Lagos — HIV/AIDS is real, almost everyone now agrees. But the prevalence rate poses a real danger that can frustrate development efforts in Nigeria. Abimbola Akosile writes.
The civil war came and ended. Over one million people were said to have died, but the war against HIV/AIDS is a continuing one, and no one can tell how many casualties will be recorded in the end.
The spread of the HIV/AIDS virus has gone beyond the alarming (epidemic) to the ominous (pandemic), and has gradually, but steadily eaten deep into the human resources material in the country, with 1.4 million estimated HIV/AIDS related deaths in year 2002 alone, which is certainly more than any war could produce. But this is a silent war.
True, enough has been written and said about the scourge, but Nigerians have refused to wake up to the stark reality that unless the problem is tackled by all concerned and seemingly unconcerned, Nigerians may one day wake up to discover that the majority of the nation's productive population would have been decimated to such an extent that the Government, like in the Scandinavian countries may have to initiate policies and incentives to stimulate population growth.
The Technical Report of the Federal Ministry of Health (Dept. of Public Health) on the national AIDS/STDs control programme, which was released in December 2001, revealed that there were more than 3.1 million adults (15 - 49 years), that are infected with the HIV virus, and the figures would probably be much higher by the time the current survey is completed.
Similarly, the overview report on HIV/AIDS in the year 2000, put together by the National AIDS and STD Control Programme of the same ministry, in collaboration with the National Action Committee on AIDS (NACA), put the estimated population of HIV+ persons in 2002 at 3.47 million, with an estimated decrease in life expectancy in 2002 due to HIV/AIDS at 4.5 years.
The same overview, which was partly funded by the United States Agency for International Development (USAID) also revealed that the cumulative number of people who would likely die of AIDS in 2002, would be up to 1.4 million, and AIDS orphans that would be produced by these deaths in the same year is estimated at 847 thousand, thereby creating more social pressures, in a country where there is no articulated programme of caring for orphans. The above-mentioned figures, which were obtained from a globally accepted survey technique (2nd Generation Surveillance System) involving pregnant women, who were attending ante-natal clinics for the first time across the country, unveiled a prevalence (degree of spread or dominance) rate of 5.8% as the national average. This simply means that for every one hundred women attending the vital ante-natal clinical programme in the country, over five of them are infected by the HIV virus.
The figures, while not taking into consideration those below fifteen years and those above forty nine years, is bad enough and goes to show that the virus has made so much progress since it was first discovered in 1986. Available statistics show that the national average prevalence rate (the rate at which it spreads) rose from 1.8% in 1992; to 3.8% in 1994; on to 4.5% in 1996, 5.4% in 1999; and 5.8% in 2001.
The pattern for the dreaded virus among the thirty-six states and the Federal Capital Territory (FCT), from available statistics highlighted some key factors that have aided the spread of the virus. These include level of urbanisation, local population of commercial sex workers, centres of commerce, transport termini, and places with favourable cultural values, and areas where there is a high population of very mobile business people. Wherever any or all of these groups can be found, the prevalence rate always far outstrips that of other places where these factors do not exist.
For example, according to the report on the HIV survey, the North Central Zone (zone E), which comprised Benue, Federal Capital Territory, Niger, Nasarawa, Plateau, Kwara, and Kogi states, had the highest average zonal estimate of HIV prevalence rate of 7.9%; while Benue State singularly had a prevalence rate of 15.4%. Some have attributed this to the relaxed cultural values and the large student population in the state. Also, Zone F, which comprised Cross River, Rivers, Akwa Ibom, Delta, Edo, and Bayelsa states, had an average prevalence rate of 7.5%, while Akwa Ibom had 12.7% on its own, and Delta had 9.3% HIV prevalence rate.
On the other hand, Jigawa, which is in Zone C (comprising Zamfara, Sokoto, Kano, Katsina, Kaduna, and Kebbi states) had the least prevalence rate of 1.8%. Altogether, between 1995 and 2001, there was an increase of 129% in the HIV/AIDS epidemic in Nigeria, with an annual prevalence of 18.4%, while the core infection spots included Benue, Akwa Ibom, Bayelsa, Enugu, and the Federal Capital Territory.
