By Sola Ogundipe
The COVID-19 pandemic has had a significant impact on the Nigerian health system. One of the areas that felt the effects of the global malaise was the National HIV/AIDS response. The Director General of the National Agency for the Control of AIDS, NACA, Dr. Gambo Aliyu gives insight into the impact.
In this interview with Good Health Weekly, he sheds light on the national HIV treatment programme, the effect of budget cuts to the Agency, the implications of ARV drug resistance, the newly introduced HIV-self test kits among other key areas of the HIV response.
Sanni who admonishes Nigerians to know their HIV status is convinced that the country has what it takes to control HIV and stop its transmission and death rate.
Burden of drug resistance in HIV treatment
Even after HIV is controlled, the testing issue is going to linger because it is an issue that borders on people having the discipline to know their status and to take treatment. People should continue to take this medication and to continue to subject themselves to periodic testing to see how this medication is helping to make the virus disappear.
The burden of drug resistance in HIV treatment is not very significant to the extent of becoming a public health issue, but our responsibility is to prevent that occurrence and to make sure that we do not see it become alarming. We don’t even want to give that room for it to grow.
As implementers and providers, it is important that we make sure there is no interruption in the supply of medication.
We may have a situation where patients are willing to and ready to take this medication but if you create an atmosphere where the medication becomes unavailable, then you are consciously or unconsciously introducing an environment where resistance can grow and it would be unfortunate.
If you have a significant proportion of your patients becoming resistant, especially in a place like Nigeria where we have over one million individuals on treatment and carrying this virus, if you introduce an atmosphere where resistance grows, then your control mechanism will be challenged.
ARV resistance is National security issue
The ARV resistance issue is a national security issue because if a significant proportion of patients are resistant, then the possibility of controlling the epidemic is going to be extremely difficult.
The result is that resistance will develop as a secondary complication in someone who has the virus, and now if the medicine is withdrawn, with the virus already exposed to the medicine, and then later withdrawn temporarily or permanently, this would give an atmosphere for resistance to thrive.
It also follows that if this person develops resistance and is able to transmit that resistant virus to another person, that virus is now getting a new infection from a virus that totally does not respond to the drugs that are available.
So this is the danger. If we are getting significant proportion of people with resistance to the HIV drugs coming up, the implication is that we would have a chunk of them that would need more expensive drugs to be treated.
HIV treatment programme
Last year we has 50,000 patients on treatment by the government of Nigeria. This year, we are having 100,000 on treatment also by the federal government of Nigeria. Next year, we hope to make it 150,000 patients despite scarce resources. Right now we have a total of 1,240,000 patients on treatment.
Impact of dwindling donor funds
Essentially the cut in donor funding that Nigeria has experienced so available and we have succeeded in placing the 100,000 patients on treatment.
HIV Trust Fund
On the side of the private sector, we have progress. In collaboration with the private sector of the business community, we plan to have this HIV Trust Fund and raise money to support HIV programmes in the country. We hope to get the Trust Fund registered. A chief executive has been identified and signed and will be ratified before the end of the year. In the next quarter of 2021, we plan to launch this Trust Fund.
We are focusing more on the area of the states contributing to the HIV response, not that the states should be giving us federal government money, but making money available to the state agencies to coordinate and control HIV/AIDS response in the respective. We have not made significant progress in this area and it is one we will focus on in the next year because the states are significant to ending AIDS.
Over 80 per cent of the people on treatment now are states’ patients. Over 95 percent of the hospitals that provide services for HIV are state owned.
Over 90 per cent of the health workers that provide services in these facilities belong to the state. The federal government has less than 115,000 patients that are taking treatment. It is important that we work with the states so they can take over the leadership of the response, not necessarily that they provide the resources, but mostly to coordinate it. It is important because on the long run, there is no way that we can attain sustainability and normalise everything and get everything under control without the states taking the leadership and being in the driver’s seat. We need to do more work, pay more visits to state governments and make more presentations at the National Economic Council
With the help of the Vice President, two years ago, we had an intervention and a few state governments responded but we need to remake a case.
ARV injection for women: We have had formal communication that this ARV injection exists and is working well. Traditionally, when such things are available, we look at the data globally, where the media action has been used and for how long and how many patients involved and how successful it has been.
This is simply because we need to do due diligence before introducing such innovation of progress. It is a good idea, inject le antiretroviral, they’re given once or twice a month, or two months, they make life easier for people who have to take these pills every day.
However, such persons would be required to come to the health facility for the injection 12 times in a year. Every month, they must visit the facility and get injected, but with the conventional ARV pills, they may only visit four times in a year. She they do visit, we give the pills that will last for three months. It is called the multi-month dispensing. The patients can now choose which they prefer – pills or injections. We haven’t started doing the injection here in Nigeria but it is something that we would be looking at very soon.
Impact of COVID-19 on HIV response
Particularly during the lock down period, Covid-19 has impacted in such a way that it has denied us opportunity to identify people with newly identified infections. Every month and every year, we go after the remaining people that are not identified so that we can identify them and bring them to treatment because that is the only way that we can get to control HIV and end AIDS.
So our numbers reduced in April and May this year because of the lock down and apart from that, the Covid pandemic has also competed with HIV simply because when it comes first, most of the laboratory infrastructure that do the testing for Covid-19 are HIV laboratories and even now these facilities provide those services.
