Working with data from NAIIS, Nigeria can meet 2030 global target to end AIDS

The Director-General of the National Agency for the Control of AIDS (NACA), Dr. Gambo Gumel Aliyu, in this interview with CHUKWUMA MUANYA, said with the data generated from the National AIDS Indicator and Impact Survey (NAIIS), which showed reasonable improvement in the fight against the scourge, the country is on course to meeting the 2030 global target to end AIDS.

What is the state of fight against HIV/AIDS in Nigeria?
At the moment, we can say that the country’s situation regarding the fight against Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) is good. We never knew that we have done so well in the last 15 years fighting HIV until last year when we did the National AIDS Indicator and Impact Survey (NAIIS).

That survey revealed to us that the programmes that we have had and whatever we’ve had in place is working; and have been very impactful reducing the prevalence from 4.4 per cent in 2005 to 1.4 per cent in 2018.

What is the implication of the new NAIIS survey result to the country?
This result means that Nigeria has done very well and can actually control HIV epidemic, and that is what we are calling the “last mile push.”

When the President released the NAIIS result earlier in the year, he urged stakeholders in NACA to push for the last mile. Pushing for the last mile means we should push hard to control HIV epidemic in the country and that is exactly what we are doing at the moment.

We are pushing hard to see that we fight stigma and discrimination, to make HIV testing attractive to people, for people to know the benefit of knowing their status and taking action.

How has the NAIIS result shaped NACA’s future response to the epidemic?
Our response now has been shaped by the NAIIS data. We know that we are dealing with an epidemic that was not as large as we knew before. We also know that now we are dealing with estimated number of people living with HIV/AIDS that is less than what we were thinking before.

So, in terms of planning, we now have enough capacity to plan for 1.9 million as against 3.5 million in the past, and we have enough energy to fight an epidemic that is shrinking obviously, and from all indications, shows that the measures we put in place, that is our interventions are working well. What we may even need to do is to make sure it works very well.

Making it work very well include using data that we have generated to shape our decisions and that is exactly what we are doing. That kind of activity, we have launched in states like Rivers, Akwa Ibom, and soon we would launch it in Lagos.

Are there plans to include AIDS care in the National Health Insurance Scheme package?
The answer to this is yes

Can Nigeria meet the 2030 global target to end AIDS?
Yes, Nigeria can meet 2030 global target to end AIDS as long as we keep this momentum.

If we keep this momentum for the next 10 years, we are very confident that we will reach the level of zero or negligible transmission, which will also translate to zero or negligible deaths from HIV. At that point we will beat our chest and say we did it!

Stigmatisation is still a major challenge in the country, how are you addressing this?
Stigmatisation is our number one enemy that has been preventing people from testing and coming forward when they test to know their status and do something about it. This is why we are planning and we have decentralised NACA offices. From one office, we now have six offices, that is, one office in each geo-political zone.

This will help us to vigorously focus on our campaign against stigmatisation and discrimination; getting people to understand the benefit of HIV treatment now, and getting people to come out and demand for HIV testing so that we can end AIDS by the year 2030.

What is your take on employers still asking employees to undergo HIV testing?
As far as this is concerned, we are embarking on a campaign to enlighten our employers and employees.
HIV situation has changed from a disease that kills to a chronic illness that can be managed just as we manage hypertension and diabetes.

As long as you take your drugs and it suppresses the virus and wipes it out from your blood, you cannot infect another person with the virus, and it cannot continue to destroy your immune system, or body defence and definitely cannot give you that bad look that it gave in the past.

If it does not do that, it will not show on your face and body. So, why discriminate and prevent somebody from being a productive employee?

Some of the carriers maybe very intelligent or some of the best staff members that an employer has, so why put them away?

Will NACA deploy HIV self-test kits to enable Nigerians know their HIV status by themselves?
Yes, we are planning to deploy self-test kits. We want to start with some special communities and thereafter expand. We want to make sure that those self-test kits are available, accessible and affordable for people who want to know their status, in the comfort of their rooms, to have the opportunity to test themselves, and to know about their status, and then do something about it.

