Why HIV/AIDS cannot be ignored
About 34 million people are living with HIV worldwide, according to World Health Organisation (WHO), and at the end of 2012, about 10 million people hadaccess to antiretroviral therapy (ART), which also has prevention benefits. Nigeria ranks high in terms of prevalence of those living with HIV, and though they have benefited from the ART treatment, these persons face challenges in terms of stigmatisation and discrimination, and there are also challenges in execution of government policies and programmes that address HIV and funding for the research, delivery and treatment of HIV in Nigeria. KEMI AJUMOBI writes
Lucy Attah-Enyia resides in Ajah area of Lagos. She has been living with HIV for 15 years. Fortunately, her three children are negative, thanks to antiretroviral drugs. Today, she is the CEO of Women and Children of Hope established in 2000to support women and children living with HIV.
“When I found out my HIV status, it was a rude shock for me. I went through my share of stigmatisation, I lost some friends but others stayed. It was really a trying period for me but now, I am bold to share my experiences with people and educate people on HIV/AIDS and the way forward. In 2000, I established the Women of Hope Foundation through which we rally round to get support for those living with HIV/AIDS. It has been challenging as funds are not readily available. Many of them haven’t gotten used to the fact that they are going to be positive for life except a miracle happens, so I do my best to counsel them,” she says.
Speaking further about her challenges, Lucy says, “The major thing is finance. I recently went to submit my application for funds here in Nigeria and I was told I was late even though it was the same day they were to close, I got there by 4pm because something came up that I had to attend to yet my letter was not accepted. HIV/AIDS is not something you can guess whether you have or not, you either have it or you don’t have it. I have been living with HIV for 15 years only by God’s grace, I came to also help better the lives of the orphans and women I am caring for and they did not put this into consideration. Living with HIV is challenging enough, we do not need for people to add to what we are going through already.”
Lilian Ode stays in an uncompleted building in Lagos where she has been living for months with her two-month-old baby. Her husband has psychiatric challenges and was even taken to a psychiatric home to be cared for. “When it rains, it drenches me, when the weather is hot I feel it, because the place is open, I am open to a lot of things. Worst of all is that once this structure gets to a certain level, I will have to leave here because the owners will plaster their house, paint and move in. I am still here because the structure hasn’t reached that level yet; when it does, I wonder what I will do or where to return to.”
“I was a tailor but now sewing is a challenge; I don’t have my machines anymore, caring for my baby also has the challenges because I can’t breast-feed her, I thank God for the people of Women and Children of Hope who sometimes help by getting baby food. As I speak with you now, I am feeling cold, my body temperature goes up and down, it has not been easy but I look to God for help and I know He will send help my way,” she concluded amidst tears.
HIV/AIDS
Human Immunodeficiency Virus infection; Acquired Immunodeficiency Syndrome (HIV/AIDS) is a disease of the human immune system caused by infection with human immunodeficiency virus (HIV). During the initial infection, a person may experience a brief period of influenza-like illness. This is typically followed by a prolonged period without symptoms.
As the illness progresses, it interferes more and more with the immune system, making the person much more likely to get infections, including opportunistic infections and tumours that do not usually affect people who have working immune system. Genetic research indicates that HIV originated in West-Central Africa during the early twentieth century. AIDS was first recognised by the Centres for Disease Control and Prevention (CDC) in 1981 and its cause—HIV infection—was identified in the early part of the decade. Since its discovery, AIDS has caused nearly 30 million deaths (as of 2009). As of 2010, approximately 34 million people are living with HIV globally. AIDS is considered a pandemic, a disease outbreak which is present over a large area and is actively spreading.
Consolidated guidelines on the use of ART Standard antiretroviral therapy (ART) consists of the combination of at least three antiretroviral (ARV) drugs to maximally suppress the HIV virus and stop the progression of HIV disease. On June 30th, 2013, World Health Organisation (WHO) launched a new consolidated guideline on the use of antiretroviral drugs for treating and preventing HIV infection.
The guidelines combine existing and new clinical, operational and programmatic guidance on the strategic use of antiretroviral drugs. They recommend earlier initiation of treatment, with simpler and safer regimens to save more lives and prevent more new infections.
Interview with ALANI SULAIMON AKANMU, Professor of Haematology & Blood Transfusion, LUTH
Prevalence of HIV in Nigeria
We have been monitoring the prevalence as far back as 1989. In Lagos University Teaching Hospital, we have monitored the virus in the population of blood donors and in 1989, less than 1 percent of blood donors were HIV infected. But over the years, we saw an increase and by 1999/2000, it rose to 11 percent among the blood donors.