We ran HIV tests during the day, and at night we ran Covix-19 tests. It wasn’t easy for our staff nationwide
HIV self-test kits
The self-test kits are amazing simply because for people that are interested in their privacy and confidentiality, which is their right, they can decide to have this test in the comfort of their rooms
They just sit down there, follow the instructions, wait for 20 minutes and the result will be out. From the guide, if you have two lines, it is HIV positive. If you have only the control line, it is negative and if there is another, the test is abnormal. If there is a line somewhere, the test is invalid. And then you have to repeat the test or you get tested somewhere.
At the beginning of this fight it would have been risky to introduce this self-test kit because people then took stigma and discrimination very seriously.
I have seen somebody that died by suicide because his wife tested HIV positive. That was over 15 years ago in Abuja but these days we do not see such things because people now understand that having HIV is not the end of the road. It is just the beginning of another journey for healthy living.
Know your HIV status
When you have the virus, we want people to have the courage to test themselves. Don’t be afraid just go and do it, when you do it and you see something that may suggest that you have the virus, contact us. When you do it, have the courage to come to the facility and get tested there with utmost confidentiality.
Confirm there that, yes, this virus exists in you and have the courage of coming forward to take medication. You can go to centres where the medications are given and they are free of charge. You can call us at 6222 and wherever you are we will direct you to where you would feel comfortable to take the medication they would give you
What this would do is that it would take care of the virus in you, make sure that the virus is not allowed to multiply which is a very good development.
The ability to multiply is what is giving the virus strength to get out of you to affect another person and to hack down the body mechanism and bring it down. Why should you allow it? You shouldn’t, so if you have the virus, you must fight it.
You must deny the virus the chance to continue to grow in you and when you do that, you will be healthy. Nobody will see sign of HIV in you even when you tell people that you are HIV positive, they will not believe simply because the medicine has taken care of the virus. It would no longer disturb you body mechanism and you are no longer giving it to other people.
So this is what we want to do, to get 95 per cent of the people that live with the virus to get to identify them and put them on medication. We want to make sure that about 70 to 80 percent of them are taking care of this virus and limiting the virus within themselves.
When we do that then new infections will be rare and death from HIV will be rare because the virus is brought under control. It is there in the body but it is not harming the body
Do not give the virus opportunity. If every Nigerian would take the courage and test themselves within the next one year or from now till the second quarter of next year, I can guarantee that we can control HIV in a year or two in Nigeria. It is doable.
Controlling new infections
We still have new infections and this is what measures the ability to control the virus but the good thing is that the number of new infections is declining and the number of deaths from HIV is also declining but not at the rate we had wanted to see.
What that is telling us is that it is either these people taking the medication are not being faithful to it or are not taking it regularly. We know that some have dropped out of treatment and we know that the virus is growing very fast inside such people and they are giving it to other people.
So there are people that have never known that they have HIV because they have never tested. So if you do not test there is just no way that you would know whether you have the virus or not.
To win the HIV war is simple. Every citizen has a responsibility to help the government to control HIV simply because it ravages society, brings people down and puts them in hospital especially the newborns. These are people that are going to live their entire lives with this virus; we should do everything within our ability to prevent transmission of HIV to newborns.
They are people that are expected to live for the next 60 – 70 years but they are coming into the world with a tragedy yet this is preventable.
So why do we continue to allow it to grow? And we cannot stop it without knowing whether we have it or we do not have it especially pregnant women.
This is why every pregnant woman during every pregnancy should have opportunity to have HIV testing and her partner or husband must also help to see that the pregnancy is tested for HIV.
If there is HIV, they must ensure that necessary measures are taken to prevent the newborn from having it. It is doable and we are doing it. We will continue to do it but we cannot do it where individuals refuse to go to the hospital to deliver and even when they deliver at home, they refuse to have their HIV testing done
Key affected population
Right now, we are doing a survey, on access to the key affected population. The survey is restricted to two states in each of the six geopolitical zones that will give us an idea similar to the nationwide survey we did two years ago that tells us what the epidemic status is in the general population
We know the epidemic is declining in the general population, however, in the key affected population, the story may be different. The groups that are at highest risk may be getting HIV infection and are also at highest risk of giving out HIV to people. If we do not find them, work with them, make services available to them, it will be impossible to control HIV.
Preventing paediatric HIV infection
We treat HIV in all categories now. In the pediatric group and pregnant women, we are making good progress. The one area that we keep emphasising and paying attention to is how we will get to the women to test them, test their newborns whether they have HIV or not and this is the area in 2021 we will focus on.
We need to look at alternatives and ways that can yield these numbers that we are talking about, culturally and socially and in whatever way giving the available access at the community level.
If there is going to be a universal vaccine for HIV, most likely that vaccine is going to be in every way different from the way we know vaccines. Since 2002-03 I started learning about the universal HIV vaccine and campaigning for it. There has never been one HIV vaccine that has gone through the cycle and has been found to be very effective just like we have with the Covid-19 vaccine. This is because the HIV virus is completely different from the COVID virus.
World AIDS Day message to Nigerians
Help us to control HIV /AIDS in Nigeria by contributing your own quota by testing yourself to know your HIV status today. If your status is positive, call us or meet our health workers anywhere in the country. Control this virus in you so that it will not be transferred to your loved ones. If your status is negative, call us to learn how you will remain negative for life.
This is your responsibility. Do not deny yourself of the treatment and prevention services that are all free.
Know your status: If you are negative learn to remain negative for life. If you are positive, it is not an end but the beginning of a journey to healthy living with HIV/AIDS. Controlling the virus is key to ending AIDS and preventing its transmission
If we know that you have HIV we will take steps to prevent it from multiplying. It is that multiplication that will bring your immunity down and put others at risk. If you have the virus but you refuse to test or go for treatment, we cannot help you. Testing is the licence to give you medication.