Lagos — Exactly two decades ago, the HIV/AIDS pandemic was discovered in the country. Since the discovery, it has challenged both health institutions and governments in the country. Nigeria still has the second highest burden of HIV infection in sub-Saharan Africa and it is rated among the 10 in the world. The prevalence rate of the pandemic rose from 1.8 per cent in 1988 to its highest level of 5.8 per cent in 2001. In 2003, when the prevalence rate dropped to 5.0 per cent, it was estimated that people living with HIV/AIDS (PLWHAs) in the country were 3.6 million.

However, in the 2005 prevalence survey, the rate of spread nationally came down to 4.4 per cent. This success in the reduction strategy was largely attributed to the focused intervention strategies of the National Action Committee on AIDS (NACA), the Federal Government agency coordinating the entire programme.

With NACA at the centre, the State Action Committees on AIDS (SACAs) in the states and the Local Action Committees on AIDS (LACAs) at the local government levels, the response at the different levels comprises the involvement and participation of different sectors of the society. In January this year, the Federal Government directed that 250,000 PLWHAs be placed on free ARVs at treatment centres spread across all the states of the federation as part of measures to mitigate the impact of the pandemic.

However, a refreshing angle to the coordination of the HIV/AIDS intervention activities was started penultimate week with the involvement of the media in monitoring the intervention activities by the various stakeholders in some parts of the country.

According to Mr. Sam Archibong, communication specialist of NACA, the media has a pivotal role to play in the AIDS response. Now 25 years into the epidemic globally, public understanding of how HIV is prevented and treated is mixed, and basic awareness about AIDS and its impact is sorely lacking in many parts of the country, particularly among women and young people. This breeds discrimination and stigmatisation of people infected with the virus and increases rates of denial.

Archibong, who led the tour to three states in the south, stated that with the media's wide-reaching nature, expertise, its ability to change the course of the AIDS crisis is virtually unparalleled. It is against this background that his organisation facilitated the tour to understudy the intervention strategies of the states, local governments and other civil society and faith-based organisations involved in the mobilisation of resources to contain the pandemic in the country. While the southern team visited Lagos, Enugu and Cross River states, the northern team traversed Kaduna, Plateau and Gombe states before the two teams met in Abuja to compare notes.

Archibong noted that since the advent of the multi-sectoral response, activities therein has enlarged considerably and the coordination efforts of the NACA has yielded much fruit owing largely to the increased activities of the various sectors at the various levels. It became imperative, he added, for the media to be part of the progress by reporting developments from the source in the states and other sectors.

In Lagos, the first port of call was the Lagos State AIDS Control Agency (LSACA), which is located within the General Hospital, Lagos. Dr. Aderemi Desalu, special adviser to Governor Bola Ahmed Tinubu on HIV/AIDS, who also doubles as the chief executive of the state AIDS control agency, said improving the health of the nation was not just about treating sick people. He said the state was partnering with a lot of stakeholders to mitigate the impact of the pandemic in the state.

Desalu disclosed that the state was working with about 700 NGOs in the effort to ensure care, support and treatment for people living with the virus. He said about 12 states from the rest of the country had visited Lagos State since he assumed office to understudy their intervention strategies.

He said the indices show that their intervention strategies have been successful because as at 1999 no person living with HIV/AIDS (PLWHA) could come out openly. He added that there was no support group of any kind, but these situations, have been reversed in the effort to contain the pandemic. He added that they were also working with international collaborators.

He said for a detailed implementation of the Lagos State work plan for combating HIV/AIDS, the agency is divided into seven work groups. These include justice, care and support, youth, VCT, resource mobilisation, I.E.C. and blood & blood products. The work group activities, he said, follow the objectives, strategies, and activities in the LSACA 5-year work plan. He disclosed that the work plan for 2006-2010 had just been reviewed and approved by stakeholders.

The special adviser noted also that in 1999, less than 30 per cent had heard anything about HIV, but today, close to 90 per cent know about HIV and the number going for Voluntary Counseling and Testing have increased greatly.

He stressed that with the state's six treatment centres in addition to those of the Federal Government, anyone desirous of being enlisted on the anti-retroviral (ART) programme gets it. "This journey has not come to pass only because of Lagos State, we know that it is everybody working together from national all the way down that has brought this modicum of success", he said.

He said with the current downward trend in the infection rate in the country must be maintained. According to Desalu, the state has stepped down its capacity building for the health workers to the local government level in order to maintain the tempo of activities. He said they also work with other ministries to reach the younger people in the population.

