Working with the theme ‘Getting to Zero,’ the world penultimate week commemorated this year’s World AIDS Day with a lot of fanfare. The weeklong event however leaves a sour taste in the mouth of people living with the virus in Nigeria, as they continue to battle the newly introduced charges. Gboyega Alaka x-rays the situation.
No man can think clearly when his fists are clenched.” – George Jean Nathan
The above quote by the late George Jean Nathan, one-time leading American critic and publisher, best describes Tina Nnamdi (not real name), a Nigerian HIV positive patient’s recent resolve to go haywire and grant as many men as ask her for sex, free express sex without recourse to condom. Put more directly, Tina has resolved to spread the deadly virus in her bloodstream to as many men as make overtures to her, and her reason is frustration; basic animal frustration. Tina can no longer access her regular dosage of anti-retroviral drugs (ARV), with which she keeps the virus at bay, and by implication she is staring death in the face. Her frustration has grown increasingly since October 2014, when the Nigerian health authorities unilaterally took the damning decision to compel HIV positive patients to pay a certain amount of money for their regular bi-annual tests, known among patients as ‘bleeding’.
Patients say the test is crucial to accessing the drugs, which they admit are still free, but conditioned upon paying for and first going through the test. Tina’s situation is further aggravated by the fact that she has no helper – no husband, no job, and she literally survives on society’s benevolence. Meeting up with the compulsory pittance fee of N12,000 a year is therefore an uphill task, the concession that she can pay twice notwithstanding.
Hers is a typical case of an angry being, desperate to survive, who has lost all sense of clear reasoning. In her angst, she can be likened to a boko haram suicide bomber, willing to take as many people as cross her way down the abyss with her.
Threat to the Zero target.
The theme for this year’s World AIDS Day commemoration, which was observed globally, penultimate week, was: Getting to Zero. It was marked with all seriousness and fervour by the relevant government agencies, various networking associations of people living with HIV and civil society organisations in Nigeria. With all intents and purposes, this target may not be an impossible one afterall, considering the level of success recorded against the virus across the world in recent years. The reality of attaining the zero target is further underlined by the declaration by the National Agency for the Control of AIDS (NACA) last week, that Nigeria has been able to reduce the spread of the virus by up to 35 per cent. Even as many stakeholders have disputed this statistics long before it came out as a deception, the truth is that people like Tina, who probably run into tens of thousands, if not millions, stand as a threat to this target, and to any level of progress being recorded against the spread of the virus.
For a country sincere and willing to tackle the spread of the virus head-long, many have argued that rather than introduce any kind of fees whatsoever, the government should have endeavoured to get rid of other existing encumbrances in the way of the patients and their drugs. For years, most HIV-positive patients accessed the ARV drugs free of any kind of charge, and this was responsible for stemming the astronomical rise in the number of infections and a seeming demystification of the virus, as it seems to have taken off its toga of a death sentence in the eye of the people.
Grimmer than NACA
In July 2015, the United Nations Programme on HIV/AIDS (UNAIDS) declared in a report that the global spread of HIV/AIDS has reduced. The report coincided with the organisation’s Nigerian Country Director, Bilali Camara’s statement that Nigeria is amongst the countries that have been able to reverse their HIV trend. Exactly a year before, the organisation had painted a grim picture of the state of affairs in the country, sending jitters through the spine. That report presented Nigeria, South Africa and Uganda as the countries with the highest rate of infection/spread in sub-Saharan Africa, with cumulative growth rate put at about 48%. That report also showed Nigeria as the country with the highest HIV/AIDS mortality rate, as well as the country with the unenviable burden of one third of all new infections amongst children in the 20 worst hit countries in sub-Saharan Africa.
While it may also appear that Nigeria does not lead from the rear, since South Africa is the unwilling occupant of that unenviable saddle, with a whopping 12.2% portion of its population to Nigeria’s 3.2 percent, the huge difference in population strength (S.A is 52.98 million, while Nigeria is over 170 million), means that Nigeria and not South Africa, has more to worry about.
The big question activist, Steve Borishade therefore asked in his essay, ‘A Tale Of Anguish: The True Story Of The HIV/AIDS Situation In Nigeria’ is, “what measures (that) were put in place that could and had ensured that Nigeria is able to reverse the spread of HIV/AIDS in just one year like Bilali asserted? And when Nigerian officials go to town claiming that the country has met some MDG goals, especially pointing at successes in HIV/AIDS, should we not ask how and what those are?”
If the country recorded marginal success when all People Living with HIV/AIDs (PLWHAs) had access to free treatment in all government facilities in the country, does it not then defeat logic that it would record significant success in just one year after fees were introduced?
Evelyn, one of the attendants at a press conference organised by the Lagos Network Forum on HIV And AIDS, Tuberculosis and Malaria to intimate the public about the predicament of people living with HIV said the whole 35% reduction success rate being bandied is a ploy to douse the noise the networks have been making and make mincemeat of their complaints.
