The Scourge of HIV/AIDS in  Nigeria; Indigenous Solution 

By

Taiwo O Fasoranti MD

Fasoranti9@yahoo.com

 

Dear Editor,

 

On the topic of HIV/AIDS in Nigeria, I would like to shed some light and suggest a practical solution I will call the “Nigerian Solution”.  Nigeria has now become the number three nation in the prevalence of HIV/AIDS in the world (USAIDS, 2004). As a Public Health Professional and an Advocate for People Living with HIV/AIDS (PLWHA), I strongly believe that dealing with this disease and curtailing it is no easy task and it requires all stakeholders pulling out all the tricks available to them.

 

Some Statistics for the Records:

 

The UNAIDS gave the following statistics for the reporting year ending in 2004:

 

  • 39.4 Million People worldwide were living with HIV/AIDS.

  • Majority of infected people live in the developing world.

  • About 60% live in sub-Saharan Africa.

  • About 5 million new infections were recorded in the same year worldwide.

  • There were about 14,000 new infections worldwide every day.

  • The same year recorded about 3 million deaths from the disease.

  • To date, there have been approximately 20 million AIDS related deaths since the onset of the epidemic.

  • Recently according to the Chief Executive of Save the Children : “Some 9 million children living in Africa have lost a mother to AIDS” 

 

HIV/AIDS IN NIGERIA:

 

 It is important to have an idea of what the picture is like in our country.

 According to the UNAIDS:

 

  • Nigeria has an estimated population of about 130 million people (2004)

  • The population of people between the ages of 15-49 is about 59 million (2004)

  • Total adult literacy rate is estimated to be around 36% of the entire population (2000)

  •  Life expectancy at birth was 49yrs in the year 2002

  • Estimated number of adults and children living with HIV/AIDS in 2004 was about 4 million (UNAIDS) making the adult rate approximately between 5%- 6% and still counting.

  • Women between the ages of 15-49 years living with the disease are about 1.9million (2003)

  • Children between the ages of 0-17years that have been orphaned as at the year 2003 are about 1.8 million

  • The reported mortality rate for the entire population of people living with HIV/AIDS in 2003 was about 600,000 people. 

 

 

OBSERVATION:

 

The statistics are frightening and calls for immediate action and a reevaluation of our strategies in fighting this disease. I will like to commend the efforts of the National Action Committee on AIDS (NACA) under the leadership of Professor Babatunde Osotimehin; it is understandable that this organization is faced with a lot of challenges as it tries to implement different programmes in the fight against HIV/AIDS in Nigeria. Understandably, the rest of the world is trying as hard as they can to fight this pandemic judging from the enormous amount of resources being channeled towards the fight. Nigeria is blessed with so many resources both human and natural that we need to employ all resources at our disposal to fight the disease and prevent the impending catastrophe we are faced with. Obviously the disease is on the rise amongst the population and nothing appears to be helping in the control of such.

 

FOREIGN AIDS INTO NIGERIA:

 

While it is commendable that many foreign Non Governmental Organizations are in the country helping in the fight, I believe that their efforts will not be effective if the population they are serving is not educated enough about measures of preventing new infections from occurring. HIV/AIDS medical professionals understand that administering and providing HIV/AIDS treatment and care is one of the most difficult areas of modern day medicine because of viral resistance to medications, costs of medicine, monitoring and evaluating treatment outcome. Even in resource rich countries like the western world, achieving long term treatment success is still a challenge. Treating the disease is no easy task as it requires enormous resources including long term financial commitment and trained professionals; presently, Nigeria does not have enough of these resources readily available. In situations whereby the medications are available, compliance in our country will be another issue largely attributable to lack of education, non regular availability of medications, lack of enough testing and monitoring sites etc.

 

CONCERNS:

 

According to the US Intelligence Community Assessment (ICA) which highlighted the rising HIV/AIDS problem through 2010 in five countries of strategic importance to the United States that have large populations at risk for HIV infection, Nigeria, Ethiopia, Russia, India, and China were selected because they are:

  • Among the world’s most populous countries, together representing over 40 percent of the world population.

  • In the early-to-mid-stages of an HIV/AIDS epidemic.

  • Led by governments that have not yet given the issue the sustained high priority needed.

 

 

 

 

According to ICA: “HIV/AIDS is spreading at different rates in the five countries, with the epidemic the most advanced in Nigeria and Ethiopia. In all countries, however, risky sexual behaviors are driving infection rates upward at a precipitous rate. It will be difficult for any of the five countries to check their epidemics by 2010 without dramatic shifts in priorities.  The disease has built up significant momentum, health services are inadequate, and the cost of education and treatment programs will be overwhelming.  Government leaders will have trouble maintaining a priority on HIV/AIDS—which has been key to stemming the disease in Uganda, Thailand, and Brazil—because of other pressing issues and the lack of AIDS advocacy group”.