The Nigerian government started the monitoring of the prevalence as far back as 1999/2000 and every two years, the federal government through the ministry of health conducts a bi-annual study of the disease in Nigeria and we see how it has grown from less than 1 percent to about 5.8 percent in 2003 but by 2005, 2008, 2010, we saw a decline from 5.8, to 5.1, to 4.6 and now down to 4.1. 4.1 meaning that 4.1 percent of the stratum of the population in Nigeria that are usually HIV infected are living positively and the population usually tested are within the ages of 15-49.
We estimate that the volume of Nigerians within that age bracket is about 80 million which implies that 4.1 percent of 80 million Nigerians are HIV infected. That is how we get the figure of 3.8 percent of Nigerians living with HIV and that is a very high figure. The only country in Africa that has higher statistics of people living with HIV is South Africa meaning that if SA is number one in the world, then India and then Nigeria, with a population of close to four million people living with HIV; that is very high, that is the magnitude of HIV infection in Nigeria.
Funding
A colossal amount of money has to be put into managing it because the population affected is large. Besides, not every HIV patient will be on ART. We estimate that any point in time, depending on the criteria to be used to initiate therapy, about 25 percent of the population that are HIV positive will need ART that is why we say in Nigeria today, approximately 1 million people should be on ART and from the figures we have today given the resources supplied by associated organisation and companies, close to 500,000 patients in Nigeria today are on ART and we have only 50 percent coverage and the ideal according to WHO is that by 2015, every country should have achieved 100 percent coverage or universal coverage so for now, we are not meeting the target of WHO.
The criteria stipulated by WHO states that the process should be more relaxed so that people can come for treatment. If this happens, then we won’t be saying only 1 million Nigerians should be put on treatment but about 2million Nigerians. If only 500,000 people are covered it means a decline from 50 percent to 25 percent. Putting an individual on treatment is not only supply of drugs but provision of laboratory equipment to monitor the effectiveness of the treatment and safety.
To put someone on treatment of ART per month, will cost N20,000 for 12 months; it is N240,000. How many people will be able to afford this? Where is the money going to come from? Managing HIV/AIDS requires huge funds. Luckily though, the Federal Government of Nigeria is talking more and more about this and recently, there was a meeting with AU on matters relating to HIV/AIDS in Abuja and it was devoted solely to the problems of finding solution to the pandemic.
In treating the infected person, funding is also needed for those who will deliver ART. There is need to invest money in training of doctors because today in schools, curriculum of training medical students of pharmacy and nurses does not include treatment for those with HIV/AIDS and this is something that is very important.
We do not have graduates coming from medical institutions having knowledge on how to manage HIV/AIDS. It is those already in service that are having in-service training that are used to manage these cases and we have to invest so much money in the training and retraining of doctors, pharmacists, nurses, lab scientists and record keeping people.
ART is a life treatment which must not stop; once it stops, resistance is developed and that is dangerous. The patient’s liver, kidney, bone marrow and others needs to be monitored so funds are required for investment of efficacy and toxicity.
Close to 75-80 percent of monies spent in Nigeria to manage HIV/AIDS comes from the US. There are implementing partners. When we started HIV treatment here in LUTH in 2004, we were partnering Havard School of Public Health in the programme called Harvard PEPFA programme, and PEPFA is an initiative of US government.
When they realised the need in combating HIV/AIDS in Africa and Caribbean, they committed 15billion US Dollars for this purpose to be spent over a period of five years and Nigeria was one of the selected countries. I remember Obasanjo insisted that Nigeria must be on the PEPFA programme and it succeeded. That is part of the reasons why the 500,000 people living on ART can benefit from this.
Possibility for cure as recently reported
This was as a result of an individual that received bone marrow transplantation in Germany. What happened that this individual had a blood cancer called ‘acutemmyeloid Leukaemia’ (AML), and to achieve cure for AML, there has to be a bone barrow transplantation and you need a donor. How this works is that the blood cells of the person with AML is wiped out, all the blood cells in the person’s bone marrow and then bone marrow tissue is gotten from a donor and put in the infected person.
What happened in the case of the person reported in Germany was that the person also had HIV infection. He had two diseases but what the doctors treated was AML. However, the cell collected from the donor had a type of cell that is not infectable by HIV; meaning naturally, there are very few percentage of the number population that cannot be infected by HIV.
