Many complaints of persons living with HIV in Nigeria

Martins Aluko (not real name) has been living with the disease since 2007. “The medication is not readily available; so many patients have to struggle to buy the drugs just to survive,” he told The Guardian. He said after the United States Presidents’ Emergency Plan for AIDS Relief (PEPFAR) for Africa was withdrawn two years ago, funding has been a challenge. “Now, we are feeling the effects badly.”

Aluko noted that many people have been forced to discontinue their treatment, while others who can afford to buy the anti-retroviral (ARV) drugs have to access them from the private market at much higher prices with some of the products turning out to be fake or expired.

Aluko is one of the estimated three million Nigerians living with the Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Virus (AIDS) and 1.05 million currently under treatment.

Critics insist myriads of People Living with HIV (PLHIV) lack access to life-saving drugs, while officials have had to destroy valuable supplies due to the expiration of the drugs.

The questions that simply come to mind are: Why were these drugs not supplied to those who required them before they got bad? Why are patients charged with service fees when it was meant to be free? What happens if the donors finally pull out?

Patients suffer societal and family isolation even as government push out policies to alleviate their sufferings. Some recount cases when they lose their jobs because of their status and the need to miss work because of doctor’s appointment or check ups.

On the contrary, the Deputy Director of Research at the Nigerian Institute of Medical Research (NIMR), Yaba, Lagos, Dr. Oliver Ezechi said that Nigeria has done well, though more needs be done.

“We noticed reduction in sick people daily. Before, in NIMR, five to 10 people register daily but now, there may be no new patient in a week. This is because, we have more centres, and those who are on treatment are getting it.”

But Executive Secretary, Civil Society for HIV and AIDS in Nigeria, (CISHAN), Walter Ugwocha, identified the pay user fees as the biggest threat patients have in the country.

In many health facilities in the country, the fees they are asked to pay ranges from N6,000 to N8,000 for services related to HIV/AIDS. We continue to emphasize that we have gone through the facilities and we have seen that the drugs itself are given free.

“But for them to get the drugs free, they have to run one test or the other that is for N3,000 and without that test, you cannot access the drugs. That also serves as a limitation and major challenge to HIV patients,” he added.

Ugwocha emphasised that if the user fees is not addressed, many people will stop taking their treatment and would default in their treatment from good to bad.

Ezechi said that the first and second line drugs are readily available by donors but the third line drug is not available. Most times, patients have to buy them.Aluko said many PLHIV have lost their jobs and family ties because of their status. “Many people are still oblivious of the fact that the virus is not transmitted by physical contact.

“For instance, the average fee one spends in NIMR is about N12, 000 for drugs in a year. Because the service charge monthly is N1,000; you see the doctor for at least two times a year, that is N2,000 naira; and do laboratory test at least twice a year for N2900; overall, an average patients spends N21, 800 naira for treatment.”

Aluko said that it is not fair enough, owing to the fact that many PLWHA are not financially buoyant. He added that most Federal hospitals collect service charge to keep the centre running while the Lagos State centres only charge for basic tests. “Is it not same government that supply the drugs?” he queried.

On stigmatisation, he said it is still very high that people don’t use hospital close to their place of residence.As a result of the sensitive nature of the HIV/AIDS related problems, patients do not wish to be seen frequently around areas known to be designated centers for counselling or laboratory tests.

On why many patients don’t use hospital close to their place of residence, Aluko said it is mainly due to stigmatisation.“We have government facilities around us but we can’t use them because the HIV centres are very open and they suspect anyone that visits the facility. This adds to the burden, many PLWHA travel as far as interstate HIV centres just to avoid prying looks.”

Nigeria’s economy or poor health care services could be said to be the obvious reason for lack of a comprehensive laboratory test for HIV/AIDS patients. Confirmatory tests are expensive, but the rigorous procedure is another challenge for those who even can afford it.

The age of getting an inclusive care for PLHIV like cancer patients remains a mirage.Aluko described HIV/AIDS treatment in Nigeria as that of mechanic car repair.He decried that there is no particular drugs for individuals.

“We don’t do drug reaction test in Nigeria, that is taking the patient sample to undergo culture so as to determine the exact ARV for the patient.

