HIV response takes knock on ending AIDS by 2030
Civil society groups have demanded the Presidency to convene a presidential forum on Nigeria’s response to AIDS, tuberculosis and malaria.
A separate summit will address antiretroviral treatment, which stakeholders have complained could hamper Nigeria’s progress toward ending AIDS by 2030.
The groups have also condemned Nigeria’s official report on AIDS response, insisting they will publish a more-inclusive ‘People’s AIDS Report’ to craft a response agenda.
In the decades since Nigeria began battling the HIV/AIDS pandemic, the number of people living with the virus (PLHIV) has risen to the present 3.5 million, but the country’s response to the disease has followed “different and parallel pathways with the international community largely driving the process for prevention, treatment, care and support services in the country,” argued Remi Obinatu, who chairs the governing council of Civil Society for HIV/AIDS in Nigeria (CiSHAN).
Hundreds of CSOs (civil service organisations) working in communities and wards across Nigeria’s 36 states and the FCT have been the foot soldiers for reaching people diagnosed and living with the virus: they helped with testing, ensured patients attended clinic and kept on treatment at supported facilities.
An estimated 750,000 PLHIVs got on treatment by the end of 2014 - 86% of them enrolled in sites supported by Presidential Emergency Programme for AIDS Relief (PEPFAR) funded by the US government. Another 12% enrolled in sites supported by Global Fund. The remaining 2% are in sites supported by Nigerian government in Abia and Taraba.
Nigeria signed its agreement with PEPFAR since 2010, indicating it would be ready to take on at least half of all responsibilities in five years. PEPFAR announced withdrawal from active support five years later-support for baseline and routine chemistry tests needed before patients get on the antiretroviral therapy line.
“They also withdrew from providing essential laboratory commodities to many of their facilities while urging the government of Nigeria to take over these responsibilities,” said Obinatu.
“Nigeria was caught napping when PEPFAR started implementing. The next thing is to push the burden onto patients. That’s the height of wickedness,” said Obatunde Oladapo of the Treatment Access Movement, which pushes for all PLHIVs to be put on therapy.
With donors fatigued and government spending inadequate, thousands of PLHIVs since 2014 faced fees for services that used to be free, and have been complaining ever since: N1,000 per month to pick up drugs, N1,000 to be bled, N3,000 for consultations, and paid for all screening and monitoring.
The demographics of PLHIVs is what is worrisome: HIV-positive women widowed by the virus or estranged from their marriages, married women unable to afford fees, young people unemployed but infected.
They are a group considered “poor and unable to provide nutritional support to either themselves or their households not to talk of being able to pay for these high user fees charged at the treatment facilities,” said Obinatu.
“This is a bad situation, and will worsen the situation of HIV in the country,” said Victor Omosehin, coordinator of the Network of People Living with HIV/AIDS.
“Nigeria cannot end AIDS by 2030, if poor Nigerians with HIV don’t have access to free services in the country.”
The demand for free services is total, but not one that’s getting much traction, as the true cost of dealing with HIV continues to emerge.
It costs around N32,000 to place one person on ARV a year-with lab work taking up to N8,000, according to Dozie Ezechukwu principal programme officer at the National Agency for Control of AIDS (NACA).
The agency has put the number of people on treatment at 780,000.
But not all can fit into the former president Goodluck Jonathan’s Presidential Comprehensive Response Plan for HIV, launched as heads of African governments met in July 2013.
The plan was to test up to 80 million people over two years, provide ART for 244,000 pregnant women positive to HIV, create 2,000 new service points each for ART and prevention of mother-to-child transmission of HIV. Combined prevention services will target some four million people and at least 500,000 people categorised as most-at-risk populations.
Its first tranche N8 billion was controversial, as was solely funding the PCRP with money saved from rolling back fuel subsidy. But it helped open federal government’s plan for HIV care in Abia and Taraba.
The choice of both states is still a sore point for civil society groups, which have called the move a political statement and are looking to see access scaled up.
Ezechukwu said President Muhammadu Buhari’s sojourn through countries at the start of his presidency has “brought invitations” from people who want to invest in ARV treatment in Nigeria, ensuring local production to cut prices. He added states accessing World Bank credit should also link it to PLHIVs.