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Global response off track amid rise in stigmatisation, discrimination against PLWHA

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With millions of People Living with HIV/AIDS (PLWHA) in different parts of the world still suffering from stigmatisation and discrimination, it is a double tragedy for those residing in hard-to-reach communities, as they face a legion of challenges.

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As if these do not represent enough worries, the outbreak of the Coronavirus (COVID-19) pandemic swung the pendulum in the wrong direction thereby undermining efforts aimed at combating the scourge.

Since the disease took the world by the jugular, stakeholders have continued to stress the need to empower and enable everyone, everywhere to access services that they need to be aware of their status, even as there is a compelling need to put patients at the centre of all interventions.

Nigeria’s prevalence of people living with HIV is 1.3 per cent, and the country has seen the incidence of HIV gradually drop in recent years, as over one million people are now accessing affordable and effective HIV treatment.

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Interestingly, AIDS-related deaths have reduced by more than half since 2004 when it was at the peak, but the country has still not got to the bottom of this public health challenge because it failed to achieve the 2020 target goal of the Joint United Nations Programme on AIDS (UNAIDS), which seeks to achieve 90:90:90 objective, that is, diagnose 90 per cent of all the HIV positive people, providing lifesaving antiretroviral therapy (ART) for 90 per cent of those diagnosed, and achieve viral suppression for 90 per cent of those on treatment by 2020.

Available data indicate that from 2010 to 2019, Nigeria only reduced 10 per cent of new HIV infections where youths, children and women are newly infected every day. To achieve control of the epidemic by 2030, the country must take the responsibility of coming up with targeted HIV testing programmes, such as self-testing, awareness creation at the community level through sensitisation and community dialogue meetings, to mobilise people to get tested, which is summarised in the country’s World AIDS Day theme for this year – “United to End HIV aamid COVID-19, Get Tested.”

Without appropriate attention being paid, the lethal COVID-19 could cause an estimated 123, 000 to 293, 000 additional new Human Immuno-deficiency Virus (HIV) infections and 69, 000 to 148, 000 additional Acquired Immune Deficiency Syndrome (AIDS)-related deaths between 2020 and 2022, according to a recent modelling of COVID-19 pandemic’s long-term impact on the HIV response.

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The UNAIDS, in a new report titled, “Prevailing Against Pandemics by Putting People at the Centre,” published last week, also drew attention to the fact that the global AIDS response was off track before the COVID-19 pandemic hit, and that the rapid spread of the Coronavirus has created additional setbacks.

The report hammered on the need for the world to learn from the mistakes of the HIV response, when millions in developing countries died while waiting for treatment.

“Even today, more than 12 million people still do not have access to HIV treatment and 1.7 million people became infected with HIV in 2019 because they did not have access to essential HIV services,” the report noted.

The UNAIDS is, therefore calling on countries to make far greater investments in global pandemic responses, and adopt a new set of bold, ambitious, but achievable HIV targets. If those targets are met, the world will be back on track to ending AIDS as a public health threat by 2030.

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The Executive Director of UNAIDS, Winnie Byanyima, said COVID-19 constitutes a threat to the progress that the world has made in health and development over the past 20 years, including the gains made against HIV.

She said: “The collective failure to invest sufficiently in comprehensive, rights-based, people-centered HIV responses has come at a terrible price.
Implementing just the most politically palatable programmes will not turn the tide against COVID-19 or end AIDS. To get the global response back on track will require putting people first and tackling the inequalities on which epidemics thrive.”

According to the report, although some countries in sub-Saharan Africa, such as Botswana and Eswatini, have done remarkably well, and have achieved or even exceeded targets set for 2020, many more countries are falling way behind. The high-performing countries have created a path for others to follow.

Over the years, UNAIDS has worked with its partners to distill those lessons into a set of proposed targets for 2025 that take a people-centered approach.

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The targets focus on a high coverage of HIV, reproductive and sexual health services, together with the removal of punitive laws and policies, and on reducing stigma and discrimination.

