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Why Nigeria, Russia, Florida have worst HIV/AIDS indices

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*NACA confirms country contributes highest burden of babies born with virus globally
Scientists have provided explanation why Nigeria, Russia, and Florida in the United States (US) have worst outcomes for Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) in the world.

According to special reports by the journal Science, each has had difficulty mounting an effective response to HIV/AIDS at a time when neighboring countries or states, buoyed by recent research advances, have made progress toward bringing their epidemics to an end.

Science produced the reports in collaboration with the PBS NewsHour, which aired a companion five-part series. Reporting for the project was supported by the Pulitzer Center.Science, also widely referred to as Science Magazine, is the peer-reviewed academic journal of the American Association for the Advancement of Science and one of the world’s top academic journals.

The PBS NewsHour is an American daily evening television news programme that is broadcast on the Public Broadcasting Service (PBS), airing seven nights a week on more than 350 of the public broadcaster’s member stations. As the nation’s first hour-long nightly news broadcast, the programme is known for its in-depth coverage of issues and current events.

The Pulitzer Center on Crisis Reporting is an American news media organization established in 2006 that sponsors independent reporting on global issues that other media outlets are less willing or able to undertake on their own.The Director General of the National Agency for Control of AIDS (NACA), Dr. Sani Aliyu, contributed to the reports.

According to the report, five of the main metrics that public health experts track to gauge progress against HIV are: How many people are living with the virus? What is the rate of new infection? What percentage of infected people are receiving antiretroviral drugs, which both stave off disease and prevent transmission? How many infected people have progressed to AIDS and how many have died from it? And how many children are infected by their mothers?

Much of the world has seen encouraging declines on many of those fronts. But Nigeria, Russia, and Florida stand out from their neighbors and, in some cases, the entire world. None of these three locales has high numbers on every one of these measures. But each ranks first—an unenviable distinction—in at least one of the five metrics assessed by total cases, rates, or proportions.

According to the report, the aim of the special report is not to shame Russia, Nigeria, or Florida, or, given their profound differences in population, politics, and economies, but to compare them head-to-head. Rather, these stories describe the distinct challenges that have hampered each locale’s response to HIV/AIDS. And they highlight people who are confronting those shortcomings and coming up with tailor-made, local solutions.

The report compares Nigeria, Russia, and the United States with the rest of the world in raw numbers. Although Russia has roughly the same number of people living with HIV as the United States, the paucity of treatment means many more deaths from AIDS and many more new infections. South Africa has more HIV-infected people than any other country, and more people receiving treatment, which explains why it has fewer deaths and fewer newly infected children than Nigeria does. A relatively small country like Mozambique (one-sixth the size of Nigeria) stands out because it has a large number of infected people per population.

Several people at the front of Nigeria’s HIV/AIDS response link the shortcomings to the government’s lack of “ownership” of the epidemic and endemic corruption. Also, foreign assistance—mainly from the United States President Emergency Preparedness Fund for AIDS Relief (PEPFAR) and The Global Fund for AIDS, TB and Malaria— that pays for nearly the entire HIV/AIDS response is dwindling.

According to the report, Russia’s rate of new infection outstrips every other country in Eastern Europe and Central Asia—even Ukraine, which has more infected people per capita. Limited access to Anti Retroviral (ARV) drugs contributes to the country’s high rate of new infections, because untreated people are more likely to transmit the virus. But Russia has succeeded in sharply reducing MTCT.

According to the Science report, compared with other US states, Florida has a big problem. Georgia has the highest rates of new infection, but half the population of Florida. New York has a larger infected population, but has a lower death rate and fewer new infections. The United States only had 122 newly diagnosed children in 2016—some detected late and possibly born elsewhere—but Florida again stands out.

According to the report, at a time when rates of mother-to-child transmission of HIV have plummeted, even in far poorer countries, Nigeria accounted for 37,000 of the world’s 160,000 new cases of babies born with HIV in 2016. The most populous country in Africa, Nigeria does have an exceptionally large HIV-infected population of 3.2 million people. But South Africa—the hardest-hit country in the world, with 7.1 million people living with the virus—had only 12,000 newly infected children in 2016. The high infection rate, along with the lack of access to ARVs—coverage is just 30 per cent—helps explain why 24,000 children here died of AIDS in 2016, nearly three times as many as in South Africa.

Mother-to-child transmission is only one part of Nigeria’s HIV epidemic. But that route of transmission epitomizes the country’s faltering response to the crisis, highlighting major gaps in HIV testing that allow infections to go untreated and the virus to spread. Dr. Sani Aliyu, said: “Nigeria contributes the largest burden of babies born with HIV in the world—it’s close to one in every four babies [globally] being born with HIV—and that’s really not acceptable.”

