In this interview by SADE OGUNTOLA, Director-General of the National Agency for the Control of AIDS (NACA), Dr Gambo Aliyu, speaks on efforts at ending AIDS in Nigeria by 2030 and the challenges.
What is the situation of HIV prevalence in Nigeria?
Nigeria has made tremendous progress on HIV control, particularly over the last four years. In fact, the achievements recorded in HIV control programming and national response over the last four years supercedes that from the past three decades. This is made possible by the tremendous efforts put into the national response to the virus. We took HIV sensitization and treatment to the doorsteps of individuals and communities; we no longer restrict ourselves to health facilities, waiting for patients to come and, so far, Nigerians are responding very well.
At the moment, over 1.8 million people are receiving treatment for HIV and their response to the medication is being monitored. We know that once this virus cannot be detected, it cannot be transmitted and it cannot affect other people. It can certainly not make them sick; let alone evolving to AIDS, which leads to death. This entire goal of ending AIDS is finding the people that have the HIV, getting the virus to disappear in their blood and sustaining the level so that the virus is no longer seen.
A former health minister, Professor Isaac Adewole, at a time said Nigeria has more HIV-infected babies than anywhere in the world. What is the situation now?
In the past, we had more HIV-infected babies because pregnant women were not accessing our antenatal services and HIV testing services. They also didn’t deliver at our hospitals. But we have expanded prevention of mother-to-child transmission of HIV services to the doorsteps of people at the community level. We found ways to get the services closer to pregnant women because that ordinary people don’t come to our facilities to either enroll for antenatal service or to deliver at our facilities.
We have a 100 percent success of preventing transmission of the virus from pregnant women to their unborn babies once we identify those women that are HIV positive and those that are at risk of transmitting the virus to their unborn babies. However, pregnant women that have no access to antenatal services and who don’t take the drugs to prevent its transmission are the ones accounting for the high percentage of mother-to-child transmission of HIV in Nigeria. That scenario, however, is changing.
We are now mapping service delivery points at the community level, based on our estimate of facilities that are not captured, so that we can add their data. That will give us an idea of the revised level of transmission. There has been a tremendous change over the last four years.
HIV seems no longer a death sentence in Nigeria. What exactly did you do to achieve that?
How many people can you recall, maybe in the last five years that are seriously sick because the person has HIV or AIDS? Does it mean that there are no people living with HIV/AIDS? In Nigeria, there are close to two million, by our estimate, that are living with the virus. But why don’t we see them getting sick and then coming down with AIDS as it happened in the past? The secret is the free medication that we give at over 2,000 health facilities across the country. It is helping to make the virus disappear. Once the virus disappears, you will not see HIV symptoms in them and they look so fresh like fresh tomatoes. This is what we are calling people to take advantage of. We cannot give these drugs without testing for HIV. The message to people is, HIV shouldn’t be a death sentence.
HIV can be managed like other chronic diseases like hypertension, asthma and diabetes. One can live with the virus for as long as one adheres to taking these medications. HIV is only killing among those people that refuse to test to know whether they have the virus in them or not and they are taking the risk. Unfortunately, if they have the virus, the virus keeps on destroying their immune system.
Things have changed over the years. Now individuals can self test in the comfort of their homes using the HIV self test kits. If the test result is positive, it means more tests need to be done to confirm HIV at the hospital.
How far has your agency gone to ensure that every home has the HIV self testing kit?
Due to limited funding, we cannot give HIV-self testing kits freely to everyone. We are only giving kits to a population known with rapid or at high risk of getting HIV. These are key affected populations like those that trade sex, men that have sex with men or those who inject themselves with drugs and exchange needles and, of course, the transgender. In addition to these are adolescents and younger persons.
For the general populace, we are making an effort to make HIV self test kits available at pharmacy shops across the country. It may not be more than N2, 500 based on our estimate. Saliva or blood can be used for the test and in less than 30 minutes, the result is ready. The kit is important, especially for people that feel strongly about others knowing about their HIV status.
Pre-exposure prophylaxis and post-exposure prophylaxis for HIV, what are they and their significance in HIV control in Nigeria?
