The Battle against HIV/AIDS in Nigeria: Are we winning?

Ibrahim Abdulmumin Damilola

HIV/AIDS is a global pandemic. It was first reported clinically on June 5, 1981, in the United States. Ever since then, it has been one of the most serious and dangerous public health threat in the world. It is easily transmitted through various means, of which sexual intercourse is the most common. It does not discriminate between man and woman, boy and girl, child and adult or even the rich and the poor.

More than 32million lives have been lost to this disease globally since its advent. At the end of 2018, there were approximately 37.9million people living with HIV. Despite its advent almost 38years ago, there is still no known cure for HIV infection. Fear not, however, Anti-retroviral Therapy has proven to be effective in controlling the virus and preventing transmission to other people.

As of 2018, Nigeria had the second largest HIV epidemic in the world and one of the highest rates of new infection in Sub-saharan Africa. Making it worse is that Nigeria also has the fourth-largest tuberculosis epidemic in the world, with HIV and TB co-infection now becoming an increasing concern for people living with HIV.

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Most Nigerians are not aware of their HIV status. Some are afraid of checking, wrongly believing a positive HIV status equals death. As erroneous as it is, this thinking is rampant in the country. Thankfully, steps have been and are still being taken to counter the growth of HIV/AIDS in the country with some amazing success.

HIV stands for Human Immunodeficiency Virus whereas AIDS is Acquired Immune Deficiency Syndrome. HIV is a virus that damages the immune system. The Immune System helps the body fight infections. Untreated HIV infects and kills CD4 cells which are a type of immune cells called T cells.

Over time, as HIV kills more CD4 cells, the body is more likely to get various types of infections and cancer, A ripe avenue for opportunistic infections. HIV is transmitted through bodily fluids like blood, semen, vaginal and rectal fluids, and breast milk. It is not spread through air, water or through casual contact. However, it can be spread through sexual intercourse with an infected, an infected mother breastfeeding her child, sharing sharp objects that can withdraw blood and more.

Without effective treatment, an infected person is likely to develop a more serious condition called AIDS(Acquired Immune Deficiency Syndrome). At that point, the immune system almost collapses, with it being too weak to fight any other diseases and opportunistic infections. If left untreated, life expectancy with AIDS is about three(3) years.

AIDS is rightfully described as the most advanced stage of HIV. It should be noted however that, just because a person has HIV doesn’t mean they will develop AIDS. Opportunistic infections like pneumonia, tuberculosis, other illnesses including Cytomegalovirus(CMV), toxoplasmosis and cancer find a person afflicted with AIDS easy pickings and easily takes advantage of the situation.

Symptoms of HIV show as early as the first month or two in some people, although they don’t often realize they are caused by HIV. This stage is normally called the Acute Infection stage. The symptoms experienced in this stage are similar to those of the flu or other seasonal viruses, as such early detection is a little hard.

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The early symptoms may include fever, chill, skin rash, headache, nausea, sore throat, and upset stomach. With these symptoms, even the physician might not suspect HIV. Although during this stage, regardless of the symptoms showing or not, the viral load is usually very high.

The Viral load is the amount of HIV found in the bloodstream. A high viral load implies that HIV can be easily transmitted to someone else during this time. It should be noted that skin rash is often one of the first symptoms of HIV infection. At the clinical latency stage, symptoms include headache, swollen lymph nodes, recurrent fever, night sweats.

These symptoms are nonspecific, regardless though HIV is still infectious and can be transmitted. It is essential that a person with these symptoms and possible exposure to HIV, get tested. This is so proper treatment and management can start earlier if positive.

There is a common saying when it comes to HIV/AIDS, “Prevention is better than Cure”. Another set of words popular and essential to preventing HIV infection is “An (ABSTINENCE) B(BE FAITHFUL) C(USE CONDOM)”. This all has to do with sexual contact.

A person either stay away from casual sex, be faithful to your partner and/or use condoms during sex. These essentially reduce the risk of HIV. Consistent use of a condom by a couple in which one person is infected has shown the rate of HIV infection to be less than 1% per year. An established fact is that unprotected sex accounts for 80% of new infections in Nigeria, with the majority of the remaining HIV infections occurring in key affected populations such as sex workers.

