2014: Turning Point For HIV/AIDS?

Not many people will dis
agree that no ailment has received as much attention as HIV/AIDS in the whole World. True still, there is yet to be an ailment which had evaded prevention, treatment and cure like HIV.
Since it came to the fore in the early 80s in the United States of America (USA), the best that has been achieved has been tremendous progress in terms of diagnosis, knowledge of the disease, treatment and prevention.
Thus, for over three decades, cure for HIV/AIDS has been elusive. Some of the world’s greatest virologists, are said to have given up hope, at some point, for a permanent cure to the virus.
The world scenario, as revealed by Professor Francoise Barre- Sinoussi, states that about 10 million people are currently on HIV/AIDS treatment in the world.
Painting the reality about HIV, Professor Barre-Sinoussi, a virologist who co-discovered HIV in 1983, noted.
“The virus is attacking our immune system, the cell that are there to respond against a pathogene (HIV or any others) that makes a challenge, because the virus is altering the function of our cells very, very quickly.
“More quickly than an immuno response generally can be obtained. So, this is a critical challenge.”
According to the current United Nations report on global HIV/AIDS status, people newly infected with HIV/AIDS declined by 19 per cent ten years before December 2009, with at least 33 countries experiencing a decline in HIV incidence of at least 25 per cent, and that 10 high-prevalence countries achieved the global goal of reducing HIV prevalence among young people at least by 25 per cent.
In spite of these relative successes, the report noted that the HIV epidemic has continued to outpace the response, thus under scoring the need to revolutionise efforts to prevent new infections.
The report also states that as at December 2010, more than six million people were estimated to be receiving anti-retroviral therapy in low and middle-income countries, including Nigeria. Yet the majority of people in need still lack access to the drugs due to peculiar problems relating to countries and environment.
It further noted that about three in 10 countries globally still lack laws prohibiting HIV  related discrimination. Meanwhile, more than half of the countries with such laws or policy indirectly or inadvertently reduce services access for vulnerable populations. Thus, many of the countries with anti-discrimination laws do not rigorously enforce them.
A clear global HIV statistics, according to the report, reveals that: more than 35 million people now live with HIV/AIDS; 3.3 million of them are under 15 years.
In 2012, an estimated 2.3 million people where newly infected with HIV/AIDS, and 260,000 were under 15 years.
It also revealed that 6,300 people contract HIV daily (nearly 262 every hour), in 2012, 1.6 million people died from AIDS, 210,000 of them were under 15 years, and since the beginning of the epidemic, more than 75 million people have contracted HIV, while about 36 million have died of HIV – related causes.
According to UN report, 25 million people living with HIV (constituting about 70 pr cent of the global figure) live in sub-Saharan Africa. This number include 88 per cent of the world’s HIV positive children.
In 2012, an estimated 1.6 million people in sub-saharan Africa were newly infected, while 1.2 million adults and children were also estimated to have died of AIDS. The number accounts for 75 per cent of the World  AIDS in 2012.
Nigeria, one of the sub-Saharan Africa countries, has been noted to have a high HIV prevalence among adults between the ages of 15-49, which was rated about 3.1 per cent in 2012, making Nigeria the second largest number of people living with HIV/AIDS.
The HIV epidemic in Nigeria varies according to region.  It is more concentrated in some regions and driven by high risk behaviours.
Prior to 2013, Nigeria’s HIV prevalence was 4.2 per cent. But after series of intervention measures, the country’s prevalence, according to the report of the National Reproductive Health Survey (NARHS) plus, in 2013 reduced to 3.4 per cent.
The report showed that of the 36 states and the Federal Capital Territory, Rivers State has the highest prevalence of 15.2 per cent which was higher than the national prevalence.
Of all levels of HIV prevalence in Nigeria, however, the most alarming is amongst children, according to the latest UN report.
Titled “2013 Progress Report on the Global Plan: Towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive”, the report shows that the prevalence of HIV among Nigerian  children has been relatively stagnant with no significant improvement.  In 2012, total number of children infected in Nigeria, according to the report, stood at about 60,000, a number that has remained largely unchanged since 2009.
“Nigeria accounts for one third of all new HIV infections among children in the 21 priority countries in sub-Saharan African, the largest of any country. Progress here is therefore critical to eliminating new HIV infections among children globally.
“Nearly all indicators access show stagnation and suggest that Nigeria is facing significant hurdles,” the report stated. Part of these hurdles, according to the Executive Director, Centre for Women’s Health and Adolescents’ Development in Port Harcourt, Rivers State, Ms Helen Odega, is largely due to the fact that the authorities in the health sector have been lagging in the implementation of the prevention of mother to child transmission (PMTCT) of HIV policy.