According to the report, it is a solvable problem. The key is to find and treat the relatively small population of pregnant, HIV-infected women, because those who receive ARVs rarely transmit the virus to their babies. Like most countries, Nigeria has made mother-to-child transmission a priority for more than a decade, and it has seen a reduction in children born with HIV. Still, the country stands out for its slow progress. “What we’ve realized is that we need to think outside the box,” Aliyu said.

According to the World Health Organisation (WHO), a pregnant woman living with HIV has a 15 per cent to 30 per cent chance of transmitting the virus to her baby in utero or at birth, and breastfeeding will infect up to 15 per cent more. In 1994, a study showed that one ARV drug, azidothymidine, cut transmission rates by two-thirds if given to the mother before and after delivery and to the baby for six weeks. But few poor countries used that regimen because it was expensive and complex, requiring an intravenous drip of the drug during labor. Five years later, a study in Uganda showed a single dose of another ARV, nevirapine, given to a mother in labor and a baby at birth, could reduce transmission by 50 per cent, which soon became a standard of care. Countries all over the world began aggressive prevention campaigns. Nigeria launched a programme in 2002 when it had 54,000 newly infected children, and transmissions began to slowly decline.

Today, the standard of care is to treat all HIV-infected people, including pregnant women, with daily combinations of powerful ARVs. When treatment suppresses the virus in pregnant women and, as an additional safety measure, their newborn babies also receive ARVs for six weeks, transmission rates typically plummet to less than one per cent. In the developed world and many developing countries, mother-to-child transmission is now rare. But the regimen can not be given if pregnant women do not know whether they are infected.

According to estimates from the Joint United Nations Programme on HIV/AIDS (UNAIDS), 21.58 per cent of HIV-infected, pregnant Nigerian women transmitted the virus to their children in 2016. Nigeria’s central problem is that some 40 per cent of women give birth at home or in makeshift clinics run by traditional birth attendants, where women are unlikely to get tested.According to the Science report, the reasons women do not seek care at more formal health care facilities like Asokoro Hospital, Abuja are many and overlapping: poverty, fear of stigma and discrimination for simply seeking an HIV test, lack of education, tradition, and husbands wary of health care.

Another barrier is the “formal” fee that the government levies for care at a clinic. Director of PEPFAR in Washington, D.C., Deborah Birx, said the fee “opens the door” for others to tack on more insidious “informal” fees. . According to the report, PEPFAR has invested more than $5 billion in preventing and treating HIV in Nigeria.

“If you want to get your lab results back or you want to get your blood drawn, that nurse may charge you,” Birx explained. Those fees, she said, “are very hard to police.” When one Nigerian state eliminated the formal fee, the number of women who came to clinics for antenatal care doubled, she said.An HIV/AIDS researcher at Vanderbilt University in Nashville, US, who is Sani Aliyu’s identical twin, Muktar Aliyu, said corruption is a major factor. “It’s a big elephant in the room,” said Muktar Aliyu, who still conducts studies in his home country. Scams such as informal fees are just part of the problem.

The Global Fund to Fight AIDS, Tuberculosis and Malaria in 2016 suspended payment to the country after detecting what it called “systematic embezzlement” by Ministry of Health staff as well as improper auditing.Conducting large-scale HIV testing is also hard because the virus is dispersed unevenly across the country, with some states having a much lower prevalence than others. In Niger, a state in the central part of the country, it is just 1.7 per cent, according to 2015 estimates. “We would test 1000, 2000 individuals and we would get barely 20, 30 positive,” Muktar Aliyu said. But Benue, an east-central state that has been hardest hit, has an estimated adult prevalence of 15.4 per cent.

Health Minister Isaac Adewole, an Obstetrician and Gynaecologist (OB-GYN) who worked in HIV/AIDS, said the “Number one challenge” is for Nigeria to move “from a donor-dependent programme to a country-owned programme.”

Since taking over NACA in 2016, Sani Aliyu has made some progress. For the first time, the federal government has been taking steps to prevent mother-to-child transmission, and state governments have devoted up to one per cent of their budgets to efforts against HIV/AIDS. President Muhammadu Buhari, who appointed Sani Aliyu, authorized federal funds to pay for 60,000 new HIV-infected people to receive ARVs and vowed to add that same number to the treatment rolls each year. “The programme, if successful, will serve as the exit gateway for PEPFAR as future programs acquire national ownership status,” Sani Aliyu said.Perhaps most important, NACA—with $120 million in funding from PEPFAR and The Global Fund—now is working on a massive epidemiologic survey that many hope will bolster the country’s efforts.


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HIV/AIDSSani Aliyu
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