HIV/AIDS Treatment Gaps: Any Solution?

Since the early eighties
when HIV/AIDS came to the fore in Nigeria, there had been various fears at different points regarding the pandemic.
The first was the fear associated with the mode of contracting the virus, which was blown out of proportion; people even thought then that mere hand shake with an infected person would result in contracting HIV/AIDS.
The next type of fear had to do with stigmatization: people refused to go for Health Counseling and Testing (HCT) for fear of being stigmatized, rejected and ostracized by the society. Consequently, they would rather prefer to die than access treatment.
For those who are employed, the fear of losing their job as a result of stigmatization was too much for them to comprehend.
Beyond these, there had also been various levels of fears within individuals, groups and government at various levels: if the fear is not associated with lack of HIV test kits, it could be the attitude of Health workers towards HIV/AIDS infected persons or lack of fund to provide necessary AIDS related drugs.
The current fear is associated with what will happen as a result of a persistent lack of antiretroviral drugs and the inability of infected persons to ascertain the level of HIV in their blood because out of 37 states in the federation, only five states have functional viral load machines in Nigeria.
The viral load refers to the amount of HIV in the blood. If the viral load is high, T-helper cells tend to be destroyed more quickly. Therefore, the aim of the antiretroviral therapy (ART), which is not readily available, is to keep the viral load as low as possible.
The T-helper cell plays an essential part in the immune system by helping to co-ordinate all other cells to fight illnesses.
Across the country, the scarcity of ARV drugs has posed serious problems for People Living with HIV/AIDS (PLWHIV). For instance, almost all the states introduced free ARV treatment for PLWHIV but most times, the program  experiences drug stock outs.
In Rivers State, precisely, a reliable source who spoke on condition of anonymity told The Tide that the ART is under the free medical by the state government, but because no fund was released in 2012 for the program, People Living with HIV (PLWHIV) suffered drug stock outs all through.
Besides, the lack of functional viral load machines in most states in Nigeria currently has raised the fear that the country may witness an astronomical increase in HIV related deaths, and this is capable of jeopardizing its quest to attain the Millennium Development Goal (MDG) goal 6 which has to do with combating HIV/AIDS to a reasonable level by 2015.
National Agency for the Control of AIDS (NACA), which co-ordinates the activities of the State Agencies for the Control of AIDS (SACAs) in Nigeria, is vested with the responsibility of providing the viral load machines in the country. It also takes care of the repair and/or maintenance of the machines.
Currently, though, only Lagos, Abuja, Anambra, Ibadan and Benin have functional viral load machines bought and distributed earlier by NACA to all states are now beyond repair.
The Tide’s  gathered that the viral load machines, bought from abroad are very expensive, and each time any of them malfunctions, the supplier is invited from abroad by NACA to come and repair it.
This has eaten deep into the purse of NACA, Which is currently in search of partners for the purpose of purchasing and maintaining new viral load machines.
The co-ordinator, Network of People Living with HIV/AIDS (NEPWHAN), Rivers State Chapter, Mrs. Josephine Emmanuel, who was on her sick bed during press time, chatted endlessly, lamenting what she described as the indiscriminate loss of their members to HIV/AIDS, and the absence of viral load machine in River State.
“For the past three weeks I have been sick from one illness to the other and because there is no viral load machine in the state, I was taken to Benin to ascertain my viral load levels. To my greatest surprise my viral load was extremely high, which ostensibly shows that all the HIV treatment I have been taking failed.”
“Most of us find it extremely difficult to afford transport fare to Benin or Ibadan, to ascertain our viral load in a bid to know when to commence new drug regimen”, Mrs. Josephine lamented, tears rolling down her cheeks.
Mrs. Emmanuel pleaded that both the federal, state and local Government Areas should endeavour to earmark certain amount from their HIV budget for the purchase of viral load machines in Rivers State and other states to alleviate the economic, financial and psychological burden of PLWHIV.
Ironically, NACA is believed to be well funded, though by Donor Agencies and the Western World.
For instance, NACA (2012:59) report shows that the expenditure on implementing HIV/AIDS programs in Nigeria was $300 million in 2007, of which the majority $225,392,257.00 (85.3%) was from international funds, with bilateral contributions totaling $197,219,307.00 (19.43%). The rest were from international not-for-profit organizations and foundations amounting to $32,479 (0.01%).
The same trend continued in 2008 with international funds contributing 92.3% of the $364, 581, 432. 00 of the total expenditure.
$364, 581, 432.00, (80.8%), $845, 477, 907.00 (11.5%), and $63, 000.00 (0.01) were respectively contributed by the direct bilateral contributing multilateral agencies and international not-for-profit organizations and foundations.
Funding for HIV/AIDS spending in low and middle income countries is distributed by multilateral organizations which obtain their funding from a number of national governments. The largest of such body is the Global fund to fight AIDS, Tuberculosis and Malaria, which had distributed about $16.2 billion for HIV/AIDS, Malaria and TB by November 2011.
Investigation revealed that under the consolidated phase I of Rounds 5, 8 and 9 Global fund HIV grant (2009-2012), NACA received about $151.6 million for HIV/AIDS activities in the country.
