The sea of heads, with women constituting a preponderance at the vast concourse of the AIDS Preventive Initiative of Nigeria (APIN) complex, Federal Medical Centre, Makurdi, Benue State, tells a glum story, a story of a state ambushed by a debilitating scourge.
A conjectural estimate put the figure at well over 800 persons- men, women and children. On this day, April 9th, this gathering reportedly paled significantly against the previous days’ figure put at about 1,000 of People Living With HIV and AIDS (PLWHA), who daily throng the complex from Monday to Friday, for counselling and treatment.
A cursory peek of the PLWHA hordes first conveyed a picture of a congregation of religious faithful waiting for their pastor’s homily. But the images became starker when this reporter eventually found himself swathed by people who were in no way out to receive a sermon on the kingdom of heaven, but on how to live normally with the pandemic of HIV/AIDS.
This sight is not peculiar to the Federal Medical Centre, Makurdi, alone. In Otukpo, Ohimini, Okpoga and elsewhere, the spectacle mutually replicates itself, with women and children mostly, at the highest rung of the HIV/AIDS ladder. For long, the monster has been stalking the state like an incubus. Finally, it has laid a seeming terrorist siege, progressively for eight years running.
Benue State is currently burdened not only by the high prevalence of the disease but more as the highest army of people living with HIV/AIDS in Nigeria. From the available statistics released in 2010 by the National HIV Sero-Prevalence Sentinel Survey, the state reportedly had 12.7 per cent prevalence rate, a figure considered far above the national average of 4.1 per cent.
Additionally, Benue State is adjudged as having the highest urban and rural prevalence rate of 12.5 per cent and 13.3 per cent respectively, with prevalence as high as 21.3 per cent in wannune, 18 per cent in Ihugh and 5.3 in Okpoga, Okpokwu Council Area, all of which are rural communities.
During the period under review, Makurdi and Otukpo (both urban centres), posted 10.3 percent and 9.1 percent respectively.
Investigations also show that the youth population stands imperiled by the HIV prevalence in the state, with the figure reported to have been consistently higher at 5.5 than its value or projection in 2008. Transmission dynamics, according to existing data, affect both key most-at-risk populations and a strong generalised constituent driven by behavioural patterns through high-risk sexual network of the general population.
But prior to the 2010 sentinel survey, the 2005 United Nations General Assembly Special Session (UNGASS) report had put the HIV/AIDS prevalence rate in Benue State at 10 per cent, with Otukpo Council Area ranked as one of the highest with incidence rate at 7.2 per cent. Makurdi, the state capital, was 10.3 per cent and 4.4 at the national level respectively.
The corollary of the survey showed, therefore, that there was a geometric increase of 2.7 per cent and 2.1 per cent within the five-year period from 2005 to 2010 for state and Otukpo local council respectively.
According to a progress report by the Otukpo Local Government Area Local Action Committee on AIDS (LACA), a copy of which was made available to The Nation by the council’s Head of Department on Health and LACA Coordinator, Mrs. Rebecca Audu, showing the result of a sentinel survey in 2010 on pregnant women, 160 sites were sampled across the country, of which 86 were urban and 74 were rural sites. A total of 36,427 pregnant women were sampled across the country.
Similarly, in Benue State, five sites, involving the three senatorial zones, were sampled during the period under review. The outcome of the study revealed the highest incidence rate of 12.7 per cent with infections mostly in the rural areas. The age groups most affected were between 15 and 35 years.
In summary, the study showed that there was a 20 per cent increase of HIV prevalence from 2005 to 2010, with a dire consequence of about 40 per cent projected increase if nothing was done to abate the trend by 2012. The survey further reveals that about 603,000 people are infected with HIV, while about 28, 948 pregnant women are infected yearly with HIV/AIDS, and about 10,421 children infected yearly through mother to child transmission (MTCT).
Records from the Comprehensive Health Centre, Otukpo (Ward 2), showed that of the 178 ante-natal cases, three are positive and currently on drugs as at January 2013.
