Taming the walking time-bomb

THE cries of discrimination and stigmatization of People Living with HIV/AIDS that rented the air at the African Hall of the International Conference Centre, Abuja was a pointer of what would likely dominate discussions at the fifth National Conference on HIV/AIDS, which ended last Thursday.

Expectedly, on the lips of the 4,000 researchers, clinicians and stakeholders, that attended the four-day talkshop was the urgent need to pass into law the anti-discrimination and stigma bill before the National Assembly.

To them the passage of the bill would bring justice and succor to People Living with Human Immunodeficiency Virus (PLHIV) who have been delayed and denied justice.

The C `oordinator of Network of People Living With HIV/AIDS (NEPWHAN), Mr. Edward Ogenyi, captured the feelings of his members thus: “Many are loosing their jobs, women are ejected out of their matrimonial homes and there is no law against such practices”.

A gory picture of healthcare services in the country was also painted by the participants.

According to former Head of State, Gen. Yakubu Gowon, “the period spanning the last 2005-2009, HIV strategic framework witnessed renewal global and national interest and commitment to redoubling efforts at mobilizing resources for HIV prevention, treatment, care and support in the country. The period also witnessed the impact of universal access globally and commitment from the public, private sector, civil society and development partners”.

He however noted that despite these efforts, the challenge of HIV/AIDS has continued to increase in Nigeria, particularly in terms of the number of people infected and affected.

He said: “A recent UNAIDS study indicated that presently for every two cases of HIV placed on treatment, care and support, five new cases occur. Most importantly, these challenges are coming on this period of the global economic meltdown with the high probability of some degree of scaling down of donor support to our national response. At as at the last report on HIV/AIDS expenditure in the country, data showed that over 85 per cent of our national response activities are still donor driven.

“This prevailing situation called for the urgent review of our national policy and national strategic framework to meet with the challenges and changing realities of the epidemic”.

The Minister of Women Affairs, Mrs. Josephine Aneni said: “The HIV/AIDS pandemic poses a clear and present threat to our future socio-economic development, as most of those infected or affected are youths. My message here is a simple one: We cannot afford to allow this generation of children slip through the cracks of society.

“My warning is that if we fail to pay attention to the plight of these vulnerable children now, we shall surely pay in the not-too-distant future. A destitute child without any guidance, any education, or ties to society, is a walking time-bomb. No nation has the resources to intercept and defuse 17.5 million of these walking time bombs. So, we cannot afford to be reactive. We must protect and provide for our children now; as it is the only way we can stave off a future of chaos and destruction”.

According to the stakeholders who included researchers and clinicians, the adoption of performance-based financing of health services would go a long way in improving performance and strategic investigation.

They noted that opportunities for linkages and synergies across levels of healthcare delivery have not been well explored thus programmes, especially HIV and AIDS, continue to be run vertically by different development partners and implementers. This results in undue duplication and inefficient use of scarce resources.

They noted that though facilities for delivering healthcare services are mostly dilapidated, overstretched and inadequate, global financial crisis has caused most donor countries/ partners to cut down on aid financing. “Lack of integration of programmes is leading to wastage of resources.

“There is a shortfall of $3.5-$5 billion in the country’s HIV financing needs, 85-92 per cent of HIV/AIDS funding in Nigeria is from external donors,” Prof. Oni Idigbe, Chairman of the Organising Committee stated.

The researchers noted that while political commitment seems strong at the centre, same cannot be said at the state and local council levels.

“Research data and information are poorly linked to policy and interventions. Our low performing health systems correlate with our high HIV burden”, he said.

Out of the estimated 833,000 Nigerians eligible for drugs, only 350,000 (42 per cent) are currently receiving it. About 85.7 per cent of this is donor funded.

If the new WHO recommendation is adopted in Nigeria, 1.5 million will be eligible for ART; a deficit of 1.15 million, the participants noted, that this will put additional pressure on the already weak health system.

However, in the long run, costs will reduce as a result of reduced transmission, fewer co-morbidities and mortality.

Prevention of mother-to-child transmission (PMTCT), HIV counselling and testing coverage of 11 per cent and 14 per cent are abysmally low. Nearly 90 per cent of women are not reached for PMTCT.

They called for early passage of the National Health bill and the implementation of the sector’s development plans expected to reduce health cost per capita.

In order to ensure sustainability, the Primary Health Care (PHC) system needs to be strengthened.

The government at all levels should fulfill their commitment to allocate 15 per cent of their budget to health.

