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HEALTH INTERACTIVE WITH DR. AMINU MAGASHI Critical Look at 2003's HIV Prevalence From 9th to 15th May, 2004 I was at the University College Hospital, Ibadan in Oyo state attending a course entitled " strategic leadership in HIV/AIDS programming for NGOs convened and implemented by The Social Sciences And Reproductive Health Research Network ( SSRHN ). I must confess that by the end of the training course what I was able to gather in terms of latest materials and up dates on HIV/AIDS and skills and knowledge on programming , in the last 2 years, hitherto, I couldn't have such extensive and elaborate data and information and exposure on strategies and techniques toward effective leadership and programming. . It was in that session that I begin to look at the 2003 Nigeria's HIV prevalence in apparent comparison to the previous 2 sentinel surveillance (1999 and 2001) with a view to examine the rise and fall in percentages, factors attributing to that and what could be done in terms of policy reforms and impacting on the life of the impoverished populace with the aim of ameliorating their suffering and helping those that are not infected towards prevention. Since the first global cases of AIDS were diagnosed in New York in 1981, the problem has undergone a lot of transformation from being a health issue to a developmental problem affecting social and economic life of individuals. The HIV so far, by 2003, has infected a cumulative total of more than 60 million people, over one third of such people have subsequently died. Africa in particular is been faced with a grave crises of HIV/AIDS with nine out of every ten new cases from the continent and an estimated 13 million AIDS orphans currently live in Africa. Coming back home, Nigeria, the first case was reported in 1986. The prevalence since then has been on increased from 1.8 % in 1990, 3.8 % in 1993, 4.5 % in 1995, 5.4 % in 1999 and 5.8 % by the year 2001. Nigeria now has the highest number of people living with HIV/AIDS (PLWHA) in the world (UNICEF, 2002). Between 1986 and June, 2001, 52, 962 AIDS cases were reported in Nigeria, although that is far from being the actual figure due to under reporting, fear of stigma, under diagnosis and poor service utilization. Current UNAIDS estimate , indicate that 3.5 million Nigerians may be living with AIDS. Looking at the 2003's prevalence rate in the country, which is the most recent, it shows that 5.2 % of the population are living with the virus , meaning, 5 out of every 100 people are infected with the virus, this is a slight decline when one compared the figure with 1999 ( 5.4 % ) and that of 2001 ( 5 . 8 % ). Never the less, it shows that over the last two years the tripartite relationship and partnership between Government, International Donor Organizations and NGOs has made some tremendous achievement, no matter how small in quenching the fire in our society. However, looking at the prevalence with a quizzical mind, one is bound to discover that it is not yet Uhuru with regard to dampening the devastating effect of the disease which complicates other diseases and made them more grievous, notably among them, Tuberculosis, Malaria, Malnutrition, Skin Infections to mention but few. As we all know that, Nigeria is adopting a sentinel survey not an epidemiological one, and at the same time it is only using a sample of pregnant women attending antenatal care across the 6 geopolitical zones. Going by that, do the women attending ante natal care, as a sample represent the population of Nigeria and give a fair view as to the actual problem and prevalence of HIV? The answer is far from being yes. This is because, it is perceive that among women attending antenatal care, above 90 % of them are regarded as carrying legitimate babies by choice, are faithful and happily married and the society regard them among the safest population. On the other hand , if we are to do sentinel surveillance among Commercial Sex Workers, Men Attending Sexually Transmitted Infections (STIs) Clinic, Youth In Tertiary Institutions, Long Distance Drivers, Patient With Tuberculosis, one is bound to have a very high unimaginable figures that can make Nigeria declare state of emergency on the entire nation . Base on this submission and assertion, the study that may help produce the actual Nigeria's HIV prevalence, is not of course taking a sample of women attending ante natal care but rather taking samples of low risk groups and that of high risk groups, and then take an average, that way we will have a better view of the calamity bedeviling our nation. I strongly advocate to the partners involve in conducting surveys to really review the methodology and take as much samples as they can in the next survey coming up in 2005. Let me conclude by looking at some factors that are contributory to the fuelling of the epidemic in Nigeria with a view of making the issue clearer for policy reforms and programming. On the top list is poverty, as a driving force, it renders the working force (youth) in the country highly vulnerable to sexual harassment, exploitation, abuse and inducement by the older generation. It complicates and worsen the mild form of the disease to reach the stage of AIDS and provide a compromised body immunity which pave way for other opportunistic infections and also it makes it very difficult for PLWHA to afford routine anti retroviral drugs, other essential drugs and adequate nutrition capable of reversing the complication of HIV/ AIDS. The policy of the Federal Government And Other International Partners In The Provision Of Anti Retroviral Drugs is far from achieving the desired result of down sizing the prevalence and reducing the calamity of having children orphaned by HIV/AIDS. With 15, 000 people on the list of federal government and 8000 people coming on board on the list of AIDS Prevention Initiative In Nigeria ( APIN ) yearly, definitely there is no way a remarkable result will be achieved. Other factors are related to NGOs viewing HIV as a national cake and instead of using meager available resources to impact positively, they are busy living on HIV/AIDS and of course factors in our hospitals related to blood screening are not encouraging and helping matters. In essence, I am of the belief that, Nigeria need to nurture leaders with utmost dedication and social responsibility who will strongly advocate towards policy reforms and programming to address factors mentioned above |