He said the state's prevalence rate which was 6.7 per cent in 1999, has come down to 3.3 per cent in the 2005 survey and it was indicative of the fact people are changing their behaviour. He noted that LSACA in conjunction with FHI-GHAIN project, MSF and other partners, are making ARVs and other drugs to treat opportunistic infections available.

However, he mentioned that part of the challenge is that a large number of people are not being reached. Another challenge is that of funding. "The required activities to put HIV/AIDS control in place are enormous and they require a high level of funding. There is still the coordination constraint. Many donor-funded NGOs are still not giving LSACA the details of how much these projects cost or what specifically is being done. Of course, we need more office space", Desalu stated of the agency's challenges.

At one of the treatment centres within the premises of the General Hospital, which is being manned by Medicines Sans Frontiers (MSF) (Doctors Without Borders), an international NGO, there was an array of equipment for VCT, CD-4 Count and treatment for PLWHAs. Speaking with the newsmen at the site, an MSF staff, Dr. Helen Bygrave said the NGO has been working in the area of HIV/AIDS since 2003 and they started providing ARVs since July, 2004, About 100 PLWHAs, she said, are currently receiving treatment for free at the site. She added that all services provided at the facility, which is complemented with counselors, laboratory technicians and doctors, are free.

She said about 25 people turn up for the VCT in a day and whoever turns positive after a confirmatory test, automatically qualifies for their ARV programme. While in Enugu State, which has the fourth biggest infection rate in the 2005 survey at 6.5, Dr. Simon Idike, the state commissioner for health, told the team that the HIV case had gone beyond the health issue. Idike said every strata of society should be involved in the effort to combat its spread. He canvassed the involvement of every segment of the health system in the care, treatment and support of HIV/AIDS issues.

He said the state's seven health districts structure was adopted by the government to give fillip to the bottom-up approach on health issues.

Idike said initially, spread of the virus was more in the urban centres, but that this trend has been reversed and the rural areas hold the ace at the moment. He said poverty was responsible for the deepening crisis of HIV spread in the state. Government, he added, was introducing strategies at reducing poverty and improving the quality of life of people.

Later in his own comments at the Enugu State Action Committee on AIDS (ENSACA) secretariat, Dr. Christian Ani, its secretary, said resource mobilisation was at the centre of its activities in order to mitigate the impact of the pandemic. He said the agency came into existence following the Federal Government's HIV/AIDS conference in 2002.

"The state government has shown enough political will to fight the HIV/AIDS pandemic. ENSACA works to strengthen the institutions that are involved in reduction strategies", Ani stated.

He said they were four treatment centres in the state with the University of Nigeria Teaching Hospital (UNTH) serving the Federal Government. Ani noted that combating HIV spread was not a job for the government alone, so, they are collaborating with some NGOs in the state on some specific areas of interventions.

The ENSACA secretary led the team to the Enugu State University Teaching Hospital, (ESUT) where Dr. D. Ude, the chief medical director said they started screening blood for HIV since 1996. He said VCT services were available at the hospital. However, patients are required to pay for all services including ARVs since it is not a Federal Government centre.

Ude said the institution trained 42 health workers to undertake the VCT programme. Some of the constraints he pointed out include, stigmatisation which makes patients to come when the full blown AIDS would have developed, high cost of treatment which many of them could not afford, non-challance towards follow-up tests and lack of funds to assemble more test facilities. He advised the Federal Government to liberalise its free treatment centres to accommodate more PLWHAs.

At UNTH, which is the Federal Government's centre, Dr. Peter Nkwo, head of the HIV treatment unit, disclosed that the programme started in 2002. He said UNTH was among the first pilot sites adding that UNICEF's mandate was for Prevention of Mother-to-Child Transmission (PMTCT) of HIV.

According to Nkwo, the entry point to the ARV services is VCT adding that 95 per cent of ante-natal women access the facility. He said there was high prevalence of HIV among ante-natal women.

He said although the drugs were free at the centre, the tests were usually paid for because the test equipment were bought and they use consumable.

He advised NACA to scale up its services to include test facilities. He said the PCR machine was currently not available in any public hospital in the entire south-east and South-south.

Also speaking, Dr. Chinwe Chukwuka, head of the adult ARV at the hospital declared that the number of people accessing the drugs at the centre was so much that the Federal Government needed to scale up its supplies. She revealed that PLWHAs pay N4,800 for CD4 count tests at the centre.

