Why Nigeria is closer to ending AIDS

Dr. Gambo Gumel Aliyu as the Director-General of National Agency for the Control of AIDS (NACA). Aliyu, an epidemiologist and a public health specialist, was the Chief of Party for the Nigeria Indicator and Impact Survey (NAIIS). Aliyu, in this interview with The Guardian said the country is closer to ending Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) than ever before but challenges persist. CHUKWUMA MUANYA writes.

•HIV now like diabetes, hypertension, a chronic disease that can be treated, does not kill any longer
•Country to spend N150bn yearly to keep two million people living with virus on treatment
•Stem cell cure for HIV cannot be expanded to treat many patients because it is risky, cost $1m per person

Do you have any milestone to celebrate 15 years after establishment of NACA?
Fifteen years after, we have achieved lots of milestones and we still have more to achieve. But we are still happy to say that after two decades of active fight against HIV/AIDS epidemic, using multiple stakeholders and development partners, Nigeria is much closer today to controlling the epidemic than we are ever in the history of fighting the epidemic.

When you say much more closer, do you mean eliminating HIV/AIDS?
When we say control, we mean identifying people that have the disease among us, and making sure we fix the virus so that it does not leave their body to affect other people. That way you keep HIV with individuals that happens to have it.

In these 15 years what have been the challenges and how have you been able to surmount them?
Major challenge is stigma and discrimination and that impact on our case findings. People find it difficult to come and demand for HIV service simply because if they turnout to be positive, they may not know how to handle it and because of that, they do not even want to start it and it is better they do not know their status, than a situation they will find very difficult to handle.

However, things have changed because people understand that HIV is like diabetics and hypertension, it is a chronic disease that can be treated, it does not kill any longer as it did in the past. Because of that people are happy to access our services at community level, people are happy to come forward and demand for HIV services and people are happy to take our self-testing kits to their homes, test themselves and know their HIV status.

The most interesting part of it is the fact that people now have started demanding for HIV service and that is a very exciting stage. The day people feel comfortable to demand for HIV services will signal the end of HIV as an epidemic.

The main issue we have now in Nigeria is that of scarcity of paediatric version of HIV drug and the issue of mother-to-child transmission. According to the latest statistics I saw sometimes last year, Nigeria has one of the worst figures. How is the situation right now?
That is true and partly because it is not that we do not have the services in places but because of the way people access care especially pregnant women. Not all pregnant women come to regular clinics for antenatal and not all pregnant women even after doing the antenatal end up delivering in hospital facilities were our services are available. Any pregnant woman that happens to be identified by us as HIV positive, we have 100 percent success rate of linking them to our life-saving programme where they receive drugs that prevent mother-to-child transmission. We succeed in preventing the mother-to-child transmission, however, for pregnant women that do not show up early at the facilities, it is very difficult for us to know whether they have HIV in them, and if they have HIV in them then it is also difficult to prevent that transmission from mother-to-child.

Most of the transmission that is reported and seen is among these categories of individuals that do not access antenatal services and even when they access antenatal services they do not accept HIV testing and for those that accept HIV testing are probably when they have found out that they are HIV positive, they don’t show up to take the medication to prevent mother-to-child transmission.

Another thing I noticed is that some reports, which I think are foreign reports, are commending Nigeria for making efforts especially towards eliminating HIV. What is the key factor for foreign media, for once, appreciate that Nigeria is making progress. What are the key factors?
There are several factors, one of the factor was the fact that we were able in 2018 to show to the world that we are very transparent in the programme we do and we are very open to have our system scrutinized. We went a step further to even scrutinise our system to do the largest survey on HIV that nobody have done it in the world and to collect genuine data from the field. To go up to Chibok to collect data, to go up to Zamfara to collect data, to go all areas that are considered ‘no-go-area’ or battle zone to collect useful data to just know what the actual number is of people living with HIV/AIDS in Nigeria. We were able to find out that we had fewer people living with the virus than we had thought before in the global community. Instead of 3.5 million we found out we had just about two million people living with HIV/AIDS. Also, as at that time we discovered that we have actually identified almost 800,000 plus of those people living with the virus and placed them on treatment. As at the time we did this, we had about 1.2 million or thereabout. But now as I am talking to you we have bridged that gap and we actually have less than 200,000 now to go.