Others have also argued that it is to justify the huge funds and investment that the government have expended on the project till date.
A long way to go
Fred Adegboye, a journalist with The Nation newspaper, argued that as insignificant as the amount being charged may seem, the reality is that many of the people living with HIV are not able to afford the fees. “In my centre at the University College Hospital, UCH, Ibadan, they say the drugs remain free, but we have to pay N6,000 for each chemistry test before we get them. We do two chemistry tests per year, so the fee amounts to N12,000; but the reality is that many people cannot afford it and that is our agitation. To make matters worse, some people always have to travel long distance to access their drugs, because they fear that they could be stigmatised if they chose a dispensing centre near their homes. So we have lots of people who travel from Lagos to University College Hospital UCH, Ibadan, where I access my drugs on a regular basis to collect their drugs; and by the time you add their transport fare to it, you find that it becomes way too high for most of us. I for one can afford it because I have a job, but many do not have a job and rely on goodwill of people around them, which is not guaranteed. In fact the last time I went for my bleeding, even I could not afford the N6,000 but I went anyway and gave them the N5,000 that I had on me. To tell the truth, I was ready to raise all hell should they reject it, but thankfully they collected it. So, if I who has a job could run into such difficulty, then you may begin to understand the problem other people are facing.
Azeez Aladeyelu, an HIV/AIDS activist, state co-ordinator of CISHAN (Civil Society Consultative Network on HIV/AIDS in Nigeria (CiSHAN) said although the authorities have explained that the fees is a running cost, he said the networks have been protesting the decision, going as far as South Africa to embarrass the then health minister last year, in order to force the government to rescind the decision. He said the donor agencies are still supplying the drugs and have only pulled out partly in the area of funding of running costs, and wondered why the Nigerian government cannot shoulder that responsibility for her people. He said those having problems accessing their drugs should endeavour to reach-out to their support groups, so they could know their problems and how to help them.
He carpeted a situation whereby the private sector is standing aloof, while things are going wrong, forgetting that when the population is depleted the labour force that it depends on will also be affected. “Even if these corporations pull their meagre donations together or commit a part of their CSR budget to the service of our people, it would go a long way. But if you approach them, their excuses have always been ‘we have our workplace policy; we can only attend to people in our organization.’ They may even tell you that you should have approached them before and that they have mapped out their spending for the year. Meanwhile, when Ebola came, nobody prepared for it yet, we saw how everybody, the government and private sectors, pulled their resources together. Nobody made excuses.”
Aladeyelu however said the network has resolved to continue crying out about their predicament until somebody listens. He also expressed optimism that the new government would be a listening one that would help ameliorate their problem.
A spurning government
One of the panellists at the press conference and a representative of NEPHWAN said it is amazing that the government is no longer serious about HIV/AIDS issues, suggesting that the networks look the way of the private organizations. He said NEPHWAN has taken it upon itself to encourage strict adherence to the drug, adding that sometimes, the organization goes as far as raising money for those who cannot afford the charges. He said the organization and other networks are not relenting in their efforts to draw attention to their situation and that they’ve organised rallies and demonstrations at major city centres and offices to draw government and public attention to the new problem. He said it is just unfortunate that the government doesn’t seem to want to hear anything about HIV/AIDS anymore.
He said, “There was a place we went to last year to create awareness on the newly introduced fee; but while we were at it, somebody from the government office came out and started shouting us down and asking, ‘Is HIV the only disease we have in the country? What about tuberculosis? What about malaria? Why are they not coming out to make so much noise?’ She said there are thousands of people who suffer from cancer and who are not making as much noise as we’re making. But we replied her that that may be because they don’t have organisations articulating and channelling their case like ours. Now that we have come out, we need help, please help us.”
He said former President Obasanjo helped people living with HIV/AIDS by providing free treatment for them, but the current situation spells danger as the country may be retrogressing to the pre-Obasanjo years.
Evelyn said it is a shame that Nigeria still records high rate of infection and AIDS-related deaths. Citing how Kenya was able to turn around a precarious situation, she said it is a sign of unseriousness on the part of the nation’s policymakers. “The authorities there realised that the infection rate was rising because their men were not using condoms at brothels, so they made a law that any man who goes to a brothel and refuses to use a condom should be penalised. From that moment, they started adhering to the new rule and the rate dropped from 12% to 4%.
Victoria Mba also echoed the efforts being put in to impress on the government to take off the new charges and said there has been no positive response yet. But when asked if indeed casualties are being recorded in the case of people who are not able to afford the charges and access the drugs, she said, “Though we have always had AIDS-related deaths, we have not been able to gather information to that effect in Lagos, although we hear of such cases outside Lagos.
