAs is that government doesn’t assist in the treatment of opportunistic infections such as malaria and tuberculosis. Though, the AIDS, TB and Malaria (ATM) Task force is headed by the minister of Health, government has often argued to the chagrin of PLWHAs that it will not be able to provide free treatment for these infections, blaming its position on paucity of funds. Another issue government has performed poorly on is its structural approach to the control of AIDS especially among commercial sex workers. This problem remains a stumbling block to stopping new infections. In Nigeria, a country where over 70 percent of new infections is recorded among heterosexuals, commercial sex workers have been identified as one of the groups that fuel the disease, yet, they are often criminalized just as they are stigmatized and discriminated against.

According to the NACA Director General even with the IAS conference tasking countries to seek innovative ways to integrate sex workers into their programs, such interventions remain a Herculean task in Nigeria. “Combination prevention strategy takes into cognizance, behavior, biomedical and structural intervention. For structural approach, it is about solving the problems we know that put people at risk of the disease, from the political, socio-cultural and socio-economic perspective. We have a big problem with commercial sex work in Nigeria. First thing is that commercial sex workers are not organised. There are a few commercial sex workers who have orgnaised themselves into groups but things are still patchy and this makes it difficult for us to reach them”. Continuing he said, “on this issue we also have to address the problem of stigma and discrimination, so they can be open to testing and getting treatment for those who test positive. We also need to create jobs or create the right conditions for income generation so some of them will leave what they are doing”.

Probably the most disturbing setback for AIDS control is the low percentage of research in Nigerian Universities and allied institutions. While most of the work presented at the IAS Conference 2011 came from or was done in association with the academia, Nigeria had only a few papers presented with Universities poorly represented. One of the few Nigerians with an abstract at the conference, Adamma Emejulu a Doctoral student and lecturer at the HIV Research Unit of the Biochemistry Department of the Federal University of Technology Owerri explains why there was a poor showing by Nigeria. “We hardly get funding for research. Here, I have seen colleagues from other parts of the world being funded by the UN agencies, the private sector or some of them are beneficiaries of research funds provided by their government. In Nigeria we have resorted to limiting ourselves to where our pockets can carry us and this is frustrating”. On resumption in office the current NACA DG had stated the need to focus on research as the agency stands to benefit from locally carried out research. On how much of the promise has been kept, especially as there are willing scientists who are being slowed down by lack of funds, he said, “We have established a research Unit in NACA, last year we brought in two professors on sabbatical and we have put a research policy together outlining our priorities. We are putting up a fund for we will soon advertise for people to apply to an expert committee who will now select proposals that will be funded by NACA. We are also planning on a fund for young scientists and young media scientists”.

In all Nigeria’s outing at the IAS is reflective of its position in the global fight against AIDS. NACA as the statutory body in charge of the control of AIDS is carrying out its duties within many limitations. Most of the prevention and treatment polices enunciated at the conference were already in practice in Nigeria but there is urgent need to scale them up particularly in the rural areas. The absence of the ministries who should spear head the control of the disease highlighted the disjointed nature of the national response to AIDS. The handful of researchers from Nigerian institutions mirrored the lack luster situation in the country’s academia.

http://www.independentngonline.com/DailyIndependent/Article.aspx?id=38310