In other words, they put people at the centre, especially the people most at risk and the marginalised—young women and girls; adolescents; sex workers; transgender people; people who inject drugs; gay men and men who have sex with men.

The New HIV service Delivery Targets are also aimed at achieving 95 per cent coverage for each subpopulation of people living with, and at increased risk of HIV; adopt a person-centered approach; focus on the hotspots, as well as getting countries better placed to control their epidemics.

According to the report, the 2025 targets also requires ensuring a conducive environment for an effective HIV response, and include ambitious antidiscrimination targets so that less than 10 per cent of countries have punitive laws and policies; less than 10 per cent of people living with, and affected by HIV experience stigma and discrimination, and less than 10 per cent experience gender inequality and violence.

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According to the report, insufficient investment and action on HIV and other pandemics left the world exposed to COVID-19. And had health systems and social safety nets been even stronger, the world would have been better positioned to slow the spread of COVID-19 and withstand its impact. COVID-19 has shown that investments in health save lives, but also provide a foundation for strong economies. Health and HIV programmes must be fully funded, both in times of plenty and in times of economic crisis.

Byanyima added: “No country can defeat these pandemics on its own. Forging global solidarity, accepting a shared responsibility, and mobilising a response that leaves no one behind can only defeat a challenge of this magnitude. We can do this by sharing the load and working together.”

On December 1 every year, the world commemorates World AIDS Day, when people across different climes unite to show support for people living with and affected by HIV and to remember those who lost their lives to AIDS.

This year, attention has been focused on COVID-19 impact on health, and how pandemics affect lives and livelihoods. COVID-19 is showing once again how health is interlinked with other critical issues, such as reducing inequality, human rights, gender equality, social protection and economic growth. This, perhaps, informed the theme of this year’s celebration, which is “Global Solidarity, Shared Responsibility.”

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However, towards ending HIV/AIDS in the country by 2030, the Network of People Living with HIV/AIDS in Nigeria (NEPWHAN) has demanded that members should be supported to implement the community-led monitoring of HIV intervention across the country so that government and partners can be held accountable and have proper feedback on the quality of services rendered to them.

The National Coordinator of NEPWHAN, Mr. Abdulkadir Ibrahim, told The Guardian that over the years, stigmatisation and discrimination of members have remained a big challenge, adding that PLWHA are still experiencing challenges, most especially those at the hard-to-reach communities.

He confirmed that cases of drug resistance are growing in the country, especially among those who without proper treatment adherence and counselling.

Ibrahim equally regretted that COVID-19 has affected access to treatment due to the prolonged lockdown, even though drugs were made available to their members through community distribution.

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For some time now, reports that treatment programme for his members has not been free as they still have to pay for some tests and services have been making the rounds. And Ibrahim, in reacting to it said: “Antiretroviral drugs (ARVs) are free, including viral load tests, and CD4 count tests (a marker for the immune system).”

He, therefore, called on “everyone to take responsibility to invest more in targeted HIV testing so PLWHA can have access to medication and help in bringing the epidemic under control.

He added: “I am pleased to let you know that funds are being made available to the National Agency for the Control of AIDS (NACA), and we are very grateful. We also want the government to look into improving the lives of our members through economic empowerment programme.”

Last year, about 45,000 PLWHA in the country, according to the United Nations Systems in Nigeria.
But the NEPWHAN has consistently maintained that ending the AIDS epidemic is possible if the Federal Government closes the gaps between people who have access to HIV prevention, treatment, care, and support services and people who are being left behind.

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That notwithstanding, the Institute of Human Virology Nigeria (IHVN) has expressed its commitment to providing HIV testing for one million persons and maintain over 300, 000 PLWHA in therapy, in a exercise, which started on October 1, running through to September 29, 2021.

A representative of the UN Systems in Nigeria, Dr. Fiona Braka, who spoke recently in Abuja, described the death of 45, 000 PLWHA as unacceptable, even as he regretted that this is happening at a time when the government, donors, and partners have successfully made lifesaving medication and commodities available.