It further gathered that about $228 million was recently approved for phase II (2013-2015) for the scaling up of gender sensitive HIV/AIDS prevention, treatment, care and support for Adults and children, including health and community strengthening in Nigeria.
A presentation made at a two-day National Antiretroviral and co-trimoxazole Quantification Assumptions workshop by senior programme specialist, Centre for Disease Control (CDC) on the strategic use of ART, Dr. Ogbanife Obinna, noted that over 270, 000 new HIV infections occur annually in Nigeria; while only about 56,000 new HIV clients are put on ARVS in the same period with a ratio of approximately 1.5. Comparatively, South Africa record about 350, 000 new HIV infections annually, put about 227, 000 positive persons on treatment annually.
This is an indication that Nigeria is doing poorly for a country with high burden of HIV.
Meanwhile, several African Countries such as Bostwana, Cambodia and Malaysia are now ahead of their HIV epidemic because the number of people put on treatment annually surpasses the rate of new infections recorded.
In a telephone interview with the Tide, the Executive Director of the Rivers State Agency for the control of AIDS (RIVSACA), Dr. Chimeizie Okeh said, in a bid for Nigeria to meet her HIV treatment goals, resources needs to be redirected at HIV Programs with the greatest impact.
According to him, research should continue towards more effective HIV treatment options and that the National guidelines for HIV/AIDS should be appropriately implemented.
The Rivers State co-ordinator of Women Living with HIV/AIDS, Mrs. Peace Elijah told The Tide during the triennial Delegates Conference of PLWHIV, Rivers State, that apart from viral load machines, HIV pregnant women encounter difficulties in accessing ARVs treatment in health facilities in the state.
“We have a lot of PMTCT sites in the state but there are not enough drugs for both mothers and babies born by HIV Positive mothers. After delivery, the mother is supposed to be placed on complete dosage of Neviraphine, while the babies will also be administered ARVs drugs but these ARVs are not readily available thereby leading to mass deaths of both mothers and babies”, she said.
Mrs. Elijah, who is currently pregnant, further advocated for Greater Involvement and Investment of People with AIDS (GIIPA) principle in most state to enable PLWHIV become self reliant. “The GIIPA principle is a global one, of which some states in Nigeria have adopted”.
Recently, she continued, President Goodluck Jonathan introduced “President’s Emergency Response Plan” (PERP), which seeks to test two million pregnant women in two years, provide antiretroviral drugs and treatment to over 80,000 women in the next two years, as well as provide Early Infant Diagnosis (EID) to 80,000 babies newly born to HIV positive mothers.
To what extent this can be achieved going by the current incapacitating development in Nigeria as regards HIV/AIDS, and whether budget on HIV/AIDS released to states and NACA were not meant for the purchase of viral load machines are questions that requires urgent answers by all stakeholders
Meanwhile, The Tide, source gathered that most of the investment on HIV/AIDS in Nigeria comes from international sources. As of 2008, only 7.6 percent of investment was domestic public expenditure. The majority of the funding came from development partners. The main donors are United State President Emergency Plan for AIDS (PEPFAR) and World Bank.
In 2008, PEPFAR provided approximately $448 million to Nigeria for HIV/AIDS, prevention, treatment and care, the 3rd highest amount out of PEPFAR’s focus countries. Also, Presentation by PEPFAR last year revealed that it is providing treatment for 489, 538 PLWHIV, “The Tide source gathered”.
NACA Boss, Prof. John Idoko, recently revealed that about three million people are HIV positive in Nigeria. One million, five hundred of the number he said require HIV treatment, but only five hundred thousand currently access treatment.
The question therefore is, if PERFAR is providing treatment for 489,538, it means only 104,62 are left in the 500,000 people accessing treatment when one consider that other donor agencies such as World Bank, Global Fund, UNICEF, etc also contribute in no small measure to HIV/AID s treatment and preventions activities in Nigeria, it leaves a huge question mark on extent to which NACA carries out its HIV/AIDs prevention and treatment activities
PEPFAR also revealed that from 2015, they will commence gradual withdrawal of fund for HIV/AIDS. This is most likely to affect HIV treatment in Nigeria, if more resources are not put into HIV/AIDS prevention and treatment in order to fill the expected gaps.
While responding to the issues as it affects NACA, the Head, State Affairs Unit, NACA, Dr. Ifeoma Ezekwe told The Tide in a telephone interview that NACA only assisted state SACAs to get the viral load machines.
In the purchase of new viral load machines, she said “if funds were available we would have bought and distributed to states as was earlier don”.
From the fore-some, for Nigeria to make reasonable progress and possibly attain the MDG goal 6, therefore, more attention needs to be directed at increasing preventive activities such as grass-root enlightenment, increase in state health budget with particular reference to HIV/AIDS for adequate provision of ARV treatments including viral load machines, as well as ensuring that the ARVs get to the end users.
One way to ensure universal access to prevention, treatment, care and support is to further strengthen the monitoring and Evaluation mechanism of all implementing partners in the country.
Meanwhile, Nigeria can reduce new infections, if the number of persons on HIV treatment is aggressively increased by about 100,000 in 2013, 150,000 in 2014 and 200,000 in 2015.

Sogbeba Dokubo