‘We need more allocations, domestic resources to sustain HIV response’

Dr Temitope Ilori is the new Director-General, National Agency for the Control of AIDS (NACA). Before her appointment, she was a consultant family physician at the University College Hospital, Ibadan. Ilori spoke with NKECHI ONYEDIKA-UGOZE on the need to increase domestic funding to sustain the HIV response in the country.
According to UNICEF, Nigeria has 190,950 Human Immunodeficiency Virus (HIV) and Acquired Immuno Deficiency Syndrome (AIDS) infections per year, the second highest rate in the world. What are the challenges facing HIV/AIDS response in the country?
We need more domestic resources from the federal, state and local governments to embrace and sustain HIV response. We have to eradicate stigma and discrimination so that people can be tested and access health without being discriminated against. We also need to increase our preventive messages to reduce the rate of new infections.

Inflation is hitting hard on all facets of the economy. Is the current high cost of drugs affecting HIV response in the country?
It is and that is why we are advocating for more budgetary allocation to meet up with our expectations as a medication we bought for $20 last year has increased due to the current exchange rate. The gap is huge and that is why we said domestic funding is the way to bridge the gap.

Why is Nigeria recording a spike in mother-to-child transmission despite the efforts made in HIV epidemic control?
You need to know that HIV is still with us. Our record shows that we have about 1.3 per cent of the population with HIV and about 1.6 million Nigerians living with HIV/AIDS and accessing treatment. But interestingly, we seem to be faring well in other areas, our surveillance in 2023 shows we had about 75,000 new infections.

That means about 12,400 Nigerians coming down with new infections of HIV AIDS, and a reduction in the trend because, in 2019, we had about 3.4 per cent of Nigerians with HIV AIDS as against 1.3 per cent. Our target is by the year 2030, it should no longer be a public health threat. In terms of mother-to-child transmission, we realised that our coverage with pregnant women is below target, about 35 per cent.

That’s to say women are at risk of HIV infection, and about 35 per cent of them are tested, confirmed and on treatment, why is that so?
Ignorance may be part of it, perhaps it may be a general systematic problem, and perhaps our pregnant women are not accessing care the way they should. Sometimes, it is not all pregnant women that go to health facilities but as the government we have gone beyond the health facilities.

We have mapped out not only our conventional health facilities but also Traditional Birth Attendants (TBAs), mission homes and houses. We’re working with them, providing HIV test kits and linking the positive women to care because we realised that it is not every pregnant woman that receives antenatal care in government-owned hospitals. We are also working with private hospitals, providing test kits and antiviral drugs.

The issue of stigma and discrimination is another issue because some women are afraid that if they test positive, the whole world will neglect them, and their husbands will throw them out of the house. That is why we are using this medium to encourage our people to embrace people with HIV AIDS.

As a government, we have an anti-discrimination law in place, which has been domesticated in many states of the federation. People discriminated against can access this law and work with the National Human Rights Commission to get justice.

How many children are living with HIV in the country? What is responsible for new infections?
As of the end of 2023, about 140,000 children were living with HIV and 22,000 of them were new infections and about 15,000 died as a result of AIDS-related complications.

One of the reasons is that when a disease has been with us for so long, people take it for granted. We are sensitising and creating awareness that infection and disease are still with us. The preventive measure is not only by giving medication, which is not what we are doing but by preaching behavioural changes like using condoms and being faithful to one partner.

Now, we have what is called Pre-Exposure medication (PrEP) and post-medication exposure PEP, which people can use. The PrEP is for people who are at high risk, and can access some of these medications, which can help prevent HIV infection, while post-exposure is for people that are exposed either by nature of the work or by the virtue of their risky sexual behaviours and can access medication.

A committee was set up recently to check rural transmission of HIV AIDS. What prompted that decision and how is your organisation creating awareness in rural areas?
It is being handled by a multi-sectorial committee and the idea is that we continue to increase our surveillance not only in Abuja but across 36 states of the federation. We are using our national structures, such as state and local council agencies for the control of AIDS, as well as working with community, ward development partners to ensure the message gets to everybody. We also have mentor mothers, and also the Network of People Living with HIV and AIDS in Nigeria (NEPWHAN), the Association of Women Living with HIV/AIDS in Nigeria (ASHWAN) and young people living with HIV AIDS, as well as other civil societies and organisations.

What is NACA doing to remove the bottlenecks in accessing HIV care, especially antiretroviral drugs?
We have close to 50,000 facilities, made up of 25,000 health facilities and 15,000 non-conventional facilities, which have been mapped out and we are working closely with them. We are giving them test kits; and if some people are positive, we ensure they are put on treatment and followed up by implementing partners, who undertake door-to-door testing in communities.

Do you think it’s possible to have an HIV-free generation?
The target is that by 2030, HIV will no longer be a public health threat. I would say HIV-free because we are not having new infections, people who are already infected will always be here with us, and we will continue to care for them. As a government, we are working on a sustainability agenda and it is part of ownership, and domestic resourcing, which will ensure we finance their treatment and engage in local production of anti-retroviral drugs.

Today, all our anti-retroviral drugs are produced outside the country. We import them and that is why they are costly. We all know what the dollar rate to naira rate is now. So, we are discussing with our local pharmaceutical companies to engage in local production of anti-retroviral drugs, and test kits to reduce the financial burden on the country.

What are your plans for the agency?
I want to build an AIDS-free generation and ensure no child is born HIV positive, as well as get the right data so that we can make appropriate policies and plan programmes. We want to find affected pregnant women, commercial sex workers, and those injecting drugs, even the inmates, test and put them on treatment.