Once such people realise that they don’t have the HIV virus, then we will help them remain without it for the rest of their lives. And if they realise that they are HIV positive, we would help them deactivate the virus in them.

Only about 10 per cent of Nigerians have had their tests to ascertain their status. What is NACA doing to increase the drive for testing?
We are going to go out to communities to work with their gatekeepers, opinion leaders, community leaders, traditional rulers, religious leaders, volunteers, health workers and others, who live with HIV, or are affected by HIV among others. We are going to work with them to make sure their communities are mobilised to know their status and to do something about their status.

Does Nigeria still heavily depend on donor agencies in the fight to end HIV?
At the moment yes, Nigeria heavily depends on donor agencies. They pick up over 80 per cent of what is spent in the sector.

But going forward, that is beginning from 2020, there would be change, and Nigeria would begin to absorb more in terms of the funding of HIV prevention programmes, putting people on treatment and sustaining them on treatment.

There are still issues of non-availability of Anti Retro Viral (ARV) drugs in some government hospitals. What is NACA doing to address this?

Every facility that has been tagged as ARV facilities at the moment has drugs and services are given uninterrupted. If there is any facility that is lacking in drugs, or its services interrupted, we would have to be alerted directly or indirectly so that we can find out what is going on there.

Certainly, sometimes, there maybe some kind of delays in commodity delivery, but definitely not interruption.

What are the major challenges encountered by the agency in addressing HIV/AIDS in the country?
The challenges are always there, including stigmatisation and discrimination; people accepting to test themselves to know their status, and do something about it. This is a real challenge.

Another challenge is funding, which is shrinking. We need funding to sustain our activities going forward.

What is the take home message as Nigeria celebrates the 2019 World AIDS Day?
The take home message is that every Nigerian should know his/her HIV status, and do something about it.

If their tests return negative results, they should endeavor to stay negative for the rest of their lives. If the test is positive, it signals the beginning of a new journey. Therefore, they should reach out to us to deactivate the virus.

What do you make of the budgetary allocation to HIV treatment, control and prevention in the 2020 budget proposal?
The allocation for HIV in the 2020 budget has never been that good; it has been very discouraging. The president graciously approved an increment in the amount of money NACA receives.

NACA, beginning from 2020 will now put additional 50, 000 people living with HIV/AIDS on the treatment bill of the Nigerian government.

By next year, Nigeria will be treating 100, 000 instead of the current 50, 000, so it is kudos to the President and the government of Nigeria.

Currently, how many people are living with HIV and that are on treatment in Nigeria?
Our record shows that about one million people are on treatment and our estimate shows about a million, 800, 000 or 900, 000 people are living with HIV/AIDS. If you like, you could say that close to 55 per cent of people living with HIV/AIDS in Nigeria are currently on treatment.

There have been series of HIV cure claims, what is your position and how should Nigerians respond to these claims?
The world has passed the stage where humans can be used as guinea pigs to show how their body reacts to something, or how something reacts in their body.

The agreed thing globally now, is that when you use human beings to test drugs, you must respect three things: You must respect the principle of autonomy, it has to be voluntary, and they have to know what you are using them for, as well as the implications.

There also has to be justification for the intending beneficiaries to go through whatever they are going to undergo, there must not be exploitation or harm to them.

If there is any HIV/AIDS cure claim in Nigeria that is found to be globally accepted, it would be a thing of pride to the country. It would also be of great economic advantage to us, in addition to putting Nigeria on the global stage.

That is what we are looking for from Nigerian scientists.

Persons living with HIV in prisons are neglected according to a new report by the World Health Organisation. What are you doing about this?
After a survey that we did in the prisons, we are fully abreast of situations in the prisons. We have started reaching out to the correction centres and their management. We are working together now with the prison management to make sure that people in the correction centres have access to HIV services.

They will also be able to know their status, and if they are found to be HIV positive, they would have access to uninterrupted medical services.