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.
A country like 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 (Nigeria is the most populous country in sub-Saharan Africa), this equates to around 3.4 million people living with HIV putting it only second behind South Africa in terms of absolute numbers.
Alarmingly, however, the latest report by the United Nations has shown that Nigeria has the highest number of children contracting the Human Immunodeficiency Virus, HIV, in the world. United Nations Children Fund (UNICEF) statistic in particular shows that in Nigeria, 10 per cent of all HIV infections are as a result of mother-to-child transmission. This is buttressed by records from the Ibadan meeting of the Society for Gynaecologists of Nigeria (SOGON), which confirmed that Nigeria accounts for 30 per cent of global gaps in Prevention of Mother –To- Child Transmission (PMTCT) of HIV.
In Nigeria, both at the national and states level, there are quality documents and structure to some extent to overturn stagnation in HIV/AIDS progress, no doubt. We have the National Health Sector Strategic Plan and Implementation Plan for HIV/AIDS 2010-2015 which in any ways is best known to authors and those in the health sectors. What we need to do is to assess how to allocate what are currently limited treatment resources. Ultimately, the nation requires more money and 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 not to talk of people living with HIV/AIDS.
We know that early testing is preferable, but what can we do in a country where those who go for public services are often told to come back later? 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.
One major snag is the problem of insecurity as it could dampen effort to achieve HIV free generation. Polygamous relationship, as well as multiple partners has been highlighted as key drivers of HIV transmission. One can’t imagine how many of our Chibok girls and displaced people from Boko Haram occupied and controlled communities are in danger of contracting HIV/AIDS. Displacement as a result of conflict is a factor in the spread of HIV/AIDS. In terms of prevalence rate, 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.
As with other affairs of the state, the Lagos state government is working towards achieving an HIV free generation with an uncommon passion. One of the strategies being used is improving access to HIV/AIDS services. This the government is doing with assistance of development partners (UNICEF, Clinton Foundation, (CIDA/WHO) and implementing partners (FHI/GHAIN, IHVN, ALCO, and AFRICARE).
Lagos State law for the protection of Persons Living With HIV and AIDS , PLWHA, was signed into law in 2007 and to ensure its full implementation, a mechanism whereby PLWHA (People living with HIV and AIDS) who have had their rights infringed upon can seek legal advice at no cost, was set up. This is in line with the views of Justice Michael Kirby of the High Court of Australia, when he said: ‘Paradoxically enough, the only way in which 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’. How apt!
It is, therefore, obvious that one of the fundamental pillars of getting to zero 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. Thus, Lagos state is on track towards achieving an HIV free generation with positive result its strategy of using the Governor’s wife as the face of PMTCT is yielding judging from passion with which the woman has been going about mobilizing women in the state on accessing HCT and health facilities for maternal and child care generally.
••Rasak Musbau writes from Alausa, Ikeja