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World AIDS Day: Ensuring equal access to treatment, prevention services

As Nigeria joins the rest of the world to commemorate this year’s World AIDS Day, health institutions and experts say inequalities still persist in HIV…

As Nigeria joins the rest of the world to commemorate this year’s World AIDS Day, health institutions and experts say inequalities still persist in HIV prevention, testing and treatment services.   

They call for increased efforts towards creating an enabling environment that tackles all barriers that prevent access to services.   

FIFA honours Solaja for covering 10 editions of World Cup

FIFA honours Solaja for covering 10 editions of World Cup

This year, the global theme for the World AIDS Day is “Equalize” and the national theme is “Equalize to End AIDS: Equal Access to Treatment and Prevention Services”.   

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) Country Director and Representative in Nigeria, Dr Leo Zekeng, there are inequalities that continue to obstruct ending AIDS.  

He said there is need to increase access for those left behind such as children living with HIV and AIDS, pregnant women and key populations among others.  

He said there are about 170, 000 children living with HIV and AIDS in Nigeria, and less than 60, 000 of them have access to anti-retroviral drugs.  

While describing the figure as unacceptable, he said there is need to equalise to ensure that more children living with HIV and AIDS are identified and put on treatment.  

“To equalise will mean to do everything possible to review the country’s dependency on external resources to fund programmes. It means that states should also ensure that they increase their domestic allocation,” he said.  

The Director General, National Agency for the Control of AIDS (NACA), Dr Gambo Aliyu, said while new HIV infections in the country gradually declined from 103,404 in 2019 to 92,323 in 2021, there is significant growth in key population treatment centres, rising from 10 in 2017 with a coverage of 16,147 to 118 in 2021 with coverage of over 221,010.   

He said it is  important to promote equal access across populations that are marginalized among vulnerable and key affected population groups by removing economic, social, cultural and legal barriers to HIV prevention services.  

Aliyu said access to prevention, treatment, care and support services will be intensified for hard to reach populations especially communities circumscribed by conflict.  

“Nigeria is happy to join the Global community to affirm that “We can end AIDS – if we end the inequalities which perpetuate it,” he added.  

People living with HIV/AIDS still face inequalities  

The National Coordinator of the Network of People living with HIV/AIDS in Nigeria (NEPHWAN), Abdulkadir Ibrahim, said mother-to-child transmission of HIV is still a major concern and enjoined NACA to find ways to strongly support the National AIDS, STI and Hepatitis Control Programme (NASCP) to lead and champion the prevention of mother-to-child transmission (PMTCT) of HIV services  programme in Nigeria.  

He said: “We need to step up and do our best to ensure that our mothers and our children have access to these services.”  

He said it is the fundamental human rights of every person living or affected with HIV to be protected, adding that the role of the community should not be neglected in the alignment 2.0 HIV response the country is working towards.  

“Our people are out there and can deliver very well and contribute meaningfully to what we want to achieve,” he said.  

In respect to treatment, he said while the country has done well in putting a number of people on treatment, recent findings from the Advance HIV Disease Survey conducted by NEPHWAN revealed that a lot of people are facing issues around their treatment and not really doing well.  

“We have neglected the area of care and support, the viral load of people, CD4 testing and TB screening. We need to ensure that these things are looked into to ensure that people have adequate access,” he added.  

Assumpta Reginald, National Coordinator, Association of Women Living with HIV/AIDS in Nigeria (ASWHAN), said in 2020, the prevention of mother-to-child transmission coverage was 37 per cent, adding that the uptake of ANC (Antenatal care), facility delivery and early infant diagnosis coverage is still very low.  

However, she said the low uptake of facility based services by mothers is not perculiar to women living with HIV alone.  

She said, “There is evidence of good practices that can improve the uptake of PMTCT  programming in Nigeria. All the evidence for improving maternal uptake of facility services point to the need to invest in community structures and systems. PMTCT will require active community engagement to make the needed difference.”  

She said people living with HIV/AIDS in Nigeria are concerned about the poor will to invest in community system to drive what concerns them.  

“Investment in community system to drive PMTCT is poor, inconsistent and done with tokenism. It is a breach of our rights,” she said.  

The ASWHAN National Coordinator, said Nigeria has success stories to tell about how the ‘mentor mothers programme’ can make the needed shift in PMTCT  services.  

“We can build on the lessons learnt with the mentor mothers programme and bring it to scale up, and this cannot be done with the current practices of poor remuneration,  and inconsistent engagement of mentor mothers.  

“Mentor mothers needs to be developed as a national programme with all systems  and structures to support its implementation. Community system and structure also needs to be given the due visibility to drive and do what it is specialised to do,” Reginald advised.  

Dr Patrick Dakum, Chief Executive Officer, Institute of Human Virology Nigeria (IHVN), who was represented by Dr Atinuke Omananyi, PMTCT Cascade Management Lead of the organisation at a briefing ahead of the World AIDS Day, said IHVN is engaged in different activities to equalise access to treatment and prevention services for HIV.  

He said the organisation recently implemented a programme called Accelerating Progress in Paediatrics & PMTCT (AP3) in identifying women, children and adolescents who are infected with HIV.  

 “In doing that we are strengthening our community services and that increases access of HIV testing Services to pregnant women, infants and children,” Dakum said. 

He added that IHVN has also come up with strategies to strengthen treatment in communities while reaching the key population.  

Minister of Health Osagie Ehanire said the theme for this year’s World AIDS Day commemoration, is clearly a call for action.  

Represented by the National Coordinator of the National AIDS, STI and Hepatitis Control Programme (NASCP) of the Federal Ministry of Health, Dr Akudo Ikpeazu, at a news briefing, he said it is a  call for renewed commitment to achieve epidemic control, and further  actions towards ending AIDS by 2030.   

He said Nigeria is moving closer and closer to her targets. “We are certainly proud of the achievements we have made, working together with our partners. Today we have 90 per cent  of people who are HIV positive know their status, 98 per cent of these are on HIV treatment and 95 per cent  of those on treatment have attained viral suppression.”  

He said having come this far, we must all now work together to address the inequalities which pose barriers to ending the epidemic.  

“For example, despite the availability of free treatment services, as of today, we still have an unacceptable number of children, less than 15 years, living with HIV who are difficult to find and place on treatment.   

“We need to equalise access to essential HIV services particularly for children, pregnant women, key populations and their partners and those in closed settings who are often forgotten. To do this, we must, in a consistent manner address and remove all structural barriers that impact negatively on access to services.  

“I also want to urge all stakeholders and partners to remain steadfast and join the drive to tackle stigma and discrimination and other structural barriers that affect access. Let’s all work together to EQUALIZE,” the minister said.  

Dr Ehanire added that some of the specific strides the country has made this year to address access issues include a PMTCT mapping to identify all places where women access delivery services in order to find all HIV positive pregnant women. “Based on the findings we are working toward expanding the points of service from the current 6,000 to about 40,000 locations identified in the mapping across the 36 states and FCT. Our aim is to find all pregnant women, test all, treat all and report all.  

“In addition, to address some of the concerns in access for children, Nigeria has joined the Global Alliance to end AIDS in Children by 2030. The alliance is currently made up of 12 countries that are committed to building momentum to address gaps, mutual accountability and galvanizing action for results,” he said.  

He added that the Federal Ministry of Health, through NASCP, reaffirmed its commitment to continue to push for programmes and policies aimed at addressing inequalities in access to high quality HIV testing and treatment services.   

 

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