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Achieving an HIV/AIDS-free generation

Rasak Musbau

In 1988, the World Health Organization (WHO) institutes December 1 every year as World AIDS Day. The objective is to provide a platform for the world to unite in the fight against HIV /AIDS. Part of the aim is also to ensure that governments and policy makers meet the HIV targets they set, stand by the commitments they made and mobilize the necessary resources for a world where people do not die of AIDS related ailments. For each World AIDS Day from 2005 to 2010, the theme was “Stop AIDS”. The 2014 theme for World AIDS Day is “Focus, Partner and Achieve an AIDS-Free Generation”.
The early days of the HIV/AIDS epidemic was characterized with 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, and are still having, a widespread impact in many parts of the world especially in the sub-Saharan Africa.  The main focus of fight against HIV globally today is now on 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 per cent of these women are concentrated in 10 sub-Saharan African countries: Nigeria, South Africa, Tanzania, Kenya, Uganda, Zimbabwe, Mozambique, Malawi, Ethiopia and Zambia.
Senegal has been particularly successful in managing its HIV epidemic and maintaining a low overall HIV prevalence among the general population. Strong political leadership and early involvement in the epidemic, as well as leadership among religious leaders and conservative cultural norms around sexual practices have all been attributed to Senegal’s success. 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 as well as the promotion of condom use.
Due to failure of the South Africa’s government to respond quickly to their HIV epidemic at the outset, the country has the highest number of people living with HIV in Africa with 17.9 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 putting it only second behind South Africa in terms of absolute numbers. A latest United Nations’ report has revealed that Nigeria has the highest number of children contracting the Human Immunodeficiency Virus, HIV, in the world. Also, a United Nations Children Fund (UNICEF) statistic shows that, 10 per cent of all HIV infections in Nigeria are caused by mother-to-child transmission.
In term of prevalence rate in the country, Benue state has the highest percent 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 prevalence rate of 5.1 percent. The state is one of the 12 states, which accounts for 70 per cent of the Mother-to-Child Transmission of HIV burden in Nigeria.
While awareness about HIV/AIDS has gradually increased among the Nigerian population, misconceptions about transmission are still high. Many communities are still underserved with health facilities and care. It was even estimated that just 10 per cent of HIV-infected women and men were receiving anti-retro viral therapy and only 7 per cent of women were receiving treatment to reduce the risk of mother-to-child transmission of HIV.
Ultimately, Nigeria requires more 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 talk less of people living with HIV/AIDS.
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 short cut to breaking the barriers as without access to public services for prevention of mother-to-child transmission (PMTCT), which provides antiretroviral (ARV) to both mothers and babies to prevent HIV infection, HIV free generation might be a pipe-dream.
In Lagos, the state government is improving access to HIV/AIDS services in partnership with UNICEF, Clinton Foundation, and CIDA/WHO among others. The state’s law for the protection of Persons Living With HIV and AIDS (PLWHA) was signed into law in 2007. To ensure its full implementation, a mechanism that aids PLWHAs whose rights are infringed upon, at no cost, was set up. This is in line with the views of Justice Michael Kirby of the High Court of Australia that the only way 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.
One fundamental pillar of getting to zero HIV prevalence level would be to ensure increased uptake of PMTCT services. This is already being done at the 29 PMTCT sites located in secondary and tertiary institutions across the state.  Lagos State AIDS Control Agency also provides micro-credit schemes to alleviate various problems facing PLWAHs towards their social and economic empowerment. Lagos state is, thus, working hard to achieve an HIV free generation.
The strategy of using the Governor’s wife as the face of PMTCT is yielding positive results judging from passion with which she has been mobilizing women in the state on accessing HCT and health facilities for maternal and child care generally.
As we join others in the world to mark the World AIDS Day, it needs to be further stressed that HIV/AIDS is a public health and not a moral issue and join hands with government to achieve an HIV/AIDS free nation by sharing love and not the virus.

•Rasak Musbau writes from Alausa, Ikeja

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