 

The report further stated that in Nigeria:” The HIV/AIDS epidemic is significantly ahead of that in India, China, and Russia—already advancing well beyond high-risk groups and into the general population.  The official adult prevalence rate is almost 6 percent, but unofficial estimates range as high as 10 percent—which represents 4 to 6 million people Infected. Heterosexual transmission of the HIV virus is the primary mode of spread in Nigeria, and infections appear to be as numerous in rural areas as in the cities.  The reported rate of infection apparently varies significantly by region, with the lowest reported rate found generally in the predominantly Muslim northern parts of the country. Infections are most numerous among men ages 20 through 24, but some experts caution that infection rates are rising quickly in young women. Given the already advanced state of the disease and the government’s limited capacity to respond, we expect HIV/AIDS to infect as many as 10 to 15 million people by 2010.  This number would constitute roughly 18 to 26 percent of adults—close to the current rates in some of the hardest hit countries in Southern Africa.” http://www.odci.gov/nic/

REALITIES:

  • It is misleading to assume that we have only 3 million people living with this disease in Nigeria when it is pretty much obvious that testing in some health care settings that can give us a true picture of the incidence and prevalence of the disease does not occur.

  •  Judging from the figures available, new infections are still occurring at an alarming rate nationwide and many people do not know their status.

  • Not enough people living with the disease have access to medications and the country’s healthcare capacity to effectively deal with the pandemic is limited.

  • Societal stigma associated with living with the disease will ultimately prevent those infected to seek and receive adequate treatment.

  • The potential effect of this Pandemic is the depletion of the working population in our country and production of a large pool of orphans which will definitely pose an economic disaster to our country.

  • If steps are not taken, viral resistance will be an issue we will have to deal with.

 

 

THE WAY FORWARD:

 

It is my humble opinion that the government should declare an HIV/AIDS state of emergency in the country and treat as real the impending disaster this disease might cause. We have seen the consequences of apathy in South Africa and Asia where millions of lives have been lost.

Government should take the lead in the fight and make enormous resources available to NACA and every other organization involved in the fight. This is indeed is a true “State of Emergency”

 

 

The Nigerian Solution: THE E.T.K. OPTION

 

E: Education

T: Testing and

K: Knowing your status

 

1) EDUCATION! EDUCATION! EDUCATION

 

I arrived from Nigeria in January of 2004 after visiting on a fact finding mission. I realized that we were in serious trouble with this disease when I visited with a group of highly intelligent undergraduate students. At this meeting, I asked if they could tell me how HIV/AIDS is transmitted; I got the greatest shocker by the responses I got from them. I really cannot go into the graphic details of these answers, but my belief is that if this group of educated Nigerians and future leaders do not understand how to prevent this disease, then where is the hope.

 

SUGGESTIONS

 

  • I am well aware that almost every Nigerian household has access to a battery operated transistor radio, and my call is a direct challenge to the media to assist in the fight. We need to educate our people, and the best way to do this is by continuously reinforcing prevention messages like jingles to reach the interior villages and towns of Nigeria where the disease is on the rise. This is very important; by educating our people about the preventive measures they can take in a local language or dialect: they can identify with the messages. These messages have to be relentless and continuous or else it will lose its significance. For a person to change a behavior, the messages might have to be heard more than three times. I am hereby calling on our media to donate free air time in order to accommodate these public health announcements.

  • Our religious institutions such as Churches and Mosques should be encouraged to take a more proactive role in educating the community. Millions of people attend one event or the other at these locations at least once a week, and it is a good place to educate.

 

  

The population of people between the ages of 15-49 is about 59 million (2004)

 

This is a population that we need to target with preventive messages. This population is very significant in our society because it includes the highly sexually active high school and university students who can help in spreading the message of prevention to their parents, brothers, sisters, cousins, nieces, nephews and to a large part of the population. Others in this group will also include our business men and women as well as the working class in the community. Adopting an indigenous solution to this problem as simple as above will allow us to begin influencing the course of this disease.  

It is good to treat those who are already infected, and I believe that this is being taken care of by the NGOs in Nigeria; however, if we do not prevent new infections from occurring we will be going round in a circle. It is worthy to note that historically, preventing the continuous transmission of an infectious disease will lead to an eventual eradication of such disease. The same can apply to HIV/AIDS. 

 

2) TESTING! TESTING! TESTING!

 

The next step following education should be testing. In order to reduce transmission of the disease, it is important that people are aware of their status. Encouraging and ensuring that individuals voluntarily submit to testing will further help in inhibiting the spread of the disease. The main reasons people are reluctant to test are: The fear of dying and the issue of shame associated with the disease. These issues can be addressed at different levels through education and cultural sensitization. I believe that by supporting the different HIV/AIDS advocacy groups in the country we can begin to address these concerns.

 

It should be the priority of our government to liaise with the health care professionals in the country to work out the logistics of establishing functional testing facilities across the country both at primary, secondary and tertiary health care centers. This is possible and our country can afford to make this happen. It is by knowing your status that you can begin to make healthy choices and getting help if needed. 

I am a strong advocate of the ABCs of HIV/AIDS (Abstinence, Being faithful, and the use of Condoms) but in the real world we know how difficult these choices are without being educated enough about the issues relating to the spread of HIV/AIDS.

           

Finally, the message is Education, Voluntary testing and knowing your status. This has proven to be very effective in countries that have been able to reduce disease transmission. Since we are still years away from developing a vaccine or inventing the miracle drug, we need to adopt these simple measures that have shown some successes.

 

Taiwo O Fasoranti MD (Houston, Texas USA)

Epidemiologist and HIV/AIDS Advocate