Written by Ijeoma UKAZU

HIV/AIDS: Urgent Need For Local Fund Commitment

As Nigeria joined the rest of the world to commemorate the World AIDS Day, WAD, on December 1, stakeholders say the Nigerian government needs to commit local resources to tackle the HIV/AIDS pandemic, squarely.

Currently, donor funds are dwindling and it rests on the Nigerian government to find alternative source of funding for anti-retroviral used by People Living With HIV and AIDS, PLWHAs, in order to avoid a surge.

Nigeria has the second highest HIV burden after South Africa. Local funding for HIV is less than10 percent compared to South Africa which commits 85 percent from local resources. Certainly, in Nigeria, some persons are being left behind.

In another development, findings from the United Nations Children's Fund, UNICEF, Children and AIDS Statistical update, Sec 2017, reveals that the scale up of Prevention of Mother-To-Child Transmission, PMTCT, of HIV/AIDS services is one of the greatest public health achievements in recent times. Services are increasingly integrated, new ways of delivering those services have been introduced, and antiretroviral treatment to improve maternal health and PMTCT was accessed by three quarters of all pregnant women living with HIV/AIDS in 2016.

Since 2000, some 2 million new infections in children have been averted. The vast majority of these (1.6 million) since 2010. In 2016, Armenia, Belarus and Thailand joined Cuba in receiving World Health Organization validation for Elimination of Mother To Child Transmission of HIV, EMTCT.

In 2017, this was expanded to a number of Caribbean countries and territories. Many other countries are similarly on track to achieve this goal within a few years.

But the global pace of progress is slowing.

UNICEF projects that if the reduction in new paediatric HIV infections continues at the same rate, there will be 100,000 new infections among children in 2020 alone, in relation to the 20,000 super-fast-track target.

A breakdown of regions helps to pinpoint where to focus and of the regions with available data, Eastern and Southern Africa, home to 50 percent of new HIV infections in children (aged 0–14 years), had the highest proportion of pregnant women receiving effective anti-retroviral for PMTCT are 88 percent; whereas PMTCT coverage in West and Central Africa is just 49 percent, accounting for 38 per cent of new infections in children and 25 percent of all children living with HIV.

While paediatric HIV prevention is a real success story, paediatric HIV testing and treatment is lagging. In 2016, only 43 percent of HIV exposed infants were tested within the recommended first two months of life.

Similarly, only 43 percent of the 2.1 million children living with HIV around the world received Anti-Retroviral Therapy, ART. Without timely treatment, mortality in children with HIV is very high. There were 120,000 children who died of AIDS related causes in 2016.

In order to end HIV/AIDS in children, the remaining 57 percent of children (1.2 million) who are not on treatment need to be identified and placed on lifelong treatment as a matter of urgency. Novel targeted approaches such as HIV testing in hospitalized children and in nutrition centres as well as using point-of-care virologic tests which can provide results ‘while you wait’ may help to identify these children and enable rapid initiation of treatment.

According to the Director General of National Agency for The Control of AIDS, NACA, Dr Sani Aliyu, in his remark to mark the World AIDS Day said that "since the first case of HIV was reported in Nigeria in 1986, we have averted about 1.5 million deaths and over 5 million new HIV infections. We reduced HIV prevalence from a peak of 5.8 percent in 2001 to 3.0 percent in 2014. In the last six years, the number of new HIV infections has gone down by 56 percent and annual AIDS related death by 22 percent.

"Today, we have an estimated 3.2 million people living with HIV in Nigeria. Only recently, we achieved the milestone of identifying and placing over 1 million persons living with HIV on life saving anti-retroviral drugs. In other words, we are gradually "turning off the tap" of new infections while mopping up those who are infected and enrolling them into care in our ever-growing ART programme. We are also gradually closing the unmet need for prevention of mother to child transmission.

"While we commend ourselves for these achievements, we acknowledge the huge unmet need for ART; only nine states have surpassed 50 percent ART coverage. The rate of MTCT of HIV in Nigeria is still unacceptably high. We certainly need to do more at the federal and state levels to take ownership of our HIV and AIDS response and close these gaps."

The NACA DG also added that, "Nigeria must take its response to the next level, we must address the challenges related to our health system infrastructure, unmet need for commodities, data quality and human resource for health and funding. These challenges constitute key barriers to universal access to HIV/AIDS services in Nigeria.

"It costs about N50,000 to provide ART to a person living with HIV for a year. With the size of our treatment programme (at over 1 million PLWHAs on ART), we will require at least 50 billion Naira annually to keep them on treatment, while we require triple that amount annually to achieve and maintain ART coverage saturation in Nigeria."

According to a Professor of Haematology and Transfusion Medicine at the College of Medicine, University of Lagos, Suleiman Akanmu, expressed worry over the lack of treatment facilities in the country, adding that there were growing incidence of resistance to Anti-retroviral drugs in the country.

Akanmu, who is also the chairman, National Task Team on anti-retroviral therapy, ART, in Nigeria, said "many of our patients that are on first line drugs are failing and they are supposed to be put on second line drugs which is not available now.

"Also we are not detecting failure on time. If we have facilities in Nigeria where people can easily do Viral Load Test, then we would be able to detect first line failure and be talking about putting them on second line regimen."

Recently, the World Health Organisation, WHO, alerted that drugs for HIV/AIDS treatment were failing and the development is causing anxiety not just in Nigeria or other countries with high burden of the pandemic, but all over the world.

Africa’s Bureau Chief of AIDS Healthcare Foundation, AHF, Dr. Penninah Lutung, said the epidemic can be controlled if new infections are reduced drastically through the current number of strategies and modules being used as combination prevention.

The National Coordinator, Network for the People Living with HIV/AIDS, Victor Omoshehin, demanded the removal of service charge for members of his network.

He said, "Nigerian government should own up to the HIV and AIDS response. Putting money into the national response is an investment in humanity. Our continuous access to medication and our right to healthcare is a fundamental right. Government should make it happen."

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