As I am talking to you we have 1.2 million out of that two million already identified and already linked to our services and facilities taking the medication and keeping the virus in them.

Another issue is the issue of local funding and the issue of budget for HIV. How far with that in terms of the contribution of the Nigerian government because before now the donor funding was more than 70 per cent?
As at now, the donor funding is about 80 per cent. This is a big challenge in the sense that the donor funding that we receive was geared towards helping us to identify the cases, helping us to link the cases to the treatment site and helping us to keep these patients on treatment. Now, by the time we finish identifying the cases, the next phase is to figure out how to keep those we have identified on life-saving medication for the rest of their lives. This is where the challenges will come because once we reach that bridge, the donor community will now tell us that ‘we have helped you to identify virtually everyone that has the virus, now you have the responsibility to keep these people on lifesaving medication and make sure you keep the virus in them without letting the virus go out from them’.

Keeping two million people on lifesaving medication would cost us nothing less than N150 billion every year and this is a very big challenge and that is why we launched the HIV Trust Fund of Nigeria to now see in the absence of the foreign funding who are the biggest stakeholders domestically that can now come and fill these space and continue giving the services and the lifesaving medications that are required to keep HIV in people or within people that have the infection and make sure that we do not see new cases of HIV, and we do not see them dying from HIV.

Based on the achievements and situations so far, where do you see NACA in the next five years?
I see NACA in the next five years as an agency that would look back and say yes, there was a global target to end new infection by the year 2030, to end people having AIDS by the year 2030, to control HIV, to make sure HIV is no longer a public health threat. NACA would say, ‘we are happy, we did it, we did it within the time frame, before the year 2030 and we did it responsibly. We have controlled the epidemic, we have put in sustainability structure in place and now we can say that HIV as an epidemic would fizzle and disappear as time goes on because the more you prevent new infections, the more you prevent people from dying, the more you keep HIV within these individuals. These individuals as they live and die, HIV will continue to drop and HIV will not longer continue to be public health threat. It will be reduced to every other chronic illness that we have around that we manage.

So, that is the goal, when we say end AIDS by the year 2030, what we are saying is make sure HIV has been reduced to chronic illnesses like diabetics, hypertension and the rest of them and is kept within people that have it only, we do not see new infections and we do not see people dying from HIV and we do not see what they call AIDS, these features that when you see you become highly uncomfortable.

The issue of the third patient having remission of HIV/AIDS through stem cell therapy was all over the news, last week.

What is the implication of this new scientific breakthrough?
That breakthrough has been on and we know that it cures HIV but it is not a procedure that you can take to a large scale. To cure somebody via stem cell, apart from the time it takes and apart from the search of the rightful donor, it also takes resources. It takes up to a million dollar to do that. How do you do that for two million people?

That means the treatment cannot be expanded, even in the United States (U.S.)?
There is no way you can afford to do that because firstly, it is an expensive procedure and the life of the patient is at risk. When you do that, if you do it only to take HIV out of that patient, and you know now you can live with HIV and it will not kill you, then why are you risking to kill the patient than to give him or her life with anti retro viral drugs that is the regular life-saving treatment. If you go for the procedure and you lose the patient, which is more harmful? Leaving the patient to live with HIV for the rest of his or her life or going to rush and ending his or her life prematurely, because you want to take HIV out of the system?

Is there anything you would like to tell us about the self-testing HIV kit?
What we want is for people to learn how to demand for HIV services. People should ask where these services are located, how do I get tested to know my statues today? How do I get medications if I am found to be HIV positive? How do I feel comfortable to discuss this with my wife, husband, friends, etc. without feeling being stigmatise, without feeling that sense of rejection and dejection in me?

Once we get to that stage, then HIV will no longer be seen as an epidemic and as a public health threat.