Nigeria Conveniently Controlling HIV/Aids Epidemic - Dr Aliyu Gambo, Director General, NACA

3 December 2019

Over the years, the HIV/AIDS epidemic in Nigeria has been described as one of the largest in the world and one of the highest rates of new HIV infections in sub-Saharan Africa.

Many people living with HIV in Nigeria are unaware of their status while a large percentage of those diagnosed are not on Antiretroviral (ARV) drug treatment. Worse still, the country continues to fall short of providing the recommended number of HIV testing and counseling sites.

But since the release of the report of the 2018 Nigeria HIV/AIDS Indicator and Impact Survey, NAIIS, it has become clear that the country has made significant advances in the campaign against the epidemic despite the lingering challenges.

The Director General of the National Agency for the Control of AIDs, NACA, Dr. Aliyu Gambo, in this interview with Sola Ogundipe & Chioma Obinna, gives a rundown of the current state of the national HIV/AIDS response. He also sheds light on the way forward in the drive towards HIV elimination by 2030. Excerpts:

Situation of HIV/AIDS fight in Nigeria

In terms of the situation of HIV/AIDS fight in Nigeria, we will say the situation is good at the moment. We never knew that in the last 15 years we have done so well in terms of fighting HIV in Nigeria until 2018 when we did the NAIIS survey. The survey revealed to us whatever strategy we have in place is working and has been very impactful, in the sense that it has reduced the prevalence from 4.4 percent to 1.4 percent. It was 4.4 percent in 2005 and 2018 it was 1.4 percent. And it has reduced the estimated number of people we think has HIV in Nigeria from 3.5 million in 2005 to 1.9 million in 2018. So 1.4 prevalence in 2018 and 1.9 million as estimated number of people living with HIV is good

What the new NAIIS report means for Nigeria

The new NAIIS report means that Nigeria has done well and can conveniently control HIV epidemic. And that is what we are calling the last mile push. When President Buhari released the NAIIS report earlier in the year, he urged stakeholders and NACA to push for the last mile. The last mile means we should push hard to control HIV epidemic in Nigeria and that is exactly what we are doing at the moment. We are pushing hard to see that we fight stigma and discrimination. We are pushing hard to make HIV testing attractive, we are pushing hard for people to know the benefits of knowing their HIV status and taking action.

How NAIIS has shaped NACA's future response

As I said earlier, the NAIIS report has shaped our response because we now know that we are dealing with an epidemic that is not as large as we knew before. We also know that we are dealing with a number of estimated people that is less than what we were thinking before. So in terms of planning we now have enough capacity to plan for 1.9 million as against 3.5 million in the past. We have enough energy to fight an epidemic that is shrinking obviously, and that from all indications that our measures in place is working and it is working well. All we need to do is to make sure that is working very well, and making it work well includes using data we generate to form our decision. We have launched in states like Rivers and Akwa Ibom and soon we will launch in Lagos.

Can Nigeria meet the 2030 targets?

Yes, Nigeria can meet the global targets by 2030 as long as we keep the momentum at the moment that we have, If we keep it for the next 10 years we are very confident that we will meet the target. We will reach that level where we have negligible or zero death level for HIV. We will beat our chest and say yes, we did it.

How NACA is addressing challenge of stigma

Stigma is our biggest enemy. It has been preventing people from testing and coming forward and when they test positive, doing something about it. This is why we are planning and decentralising NACA offices from one to six - one office in each geopolitical zone. The purpose is to be vigorous in terms of our campaign against stigma and discrimination. In terms of getting people to understand the benefit of HIV treatment and testing, vigorous in terms of getting people to come out and demand for HIV testing so that we end AIDS by 2030.

On employers asking employees to go for HIV test

This is why we are embarking on sensitisation of employers and employees. HIV situation has changed. It has changed from disease that kills to a chronic illness that you can manage, just like we are managing hypertension and diabetes. As long as you take your drugs, as long as the drugs are suppressing the virus and wiping it out from your blood, HIV cannot lead you to infect another person. It cannot continue to destroy your immune system or body defences, definitely it cannot give you the bad outlook that it gave in the past. It will not show on your face, or your body. If it does not do that why discriminate? Why prevent somebody from being a productive employer. Some of them are very intelligent, some maybe the best staff that you have, why push them away?

