Is health min­is­ter celebratin­g death of HIV pa­tients?

The Punch - - VIEWPOINT - Braimoh Bello

•67% of peo­ple liv­ing with HIV knew their sta­tus.

•53% of peo­ple liv­ing with HIV were on treat­ment.

•42% of peo­ple liv­ing with HIV were vi­rally sup­pressed. Although Nige­ria has done well to in­crease the num­ber of peo­ple who know their HIV sta­tus, the per­cent­age of peo­ple who know is still much be­low the tar­get 90% and 2020 is upon us. Also, the per­cent­age of peo­ple ini­ti­ated on treat­ment among those who tested pos­i­tive is low. On the World’s AIDS Day, th­ese are the sta­tis­tics that should be con­veyed, along with mes­sag­ing to im­prove HIV test­ing.

Rather than cel­e­brate the de­cline in HIV preva­lence, which prob­a­bly re­flects the nat­u­ral his­tory of the epi­demic, the coun­try’s con­trol pro­gramme should place more em­pha­sis on the an­nual num­ber of new in­fec­tions. In­ci­dence is a more im­me­di­ate re­flec­tion of the pro­gramme’s ef­forts. Are the num­ber of new in­fec­tions de­creas­ing in Nige­ria?

The global cam­paign is to com­bat the scourge to the level of zero new in­fec­tions by 2030. The govern­ment should be telling Nige­ri­ans where we are on the way to zero in­fec­tions. Un­for­tu­nately, it seems our jour­ney is yet to start. Re­cent es­ti­mates show that there has been an in­crease in the num­ber of new HIV in­fec­tions in Nige­ria from 120,000 in­fec­tions in 2010 to 130,000 new in­fec­tions cur­rently. Also, about two thirds of new HIV in­fec­tions in West and Cen­tral Africa oc­cur in Nige­ria. If the num­ber of new in­fec­tions has in fact in­creased in the past decade, why should the de­cline in HIV preva­lence be high­lighted and lauded?

The UN tar­gets that mother-to-child trans­mis­sion should be elim­i­nated by 2020, but Nige­ria is quite far from achiev­ing that. The suc­cess of the govern­ment’s pre­ven­tion of mother-to-child trans­mis­sion (PMTCT) is tied to the suc­cess of an­te­na­tal care up­take. Un­for­tu­nately, both an­te­na­tal up­take and PMTCT are be­low op­ti­mum in Nige­ria.

Only 44% of preg­nant women liv­ing with HIV in Nige­ria re­ceived an­tiretro­vi­ral medicine to pre­vent trans­mis­sion of the virus to their baby. Fur­ther­more, early in­fant diagnosis at eight weeks of age to de­ter­mine if in­fants born to HIV pos­i­tive moth­ers were in­fected was only 18%. Cur­rent UNAIDS es­ti­mates show that over 20% of hiv-pos­i­tive preg­nant women in Nige­ria trans­mit the virus to their chil­dren be­cause of the coun­try’s weak PMTCT pro­gramme. In con­trast, in South Africa in 2018, 95% of preg­nant women liv­ing with HIV re­ceived an­tiretro­vi­ral medicine to pre­vent trans­mis­sion of the virus to their baby and early in­fant diagnosis us­ing PCR test­ing stood at 94%. Mother-to-child trans­mis­sion of HIV is now rare in South Africa, at less than one per cent.

The govern­ment should cease celebratin­g the de­cline in HIV preva­lence in Nige­ria and at­tribut­ing it to the ef­forts of the coun­try’s re­sponse pro­gramme. This de­cline is ei­ther due to im­proved sur­veil­lance or high HIV deaths. Rather, at­ten­tion should be drawn to in­di­ca­tors that are more valid and mean­ing­ful, re­flect­ing the progress made by the coun­try to­wards tar­gets set by the UN. Such in­di­ca­tors in­clude, num­ber of new HIV in­fec­tions, per­cent­age of peo­ple who know their HIV sta­tus, the per­cent­age of PLHIV who are on treat­ment and the per­cent­age of hiv-pos­i­tive preg­nant women who re­ceived treat­ment to pre­vent trans­mis­sion of in­fec­tion to their un­born chil­dren.

Con­cluded. •Bello, an epi­demi­ol­o­gist, univer­sity lec­turer and the re­search tech­ni­cal lead at the Cen­tre for Sta­tis­ti­cal Anal­y­sis and Re­search based in Jo­han­nes­burg and Abuja, wrote in via [email protected]­sar-africa.com

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