HIV - Return of a Pandemic

The spread of the human immunodeficiency virus, HIV, is not declining; rather it is on the rise, the major reason being that those living with the virus are not ready to disclose their status for fear of stigma, and are therefore bearing in their strides, and endangering unsuspecting member of the public. Omolara Akintoye reports that achieving an HIV/AIDS free generation requires collective efforts

I could not understand the look on their faces. Time after time, each of them would look at my medical reports and request to see the next person. The one would whisper, ‘Have you told her;’ and the other would say ‘no.’ At last, one of them took the letter to the doctor, who called me in and told me the damning news. ‘You are HIV positive.’”

That was how Shola Umar, then a teenager and an indigene of Lagos, discovered his HIV status 14 years ago in 2002. As if that was not devastating enough, he was sent out of the house by his mum, the moment he broke the news to her. Even the nurses and doctors, who should know better, joined in the stigmatisation. Those were the days when the HIV story was still shrouded in lots of mystery and heavily dreaded; but one still expected succour from such informed quarters.

It all began when he discovered that he was always falling sick. Umar lamented that he would have died because those that he expected support from, especially his mother, deserted him. “My mum said if it is HIV, then it is from my father; so she sent me out of her house. But in spite of all the turbulence, I resolved to live above the challenges and stigma.” He said.
Umar was however not totally alone. His maternal grandfather, who is a medical doctor, encouraged him to be strong. “At a point, my grandfather inquired what I wanted to do for a living; I told him I wanted to be a health worker on HIV issues.”

And that was how he began his advocacy work. He explained that he has been doing advocacy work ever since; moving from one area to the other to sensitise people, especially in the suburbs of Lagos.
“We went to different places in Lagos, especially where those commercial sex workers reside, to sensitise, as well as screen people, so they could know their status.”
Umar has done advocacy work with the Lagos University Teaching Hospital, LUTH and is presently working with the General Hospital, Lagos Island, where he has joined a support group.

Olaoye, who is based in Oyo State, is another person living with HIV. He said, “I’ve been living with this virus since 1998 and here I am, still healthy. Even my wife and our last child have this virus. We’re all on drugs and no one will ever know that we are infected.”

Olaoye however advised people living with the virus to abstain from alcohol and smoking of India hemp and cigarette, as this could be damaging to their immune system. He also urged people to check their status on time, so they could immediately start treatment; in case they’re positive. He enjoined them to also go for counselling, to manage the psychological effect of the discovery.

Olaoye also urged the government to bring in experts in the field, to further notch up the standard of care and treatment in the country to meet international standards.
In the vein, Amina (not real name) discovered her HIV status when she was age 15, but was lucky to get the right counseling and is today happily married to a husband who is also positive. The greater news however, is that they both have a kid, who is negative.

Different stories abound about People Living with HIV/AIDS. The saddest part however is the recent unprecedented rise in the statistics of infected people in certain parts of the country. For instance, the Lagos State government recently revealed that a whopping 9, 572 people tested positive to the virus in the state between January and June this year alone. This is especially scary, as it seems the people have largely let down their guards. It is for this reason that the theme of this year’s World AIDS Day commemoration, Hands Up for HIV Prevention, becomes highly instructive.

Umar however blames the reason for this unhealthy rise partly on the problem of stigmatisation. He said, “Though it (stigmatisation) has reduced as a result of sensitisation and awareness, it is still on and is preventing many people who test positive from coming forward to declare their status. This, no doubt, is making the virus to be on the rise, rather than decline.”
He disclosed that people come into the hospital on a daily basis to know their status, with many testing positive on a daily basis.

In an interview with the Acting Executive Secretary of the Nigerian Business Coalition Against AIDS (NIBUCCA), Gbenga Adeolu-Alabi, he spoke extensively about what the organisation has been doing in the last 13 years to curb the spread of the virus in the workplace. NIBUCCA, he said, is the business community’s response to the HIV/AIDS challenge in Nigeria and was established in 2003 during the administration of President Olusegun Obasanjo, when the HIV prevalence was high.

