‘HIV: We still have challenges of mother-to-child transmission’

Is it true that the HIV infection rate is on the increase?
Let me start by telling you how some of these figures are arrived at. What has happened is that through our ante-natal surveillance report of 2010, UNAID used that and many other agencies, like CDC etc to  model how many new infections are in Nigeria, basically also, using the population. As you know, one of the things that has happened is that Nigeria’s population continues to rise on an annual basis. So if you are using that and other issues like, number of people on treatment and all that, you tend to get a high figure for Nigeria whose population is expanding at a very rapid rate.
If you look at the UNAID figures, it shows that new infections in this country are actually on a downward trend. But we have seen some of these figures that tend to go up but we have a challenge with it for many reasons. We know clearly that in many of the areas, we have made tremendous improvement, particularly, in the last one year. For the first time, we were able to put 150,000 persons in a year on drugs. We know clearly that that has a profound effect of cutting down new infections.
We have also seen an increase in the number of women who receive interventions; this is the highest since we started our HIV/AIDS response – 57, 000, still far from where we need to be, but we have seen the number of people accessing drugs grow from a mere 30 per cent a year to 46 per cent of those who require those drugs.  We have also seen PMTCT rise from 20 per cent to 30 per cent, still far from where we are supposed to be. But all these are supposed to cut down on new infections. So certainly, one is not sure that new infections are rising as being proposed by some people.

How far have we gone to reduce the issue of paediatric AIDS?
Clearly, the big portion of paediatric AIDS is modeled and thought to be coming from transmission from mother to child and the point I am trying to make is that it is true we are not where we should be, ideally,  our target for 2015 is 80-90 per cent. But in one year, we have made more progress than we have made in the previous four years. I remember clearly that in 2009, we were around four per cent, now we are at 30 per cent . So it is true, it is one of our biggest burdens, but we are making progress.

What is the current situation on Tylenol, which was alleged to be a sub standard drug by people living with HIV/AIDS?
The evidence from the Food and Drugs Administration from the USA, shows that the drug is satisfactory in terms of the chemical content. I can even show you the report from them. There might have been other issues but in terms of how good that drug is or was, it has no problem  and I think the minister has already announced that as well.

Tell us of your integration of HIV services in Primary Health Care centres?
That is ongoing and that actually is where we are driving a lot of our expansion right now because it takes HIV closer to the people and we are actually integrating not only HIV but TB services and PMTCT services. The reason for that is that, first, it takes the services closer to the people. Secondly, because the drugs are not a cure, you have to take them on a continuous basis. We want to make sure that a patient doesn’t drop out of his treatment. So services that are close to the people through the PHCs make a lot of sense and therefore, keep the patient in retention and reduce infection.
So adherent is a lot better. For those reasons we are pushing and we are moving beyond the PHCs to go into the private sector because we recognise that in all the things we have been doing since several years, we have not been taking into account, services that are going on in the private sector and there’s good evidence to believe that a lot of the services are actually happening there, for example, PMTCT.
So our new drive, apart from going to the PHC level, is to also ensure that we are driving services through the private sector. That is already happening in a number of states.

Are pregnant women accessing care in Primary Health Care centres (PHCs)?
Yes, they are. Where we have issues, they are structural issues. For example, if you look at PMTCT issues, there are two sides to it; the supply and the demand side.  The supply side relates to service provision,   facilities, human resources, drugs and equipment. Where we have issues which we are also addressing is the supply side. Why do we have all these and the women are not going to access PMTCT either in the PHCs, private clinics or even in the secondary and tertiary hospitals? So we find for example, cultural issues. Many of the women believe that it is better to deliver at home, in the mosque or in the church, and then you have traditional birth attendants.
So those are the things that are driving women away from various health centres and also the attitude of the staff in the health centres. We are trying to be innovative on how we can take, for instance, the testing to the communities and then give the women when they are positive  access to services in the various health centres close to them.

How many HIV positive Nigerians are currently on treatment?
We have 642,000 Nigerians on treatment. It’s a huge margin to what we had last year. That is why we went ahead to develop the President’s comprehensive response plan so that we can quickly ramp up the number of patients on drugs.

How far have you gone with the president’s comprehensive response plan? Has funds been allocated?
Some funds have been allocated for a start. It is far from where we think we should be. For example, only 8 per cent of the money was released but we are hoping that we can go back to government this year, to see how government can substantially increase the amount of funds that we need because if we have to double the number of people on drugs to 1.2 million in the next two to three years, and then test the number of people we want, which is like 80 million, we require a lot of funds because in all these services, 80 per cent of the funding actually go to procuring those commodities.

In the National Response, what are your priority areas?
We have four co-interventions; Treatment. Treatment is very key because you can keep people alive and even more importantly, you can interrupt transmission. Countries that have many people on drugs have had a dramatic drop in the number of new infections. That is actually what we need to do. There’s a point called the tipping point when the number of people on drugs overtakes the number of new infections, you start having a huge drop.  We need to test people too. In this society, so many people are HIV positive, they don’t know their status and they are transmitting. So, testing is a major issue and entry point for almost every service including our communication prevention minimum package of care, then, of course, PMTCT which you mentioned. It’s very important for us because it’s one of the areas where we can really, really save lives and then also address MDGs 4, 5 and 6.