They noted that whereas the level of awareness of HIV/AIDS has been high and increased from 87.7 per cent in 2003 to 93.8 per cent in 2007, the level of “real” knowledge remains “low” (22.7 per cent in 2003 to 24.2 per cent in 2007).

They decried a situation where treatment, care and support services are still largely urbanised and concentrated on the higher level of healthcare delivery system.

They are worried that HIV programmes are still run parallel to the existing health services, thus further compounding the issue of sustainability and ownership.

To them, donor-driven programmes are not sustainable as evidenced by dwindling support consequent upon present global economic crisis.

Apparently concerned that the anti-retroviral drugs (ARV) drugs are wholly imported, they urged government to integrate HIV services into existing healthcare services at all levels and adopt and implement new WHO ART guideline.

“Government should domesticate and implement new WHO PMTCT guideline, decentralise ART services and source for cheaper options of sustaining ARV procurement including local manufacture”, they canvassed.

The also want government to explore for additional funding mechanisms, improve efficiency in public resource utilization, and invest in new HIV prevention technologies as communities have been in existence before the national response to HIV and will outlive the national response.

The vital role of the community in successful responses to HIV was also highlighted during the conference.

“There is compelling evidence that successful responses to HIV and in deed other social problems are those that were laid on a solid foundation of community response,” Prof. Femi Soyinka said, adding: “No community response, no national response. Community engagement at all levels of policy and programme design, implementation, monitoring and evaluation engenders ownership and ensures sustainability of programmes”.

Dr. Meskerm Grunitzky-Bekele, Regional Director of UNAIDS West and Central African Regional Support Teamadded: “UN General Assembly in 2006, Nigeria, together with over 120 countries made an historic commitment to scale-up the national response towards achieving universal access to HIV prevention, treatment, care and support”.

She said Africa has made tremendous progress with some countries having reduced HIV prevalence and new infections. African countries have progressively increased accessibility to ARV for people living with HIV from about 100,000 in 2002 to over three million in 2009.

“Nevertheless, sub-Saharan Africa continues to bear the brunt of the epidemic with more than 71 per cent of new HIV infections. For example, 80 per cent of mother-to-child transmission occurs in Africa. Less than 45 per cent of people living with HIV in Africa have access to ART drugs and yet more than 90 per cent of the funding is external.

“Added to this, the global economic downturn has made it imperative that every dollar is spent efficiently to achieve maximum impact in a sustainable manner”.

The universal access targets have guided the development of the new national strategic framework and plan for 2010 to 2015.

While some have argued that universal access targets are unrealistic and unachievable, we believe that Nigeria will achieve these targets as a result of the political commitment, national leadership and ownership of the national response that we are witnessing today.

As partners in the fight against HIV and AIDS, we need to continue to work together and commit ourselves to the development of innovation strategies around certain priority areas that will guarantee the attainment of universal access and sustain HIV and AIDS interventions in Africa.

Idigbe, President, Network for HIV/AIDS Research in Nigeria (NARN) and the LOC chairman, said: “After the first case of AIDS was officially diagnosed and reported in 1986, several governmental and Non-Governmental organisations commenced various emergency response programmes to the epidemic in the country.

“Essentially, these various programmes focused on case reporting, broad-based health information and education on the disease and campaigns to prevent new infections. However, after two and half decades of the emergence of HIV/AIDS as a significant public health challenge in Nigeria, the decease has spread so dramatically to become a generalized and matured epidemic. It has infected and affected all population groups and the various geographical areas in the country.”

Director General, National Agency for the Control of AIDS, Prof. John Idoko, noted that in the decade 1991 – 2001, Nigeria progressively witnessed an increased in HIV prevalence levels.

“The national HIV prevalence rates obtained through sentinel survey of ante-natal care attendees increased from 1.8 per cent in 1991, 5.8 per cent in 2001, then declined to 5.0 per cent in 2003 and further to 4.4 per cent in 2005. This decline was followed by a recent rise to 4.6 per cent in 2008. Based on the latest report of NACA, it is estimated that 2.5 million people in Nigeria are currently living with the virus. This figure ranks Nigeria third among countries with the highest burden of HIV infection in the world next only to India and South Africa”.

Gains in life expectancy in the 1960s and 70s in Africa have declined since the mid-80s due to the HIV epidemic.

Not only is HIV/AIDS epidemic a continuing, persistent and dangerous menace to the achievement of future national development targets including the Millennium Development Goals (MDGs) but is also contributing to the reversal of some hard earned development gains of the recent past such as playing pivotal roles in decreasing life expectancy at birth and worsening national health systems and indicators.