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1.6 million Nigerians living with HIV on treatment – NACA DG 

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THE Director-General, National Agency for the Control of AIDS Gambo Aliyu, says Nigeria doubled the number of people receiving treatment for HIV/AIDS within the two years he has steered the agency’s affairs, raising the population from 800,000 to 1.6 million.

He also highlights measures taken by President Muhammadu Buhari-led government to reduce the cost of procuring antiretroviral drugs for people living with the disease, among other issues in this interview with our Senior Investigative Reporter, Marcus Fatunmole.


Excerpts:

 You’ve been in the saddle of leading Nigeria’s fight against HIV/AIDS in the past two years; what has changed since you came on board?

When I came on board, there was one thing I asked. How many people live with HIV/AIDS in Nigeria that we know? Can we count them? Can we see their names somewhere where we can count them? We want to see where they take medication. We want to see when they started taking medication. We want to know whether they are still taking this medication. If they take this medication, we want to see if this medicine controls the virus in them.

Shortly after I assumed office, we were able to have that headcount. What we had was a little over 800,000 that we had on our list. That was November/December 2019. Today, November/December 2021, two years after, I have 1.6 million on treatment that we can count.

They were contacted, and they are on treatment. We can see how the virus is doing in them. We can see how they are keeping the virus in them and not giving other people. So, there has been a tremendous shift within the last two years. We are able to add almost what had been added for the previous 16 years in the two years that we came to office.

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In what ways does COVID-19 affect your operations and the attention the Federal Government gives to your agency?

COVID-19 affects the attention governments globally give to any other disease other than the COVID-19 itself. This is a fact. The question now is, does it impact negatively on our programmes, on our national response? Yes/No. Yes, indeed that in the first phase of COVID-19 when we had a lockdown. We’re one of the few countries globally to recover very fast. We are the only country that has recovered fast in a recorded huge number that no other country has seen during this period or before.

I am saying that for the 18 months, during the COVID period that ended December 2020, we were able to identify and place on treatment 320,000 people. Our average annual identification and placement on treatment are between 50,000 and 60,000 every year. We were able to do it during COVID-19 despite the lockdown. This was because we changed strategies. We do integrated community services throughout the communities. We go to the houses, knock on people’s doors, provide HIV testing, provide HIV treatment, making sure that no one is left behind, especially communities where we know. Our data show us they are hard hit of HIV, and HIV is breathing in that community, and it is breathing fast.

When COVID-19 came last year, some experts in Nigeria made efforts to develop vaccines locally. What initiative have you brought to NACA to get the HIV vaccine?

What we are doing is to improve access of people living with HIV/AIDS to the COVID-19 vaccine/ We are working with the Network of People Living with HIV/AIDS in Nigeria to make sure people who live with the virus abide by COVID-19 protocols, and at the same time, get vaccinated against COVID-19?

What does it cost the country currently to procure kits and drugs for combating the virus?

In 2019, we bought HIV drugs at 13 dollars per patient per month. As I’m talking to you now, we buy it at seven dollars per patient per month. In 2019, we bought an HIV test at three dollars per test. As I’m talking to you now, we buy the same test at 85 cents, less than a dollar. 

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What we did was that we changed the way we sourced the commodities. Initially, we sourced them from vendors. But now, we are sourcing them directly from manufacturers. That substantially reduced the money.

Then, I needed N7.5 billion to treat 100,000 people living with HIV/AIDS in Nigeria. Now, I am treating the same 100,000 individuals with N4.5 billion.

One of the challenges at NACA, which your immediate predecessor decried, was that the bulk of money in the agency was spent on overhead or for administrative purposes. How is the situation today?

I don’t know how significant our overhead has been in influencing the cost of our drugs. They are two different things. The costs of drugs and tests are in the capital budget. The overhead which is used to run the office is a different budget line. The two are different. Our overhead doesn’t have an effect in any way on our treatment programmes.

