The global communities score pass marks on efforts to reduce the transmission of HIV infections, but not without some challenges. WINIFRED OGBEBO reports.
The latest report by the Joint United Nations Programme on HIV/AIDS (UNAIDS), released? last week shows that? new HIV infections and AIDS-related deaths have fallen to the lowest levels since the peak of the epidemic.
New HIV infections have reduced by 21% since 1997, and deaths from AIDS-related illnesses decreased by 21% since 2005.
“Even in a very difficult financial crisis, countries are delivering results in the AIDS response,” said Michel Sidibé, Executive Director of UNAIDS. “We have seen a massive scale up in access to HIV treatment which has had a dramatic effect on the lives of people everywhere.”
The coordinator, United State’s President’s Emergency Plan for AIDS Relief (PEPFAR), Shirley Dady, said more than 3.2 million Nigerians have so far benefited from PEPFAR’s services.
At a press briefing to mark the 2011 World AIDS Day, Dady noted that about 415, 000 individuals are supported through the PEPFAR programme, while others are supported through the Global Fund to fight AIDS, Tuberculosis and Malaria, to which the US is the largest donor nation.
At the end of 2010, an estimated:
• 34 million [31.6 million – 35.2 million] people globally living with HIV
• 2.7 million [2.4 million – 2.9 million] new HIV infections in 2010
• 1.8 million [1.6 million – 1.9 million] people died of AIDS-related illnesses in 2010
People living with HIV are living longer and AIDS-related deaths are declining due to the lifesaving effects of antiretroviral therapy. Globally, there were an estimated 34 million people [31.6 million – 35.2 million] living with HIV in 2010, and since 2005, AIDS-related deaths decreased from 2.2 million [2.1 million – 2.5 million] to 1.8 million [1.6 million – 1.9 million] in 2010. Around 2.5 million deaths are estimated to have been averted in low- and middle-income countries due to increased access to HIV treatment since 1995.
? The director-general, National Agency for the Control of AIDS (NACA), Prof. John Idoko noted that TB is the commonest reason a person living with HIV/AIDS (PLWHA) is sick or dies.? According to him, almost 50 per cent of the people diagnosed with HIV have TB, hence the management of TB is very important because it complicates the treatment of PLWHAs. “Malaria is also important because research has shown that HIV prevalence is high in areas where this disease is endemic. It is a bit technical, but the simplest explanation is that once a person is down with malaria, the cells that contain the HIV virus begin to multiply and once your viral load is high, the person can easily transmit the virus.
Again, PLWHA with low immunity easily go down with more complicated cases of malaria like cerebral malaria.”
? UNAIDS report states that new HIV infections have been significantly reduced or have stabilized in most parts of the world. In sub-Saharan Africa the number of new HIV infections has dropped by more than 26%, from the height of the epidemic in 1997, led by a one- third drop in South Africa, the country with the largest number of new HIV infections in the world.
Idoko observed that, indeed, treatment has helped a great deal in reducing new infections in Nigeria. “When a person uses ARVs, it reduces the viral load and this makes it less possible for the person to infects someone else. It is this principle that is used in reducing transmission of the virus. We have also adopted the principle that we will not restrict treatment for pregnant women whose CD4 count is less than 350. We use the HAART option, we give three drugs from the pregnancy, to delivery and to when the woman weans the baby. so you protect the woman and she will not transmit the disease during pregnancy, delivery or during breast feeding. The second option is to use two drugs from the time of pregnancy any time from 24 weeks to one week after delivery. in addition, you will give the baby neverapine syrup. All of these are done to prevent transmission through treatment, and we have recorded success, though we are working towards doubling the number of success stories.”
According to Dady, in Nigeria, more than 3.2 million adults and children living with HIV/AIDS have received care to support quality of life, including TB/HIV care services and about 723,000 children orphaned by AIDS and other vulnerable children receive care and support.
Declines in new HIV infections are also being spurred by changes in sexual behaviour, particularly in young people, as people reduce their numbers of sexual partners, increase condom use and are waiting longer before becoming sexually active.
