With the dwindling foreign financial assistance posing a major challenge to the health sector, the National Agency for the Control of AIDS, NACA, has launched an initiative to mop funds from the private sector to support the campaign against HIV-AIDS in Nigeria. In this interview with Onyebuchi Ezigbo, the Director General of NACA, Dr. Gambo Aliyu said the agency is seeking to galvanise private sector resources to fight HIV.He also spoke on milestones achieved as well as strategies to eradicate AIDS in Nigeria
What is your scorecard in the fight against HIV in Nigeria since you assumed office?
When we are looking at milestones in controlling HIV we look at two big milestones. Where are we in terms of our ability to control the epidemic? The second one is after we achieved epidemic control, what measures are we putting in place to sustain the control? On the first one there are programatic indicators which we use now to attain epidemic control. These indicators are that people living with HIV AIDS, 95 per cent and above should know they have HIV.
Another 95 per cent of those who know they have HIV in them should have unmitigated access to life saving drugs and another 95 percent of those that have this access should have the drugs working in them, suppressing the virus, making the virus to disappear from the blood and it is not seen. Once it is not seen, the virus isn’t transmitted and if it is not transmitted then it doesn’t have the capacity to break the body’s defence mechanism to make the person sick.
When I came on board, we had on record close to 800,000 people that where identified and were linked to the life saving treatment out of about two million people that live with HIV AIDS in Nigeria but today as I speak to you in the span of three years we were able to identify additional one million people. We at the moment have 1.8 million people identified out of the two million we are looking out for and they have been successfully placed on treatment. We are testing them to find out how these medications are working on them to achieve that goal of making the virus disappear. If it is not seen then it is not transmitted. This is the first trench. In the first phase we have done exceedingly well.
Nobody had expected that in the span of three years we would be able to turn around the national response and add a million people on treatment. Prior to 2019, we on average identified and added 50,000 to 60,000 of person every year. However, in 2019 to 2020, 2020 to 2021 now 2021 to 2022 we have identified on the average more than 300,000 every year. So this is how the narrative changed for the last few years I took over with regards to the first phase.
For the second phase which is sustainability, this is putting structures in place, financial and otherwise knowing fully well that by the time we achieve the first phase, this money that we have and we enjoy will no longer be as big as it is. The question now is, from there onward who pays for the medication? Who provides this uninterrupted medication for these people to keep this virus in them without sharing it with the rest of us for the rest of their lives.
NACA has identified unmarried people and sex workers as the highest multiplier of HIV infections. What measures have you put in place to put them in check and arrest further spread of HIV ?
We already have measures that we put in place that are ongoing. The group you are talking about is the group we call key affected population. These are sex workers, men who have sex with men, injection drugs users, transgenders and the other category you are talking about are young unmarried which cuts across men and women that for some reasons are now disconnected in terms of access to our prevention services.
Our prevention services are available and accessable. However, somebody needs to be aware of the existence for them to take advantage and make good use of them. One thing that is obvious to us is that the adolescents and young adults pay attention more to social media and spend most of their time on social media and because of that we have expanded our tentacles there.
We are out there on the social medias, we are sending messages, tweeting, we are on Instagram, WhatsApp, Facebook spreading this message. Why it is important for you to know about your HIV status and why it is super important for you to remain negative if you are negative and what benefits awaits you if you are positive in terms of us helping you to fight the virus and keeping it in you without the virus leaving you to affect other persons and without the virus having the upper hand to make you sick.
How many new infections do we have since you assumed office and what is the total number of people infected with HIV in Nigeria as at this year?
I don’t have the total new infections to give you for the last three years in my head but one thing I can tell you is that the number of new infections are declining and the number of deaths from HIV is also declining and these are the critical milestones or indicators for progress towards epidemic control.
As you approach epidemic control and the community is getting saturated in terms of identifying people living with HIV and placing them on treatment the virus will now be caged and demmobilised, so if it is not moving as before. It means you won’t be seeing new infections as before and at the same time, you won’t be seeing deaths from HIV because more 90 per cent of people who have the virus now know they have the virus and are taking good care of it. So because of that the virus doesn’t progress to what we call AIDS and it has to go to AIDS before it kills so it doesn’t go there.
What about the mother to child transmission of HIV? Have you been able to check that?
Unfortunately no. We haven’t been able to arrest mother to child transmission but we have taken every measure that are necessary to halt mother to child transmission, to reduce it significantly this year and to further reduce mother to child transmission in the next coming years for us to see ourselves being counted as countries that are making huge progress towards eliminating mother to child transmission. It is global and it is possible. other countries have done it and some other countries are doing it now and we are also in a good position to do it and we are on track to drastically reduce the mother to child transmission beginning from this year and then progressively eliminating it.
What is the rate at which the pregnant women respond to HIV test because it has been identified as a problem and that most of them don’t go for test?
You are right. The first limitation is having access to the pregnant woman. From our programme, from what we have seen once we have access to the pregnant woman and we introduce our services to them, almost 100 percent accept our service. They test and those that are found to have HIV also agree to take the medication to prevent the spread of the virus from them to their unborn baby. They understand the risk and most of the time they are very co operative. They want to make sure that the virus isn’t seen in their unborn baby. Where we have the problem is the access. Significant number of pregnant women don’t come to conventional facilities whether government or private to deliver.