Further check by The Nation at the Otukpo General Hospital revealed a worrying incidence of new cases in the last quarter of 2012 (October to December). For instance, in the month of October, 71 people were admitted, 22 of whom were males and 49 females. November records also indicated that out of the 75 new cases, 24 were males and 51 females. For the month of December, 2012, there were 43 new cases, 13 of whom were males and 30 females.
Conversely, in the first quarter of 2013 (January to March), The Nation investigation at the same Otukpo General Hospital shows that of the 88 new cases of people living with HIV in the month of January, 25 were males and 63 females. February records put the figure of new cases at 43 with 10 males and 33 females. While those of March were 73, with 26 males and 47 females.
At the Pediatric Ward of the same hospital, new cases of children admitted in October 2012 were three, in the ratio of one female to three males. in November, the figure shows that eight new cases were recorded in a disparate ratio of five males to three females. In December, it was two males to zero female.
Similarly, in the first quarter of 2013, January to March, eight children in an equal ratio of four males to four females were recorded. In February, out of six cases, one was male and five were females. It was two males to five females in the month of March.
A survey of death rate in the last quarter of 2012 stood at one in January and one in February, all of whom were females, while three male deaths were recorded in the month of March.
Figures at other centres –Makurdi, Okpoga and elsewhere – could not be immediately gleaned owing to unavailability of data and red tapism.
According to the National Agency for the Control of AIDS (NACA), 10 in every 100 persons are said to be living with HIV in Benus State, with ages ranging between 15 and 49.
According to The Nation investigation, the conveyors of the epidemic in the state include high illiteracy, particularly in rural areas, high rates of Sexually Transmitted Infections (STIs) in vulnerable groups, poverty, general apathy to condom use and carefree attitude to perceived personal risks.
Findings also revealed that average monthly new cases in the state are put at 200 per general hospital, which brings the aggregate haul in the state to about 3,000 per month.
Investigation by The Nation indicated that Nakar town has recently been discovered to have high prevalence of people living with HIV as records at the Federal Medical Centre, Makurdi, showed, prompting APIN and other implementing partners to contemplate the setting up of care centres in the area. At Logo in Gwue Council Area, it is the same running story as statistics at the FMC also revealed.
The outlook cannot be any grimmer for a state famed as the ‘food basket’ of the nation. Not with its productive farming population insufferably being pillaged by the high prevalence of HIV/AIDS. It just may gradually be turning the world of the state’s agro-industry on its head.
Factors aiding prevalence
Considered as one of the biggest headaches in the effort at containing the scourge, is the general apathy on the part of the men folk to submit themselves to testing. According to Isaac Agbe Azor, Data Manager with the AIDS Preventive Initiative of Nigeria (APIN), FMC, Makurdi, “the men have posed the biggest challenge in combating the scourge. While their women counterparts are easily convinced to come forward for screening and testing, men have constituted our biggest obstacle. So they constitute a factor in the spread of the disease. As long as they are positive and refuse to come forward to be tested, diagnosed and managed, they will go on spreading the HIV virus.”
He also identified logistics in the rural areas as hindering awareness campaign. “The awareness campaign has not been so vigorous as a result of logistics. Even in some of these areas, the response level is always higher with the women than the men.
“Another challenge is poverty. There are many who cannot afford to bring their wards for testing. If, for instance, a member of the family is found to be positive and we ask them to bring the rest of their wards for testing, it is usually difficult for an individual to transport herself or himself, much more transporting the entire family from a distance of say, 50 kilometres.”
The emergence of gay clubs in the state has also been identified as working to undermine the efforts at containing the spread of the disease, with Makurdi and Otukpo as the epicenter of the new trend in homosexual activities. According to The Nation finding, membership of these gay clubs currently stands at over 400, a figure, it is feared, is likely to snowball as youths are said to be the prime target usually recruited from some of the state’s tertiary institutions.