“Sincerely speaking, I think PMTCT implementation is really zero, and the country is not taking responsibility and ownership. We have policies which are not being implemented and the problem lies with the government, which ought to channel the resources, claim ownership and do the right things.
A presentation made at a two-day National Anti-retroviral 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, of this number , only about 56,000 new HIV clients are put on ART in same period with a ratio of approximately 1.5.
Comparatively, South Africa recorded about 350,000 new HIV infections annually, and put about 227,000 positive persons on treatment annually.         This is an indication that Nigeria is doing poorly for a country with high HIV burden.
Meanwhile some African Countries, such as Botswana, 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 the light of the fore-going development in HIV/AIDS, the immediate question that easily comes to mind is, where have we gone wrong in the search for HIV prevention, treatment, care  / support for people living positively, and cure for the pandemic?
Generally, there are so much amiss: one key area in which the fight against HIV has faced the greatest challenge is in the institution and implementation of relevant laws to protect the rights of PLW HIV.
As noted earlier, only relatively few countries  have instituted laws that both protect PLW HIV and punishes offenders.  Worst still, most of these few countries are yet to fully implement such instituted laws, which would have served effectively as a spring board towards the implementation of efforts aimed at checking the spread of HIV.
The same incapacitation is noticeable in the health systems of most countries with high HIV prevalence.
The organisation of health service in Nigeria, for instance, is complex. It includes a wide range of providers in both the public and private sectors.
In the public sectors, Nigeria operates a decentralised health system run by the Federal Ministry of Health, State Ministries of Health and Local Government Health Department (LGHDs). The FMOH is the overall health policy formulating body. It coordinates and  supervises the activities of the other levels. It also provides tertiary care through teaching hospital and federal medical centres. The State Ministeries of Health provide secondary health care through the state hospitals and comprehensive health centres, while the LGHDs provide primary health care service through the primary health centres.
On paper, this decentralisation of the health care delivery system in Nigeria seem effective. However, in practice it is hardly so. This is because health service delivery is mostly concentrated in the urban areas. The rural (precisely hard-to-reach), areas are in most cases excluded from key health commodities.
Consequently, rural dwellers often find it difficult to access health care in the urban areas as a result of the distance. This has financial consideration on the part of the rural dwellers, who due to financial incapacitation could remain in the rural area till death comes knocking.
In spite of the numerous global collaborative efforts ultimately aimed at getting a cure for HIV/AIDS, it has remained elusive. This has constituted a major challenge to scientists all over the world, particularly, virologists involved in HIV/ AIDS.
It has also become a challenge to other key stakeholders, and the entire world as a community to step up their collaboration in the quest for a cure. Such key stakeholders include scientists involved in HIV, clinicians, media and governments.
On the part of the scientists, over three decades after the first case of HIV was detected, the best they had achieved that is closest to a cure is the case of Timothy Brown, the first man cured of HIV through a bone marrow transplant and that of the mississi ppi baby, who was treated with anti-retroviral drugs for HIV immediately after birth. Two years since being taken off therapy at 18 months, the baby has remained free of HIV.
As late as this may seem to have come, it has been a long but fruitful journey. But the journey may still remain long until a permanent cure is found and made easily accessible.  Clinicians, particularly in the developing countries, would need to create a much more conducive, less discriminatory and trust worthy relationship with PLW HIV. This will greatly encourage infected / affected persons to come out from their hideout to access care and support.
Health care providers in Nigeria need to ensure, for instance, that one way to check MTCT is to strengthen follow-up mechanism to track HIV positive pregnant women who go for traditional birth attendants (TBAs). This will encourage them to return to the hospital to give birth, not just attend anti-natal sessions alone.
Government at various levels also need to go beyond HIV financing to instituting necessary discrimination laws and policies and implementing same.
All of these efforts may come to naught without effective collaboration with the media, which is vested with the responsibility of creating awareness.
Without relevant and continuous awareness, the populace will be left behind on developments about HIV/AIDS.  If   these and other key stakehdolers involved in HIV response could play their roles effectively in their peculiar environments across the globe, the hitherto long journey so far in the fight against HIV/AIDS may have been shortened.   As the world assembly in Melbourne, Austrialia for AIDs 2014, therefore, expectations are rife that given what have been achieved so far, the 20th International AIDS Conference will pave the path towards an end to the HIV/AIDS epidemic.

Sogbeba  Dokubo

LAS President, Professor Francoise Barre-Sinoussi