NACA's distribution of rapid self test kits to enable Nigerians know their status

We are planning to deploy rapid self-test kits to Nigerians. We are planning to start with some special communities and then we expand. We want also to make sure that the test kits are available, accessible and affordable for people who want to know their status in the comfort of their rooms and then do something about their status. The essence of knowing your status is to help yourself. Once you realise that you don't have HIV, then we will help you remain HIV-free for the rest of your life. Once you realise that you have HIV, we will help you control the HIV in you in such a manner that it doesn't show on your face or your body and affect your loved ones. Technically, we deactivate HIV in your body.

Efforts on getting more Nigerians to go for HIV test

We are going out and working at community level, getting opinion leaders, community leaders, religious leaders, volunteers and health workers and people affected by HIV and young people to make sure that people in their communities are mobilised to know their status and make sure they are doing something about their status.

Does Nigeria still heavily depend on donor agencies?

Yes, we still depend heavily on donor agencies. As we are talking the donors still pick about 80 percent of the bills. What the government is planning, going forward, beginning from 2020, where Nigeria will begin to absorb more in terms of funding of HIV and more in terms of putting more people on treatment and sustaining them on treatment.

On non-availability of ARVs in some government institutions

Those ones we aren't sure that treatment is not available. Every facility that has been tagged as ARV facilities at the moment has the drugs and at the moment treatment is being given uninterrupted. If there is any facility that is lacking of drugs or services are interrupted, we have to be alerted, either directly or indirectly and we will find out what is going on there. Certainly, sometimes there may be some kind of delay in commodity delivery but definitely not interruption.

Challenges encountered in addressing HIV /AIDS in Nigeria The challenges are always there. The challenges are stigma and discrimination. The challenges are people accepting to test to know their status and doing something about it. The challenges of funding - funding that is shrinking; funding that needs to come as much as we need it, funding that will be able to sustain our activities going forward.

On allocation to HIV in 2020 health budget

The allocation to HIV in the 2020 budget has never been that good, but it is very encouraging. The President approved increment from the money NACA receives. Going from 2020 NACA will now put additional 50,000 people living with HIV on treatment on the bill of Nigerian government. By next year Nigeria will be treating 100,000 instead of the current 50,000, so kudos to the country, kudos to the government of Nigeria.

How many people living with HIV on treatment currently?

Our record is showing a million people. Our estimates show 1,800.000 or 1, 900,000 are living with HIV in Nigeria. You can say close to 55 percent of people living with HIV are currently on treatment.

On HIV cure claims in Nigeria

The world has passed the age where you wake up one day and push something to the people with the aim of using them as guinea pigs to show how their body reacts to it or how it reacts in their bodies. The thing globally now is that when you use human beings as guineapigs, you have to respect treaty, principle of autonomy, it has to be voluntary. When you use them, they have to know what you are using them for and they have to know the implication. And there must be benefits, what are they going to get out of it. There has to be justice. Justice meaning that there must be justification of whatever you are going to do. And you are not exploiting or harming them. There must not be harm or exploitation, that is why products are now tested on animals before they are tested in human beings. So if you have cure claims, come, we will help you. We will set up things for you. We will make sure you verify your cure claim. If there is any cure claim in Nigeria, and now found to be a cure globally, that will be a plus to Nigeria. It is also going to be an economic advantage to Nigeria. That will put Nigeria on the global scale and take Nigeria to the highest level. And that is what we are looking for from Nigerian scientists.

Currently, we did a survey, we have seen the situation in prisons and we are reaching out to correction centres and prison management working together to make sure that people in the correction centres have access to HIV services, they have access to knowing their status, if they are HIV positive, they have uninterrupted access to medical services.

Take home message: The take home message is that every Nigeria should know his or her HIV status and do something about it. You test yourself, you are negative, remain negative for the rest of your life. You test yourself, you are positive; a new journey begins. Come to us to deactivate HIV in you. We will ensure that it does not give you bad looks as in the past and we will make sure that it does not affect your loved ones.

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