By Chioma Obinna
You may know that HIV is treatable and preventable? But are you aware that new HIV infections can be prevented even among high-risk groups? Do you also know that you can now test for HIV in the comfort of your homes? These are the latest innovations in the management of HIV in Nigeria today.
The first two AIDS cases in Nigeria were diagnosed in 1985 and reported in 1986 in Lagos one of which was a young female sex worker aged 13 years from one of the West African countries.
As of the end of 2020, the number of people living with HIV, rose to 1,354,314. Of this, 895,202 (66.1 per cent) were women; 399,523 (29.5 per cent) men; 120,534 (8.9 percent) young people while 60,944 (4.5 percent) were children.
In the views of the medical expert, even though the COVID-19 pandemic has strained health systems and exposed gaps in public health almost everywhere, newer HIV prevention options exist that utilise antiretroviral medications to prevent HIV infection before exposure to HIV. Unfortunately, HIV management in Nigeria is marred by low awareness on treatment and prevention services.
Across the world, prevention of HIV in high risk populations is happening to reduce new infections particularly among the young population that is mostly affected. Known as Pre-exposure Prophylaxis, PrEP, according to the Director of Research, Nigeria Institute for Medical Research, NIMR, Prof. Oliver Chukwujekwu Ezechi is a way for people who do not have HIV but who are at very high risk of getting HIV to prevent HIV infection by taking a pill every day.
Ezechi explained that the pill which brand name is Truvada contains two medicines tenofovirdisoproxil fumarate plus emtricitabine (TDF/FTC).
According to him, when taken as directed, PrEP is greater than 90 per cent effective at preventing HIV, protects against HIV, but not STIs or pregnancy.
“PrEP, or pre-exposure prophylaxis, is an HIV prevention method in which people who don’t have HIV take HIV medicine to reduce their risk of getting HIV if they are exposed to the virus. PrEP can stop HIV from taking hold and spreading throughout your body.
Maintaining that currently, there are only two FDA-approved daily oral medications for PrEP, he maintained that it is strictly prescribed to HIV-negative adults and adolescents who are at high risk for getting HIV through sex or injection drug use.
To have a effective PrEP, the programmes need to be appropriately focused according to the epidemiological profile in a given country or setting to reach the highest-risk population groups and individuals.
He lamented that PrEP services are affected by widespread poverty, young populations and increasing population that require PrEP for HIV prevention, ongoing emergencies –conflicts, insecurity, unrest and economic distress as well as weak health infrastructure and limited health workforce.
Speaking on HIV care continuum, he pointed out that without prevention services, care and treatment retention, new HIV infections will be like unlocked tap.
Ezechi stressed the need for tailored prevention services in management of HIV such as protection before HIV exposure PrEP, protection during sex: barrier methods eg condom, protection during drug injection: syringe exchange programme, protection after HIV exposure – Post Exposure Prophylaxis, protecting others if HIV positive using Treatment as prevention (TasP), Prevention of Mother To Child Transmission and HIV testing services such as HIV self-testing.
In her presentation entitled: “HIV Self – Testing – An Emerging prevention approach in Nigeria” during a media training for journalists organised by INTERNEWS in Lagos, HIV Self-Testing Officer, Jhpiego, Mrs Tobi Ademola- Kay who noted that only 67 percent of people living with HIV know their status according to UNAIDS, 2018 report regretted that there was a low HIV testing coverage among men, young people and key population in Nigeria.
She said HIVST was a process by which an individual wanting to know his or her HIV status collects oral fluid or blood sample, performs HIV test, and interprets the results by him or herself privately, correctly, and accurately.
“HIVST is a screening test which does not provide an HIV-positive diagnosis–as all persons with reactive results need to be linked to a trained provider for further testing and confirmation.
“HIVST will play a substantial role in accelerating progress towards the UNAIDS 95:95:95 targets by the end of 2030.”
Sharing the Jhpiego/Star Project experience on the benefits of HIVST, she said HIVST was available to key populations and hard-to-reach clients and can be bought over the counter.
According to her, HIVST gives privacy that allays confidentiality concerns and reducing stigmatisation and discrimination as well as ease of use with minimal bio-hazard waste generated.
Ademola-Kay said the self-testing device promotes partner testing expands testing to partners of PLHIV and social networks of key populations.
“It also Increases access to HIV testing services and knowledge of HIV status, help address the huge gap in HIV case finding and rapidly increase uptake of HIV testing services.”
Noting that there were challenges implementing HIVST Scale up in the face of COVID, she lamented poor Knowledge and awareness among the general populace.
She also added that there was also the challenge of non or no disclosure results and relative high cost of HIVST kits in private sector space due to monopoly of product.
To create demand for HIVST, Ademola-Kay called for the dissemination of demand creation materials across various media, community interventions to create demand, sensitisation and awareness as well as the need for private sector interventions.