In June this year, you said only 18 per cent of the HIV/AIDS fund was sourced locally, while the remaining is from foreign donors. What are you doing to raise the fund coming into NACA locally?

If you observe, domestic resource financing is one of the themes for this year’s World AIDS Day. As we march towards controlling HIV, keeping HIV within people who have it, within the next 18 months, the challenge that will come after the control is how we can sustain it. This is what we are preparing for. We are looking at sourcing funds from different sources internally. This includes the private sector. Because of that, we are bringing on board the HIV Trust Fund of Nigeria, which is purely private-sector driven. Money will be mobilised, which will assist the national response by providing drugs, tests, reagents to the national response and the logistics to distribute these drugs nationally.

One of your surveys showed that women aged 15-49 are more than twice likely to contract HIV as men. How is that possible?

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Generally, women, especially young women, are more likely to contract HIV globally, anywhere, more than men. This is for two reasons—one: biology. A man is more likely to transmit than to take because of his nature. The second one is that women show up more for testing than men. So, women are counted more than men when it comes to access to HIV services. For whatever reason, women care about themselves more than men. That is why we tend to identify the disease more in them than men. Third: access to resources and inequality. Women are poorer than men generally. Because of that, they are vulnerable to manipulation. They are vulnerable to diseases. They are vulnerable to harassment and violence. They are less likely to protect themselves against HIV compared to men. 

Where is Nigeria on UNAIDS targets 90-90-90? 

We call them UNAIDS conditioned-90s. There is 90-90-90, and there is 95-95-95. The 90-90-90 was the target for the last year, 2020. The 95-95-95 is the target for now to 2025. I’m happy to say that for the 90, ninety per cent of people living with HIV/AIDS in this country have been identified. Ninety-six per cent of those identified are currently receiving treatment; 84 per cent of those receiving treatment are suppressing the virus. The next phase is to make sure we move the 90 to 95. We’ll identify 95 per cent of people living with HIV, and 95 per cent of those who know they have HIV should be placed on life-saving medication. Also, 95 per cent of those people should have the virus under control. That is, they will keep the virus within them. They will not be able to transmit it to other people. 

Are HIV infections shrinking or rising in the country?

With increased access to antiretrovirals, with increased identification of people living with HIV/AIDS and placing them on treatment, it is natural you expect infections to shrink. You don’t see a new infection as you saw it before. You expect deaths from HIV also to come down precipitously. This is what is taking place now as we march towards epidemic control. By the time we reach epidemic control, you won’t see new infections as we often see them now. You won’t see deaths from HIV as you see them now because then, virtually everyone with HIV is keeping the virus in them without the virus killing or showing up in their blood and without the virus leaving them to affect other people. 

 2021 World AIDS Day’s theme is Ending inequality. End AIDS. What roles do stigma and discrimination play in ending the disease?

HIV has been in existence for 40 years, and the fight against HIV in this country has been vigorous in the last 18 weeks. The number of people living with HIV in this country is a little less than two million, precisely, between 1.8 million and 1.9 million. For the last 18 years that we’ve been fighting HIV vigorously in this country, we were able to identify 1.6 million out of this 1.9 million. 200,000 to 300,000 are still at large. They have not been identified. The main barrier to this is stigma and discrimination. For almost 20 years, stigma and discrimination have come in between us. We have identified between 1.8 million and 1.9 million that live with HIV in this country. So you can see the damage stigma and discrimination do.

We want people to know that if you stigmatise and discriminate against people living with HIV, you’re helping the virus breathe. People will keep the virus in them, and they will not access medication.

We can only stop HIV from spreading if we control HIV within people that have the virus. 

For now, we are saying that about 200,000 or 300,000 people are running around and giving HIV to others because we can’t access them, or we have been unable to access them for the last 20 years to put them on life-saving medication to stop the spread of HIV.

So, ending inequalities means improving access, fighting stigma and discrimination, and providing access to marginalised people who do not have access to services because of societal or whatever norms.

 

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