High rate of promiscuity, especially in rural areas with dense illiteracy rate, an APIN official noted, is another disturbing concern. “Sexual activities in such areas are often concentrated because people do not migrate. So the spread is also concentrated, leading to a crisis proportion. In these communities, there are cases of either deceased or infected victims of HIV/AIDS in almost every household,” the official said.
Indifference to use of condoms
Ali Baba Emmanuel is the General Secretary of the State Coordinator of Benue People Living with HIV/AIDS (BenPlus), a network of non-governmental organisations (NGOs), which coordinates the activities of people living with HIV/AIDS across the state.
He lamented the general apathy of the people of the state to the use of condoms. “Despite campaigns for behavioural change, people are yet to embrace the advocacy for the use of condoms. Poverty among the people has also accounted for the rapid spread of the disease, just as stigmatisation is a major hindrance to people submitting themselves to HIV screening.”
Ali Baba further hinted: “It has also been discovered that even those on ARV have gone on to spread the virus through reckless sexual activity because their HIV status is known only to themselves. Here in Benue State, your sexual partner is likely to find it strange and will ask why you want to use a condom on him or her. He or she will demand to know why because they say sex without condom is more enjoyable. So, to avoid this embarrassing situation, an HIV person who does not want to reveal his status will go ahead and have unprotected sex with a non-HIV person. And the spread goes on and on.”
Dr. Ali George, an anti-retroviral therapist (ART), at Saint Mary’s Catholic Hospital, Okpoga in Okpokwu Local Government Area, offers an insight into how the scourge has assumed this pandemic proportion in Benue State, culminating in its top ranking in the country’s HIV/AIDS log.
“From my experience and from the much I have gathered as an ART at Saint Mary’s Catholic Hospital, Okpoga, the ignorance of the people is one of the factors that have facilitated the high rate of HIV/AIDS prevalence in the state.
‘’Oftentimes, those who are infected by the HIV virus, rather than seek medical treatment or diagnosis, resort to other means than medical. Some blame their circumstance on witchcraft or spiritual attack. Their next line of action is to go to their pastors for prayers and deliverance. This belief is also common among the enlightened ones.
“The emergence of ‘miracle pastors’ has also been found to be one of the factors for the prevalence of HIV/AIDS, not only in Benue State, but in Nigeria as a whole. Without mentioning names, we have had cases here in Okpoga where PLWHAs abandoned treatment and sought relief in churches. Many have taken off to Lagos to get ‘cure’ from a particular church in Lagos renowned for miraculous claims in such areas. It is a major challenge in the management and prevention of HIV/AIDS in the state.
“A particular patient was recently ripped off by a pastor who allegedly demanded for and collected N250,000 to pray for him. The same patient, who could barely afford decent meals, had to borrow to pay in order to be prayed for. A month or two later, he came back looking like a bag of bones. Before we conduct a check, the virus had seriously ravaged him because he discontinued his treatment. After much probing, he confessed and said the pastor told him to stop taking drugs as God had already healed him.
‘’But the sad and unfortunate thing is that the virus will begin to multiply and ravage them progressively.’’
Pregnant women not going for ante-natal
In many parts of the state, many pregnant women do not register for ante-natal. And when it is time to put to bed, they go to traditional birth attendants. There is also the existence of substandard maternity clinics operated by quack nurses. Pregnant women usually prefer these quack clinics because they feel they are cheaper. In these clinics, both mother and her new born child are not given quality services usually extended to pregnant women. It is very common to find mothers infecting their new born babies with the HIV virus.
Disappearance of Support Group
According to Mrs. Roseline Agbo, Health Line Coordinator, Otukpo Comprehensive Health Centre, “the disappearance of the Support Group has also been hampering the management and control of the spread of HIV/AIDS in the state. The Support Group deals with the welfare of PLWHAs, counselling, social wellbeing, break up of stigma which hitherto made it impossible for victims to interact socially. Paucity of funding has led to the disappearance of the Support Group. Funding used to come from both the government and donor agencies. Through the Support Group, PLWHAs are counselled to socialise sexually within the same ‘positive’ group. On a few occasions, marriages had been contracted for some members of the support group. The idea is to ensure that they do not seek sexual remedy outside the fold.”
