13th December, 2011
The fact today is no more about the reality of AIDS, rather, the concern is about the best way to tackle the spread of this dangerous disease that is capable of destabilising our economic foundation and our valued network of sociocultural relationship.
The AIDS epidemic is a global catastrophe responsible for over 20 million deaths worldwide, leaving tens of millions of children orphaned and some 33 million people living with the dreaded virus.
Although global HIV prevalence has levelled off, AIDS remains one of the leading causes of death globally and remains a major cause of death in Africa.
Despite being the largest oil producer in Africa and 12th largest in the world, Nigeria is ranked 158 out of 177 on the United Nations Development Programme (UNDP) Human Poverty Index.
This poor development position has meant that Nigeria is faced with huge challenges in fighting its HIV and AIDS epidemic.
In Nigeria, as at the end of 2009, an estimated 3.6 per cent of the population are living with HIV and AIDS. Approximately 220,000 people died from AIDS in Nigeria in 2009.
It was estimated that just 10 per cent of HIV-infected women and men were receiving anti-retro viral therapy and only 7 per cent of women were receiving treatment to reduce the risk of mother-to-child transmission of HIV.
The HIV prevalence in Lagos has varied over the years from 1.9 per cent in 1991, 6.7 per cent in 1999, 4.7 per cent in 2003, and 3.3 per cent in 2005, to 5.1 per cent in 2008, to the current prevalence of 5.1 per cent in 2010. These figures are obtained through surveys of women attending antenatal clinics.
There are currently over 57 free HCT sites in Lagos run by government, civil society and the private sector. There are 29 free PMTCT (prevention of mother to child) sites, 24 free ART (Anti-retro viral therapy) sites, six EID sites in secondary and tertiary facilities across the state.
From the data available in Lagos State Aid Control Agency (LSACA), between 2008 and June 2011, 350,000 people had been counselled, tested and received results; 65,000 pregnant women were counselled and tested with about 1,400 receiving ARV. Over 20,000 people have been placed on ART.
Over 100,000 OVC (orphan’s and vulnerable children) and their families have received some form of support, while over 8,000,000 free condoms were distributed through education and distribution programmes targeting various groups and over 4,000,000 through condom social marketing.
Taking into account that resources needed to provide sufficient treatment and care for those living with HIV in Nigeria are seriously lacking, it is reasonable that government is now committing large sums of fund to prevention, especially when it is a fact that HIV is largely a preventable infection.
More concentration on prevention is logical as prevalence rate in the state is 5.1, while 95 per cent of the population is negative and we can keep them that way.
But can we get to zero new HIV infection? In the words of President Barrack Obama, “Yes we can.†We can achieve zero new HIV infection by first of all attaining zero discrimination. Towards achieving this, Lagos State law for the protection of persons living with HIV and AIDS was signed into law in 2007.
To ensure full implementation of the law, a mechanism whereby PLWHA (People living with HIV and AIDS) who have had their rights infringed upon can seek legal advice at no cost, was set up.
This is in line with the views of Justice Michael Kirby of the High Court of Australia, when he said: “Paradoxically enough, the only way in which we can deal effectively with the rapid spread of HIV/AIDS is by respecting and protecting the rights of those already exposed to it and those most at risk.†How apt?
A vital means of achieving zero new infection in the state is what is being done at the health facilities concerning encouraging all pregnant women to get tested for HIV and providing ARV to all pregnant positive women.
Over 80 per cent of infections in children under 15 are acquired from their mothers. PMTCT interventions, when properly implemented, have been proved to reduce the risk of MTCT of HIV to less than 2 per cent (from about 40 per cent in the absence of any intervention).
It is therefore obvious that one of the fundamental pillars of getting to zero would be to ensure increased uptake of PMTCT services. This is already being done at the 29 PMTCT sites located in secondary and tertiary institutions across the state.
The state government has also scaled up its counselling and testing. Besides the over 57 free HIV counselling and testing (HCT) sites, in marking this year’s World Aids Day, the Lagos State government provided mobile HIV counselling and testing campaign in the five divisions of the state.
The large attendance of Lagosians at the five centres gives hope that the journey is achievable. On request, LSACA is also providing mobile services to several organisations. Treatment as prevention is a new buzz phrase that is doing the round in the HIV and AIDS field.
The raising of the CD4 threshold for treatment from 200 to 350, means more people are eligible for treatment and is expected to translate into fever new infections.
But how do we get people on treatment if they do not know their status? HCT is the entry point to all services. People who tested negative would have had access to information which would hopefully influence their lifestyle.
Positive people are referred to whatever service they need and can prevent progression to AIDS. One other way through which the government is working to achieve zero new infection is strengthening of prevention programmes by targeting young people in and out of school.
Reaching young people even before their sexual debut with information about HIV and other reproductive health issues would help to avert new infections. The state Aid Control Agency, ministries of Health, Education, Information and Strategy, in partnership with other organisations, have carried out series of training programmes in schools for both junior and senior secondary schools.
It is hope that with desired interest from all stakeholders, increase and expansion of interpersonal communication and community mobilisation approaches at the LGA level the journey will become interesting and reaching the destination will become easier.
•Rasak Musbau is of the Features Unit, Lagos State Ministry of Information and Strategy