Some of them deliver at home for cultural reasons, some at a traditional centre or a nurse in the ward. Some of them deliver at religious places of worship and some of them deliver in other places. Those that we don’t have access to are the ones that we are now marking efforts and looking at how we can have access to them in addition to those that we already have access to. If we are able to double the number of pregnant women we see this year then it is an indication that we are making very good progress in terms of having access to the pregnant woman. Last year and the year before last year I think the numbers we had access to were about two million every year. This year we want to see if we can have access to about four million pregnant women and give them HIV services.
We will like to know what NACA’s budget is like, what you got from donors and the federal government?
There isn’t much different between what we have this year and what we had last year and also similar to what we had the year before last year. However, we know that going forward and it has started happening, this year we had a budget deficit of about $26 million that is the money we are getting from American government is about $26 million short of what we have had last year and this scenario we expect to continue to repeat itself as we approach epidemic control and by the time we approach epidemic control and we reach there, we know there would be this discussion about sustainability of the entire program since the American program isn’t here to stay forever.
It has a life span and the life span is dependent on our ability to control the virus and now we are right on track on controlling the virus. So we know by the time we are able to control the virus most of the monies we see now may not be there because we use money for two things; to find cases and to program and manage the cases. So if you finish finding the cases then all the money for case finding would go and now you would be looking for money to manage the cases that you have found and this money is what you should plan to have continuously on an annual bases for as long as HIV continues to exist without cure, we shall continue to give this medication to this people that we found to make sure this virus doesn’t move.
What is the federal government’s side of the budget?
Let me give you a scenario, out of the 1.8 million that we have on treatment you can make an assumption that the government of Nigeria is taking care of about 100,000. The global fund is taking care of between 300,000 to 400,000 and the United State government is taking care of about 1.3 million. It is just an example I gave you. So we have a programme we call alignment where we put all our resources together and in that alignment United States government has the largest share of contribution followed by the global fund and then the federal government of Nigeria.
You recently launched an initiative to bring in private sector fund or domestic funding into the HIV-AIDS control programme, what is the progress report on that initiative?
You are referring to HIV trust fund of Nigeria. This is an initiative that has been in the pipeline before COVID 19 came. When COVID 19 came this idea was introduced in COVID 19 response and it worked very well and this is what we call CACOVID. The private sector came together to help government of Nigeria to fight Corona virus. That same model is the model we are adopting for HIV. The private sector is coming together. At this material time we tell them that one of the areas that we are having gaps and requires urgent attention is the fight to prevent mother to child transmission of HIV and that is where the HIV trust fund is focusing and helping.
What the trust fund does is money that is contributed from private sector is 100 per cent managed by the private sector and what they do with our alignment is to provide us commodities. We have shared our commodity needs for this year and we have shared our commodity forecast for next year with the fund. We are now waiting for the trust fund to come back to us and ask us how do we want this commodity to be provided in terms of the time, in terms of location but we have done our first part and we are waiting for the trust fund to look at our request, work on it and then come back to tell us how they are going to filling in this gap we have allocated to them and everything is going on well.
In monetary terms, what will this allocation to the trust fund require?
What we requested this year because we want to expand the prevention of mother to children transmission in the community level and one thing that is required and which takes a lot of money in this business are the test kits. You may have to test like 50 pregnant women, 20 percent sometimes, or 40 sometimes before you get one HIV positive. These numbers that you test you need thes kits to test them. So this is our request for this year from the trust fund, we want them to provide us kits to help us expand the services at the community level. Maybe next year we will add drugs but this year we have enough drugs to go round including the number of pregnant women that would be identified.
Can you say that Nigeria will meet the global target on elimination of AIDS?
By the year 2030 HIV would still be in some people’s body. However, it is our hope that by the year 2030 that we don’t see people with this disease called AIDS that makes people sick and kills them and I have told you that we have observed decline and those decline are significant in terms of people that are having new infections and people that are dying from HIV and that is the area of interest that we will keep our eyes on looking towards 2030. Our hope is that within the next two to three years Nigeria should arrive at that bridge where we don’t see AIDS people anymore and every HIV infected individual is managing his or her disease as chronic illness just like we manage diabetics, hypertension and any other chronic disease. They are living with it, they are going about their business without fear, without stigmatisation or discrimination.
How far have you been able to address the issue of stigmatisation?
It is still a factor but not as it used to be in the past. We have had tremendous gains in fighting stigmatisation and discrimination. I can say that stigma and discrimination has been the major barrier that deny us that opportunity to identify these two million people we have been looking out for the last almost 20 years but for the last three years you can see we were able to identify a million and over 12 to 13 years before then we were not able to identify up to a million.
So you can see how stigma has been a factor from the time we started this vigorous fight against HIV in 2005 up to around 2018 and from 2019 we had a change that suddenly people now come close and people take the services and also people use this services. We have unlocked the barrier that prevented people from coming to facilities to request for the services. What we did is that we take the services to their doorstep, to the community level. So now what is clearly coming out is if you take the services to people’s doorstep people would be happy to take it, people would be happy to know about their HIV status and they would be happy to take this medication but if you continue to stay at facilities in our hospitals waiting for people to come and demand then we haven’t reached that stage as we want. People are still reluctant to come to facilities and demand for the services as we would have want to see but going to the communities at their doorsteps, people would take the services. You can see a change, we were identifying 50,000 a year now it is over 300,000 a year due to what we have been able to do at the community using information, using data that we were able to collect in 2018.
There is also COVID 19, is it still a factor? Does it have impact on the HIV drive?
COVID 19 had impact on our services for only two months when it came first. Up until March, April, May, June 2020 that was when COVID 19 had a profound impact on our services but as at July we were able to bounce back and since then we have being cruising at high altitude