While urging global leaders to redouble efforts to end HIV/AIDS, he noted that COVID-19 has adversely affected the delivery of routine HIV services, and the UN joint team on AIDS, along with partners are working to ensure that steps needed to combat COVID-19 in Nigeria while delivering essential HIV services are maintained.

Braka observed that in the country, progress towards 90:90:90 shows that for the first time, 73 per cent of people living with HIV know their status, adding that this is a great achievement for the country, even though more needs to be done.

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She said: “Identifying persons, who are positive is urgent and becomes more challenging as we approach the last mile. Let us continue to build on the lesson learned throughout the history of the response and say with our voice that stigma and discrimination have no place in homes, communities, schools, and healthcare facilities, and everyone regardless of sex, sexual orientation, and socio-economy standing is empowered to fearlessly access HIV testing and related services for prevention and services.”

The Director-General of the National Agency for the Control of AIDS (NACA), Dr. Gambo Aliyu, who also spoke at the event to herald the World AIDS Day, called for collaborative efforts to fight stigma and discrimination so that people would have the confidence to get tested for HIV, adding that it is only when people agree to get tested that the dream of getting to 90/90/90 can be realised.

Aliyu revealed that because of the outbreak of COVID-19, this year provides an opportunity to support people living with HIV/AIDS and people affected by AIDS, adding that Nigeria has chosen as its theme for this year, “United to End AIDS Amid COVID-19 So Get Tested,” because this year’s HIV response is different due to COVID-19.

He said, “We have seen the impact of COVID-19 on HIV programming even though we are scrutinising our data to find out the real impact of COVID-19 on People Living with HIV, but one thing that we know is that COVID-19 has had a negative impact on the economic life of PLWHA than any other population.”

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The NACA boss noted that the agency with the support of UNAIDS, and the Federal Ministry of Women Affairs, recently launched a project to Prevent, Protect and Empower (PPE) PLWHA, considering that they find it difficult to go to medical facilities to obtain their medication, and also find it difficult to earn a living.

He said, “We are focusing on indigent women simply because women are more disadvantaged economically than men. After that, we will empower the men. We want to teach them how to do small businesses and give them seed money to enable them to start their businesses.”

Aliyu commended President Muhammadu Buhari for funding NACA and for keeping to his pledge of putting 100, 000 people living with HIV AIDS on treatment with domestic resources, and appealed to the private sector to join the agency in this effort as they did with the HIV Trust Fund.

As the world battles to halt the challenge posed by the twin evil of HIV/AIDS and COVID-19, a different kind of battle is brewing between a professor of veterinary medicine at the Michael Okpara University of Agriculture Umudike (MOUAU), Abia State, Maduike Ezeibe, who is accusing the Nigerian Institute of Medical Research (NIMR), Yaba, Lagos, of trying to steal his invention.

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Ezeibe claimed to have invented an HIV/AIDS cure called Medicinal Synthetic Aluminum Magnesium Silicate (MSAMS).

But a letter written to the Editor of the World Journal of AIDS Scientific Research Publishing, by the Director of Research and Scientific Adviser to the Director-General of NIMR, Prof. Oliver Ezechi, disassociated NIMR from Ezeibe’s claims.

The letter dissociating NIMR from the article, which was published in the 2020,10, 141-148 issue of the journal titled, “HIV-Infection Reduction-Rates in Patients, on Antiretroviral Efficacy-Trial of a Nigerian Broad-Spectrum Antiviral Medicine (Antivert), requested the journal to withdraw the article.

Part of the letter reads: “It has come to the notice of the NIMR that an article, which appeared in the World Journal of AIDS, 2020, 10, 141-148 issue of the journal is purported to have been conducted in NIMR, and has names of some researchers in NIMR listed as coauthors.

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“The article is a product of the lead author, M.C.I Ezeibe’s imagination. He did not conduct any study in the prestigious NIMR, and the researchers in NIMR whom he has named as co-authors were not consulted, and are not part of this fictitious study.