Those cells infectable by HIV have unique characteristics that will make them infectable by HIV. If by chance an individual has an inherited deficiency of that characteristic, it means that you can have HIV thrown into your blood but the cell that should be infected by it lacks a particular protein with which it should interact with HIV and that protein is deficient in you. That particular protein is called ‘chemokine receptor type 5’ (CCR5 protein), and that is a protein that is meant to be present on the membrane of a cell that is HIV infectable so if you have an inherited abnormality of the CCR5 protein, someone can bring HIV infection into you and you might not be infected.
The donor of the marrow to this individual came with cells that had CCR5 protein and that was the transplant that this person had so he was cured from AML and by chance cured of HIV; what we call serendipity because the virus in the person disappeared. And because of the chance finding, the National Institutes of Health (NIH) has given a university in Pennsylvania a grant of about $20 million for years of research to ascertain whether that scientific feat can help produce a cure for HIV. The work is ongoing.
Other possibilities in the nearest future
In the last Conference on Retroviruses and Opportunistic Infections (CROI) meeting, a meeting with US scientists on retroviruses which was held few months ago in Atlanta, they presented a ‘baby Mississippi’; the baby was confirmed to be HIV positive. They initiated treatment and the baby is cured from the virus. What we are saying is that it is not impossible that with high initiation of this treatment, one may have a chance of getting cured because we know that cure is not available for the virus because the virus hits at the pivotal cells of our immunity.
PEPFA money is still there, only that it is not going through US institutions anymore; it is now going through local NGOs which are formed from the different groups that have links with US institutions e.g the Harvard PEPFA programme was just handed over to Aids Prevention Initiative in Nigeria (APIN) so I can tell you that LUTH is able to continue with the ART programme because it is getting funds from APIN and APIN is getting its funds from CPC.
Interview with AKUDO ANYANWU IKEMBA, medical practitioner, CEO/founder of Friends of the Global Fund Africa
Stigma and discrimination
Great strides have been made in the battle of HIV/AIDS globally. However, while we have seen some great improvements, there is still a long journey to battle; we still have a huge challenge with discrimination and stigma attached to people with HIV/AIDS patients and this is something that journalists need to bring to the fore and I applaud you for this.
Discrimination and stigmatisation sometimes leads to death in a lot of communities where people are not able to access treatment or own up to say they need treatment because they are being stigmatised in their communities.
I have friends and families that have gone through a tremendous amount of suffering as a result of not being able to come out and access care that they need. I have a cousin who reached out to me that he was HIV positive and I have been able to get him to an ART centre through one of the national treatment programmes and today, he is surviving, living positively and happy. Fighting stigma and discrimination is key. This is the time to do it and we need to do it with them media.
DonorFatigue
There is also the battle of funding and resources. Though world leading economies are committing to the fight against HIV/AIDS, even right from 2001 yet, there is still donor fatigue.
The pandemics is affecting communities significantly with populations like South Africa with almost 1/3 of the population affected, here in Nigeria, we have a prevalence of under 5percent but that is also quite significant given the fact that our population is large. Resources are needed to get us to the point of having zero new infections, zero stigma and discrimination, zero deaths from HIV/AIDS; we need to pour resources in it to help achieve this.
Abuja 12
Now, where will the resources come from? Recently, the President called together a union of African leaders to a summit called Abuja 12. This took place in Abuja in July 12-16 2013, where the African leaders came out with 28 pertinent resolutions on HIV/AIDS and if I am to summarise this, it can be summarised into three. Firstly, the commitment of the leaders to continue to sustain treatment programs to sustain people’s lives in their country, to provide all the interventions for both prevention and treatment of the diseases. Secondly, they committed themselves to availing resources; they will find innovative ways to finance these programmes from within their country and that is the first time it is happening in history.
Thirdly, they committed themselves to support the replenishment activities of the biggest fund supporting HIV funding and that is the Global Fund for TB, HIV/AIDS and Malaria. It is time for us to walk together and I reinstate that it would be nice to be in on this.
As Africans, we have a role to play in developing our institutions, our own non-profit institutions, our own government institutions, or private sector institutions because it is through these institutions that we would be able to deliver the proper care and prevention programs for these diseases so that we can increase our life expectancy and thus increase the economies of African nations.
FA intervention
Friends Africa is a pan-African NGO that mobilises support for the management of TB, Malaria and AIDS. We have been at the forefront of advocacy for Africa’s health for the past seven years and we see ourselves as major players in the field as long as health advocacy is concerned.
We work with private sector, civil society and government to fight these three diseases and what we do to curb stigma and discrimination is to use the power of celebrities to raise awareness concerning this. We host lots of advocacy programmes to help this course and give people opportunity for testing and counselling.