Circumcision in sub-Saharan Africa reduces the acquisition of HIV by heterosexual men by between 38% and 66% over 24months. Owing to these studies, both the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS(UNAIDS) recommended male circumcision in 2007 as a method of preventing female-to-male HIV transmission in areas with high rates of HIV. The International Antiviral Society, however, does recommend it for all sexually active heterosexual males and that it be discussed as an option with men who have sex with other men.

Other prevention methods include avoiding sharing sharp objects like needles, syringes and other items for injection drug use, sharing tattoo equipment without sterilizing it. Another prevention method is through Pre-exposure Prophylaxis (PrEP) which is effective in reducing the risk of transmission. Post-exposure Prophylaxis involves administering a course of antiretrovirals within 48-72 hours after exposure to HIV positive blood or genital secretions.

Post-exposure Prophylaxis is particularly recommended after a sexual assault when the perpetrator is known to be HIV Positive. Antiviral Medications should be administered during pregnancy and after birth in infants to prevent transmission of HIV infection from infected mother to child. Infected mothers should take note not to breastfeed their infant and replacement feeding if possible should be used.

There is currently no cure nor has there been any effective HIV vaccine. The Management of HIV infection has been through the use of Highly Active Anti-retroviral Therapy (HAART), a combination of daily medications that stop the virus from reproducing. Anti-retroviral therapy helps keep HIV from progressing to AIDS.

It also helps to reduce the risk of transmitting HIV to others. When treatment is effective, the viral load will be “undetectable”. The person still has HIV but the virus is not visible in test results. Anti-retroviral agents include zidovudine, tenofovir, lamivudine, etc.

Gradually, the HIV infection is being backed to a corner. With a combination of the highly effective Anti-retroviral therapy and prevention methods(when followed strictly), HIV infection is declining in the country and even globally. Prior to March of this year,2019, Nigeria was believed to be the second(2nd) capital of HIV/AIDS prevalence globally with 2014 data showing 3.2 million Nigerians living with the virus.

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The Nigeria National HIV/AIDS  Indicator and Impact Survey(NAIIS) result launched in march 2019 by President Muhammed Buhari in Abuja, has shown that the burden of the disease has reduced by almost half bringing the prevalence to 1.9million persons.; a move that has now placed the country at number four in the list of countries with the highest burden of HIV/AIDS in the world.

According to Isaac F. Adewole, Nigeria’s Minister of Health, “the Nigeria National HIV/AIDS Indicator and Impact Survey findings provide the country with an accurate National prevalence measure of 1.4%. National HIV/AIDS Indicator and Impact Survey(NAIIS) also showed we are able to effectively provide Anti-retroviral treatment.”

The Country has shown steady progress on increasing access to treatment for people living with HIV, with the adoption of a test and treat policy in 2016. There has also been a significant expansion in the country’s response to HIV.

The number of sites providing treatment has more than tripled,  those providing services to prevent mother-to-child transmission of HIV have increased eight-fold and the number of HIV counseling and testing sites has increased four-fold. A total of 11.3 million adults were counseled and tested for HIV in 2016, four times as many as in 2012.

The Country has been making giant strides over the years to combat this menace. From 2010 to 2017, the country almost tripled the number of people living with HIV having access to Anti-retroviral therapy, up from 360000 in 2010 to more than 1million in 2018.

However, the new estimates released in March 2018 indicates that more than half of people living with HIV still do not have suppressed viral loads. According to the Director-General of the National Agency for Control of AIDS(NACA), “Of the 1.9million Nigerians currently living with HIV, about 1million of them were presently on Anti-retrovirals, while about 900,000 were either not aware of their HIV status or have refused to access treatment which is free in the country.

In Conclusion, the danger of HIV infection is not to be underestimated but to be wary of. Nigeria has been making significant leaps over the years in combating HIV infection. There is no doubt that more needs to be done. But, slowly perhaps and gradually we are winning. We are gradually nearing the objective of ending the AIDS epidemic by 2030. This is not yet time to relax though. To end HIV/AIDS, we all have to play our parts; both the Government and the General Populace. Together, we can see to the end of HIV/AIDS in our dear country more quickly.

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