Benue government speaks
When The Nation sought the comment of the Executive Secretary of the Benue State AIDS Control Agency, Mrs Grace Wendy, on the high prevalence of the HIV/AIDS in the state, she declined, claiming that she had earlier been misrepresented in the media on the issue. But the Media Officer at the state Ministry of Information, Mr. Pius Torkuma, attributed the inexorable prevalence and spread to stigmatisation, “which has prevented people from coming forward for testing, with the attendant consequence of further spread by those unwittingly living with the virus.’’ According to him, there is currently an Anti-Stigmatisation bill before the state House of Assembly.
Similarly, the state Government had, through the former Commissioner for Health and Social Services, Dr. Oduen Abunku, expressed concern over the worrisome development when he disclosed that over 600,000 persons are currently living with the dreaded HIV/AIDS in the state.
Speaking at the joint Memorandum of Understanding (MoU) signing ceremony between the Benue State Government, the NKST Health Services and the Nigeria Indigenous Capacity Building Project, Abunku lamented that skyrocketing figures had left the state on the top of chart of available statistics of the most endemic states in the federation.
The commissioner regretted that HIV/AIDS infestation in the state was destroying and eroding the state’s capacity in the food and agriculture. “In Nigeria, Benue State has for many years topped the chart of the prevalence of HIV/AIDS with over 600,000 persons living with the virus in the state.
“The virus is destroying our farms, schools and churches and that is why we will continue to partner organisations who are providing services to the infected and affected in the state.”
Governor Gabriel Suswam, who was represented on the occasion by the Secretary to the State Government (SSG), Dr. David Salifu, had reaffirmed that his administration would continue to partner relevant agencies and international partners to ensure that the scourge of HIV/AIDS in the state was effectively checked.
The governor urged the people of the state to put aside their socio-political differences and join forces against the virus in the state, adding: “We must put aside our socio-political differences and stand up against the virus, so that our people will be able to lead a normal life.’’
As it stands presently, the state faces a stiff struggle. A struggle between sustaining its famed status as the ‘food basket’ of the nation by winning the battle against HIV/AIDS scourge or losing the battle and its acclaimed image as the nation’s ‘food basket’. In truth, Benue is a state under siege.
An encounter with some of the PLWHAs
From Makurdi, Otukpo, Ogobia to Okpoga, the story of how they came to be associated with the disease is virtually the same: infidelity and other factors as well as the attendant consequences. Except for Gertrude (real name withheld) who is single but whose HIV positive status was as a result of reported blood transfusion, many others had so much to do with untamed libido, sexual recklessness and betrayal.
For Gertrude, “It was in 2006, while I was a student of College of Education, Katsina-Ala, Benue State, that I noticed I was having frequent fever. My uncle’s wife with whom I was staying had to take me to the university clinic where I was treated for fever and malaria. When it was discovered that the fever was a frequent occurrence, our family advised me to do HIV test. Lo and behold, the outcome was positive. That was June, 2006.
‘’Since then, I have been on ARV. Before I started taking the drugs, I discovered that I was emaciating and losing weight. But the drugs have been working for me. I noticed that I have gained so much weight and I am feeling much healthier.’’
Jonathan (surname withheld) is a staff with APIN. For 17 years, he has been living with the virus. Jonathan, whose wife is also HIV positive, said: “I have been living with the disease for the past 17 years. I got to know I was HIV positive when I went for a test to know my status. That was then I discovered that I was positive.
‘’I might have contracted the virus from my first wife who is now late. I remember that before we went our separate ways, she was always falling sick and losing pregnancies. So there was pressure from my people to put her away and marry another woman. So, I did. But it was later I got to know that she died of AIDS.