“We are only placed on trial and error treatment. They start from the least potent drugs and monitor how effective it is. “In fact, only the rich can afford to run the test, which is paid for in Lagos University Teaching Hospital (LUTH) centre for N240, 000 and blood samples sent to South Africa,” he said.

Ezechi said the patient starts with the first line drugs and then moved to the second line drugs if the first is not effective. The third line drugs, which is not usually available is given as the last option.

On availability of the drugs, Aluko said the more complex the drug is, the least available it becomes.“For the past three years, it has not been funny. We are not only suppressed by the service charge but also buying the drug.

“For instance, Abacavir (a second line drug) has not been available since 2013. We spend as much as N3000 naira as dollar increases monthly. Abacavir is very essential for the body vital organs,” he said.

Aluko added that the drugs are not available because the government wants to shift PLWHA to use one drug that has three components. Though, we were told that it is to manage cost, but they don’t care if the drugs are effective or not. They are cheaper but somebody might need only Nevirapine and another combination.

“Abacavir goes as much as N3,000 naira to N19,000 naira because the government does not import it. There was a time that Atazanavir was not released because of strike.

“Funny enough, there is no substitute for these drugs, so you have to wait till you get them. Imagine what happens to an HIV patients that misses his dose because of unavailability of drugs, he either relapse or get worse.

“Even children Nevirapine is sometimes not available. Infants are expected to take the drugs within 48 hours of their birth to prevent the child from having the virus. What happens to the mother after she had gone through the process and the drug is not available?

“The drugs are not available the way it was when the PEPFAR was running. After government took over, we had issues. Since 2013, like seven times, no second line drug was available. The issue is a major concern. It is big and not funny,” he added.

On the way forward, Ezechi noted that what we need now is to focus and ensure that people know their HIV status, easy access to treatment, and provide readily available treatment services.

Ugwocha said the solution is the need to not only vastly accelerate HIV treatment and existing prevention options, but also to sustain investment to keep HIV prevention and research on track to provide the new tools that will move the world closer to ending AIDS.

Ezechi emphasised that the country should do a rebasing of HIV statistics to know the true state and ensure proper planning.He said the key is to prevent HIV in women of childbearing age. If the woman is infected, her pregnancy should be planned. If she is already pregnant, you must suppress the virus.

He added that men should not be exempted in the treatment if their wife is tested positive. “In conclusion, the country has done well but more needs to be done. 90 or 95 per cent of the treatment is donor dependent. The country need to budget because donor can only help us but should not have complete take over,” Ezechi said.

It is feared that the situation may get worse and more glaring when the effect of donor pull-out and resumed stigmatisation start to take its toll on PLHIV and the economic well-being of the nation.

Unfortunately, funding for Nigeria’s HIV/AIDS intervention has been donor dependent and donor-driven as 90 per cent of available funds come from donor agencies.The decline in foreign donor funding and increased level of HIV and AIDSstigmatisation in Nigeria also reflect that there is a clear need for the government to step-up its game to its response if she doesn’t want to lose the fight.

Earlier this year, the United States of America and other major donors to HIV/AIDs programmes in Africa reduced funding for Anti Retroviral Treatment (ART).A new report released at the 9th International AIDS Society (IAS) Conference on HIV Science in Paris showed a continuous decline in funding and its potential impact on HIV patients and death rates.indeed, as the world marks another HIV/AIDS day, with theme, “Everyone Counts, leave no one behind”, stigma and discrimination against members of the People Living with HIV/AIDS (PLWHA) makes the country’s effort herculean to end the scourge.

Indeed, the ownership and sustainability drive of the federal government is no doubt yielding positive fruits but there are still areas that need to be improved upon as highlighted by the care givers and some of the beneficiaries and relevant stakeholders who spoke with the media.

It is important that government through the National Agency for the Control of AIDS (NACA) and the State Agencies for the Control of AIDS (SACA) ensure that adequate funding is provided to avert stock-out of drugs round the year, maintenance and repairs of breakdown laboratory machines is giving necessary attention as this will ensure patients are not unnecessarily delayed from getting their investigations done which is vital to commencement of Care and Treatments.