The early days of the HIV/AIDS epidemic were characterised by fear, stigma, myth and denial. The disease was then seen as a death sentence. People living with HIV had to fight to be seen, or heard, or to be treated with basic compassion. Little was known about how to prevent and how to treat it. Today, that picture is transformed. The discourse is no more about the reality of AIDS; rather, the concern is about the best way to totally eradicate this dangerous disease. Awareness has soared; research has surged. Prevention, treatment and care are now saving millions of lives not only in the world’s richest countries but in some of the world‘s poorest countries as well.
The progress and success stories in some countries notwithstanding, HIV and AIDS have a widespread impact in many parts of the world, especially in sub-Saharan Africa. The main focus of the fight against HIV globally today is how to achieve zero new infection with more emphasis on Prevention of Mother–To-Child Transmission of HIV (PMTCT). In 2012, an estimated 1.5 million pregnant women in low- and middle-income countries were living with HIV. Over 70 percent of these women are concentrated in 10 sub-Saharan African countries: Nigeria, South Africa, Tanzania, Kenya, Uganda, Zimbabwe, Mozambique, Malawi, Ethiopia and Zambia.
A country like Senegal has been particularly successful in managing its HIV epidemic and maintaining a low overall HIV prevalence among the general population.
Senegal’s success has been attributed to strong political leadership and early involvement in the epidemic, as well as leadership among religious leaders and conservative cultural norms around sexual practices. The country has been able to keep HIV prevalence rates low through intensive screening of the national blood supply, the provision of HIV testing equipment and healthcare professionals, HIV education programmes and promotion of condom use.
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Due to failure of the South African government to respond quickly to the HIV epidemic at the outset, the country has the highest number of people living with HIV in Africa with 17.9 percent prevalence rate. In Nigeria, HIV prevalence is relatively low (3.1 percent). However, because of our large population, this equates to around 3.4 million people living with HIV, making Nigeria second behind South Africa in terms of absolute numbers.
Alarmingly, however, the latest report by the United Nations has shown that Nigeria has the highest number of children contracting the Human Immunodeficiency Virus in the world. UNICEF statistics in particular show that in Nigeria, 10 percent of all HIV infections are as a result of mother-to-child transmission. This is buttressed by records from the Ibadan meeting of the Society for Gynaecologists of Nigeria (SOGON), which confirmed that Nigeria accounts for 30 percent of global gaps in Prevention of Mother-To-Child Transmission (PMTCT) of HIV.
In Nigeria, there are quality documents and structures, such as the National Health Sector Strategic Plan and Implementation Plan for HIV/AIDS 2010-2015. What we need to do is to assess how to allocate what are currently limited treatment resources. Ultimately, the nation requires more money and resources and political will to take ownership of the effort to conquer the disease. The donor agencies may not continue to assist us for life. There are also more fundamental barriers to overcome, particularly HIV-related stigma and discrimination, the issue of gender inequality and hostile health professionals. Women going for antenatal/delivery are not finding attitude of hospitals staff palatable, not to talk of people living with HIV/AIDS.
We know that early testing is preferable, but what can we do in a country where those who go for public services are often told to come back later? Removing such barriers would encourage more people to get tested and seek out treatment, reducing the burden of HIV across the nation. This is no shortcut to breaking the barriers as without access to public services for PMTCT, which provides antiretroviral (ARV) to both mothers and babies to prevent HIV infection, a HIV-free generation might be a pipe-dream.
One major snag is insecurity. Polygamous relationships, as well as multiple partners, have been highlighted as key drivers of HIV transmission. One can’t imagine how many of our Chibok girls and displaced people from Boko Haram-occupied and -controlled communities are in danger of contracting HIV/AIDS. Displacement as a result of conflict is a factor in the spread of HIV/AIDS. In terms of prevalence rate, Benue State has the highest percentage of 10.6, followed by Nasarawa, which has 10.0 percent, while Ekiti and Osun States have the lowest at 1.0 and 1.2 percent, respectively. Lagos State has a prevalence rate of 5.1 percent. The state is one of the 12 states that account for 70 percent of the mother-to-child transmission of HIV burden in Nigeria.
As with other affairs of the state, the Lagos State government is working towards achieving a HIV-free generation with an uncommon passion. One of the strategies being used is improving access to HIV/AIDS services. This the government is doing with assistance of development partners (UNICEF, Clinton Foundation, CIDA/WHO) and implementing partners (FHI/GHAIN, IHVN, ALCO, and AFRICARE).
Lagos State law for the protection of Persons Living With HIV and AIDS (PLWHA) was signed into law in 2007 and to ensure its full implementation, a mechanism whereby PLWHAs 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, who 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.” It is, therefore, obvious that one of the fundamental pillars of getting to zero would be to ensure increased uptake of PMTCT services.
Rasak Musbau