The figures reveal that the virulence of HIV spread in the country far outstrips the level of response to the scourge. "It is either Nigerians tackle the problem now and reduce the prevalence rate to 2% in a few years time (say 2015) or risk facing a prevalence rate of possibly 40%", says Deacon Shina Falana, an expert on HIV/AIDS based in Lagos. This means that almost half of the adult population would be infected by the virus at that year.
Four categories of stakeholders can be identified in relation to the HIV/AIDS problem. There are the People Living With HIV/AIDS (PLWHA); those who are in close and constant contact with the affected individuals; the donor agencies, the non-governmental organisations and other concerned bodies; and the Federal Government and its parastataals.
Certainly, the most concerned of these stakeholders are the PLWHA, who in addition to combating the social stigma of their condition, have also have to be at the mercy of all sincere and insincere stakeholders. The Federal Government had rolled out the national anti-retroviral programme (ARV) in January 2002, after several delays and postponements, in twenty-five sites (seven in Abuja FCT, three in Lagos, among others) across the country. The drugs being offered, which included lamivudine, nevirapine, and stavudine have allegedly been administered to more than eight thousand patients, according to reports. But the fact remains that, these drugs, apart from being expensive, are grossly inadequate and demand far exceeds supply.
One of the greatest drawbacks to adequate detection and monitoring of the scourge is that those who are infected are hardly willing to admit it or own up and receive adequate treatment and therapy. It has become a classic case of deliberate self-denial for fear of social stigma. THISDAY found that affected individuals would rather die in silence than admit that they are infected. The few who have been bold enough to come out into public glare, have been derided as promiscuous and this has resulted in other potential carriers of the virus going underground, while continuing their carefree active sex lives and infecting more individuals, which is a major reason for the alarming growth and spread of the virus in the country.
Rather than live as free citizens of the nation, with entitlement to all relevant social benefits, these affected individuals, who are yet understand the issue of 'language of rights', allow themselves to be cowed into submission and subjected to all kind of patronage. But despite these, procreation and intercourse continues unabated among the affected persons, and the prevalence figures increase geometrically.
One of the major criticism of the battle against HIV/AIDS in Nigeria is that it has concentrated more on campaign and enlightenment than actually managing or controlling the pandemic. THISDAY however found that despite the enormous resources being invested in public education, many are yet to really understand the issues relating to HIV/AIDS especially the process of infection as a result of social interaction. Speaking with a randomly selected respondent, THISDAY found that the attitudes of individuals to people living with HIV/AIDS range from patronage, condemnation to outright avoidance. Opinions and attitudes of such individuals have been varied, and they constitute great impediments in the establishment and subsequent enjoyment of the rights and privileges of the HIV/AIDS patients.
Speaking with THISDAY, one respondent says what is clear is that a lot is still left to be done, even in the area of education, especially mode of transmission. "Although a lot of campaign has been going on that HIV cannot be contacted by hugs or handshakes with affected persons, personally, I will not discriminate against such a 'victim'; I will only avoid any contact with such person", he said. He called for the provision of more drugs by the government and non-governmental organisations (NGOs) to prolong the lives of infected patients; and urged the intensification of health education and creation of awareness of the scourge, its effects and implication; and emphasis on sexual abstinence and use of condom for protection against infection.
Another respondent, a female, urged every one to try and get closer to infected persons, while letting them realise that HIV/AIDS infection is not the end of the world. She said, "we need to encourage the concerned persons to carry on their lives and activities, while using the prescribed drugs. Also, the 'victims' can approach relevant organisations to share experiences which will help them relax and unburden their minds. I believe they are equal members of the society, who are entitled to all rights. To avoid greater spread of the infection, though, affected persons can marry amongst themselves, but they must desist from having kids who might end up with HIV/AIDS infection at birth".
Falana is an anti-HIV/AIDS worker and Country Coordinator of the SMARTWORK (Strategically Managing AIDS Responses Together in the Workplace) Programme. He said though the causative agent of AIDS is HIV, the major modes of transmission included sexual intercourse (accounting for almost 80% of the virus' spread); Mother-To-Child (MTC) transmission; and through unsafe blood (using unsterilised surgical instruments) or dental surgeon needles or syringes.
