People living with HIV in limbo

For two years, the scandal was waiting to break after Global Fund (GF), which part-funds programmes for HIV/AIDS, tuberculosis and malaria in Nigeria, discovered discrepancies in books kept by the federal health ministry’s department of planning, research and statistics (DPRS). It broke when the GF inspector-general published its report, and reacted with a freeze on […]

For two years, the scandal was waiting to break after Global Fund (GF), which part-funds programmes for HIV/AIDS, tuberculosis and malaria in Nigeria, discovered discrepancies in books kept by the federal health ministry’s department of planning, research and statistics (DPRS).
It broke when the GF inspector-general published its report, and reacted with a freeze on some of its commitments.
Organisations working in HIV/AIDS have computed the sector will need a minimum of $13 billion to fund services between 2017 and 2019.
“If that money is not obtained, millions of people will die,” says Dr. Kema Onu, state coordinator for AIDS Health Foundation (AHF) in Abuja.
AHF advocates for increased funding of HIV services. It’s Fund campaign is pushing for the US, the UK, China, Germany and Japan to step up their corporate social responsibility by increasing their financial commitment to the GF this September when replenishing GF comes up.
The campaign targets China, Japan and Germany for not committing enough into the Global Fund.
Some 3.5 million people live with HIV/AIDS in Nigeria and only around 700,000 are on treatment. It is a treatment gap of 27 percent, which means up to two-thirds of people who need treatment are not getting it.
The lack of funds is also why criteria have been drawn to determine who is eligible for treatment. Stakeholders are questioning Nigeria’s own criteria which have kept many off treatment at a time when global recommendations are urging for nearly everyone to be on treatment.
The GF scandal has hit people living with HIV/AIDS hardest. The National Agency for Control of ÀIDS (NACA), a principal recipient through which GF financing reaches DPRS, faces an embargo. NACA also is conduit for funding to the Network of People Living with HIV/AIDS in Nigeria (NEPWHAN).
NEPWHAN has more than 130 support groups working to get patients to adhere to treatment. Since the scandal, that work isn’t happening and the patient community is “in limbo,” says Victor Omosehin, president of NEPWHAN.
GF is not the lone international donor. Sites supported by the US President’s Emergency Programme for AIDS Relief are still on, even though PEPFAR has turned to “flat funding” — not upping it’s funds to the sites year on year.
But most services PEPFAR previously paid for in more than 30 local government areas with the most need are no longer free, and the burden is on patients themselves.
“Other providers are providing drugs, but people need more than the drugs,” says Omosehin. “They need to adhere to the drugs, they need treatment literacy; they have to know how to disclose to their partners.”
He adds that: “So many are defaulting on their treatment.” The picture is of patients groaning under the cost of treatment and then going off drugs once they feel slightly better, unable to bear the cost of services.
“If they are not there, we will be having a lot of client attrition. Retention in care will be dropping, which is what we are witnessing,” says Omosehin. “It doesn’t make sense that we are giving out so much money giving out drugs, enrolling people on treatment and then people aren’t coming back to be retained on care.”
Since 2014 when support groups once funded by GF shut down, it has been back and forth, and there is no yield on any investment in HIV services, says Omosehin.
The argument is 3.5 million people living with the virus should continue to have access to treatment, and more of the funds should come from the federal government.
Stakeholders have pushed to expand health insurance to cover HIV services to reduce out of pocket spending, or a special trust fund to pay for services in the manner the Petroleum Trust Fund paid for university research and upgrade.
They have also called for better environment to enable local pharmaceutical manufacturers venture into antiretroviral drugs, stopping 16 years of importing the drugs they need to stay alive.
“It is not enough to keep telling us ‘it’s in the pipeline’,” says Omosehin. “Gone are those days. We need to see the pipeline busted. We want to see things happen now.”
What’s happening now is confusion, he notes.