“There is indeed an ongoing study at the institute evaluating the efficacy of Medicinal Synthetic Aluminum Magnesium Silicate (MSAMS) in the management of HIV infections, but that study is still ongoing, and Mr. Ezeibe is not a member of the study team.”

But Ezeibe in his reaction via a press release stated that NIMR’s action and current attitude towards him suggest that, “they are faking the MSAMS.”

He said: “Since June 2020, they (NIMR) have not asked me for more supplies of the MSAMS yet they wrote that the trial is ongoing, which suggests they are faking the MSAMS.”

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He, consequently, called on President Buhari and the National Assembly to investigate any recent, or soon to be made claim of antiviral medicine invention by NIMR, whether they claim to be using MSAMS, or given it any other name.

Ezeibe also urged the Academic Staff Union of Universities (ASUU) and other staff unions in Nigerian universities to insist on getting to the root of the matter.

“MSAMS is a trade name (patent) granted me (Prof. Maduike C. O. Ezeibe), by the Nigerian government in 2012. So, nobody is permitted by law to work on the patent (medicine) without my permission, while the period of monopoly (20 years) lasts. Even after that period, the use of the same name by anybody, other than the original owner is not allowed.”

Ezeibe alleged that NIMR is also boasting to unveil COVID-19 medicine soon, which means that they may also have tried the MSAMS on COVID-19 patients.

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“The MSAMS is much more than antiviral/anti-cancer medicine. It is also a pharmaceutical raw material, which the world would come to buy from Nigeria,” he said.

On how he got connected with NIMR, he said he met the NIMR Director-General, Prof. Babatunde L. Salako, in August 2017, during an NTA Good morning Nigeria Programme.

“He was accompanied by Dr. Chikwe Ihekweazu, the DG of National Centre for Disease Control, and Dr. Sani Aliyu, the then DG of NACA, and the current Chairman of COVID-19, to oppose his (Ezeibe) claim of having invented a medicine to cure HIV/AIDS (MSAMS),” Ezeibe said.

Ezeibe continued: “During the NTA Live debate, I tried to convince them that MSAMS, which is an approved medicine can function as an antiviral medicine because its molecules are made of nanoparticles that are smaller than any known virus, and that the nanoparticles have both positive and negative ends, while viruses are either negatively or positively charged.”

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Ezeibe also stated that Ezechi who wrote to the journal also represented the NIMR at the inter-ministerial committee to verify his claim that MSAMS is effective against HIV/AIDS.

Ezeibe, therefore, argued that both Salako, Ihekweazu, Aliyu, Ezechi and other senior veterinary academics that they may be working with have learnt the secrets of his MSAMS (his patent) from him, adding that Nigerian laws do not allow them to use it, or work on it without his permission.

He wondered how the NIMR could be working on MSAMS and at the same time saying that it has nothing to do with him/Ezeibe, the patent holder.

“Beyond these, Salako invited me in 2017 to lecture NIMR on the MSAMS, and requested that I collaborate with the NIMR to test the MSAMS on HIV/AIDS patients, and my vice-chancellor permitted me to accept the invitation.

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Reacting to Ezeibe’s allegations, Salako told The Guardian: “The man is very dishonest, we are conducting a trial on his drug, but he did not wait for the trial to be concluded before sending a manuscript to a journal. Where did he get the data? We are also not part of the publication please!”

Ezechi also corroborated Salako: “Yes, we are working on his invention, but he went ahead without our permission to talk to the press, and publish an article in an AIDS journal claiming that the product works. That is not true. Although we are yet to finish the study, our preliminary findings show that the drug does not reduce viral load. The only positive thing is the safety profile. It did not show any toxicity.

“It is laughable for him to allege that we are trying to steal his patent. We were the ones that helped him to get a patent for his invention through our ethics committee. The situation is he used the names of researchers in the institute without their permission as being part of his study.”

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