These are prophylaxis given before and after exposure to a situation where there is obvious risk of HIV infection. The idea of pre-exposure prophylaxis and post-exposure prophylaxis is to prevent HIV infection from happening in a situation where there is an obvious risk of it happening. In case of rape, there is the need to provide HIV drugs to the victim to prevent HIV infection in the event the person that committed the act has HIV. It is the same with needle pricks injury in healthcare providers managing somebody that is living with HIV/AIDS. It is important to give these individuals drugs so that the infection does not set in, in the event that HIV transmission has taken place.
However, pre-exposure prophylaxis is the prevention of HIV infection happening before the risk is taken and this is mostly for the key affected population like men who have sex with men and sex workers. If they test HIV negative today, they may likely test HIV positive in the next one or two months just because of their behaviour. Even as HIV negative individuals, they take certain HIV drugs to prevent HIV infection, peradventure they come across HIV behaviourally. And the prophylaxis for HIV is given at facilities called one-stop shops across the country.
We are promoting the use of exposure prophylaxis where we know obviously the risk of the infection is there and it is visible. It is not for the general populace to prevent them from HIV infection. Rather, we encourage the general population to use our prevention packages.
The Joint United Nations Programmes on HIV and other foreign partners launched the 90-90-90 strategy with the target to end the AIDS epidemic by 2030. How far have we gone in achieving this target in Nigeria?
What we are doing exactly is to find the people living with the virus in the country and putting them on treatment. When I came on board in 2019, about 800,000 to 900,000 people were identified and taking our medications. Today, we have about 1.8 million people that have been identified to be living with the virus and they are taking medication. The more people with HIV are identified and are on treatment, the closer we are to ending AIDS.
Now, our target is 95-95-95; it is no more 90-90-90. What that means is that you identify 95 percent of the people that live with the virus in the country and you put them on life-saving medications. Out of those 95 percent that you put on life-saving medication, 95 percent of them should be able to achieve viral suppression, meaning that the drug should make the virus disappear from the blood. That is the key. Once you reach that, you will no longer be seeing new HIV infections or people developing AIDS and then dying.
By the year 2030, it is expected that every country in the world should attain this level where you don’t see people dying from HIV anymore, because they don’t progress to AIDS, since they are identified and placed on medications. By the time we reach that milestone, you will probably test 500 persons before you find one. This is what is meant by ending AIDS and once that is achieved, it means the people now keeping the virus in them are going to leave this world with the virus in them and, over time, you will look for HIV and you will not find it in our communities and societies because it would have been curtailed. If we are lucky to find a cure for HIV before 2030, then that will probably solve this global problem.
HIV control programme is not the only one that needs money. How are you going to bridge the funding gap to ending AIDS by 2030?
Money is always an issue and it will continue to be an issue. However, at the moment, we’re doing very well with the money that we are getting from our development partners and the Nigerian government. In the next two to three years, things will begin to change as the big envelope we have from the development partners, mainly the United States and the Global Fund, begins to shrink. We are supposed to come up with innovative strategies in the country to fill this gap as they emerge with services and later on with money.
The question now is, ‘how do we source this money?’ The Federal Government at the moment is doing tremendously well. Its contribution is more than the number of patients that are treated for HIV at the teaching hospitals and federal medical centres all over the country. If you take count, they are not more than 10 percent of the entire number on HIV treatment nationwide.
The remaining 90 percent are treated at state government hospitals and this is where we are not getting much contributions and this is what is going to be our preoccupation going forward. We want to see the state governments taking up provision of these services. Even if they don’t have money to give at the moment, they can give services such as keeping these clinics running. That will help in a big way in preparing Nigeria to own the HIV response nationally and also to create sustainable structures.
Last year, the HIV Trust Fund was launched by former President Muhammadu Buhari with a target for the private sector to mobilise about N42 billion over the next five years. This money, to be managed by the private sector, will be utilized to support the programme for eliminating mother-to-child transmission of HIV nationally. This is the big pot that is coming on board to make sure that this service is available, whether at facility level, community level or at household level, in ensuring that we have a 100 percent success in preventing mother-to-child transmission of HIV.
At the moment, we are looking at resource mobilisation and following up pledges from corporate institutions. Also, donations, no matter how small, can be made on the portal of the HIV Trust Fund of Nigeria towards preventing mother-to-child transmission of HIV in this country. We are hoping that in a year from now, we will see more efforts coming towards that direction.
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