? However, the NACA DG?? highlighted the challenge of addressing the social, economic and political inequalities that put sex workers at the risk of being infected with HIV.”?
“We have a big problem with commercial sex worker in Nigeria. First thing is that commercial sex workers are not organised. There are a few commercial sex workers who have organised themselves into groups but things are still patchy and this makes it difficult for us to reach them.
“On this issue, we also have to address the problem of stigma and discrimination, so they can be open to testing and getting treatment for those who test positive. We also need to create job or create the right conditions for income generation so that some of them will leave what they are doing. Government should also think of how we can help them get an education so they can be better informed on how to protect themselves from sexually transmitted infections (STI). We have started the move to create a sex network but it has been difficult. Commercial sex workers are a reality in Nigeria but many people pretend that they don’t exist. Those who recognise them criminalize them and this is detrimental to the national response on HIV.”
Around 400, 000 new HIV infections in children are estimated to have been averted since 1995 due to increased access to effective antiretroviral regimens in low and middle income countries. By 2010, almost half (48%) of all pregnant women living with HIV were able to access effective regimens to prevent their children from becoming infected with the virus.
But the country is still having problems in scaling up Prevention from Mother To Child Transmission (PMTCT). Idoko says, “All our challenges can be traced to a weak health system. The natural thing is to implement PMTCT at Primary Health Centers (PHCs) during ante-natal. But most PHCs are dilapidated while they should be fully functional because they are located in the rural areas where over 70 per cent of Nigerians live. The other thing is that we are yet to get the PMTCT services to the private hospitals in the urban areas, though a large percentage of women are registered with them.? In order for us to scale up PMTCT services, we have to rehabilitate the PHCs, re-train staff working there, buy new equipment and re-introduce the centres to the people. Another thing we have to look into is the lopsided distribution of health workers. When you look at the South East and the? South West, there are ample number of trained personnel to provide health services but you cannot say the same for? quite a large percentage of the north. So we need to task shift by training lower cadre staff to handle PMTCT services in areas where we cannot get higher cadre staff to work in PHCs. Most importantly, we have to integrate PMTCT services into core ante-natal services. We are still trying to get the integration of PMTCT into health programmes for mother and child survival. To do this, we are also stepping up intervention for the management of malaria and TB. We are equally mobilising communities to key into these programmes. Because Nigeria is a large country with 774 LGAs, we are battling to get the results we desire, though there has been a lot of improvement in the last two years with the support of PEPFAR, The Global Fund and the World Bank who just gave us grant to be used in providing PMTCT. Due to their support, we had PMTCT coverage move from 11 per cent in 2009 to 30 per cent this year. But we need to get to 70 per cent or even 90 per cent like some of the countries here at the summit.
UNAIDS? says it has mapped out? a new framework for AIDS investments which is focused on high-impact, evidence-based, high-value strategies.
“The investment framework is community driven not commodity driven. It puts people at the centre of the approach, not the virus,” said Mr Sidibé.
This new strategic approach to investments, he said, would achieve extraordinary results; at least 12.2 million new HIV infections would be averted, including 1.9 million among children between 2011 and 2020; and 7.4 million AIDS-related deaths would be averted between 2011 and 2020.
Sidibe disclosed that at the end of 2010 around US$ 15 billion was available for the AIDS response in low- and middle-income countries. “Donor funding has been reduced by 10% from US$ 7.6 billion in 2009 to US$ 6.9 billion in 2010. In a difficult economic climate the future of AIDS resourcing depends on smart investments.”
But the country director, Centre for Disease Control, Nigeria, Dr Okey Nwanyanwu, urged the federal government to endeavour to fulfill its commitment to funding the HIV/AIDS programme. He explained that with the provisions of the Memorandum of Understanding signed between the US and Nigeria, it is expected that Nigeria would provide 50 per cent of the funds needed for the HIV/AIDS prevention, treatment and support in the country by 2015, adding, “The Nigerian government needs to step up and walk the talk”
To rapidly reduce new HIV infections and to save lives, the 2011 UNAIDS World AIDS Day report underscores that shared responsibility is needed.