She said there was so much pressure on them because of shortage of personnel. Chukwuka also complained about office space which has changed twice, yet, there has being no appreciable impact. She said it was easier accessing the Global Funds' ARVs than those of the Federal Ministry of Health. According to her, adult ARVs have no partner beside the Federal Government. She sees between 50 to 55 PLWHAs weekly. She added that they were about 1375 PLWHAs at the centre.

The team also visited the Annunciation Specialist Hospital, owned by the Catholic Church in Enugu. Rev. Sister (Dr.) Ancilla Umeoberi, who stood in for the administrator, stated that the hospital started managing HIV/AIDS cases in 1998. Sister Umeoberi disclosed that all facilities are available at the hospital for the comprehensive management of the pandemic from all ramifications.

She said it is a fee paying centre for people who could afford. Although they have a health insurance scheme for other ailments, it does not include HIV/AIDS care. However, for PLWHAs who could not raise money for treatment, appeals are made for volunteers to assist.

Also speaking, Rev. Sister Bridget Aroh, who is charge of the counseling unit said from January to May 804 people were screened at the hospital. Of the number, 92 were positive comprising 39 males, 53 females and three children. She said part of the challenges they face, is that some positive patients could not raise money to access treatment and some simply go underground.

She said although all testing equipment were assembled at the hospital, there were greatly under-utilised. She canvassed a referral system where government hospitals without the equipment could use their facilities in order to reduce cost.

Cross River State, which topped the chart in the 2003 survey was the next port of call for the team. Even before the officials spoke, available statistics from the 2005 survey, showed that the state has climbed down to the 6th position with 6.1 current infection rate.

In her address, Dr. Regina Ella, SACA coordinator, said the feat was achieved because of the political commitment of the state governor, Donald Duke, who along with his wife, Onari, were personally involved in the prevention strategies. She said a lot of focus had been beamed on the state in recent time because of its performance in the reduction strategies. She said about three states had visited them lately to understudy their intervention strategies.

Also speaking, Mr. Gabriel Undehkwo, deputy director (finance), the reasons for the success story include political will of the government, (Governor Duke is the chairman of the governing board of the AIDS agency), engaging the LACA effectively, a strategic work plan and effective mobilisation of donor agencies in the reduction strategies. Undehkwo added that they also hold stakeholder meetings regularly to review activities and for sustainable programmes.

During a visit to Mr. Abu Eyo Abu, state information commissioner, he said besides the governor chairing the SACA board, the government also uses the festival in December to sensitise the populace on the pandemic. He said the state decentralised VCTs to ensure more people have access to them. He said they have set 2010 as the target date when the state will be HIV free. Abu stressed that all hotels in the state are directed to ensure that they keep condoms in their rooms.

At the General Hospital Calabar, which is one of the four treatment centres of the state, Dr. Joe Bassey, the medical superintendent and project consultant, GHAIN, said the centre is a major one for VCT, treatment and counseling. He said the HIV treatment programme started in 2005 with the assistance of GHAIN and the state government. He said initially, the PLWHAs paid for test only but at the moment, both services are free. People accessing treatment there, he said, come from all parts of the country adding that people from distant places are quartered in a hostel before their return journey home.

He stressed that services offered free there include, VCTs, ARTs, paediatric ARVs and PMTCT. According to Bassey, since inception, over 7,000 have been counseled, 6800 tested out of which 2,500 were positive and are currently on treatment. He said drug supplies come from PEPFAR and other donor agencies.

He added that mortality have dropped and many more people are appreciating the fact that they can live positively and productively with the virus. He said they have facilities for all tests except viral load, where samples are collected and taken to specialist centres elsewhere.

He advised people to come forward and know their status because HIV is just like hypertension, diabetes or leukaemia where sufferers are treated for life. Bassey added that HIV should not be regarded as a death sentence or be stigmatised.

Also speaking, Prof. Etim Asuquo, chief medical director of the University of Calabar Teaching Hospital (UCTH), which is the Federal Government treatment centre, said they started operation in 2005 with PEPFAR drugs. He said 570 PLWHAs currently access treatment there out of the 1,500 spots available to them. He stated that the centre also does outreach programmes on the need for screening to the public.

Coordinator, Futures Initiative, Mrs. Emen John Akpakpan, who is head of her support group, declared that living positively with HIV was no big deal. A mother of two, Akpakpan took control of her destiny soon after her husband died of AIDS and she has not looked back on her sensitisation drive to demystify HIV.

What stood out as a major constraint in all the states was the paucity of funds to increase intervention strategies. Another issue is lack of adequate office accommodation in Lagos, Gombe and the challenge of manpower.