‘’Despite testing positive, I did not seek treatment until four years later. I have four children, but none of them has tested positive. I have been doing regular HIV tests for them.’’
Thessy (surname withheld) is a primary school teacher with one of the state’s primary schools. She has been on ARV for the past 10 years. She got married at the age of 16 years and had her first child at the age of 18. A mother of four, Thessy’s first child is a 25-year-old medical student. Her story is not only heart-tugging, but depressing and tears-conjuring.
At 44 and widowed, life can only be said to be abrasive, dreadful and unkind to her. At the onset of her travail as a person living with HIV/AIDS in 2002, she said she had journeyed to the land of the dead only to be chased back to continue her now gloomy life among the living.
She lost her husband to the dreaded AIDS scourge in 1997 and thereafter, life took a battering for her and her four HIV-negative children. But she was not so lucky as her late husband had bequeathed her the HIV virus. Reliving what has now become her life’s downward trajectory since her husband’s death, Thessy said: “My condition became very critical when my husband died. There was no remedy as there were no free drugs then when I tested positive.
‘’Earning below N10,000 monthly income as a primary school teacher, it was not easy accessing the drugs, hence, I had to be borrowing to stay alive and look after my four children. I am alive today by the special grace of God. When my husband died, I did not know what was responsible for his death. It was not until a doctor friend confided in me that he died of AIDS.
‘’It was the same doctor who advised me to do HIV test. The test was N10,000 then. I did not have the money but the doctor advised me to borrow the money anywhere I could to do the test. I resigned myself to death, because I was already a dying woman. Where would I get N10,000 to pay back as a primary school teacher? So I was waiting for death to come.
‘’Fortunately, some health personnel were available to carry out tests. So, the cost was later slashed to N7,000, but it was still difficult to raise the money. Eventually, I did. Nobody thought I could still be alive as my case had neared a terminal stage. Even the doctors had given up on me.’’
Thessy’s first son is a 300-level medical student. She has been slumming life to see him through medical school. But life itself has been a sticky patch for the family, leaving her in a lurch as to how her son will graduate as a doctor. Destitute of a breadwinner, Thessy has been buffeted on all fronts: inability to feed her four children, sustaining her son in the medical school and sundry deprivations in her home.
She bemoaned her helplessness to The Nation in Otukpo amid sobs: “In Benue State, primary school teachers are not part of the minimum wage. In order to continue to support my children, I took up a part time job with the Catholic Archdiocese of Otukpo which was also involved in HIV/AIDS programme, earning a stipend. But since their project stopped in 2010, I depend solely on the irregular income from the government. I have continued to borrow to see my son through the medical school and taking care of his siblings. today, I owe N300,000.’’
For Okpanachi (surname withheld), his plight was self-inflicted. It is the comeuppance for his unbridled libido. With bloodshot and sunken eyes, burrowed deep into their sockets and a long woozy neck completely receding into his collar bones, Okpanachi cuts the image of a man whose life hangs in the balance. Pithily, he relived his stigmatisation ordeal: ‘’Even my own biological brother who was serving in the military and with whom I used to share food, started keeping me at a distance. This discrimination became unbearable for me. I felt that the only thing left for me was suicide.”
A once-upon-a-Sunday school teacher with the Assemblies of God Church, Otukpo, Okpanachi would soon discover that the stigma he experienced at the hands of his own brother was also waiting for him in the house of God where he conflated with the brethren and taught the scriptural tenets of love, compassion and meekness.
A father of eight, Okpanachi told this reporter at Otukpo Comprehensive Health Centre, where this dialogue took place, that he married his wife as a virgin and vouched for her fidelity, but admitted amid penitence that he brought the faggot to his home as a result of his philandering.
His wife, now separated, and their last child, 7, are plagued by the scourge. His other seven children, he said, are, however, all negative.
