‘Stigma, discrimination still affecting services for people living with HIV/AIDS’

We are now planning to get out of the facility and go to the community the same way we did for other HIV treatment programmes

Doctor Gambo Aliyu is the Director General (DG) of the National Agency for the Control of AIDS (NACA). In this interview, he speaks on ways early budget releases will shore up HIV drugs supply, status of the uptake of biomedical prevention tools such as Pre-Exposure Prophylaxis (PrEP) and dapivirine ringy, score card of the agency 14 years after it was established, among other issues.

How is Nigeria faring in the prevention of mother-to-child transmission of HIV?

That is an area that we have struggled on for several years in the sense that we focus our activities at facility level.

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At facility level, we get less than half of the pregnant women that have HIV, and because of that we have increased number of mother-to-child transmission that occurs outside the facility.

We are now planning to get out of the facility and go to the community the same way we did for other HIV treatment programmes – we moved from facility which is the hospital to the community by getting the services to the doorsteps of people who need it.

As a result of that we recorded remarkable success in identifying people who had not been identified before with HIV and brought them to treatment. This has given us the highest number anyone has ever had in one year in the world.

What have been the challenges in the HIV response so far?

The challenges include access to services, but now we have much access to services than before. We have stigma and discrimination which we are still fighting and we are making successes in the fight against them.

However, some people have the virus in them and are reluctant to come out and do the test, and some who come out and do the test and discover they have HIV, they don’t want to come forward for treatment all because of stigma and discrimination.

Domestic investment for sustainability has also been a challenge. HIV is one disease that if you succeed in controlling, then you get ready to pay pension and gratuity to the people that have it; all of them continue to live with it to the end of their lives.

The guarantee for domestic investment right now is not in place and that is what the agency is now focused on building. The money we get is good, but we don’t get it on time to enable us place order for drugs. When you place an order, it takes six months before you get it. Now if I get my release somewhere in the middle of the year and I get the money and place an order, it will be until the end of the year before I will get the medication. This is not going to help me to guarantee continuous flow of medication even with the money I have. Releasing this money to me immediately when the budget is approved or passed will help me do things better.

Nigeria’s HIV response has been mainly donor-driven. What is NACA doing to ensure that it owns its response?

That is what we are working on now; to own your response you need to pay for your response, you need to figure out who pays for what. We are working towards how the private sector can support the federal and state governments and how state governments can contribute to funding at the centre.

We are also looking at how to do business in such a way that we have value for money with our little resources and get better results.

Some months ago you mentioned that a fund for HIV was in the pipeline, what is the status of that now?

A new Chief Executive Officer (CEO) has been hired. He has received training or induction from the agency on what the agency wants and how the trust fund is going to help it in coordinating the national response. What remains is launching of the fund which we believe will be done as soon as the COVID-19 situation improves.

What is your plan towards putting more people on HIV treatment?

That is what is going on now in the states; after realising that our epidemic is not as big as we thought, we identified hotspots. What we do now is going to these hotspots; and we have been doing it in the last 18 months. We have been getting people that have the virus but have not been identified and placing them on treatment.

We have enough medication for everyone. We are also still waiting at the facility for people to come and take HIV drugs, and to find them, we need to test them.

So the gateway to HIV services is the HIV test and this is what we are enjoining every Nigerian to help us do.

Contribution towards controlling HIV in Nigeria begins with you; testing yourself and knowing your HIV status. If you can help us do that you have contributed immensely in controlling HIV in this country.

Can you outline the key achievements of the agency as it marks its 14-year anniversary?

When NACA was established, HIV prevalence then was 4.6 per cent; meaning at that time, if you took a sample of 100 Nigerians and put everyone in a room, it was likely five of them would test positive to HIV. Today if you repeat the same thing, you are likely to have one instead of five testing positive to HIV.

Also, at that particular time we were having an estimate of 3.5 million people living with HIV, but today we have 1.8 million people living with the disease.

At inception, we had about 200,000 people on treatment, but today we have 1.4 million on treatment.

How accessible is PrEP to people at high risk of infection?

The situation in the country is improving. This is a service that people need to know about; how to make use of it and to take advantage of it, because people have to be consistent when they start using the service.

When we started, the number was scanty, but now we have over 16,000 people on PrEP.; and this cuts across serodiscordant couples and key affected populations, but the awareness in this group is not up to optimal level, so we are working on it.

Is PrEP available in all health facilities in the country?

It is available at designated facilities. We don’t see this population in almost all health facilities, and most times we see them in places that are designed to protect the privacy of the client and make him or her feel comfortable to go there.

The dapivirine vaginal ring is another biomedical HIV prevention tool that has been approved by the World Health Organisation (WHO). What are you doing towards implementing its use in Nigeria?

It is an additional tool; it has one out of three chances in preventing HIV; which is about 30 per cent.

What that means is that firstly, awareness is very key; people have to know about it. We need to also let the population or target groups that are at risk; that is females, and those at high rate of getting HIV to know.

We are going to have the issue discussed and see how to use our traditional vehicles to create awareness, and when you create awareness you now need to make it available to the people that need it (they are in two categories: those that need it and can afford to buy it and those that need it but cannot afford to buy it).

We haven’t taken a decision on it yet, and once we make a decision we will create awareness on it and make it available.

What is the state of HIV prevention research in Nigeria?

We are faring well in prevention research because last year we did integrated behaviour surveillance survey. The survey tells us the distribution of HIV among people that are spreading the virus fast and people that are at risk of getting the virus to see how to prevent them from having it.

It also helps us to see what age group and geographical locations are involved, as well as what sex is involved. It is also to listen to them in terms of preference of services.

Right now we are preparing to estimate the size of the key affected populations in Nigeria, in addition to the size of the estimation we have done in order to have an idea of where they are located, to what extent we have been accessing them, and how we can access them better.

For sub classes of the key populations, we have some prevention studies in view. The Needle and Syringe Programme is already going on and this is mainly for people that abuse drugs. We are giving them needles and syringes and encouraging them not to share them and we are seeing acceptability in the pilot programme.

This is in addition to some analysis and information we collected in our recent survey from the key affected populations on how we can map this virus to monitor how fast it is spreading and where. We should have that information in the next couple of months.

Where do you see NACA in the next 10 years?

I see NACA controlling HIV/ AIDS in Nigeria, sustaining the control, and also doing well in pension and gratuity for HIV services.