When AIDS emerged from the shadows three decades ago, few people could predict how the epidemic would evolve, and fewer still could describe with any certainty the best ways of combating it. Today, we have passed the stage of conjecture. We know from experience that AIDS can knock decades off national development, widen the gulf between rich and poor nations and push already-stigmatised groups closer to the margins of society. Unlike time when the affliction of HIV/AIDS was considered by many as the Western World’s burden, the concern of everyone today is about the best way to tackle the spread of this killer disease.
The AIDS epidemic is a global catastrophe responsible for over 20 million deaths world-wide, leaving tens of millions of children orphaned and some 33 million people living with the dreaded virus. Sub-Saharan Africa accounts for 25 million of these people and estimates from the joint United Nations AIDS programme (UNAIDS) revealed that not less than 3.14 million Nigerians were found living with HIV as at the end of 2011.
Currently, Nigeria bears the second highest burden of HIV/AIDS in Africa, next to South Africa and third in the whole world after South Africa and India. It is estimated that approximately 220,000 people died of AIDS in Nigeria in 2009 and the disease has also been associated with Nigeria’s declining life expectancy which in 2010 was only 52 years. Since HIV is found in body fluids-such as blood, semen and vaginal secretions, it can be transmitted when fluid from an infected person enters the body of another person. Given this modes of transmission, everyone is at risk of contracting the virus. This can happen through sexual intercourse, during blood transfusion, when using unsterilised skin piercing instruments and from an infected mother to her baby during child birth or after birth through breastfeeding.
Regarding HIV/AIDS, it is worrisome that the average Nigerian have turned knowledge is power into knowledge is death certificate. Despite the availability of many voluntary counseling and testing services in various hospitals/centers across the country, very few know their HIV status. For instance, in Lagos, there are currently over 57 free HCT sites run by government, civil societies and the private sector. There are 29 free PMTCT (prevention of mother to child) sites, 24 free ART (Anti-retroviral therapy) sites, 6 EID (early infant diagnosis) sites in secondary and tertiary health facilities across the state.
Till date, the figures on HIV in Nigeria are still one obtained through surveys of women attending antenatal clinics. Yet, only few comprehend how to assess risk to HIV with behaviour and practices that increase risk of HIV infection still rampant among our people. The big question, of course, is can we get to zero new HIV infection? We can achieve zero new HIV infection by committing large sums of fund to prevention especially when it is a fact that HIV is largely a preventable infection. We can achieve it by first of all attaining zero discrimination. Persons living with HIV and AIDS require information, counseling, care and support and not discrimination.
Given its strategic place and importance in Nigeria, Lagos State has been very proactive and in the forefront of the national response to the HIV and AIDS epidemic through strengthening of institutions, social mobilisation and enlightenment.
In Lagos, the State Law for the Protection of persons living with HIV and AIDS was signed into law in 2007. To ensure full implementation of the law, a mechanism whereby PLWHA (People living with HIV and AIDS) who have had their rights infringed upon can seek legal advice at no cost was set up. This is in line with the views of Justice Michael Kirby of the High Court of Australia when he said: “paradoxically enough, the only way in which we can deal effectively with the rapid spread of HIV/AIDS is by respecting and protecting the rights of those already exposed to it and those most at risk”. How apt!
A vital means of achieving zero new infection in the state is what is being done at the health facilities concerning encouraging all pregnant women to get tested for HIV and providing ARVs to all pregnant positive women. Over 80% of infections in children under 15 are acquired from their mothers. PMTCT interventions, when properly implemented, have been proven to reduce the risk of MTCT of HIV to less than 2% (from about 40% in the absence of any intervention). It is therefore obvious that one of the fundamental pillars of getting to zero would be to ensure increased uptake of PMTCT services. This is already being done at the 29 PMTCT sites located in secondary and tertiary institutions across the state.
Another way is to provide care and support to PLWHA. People should be aware that AIDS is NOT a moral issue- it is a public health problem. The vicious circle of fear, prejudice and ignorance has not and cannot help our quest to eradicate the problem. This is high time people should stop imagining number of partners PLWHA must have slept with to be in the condition. Do we turn our back on thousands of children who are infected and are living with the virus due to circumcision by untrained health personnel? What of many who got infected through transfusion by unscreened blood? Do we also turn our back on millions of children who got infected by their positive parents? Ed Koch said: “if you turn your back on these people (PLWHA), you (yourself) are an animal. You may be a well-dressed animal, but you are never the less an animal.”
The state government has also scaled up its counseling and testing. Beside the over 57 free HIV Counseling and Testing (HCT) sites, in marking last year World Aids Day; the Lagos State Government provided mobile HIV counseling and testing campaign in the five divisions of the state. The large attendance of Lagosians at the five centres gives hope that the journey is achievable. In 2013, the target of the state is to get 1.3 million people in the HCT net. Treatment as prevention is a new buzz phrase that is doing the round in the HIV and AIDS field. The raising of the CD4 threshold for treatment from 200 to 350 means more people are eligible for treatment and is expected to translate into fever new infections.
But how do we get people on treatment if they do not know their status? HCT is the entry point to all services. People who tested negative would have had access to information which would hopefully influence their lifestyle. Positive people are referred to whatever service they need and can prevent progression to AIDS. One other way through which the government is working to achieve zero new infection is strengthening of prevention programs by targeting young people in and out of school. Reaching young people even before their sexual debut with information about HIV and other reproductive health issues would help to avert new infections. There is one British AIDS education slogan which could also be adopted in our schools. It goes thus: Every time you sleep with a boy you sleep with all his old girl friends.
In Lagos State the availability of a screening test to detect HIV in donated blood has nearly eliminated blood transfusions as a possible source of infection. Other preventive efforts include education about safer sex practices, such as consistent condom use, and avoidance of needle sharing among people who inject drugs.
It is hoped that with desired interest from all stakeholders, increase and expansion of interpersonal communication and community mobilisation approaches at the LGA level, the journey will become interesting and reaching the destination will become easier.
Musbau is of Features Unit, Lagos State Ministry of Information and Strategy, Alausa, Ikeja.