Falana claimed that sexual intercourse as a mode of transmission varied from anal, vaginal, oral, or ejalo-sexual transmission, with emphasis on men who have sex with other men (MSM). He said the survey carried out on the virus' prevalence in Nigeria revealed that urbanisation, industrial development, culture, and other factors like commercial sex workers, poor people, ignorant people, people with highly mobile jobs, construction workers, military authorities and formations greatly enhance the prevalence rate. "There is a serious correlation between poverty and the drive of the epidemic, and a basic denial of the virus' existence among all the categories", he said.
On what to expect in twenty years' time concerning the issue, Falana declared that an accelerated campaign would help avert serious problem, while the rate of epidemic would nose-dive. But if nothing concrete is done, he warned, the situation would be serious e.g. twenty AIDS related deaths in a company within a few months, signifying an alarming growth and spread of the scourge. In fifteen years, he claimed the prevalence rate would either be 2% (if something is done), or 40% (if nothing is done). "The trend is worrisome unless all stakeholders do something about it. People who are infected tend to hide the disease, thereby fueling epidemic. A problem half-shared is half-solved, although it is not easy to come out", he said.
The qualified nurse claimed several factors are hindering the acknowledgment of HIV/AIDS in Nigeria. "There is a difference between knowledge and attitude of the people, for example, a smoker medical doctor. Those who should know are not willing to change. Even among health workers, the knowledge-attitude gap make people afraid to come to hospital for treatment, out of fear of medical workers' scorn, and so engage in self-medication, and quack consultants, which only serve to increase the spread of the virus", he said.
Falana called on all Nigerians to learn from the Ugandan example. Uganda, formerly had one of the high prevalence rates of HIV/AIDS in the world, but today, he stated, they have been able to successfully reverse the trend. Uganda succeeded because of a political will, which involved everyone, from family, institutions, government, and other organisations talking about the scourge, creating awareness and tackling the problem from the roots.
Among business executives, through the Nigerian Business Coalition Against AIDS, he revealed that government is going ahead to ensure that the management of business concerns in Nigeria sign a letter to recognise existence of AIDS and protect organisations and individuals from its impact. "In fact there is a draft that will address the issue of no anti-body test for any individual before employment, which will soon be made law", he said.
He claimed there was no known cure for HIV/AIDS yet, due to its viral nature, and that what people living with the virus really need is psychotherapy. He called for avoidance of discrimination at all levels, claiming there is a policy draft, started in 2000 by the Federal Government, which involves a national policy on HIV/AIDS in the workplace, as a reference material for interaction in the workplace, scheduled to come out sometime in April. "Some organisations already have similar policies, but all enterprises must have workplace policies to protect infected persons. Something must also be done to protect people from occupational exposure to infection. For example, the laboratory attendants, who are easily prone to infection, must be entitled to some benefits from employers in the event of infection with the virus", he enjoined.
Falana commended the National Action Committee on AIDS (NACA) for its ongoing efforts while calling for more to be done, including a restructuring and upgrading of the group into an agency to better equip it to ensure success and greater efficiency. Antiretroviral (ARV) drugs, he said, must be made accessible and affordable to the masses. "ARV therapy is a double-edged sword, which can lull infected persons into a false sense of cure or security; and at the same time cause severe setback if the procedure is not strictly followed, because of the deadly nature of the virus", he said.
While search for cure continues, the AIDS worker called on Government and other stakeholders to ensure adequate awareness creation about the scourge, while taking care of already infected people. "We must be research minded. Ordinarily, there is no cure for viral infections but we shouldn't close our minds to a cure, which can come soon. But ARVs must be made available and affordable to people, while nutrition education is equally very important", he said. Infected persons, he claimed, need to possess adequate nutrients in their body to allow the drugs work effectively, and that there should be a balanced diet to enhance the drug effect, which can only be achieved through continuos education and enlightenment on what or when to eat.
While the debate on the issue rages on, more people are daily being infected with the virus, especially among the poor people, who have long accepted sex as the major form of recreation, without adequate protection or consideration for personal safety. It behoves each Nigerian to reach out to fellow citizens, like the Ugandans did, to ensure awareness and joint tackling of the problem, before it gets out of hand. It wouldn't do to ignore the scourge, or wish it away, which will be to a national disadvantage. What can be done urgently, is to acknowledge the existence of the virus, its potential damaging effects on the people, and take steps to check or reverse the current trend.