He pointed out that “those that are actually affected by HIV/AIDS are the working class between 19-50 years of age. That was what gave birth to Nigeria Business Coalition Against AIDS (NIBUCCA). That is why government thought it wise to establish NIBUCCA to address HIV/AIDS in the workplace.”
So far, Adeolu-Alabi said the experience as Executive Secretary of the body has been interesting and challenging. “Interesting in the sense that all the organisations are not on the same page,” he said.

Explaining the challenges, Adeolu-Alabi said he has been able to interact with three sets of people in the course of his work namely, the unaffected, the affected and the infected. To the unaffected, he said NIBUCCA provides necessary information. “Most Nigerians who are unaffected believe HIV/AIDS is not real, so we put together programmes to enable them see that the pandemic is real.”
For the infected (People Living With the Virus), he said NIBUCCA encourages them to change their behaviour. “We introduce human face to the virus, as well as preach hope to them. We also provide job opportunities for them. NIBUCCA takes care of wives and children of those with the virus, whom we call Orphan and Vulnerable Children (OVC). Failure to do this will encourage stigma, which will no doubt aid the spread the virus the more.”
Speaking about stigma, Adeolu-Alabi said though it has reduced but it is still there. “As a result of stigma and discrimination, PLWHAs (People Living With HIV/AIDS) don’t want to declare their status. In Africa, our health challenges are shrouded in secrecy because of stigma and discrimination.”

Like Umar, Adeolu-Alabi is of the opinion that stigmatisation aids the spread of the virus. “Once you are infected, UN Initiative says you are expected to commence treatment, but once you get to the health facility and people get to know, stigma sets in, making such persons to run away from accessing treatment.”
He said failure to access treatment automatically increases the infection, as the viral load keeps increasing; while accessing treatment prevents new infections, as it suppresses the virus and one can have sex once it gets to an undetectable level.
Another major issue, Adeolu-Alabi said, is funds. He revealed that many years back, Nigeria was getting funds from donors such as Global Fund, USAID, among others, which were used to institutionalise HIV/AIDS programmes, especially in the workplaces. But now that the fund is no more forthcoming, most of the SMEs are struggling.

“To compound the economic issues, Nigeria is now in recession and experiencing economic meltdown, which is called ‘donor fatigue’. Most PLWHAs are no more enjoying easy access to treatment, as most of the ART (anti-retroviral therapy) drugs from donors are no more there and government is not able to provide enough resources to sustain those on treatment. “The only way out,” he pointed out, “is for us to look inward and source for means of sustaining the programme by increasing the tempo of our activities.
“Also, there is need for the three arms of government to make available a substantial amount of resources to be used to address HIV and AIDS.”

The Lagos State government for one is not resting on its oars, especially with the alarming statistics of nearly ten thousand new cases in the first half of 2016 alone. Aside risky sexual behaviours, there are so many other activities people engage in that may promote the spread of HIV. This includes harmful traditional practices such as female genital mutilation. Three types of female circumcision occur in Africa.
According to Oyefunsho Orenuga, a medical expert with the Lagos State government, the most extreme, termed infibulations or pharaonic circumcision, involves partial closure of the vaginal orifice after excision of varying amount of tissue from the vulva. In its extreme form, all of the mons veneris, labia majora and minora, and clitoris are removed and the involved areas closed by means of sutures or thorns. After the operation, the thighs are strapped together for 4-8 weeks, with complete occlusion of the insertion of a matchstick or other wooden object.
A more moderate form of female circumcision is excision, which involves the removal of the clitoris and part of the labia minora. The mildest form, sunna circumcision, is circumferential excision of the clitoral prepuce.
Another practice, that involves female genital mutilation, is making “gishiri cuts”, which are incisions on the vaginal wall, and presumably serve the same purpose as female circumcision.
“Indeed, most of these cuts are done with tools or instruments that are not sterilised, more so, when those involved in this cultural practice, are not informed about HIV and its transmission. These instruments are thus used repeatedly on numerous girls, thereby increasing the risk of blood-transmitted diseases, including HIV/AIDS. Thus, in a society where information and education on the use of sterilised tools or instruments seem inadequate, the resultant effect is usually an increase in transmission of diseases, such as tetanus, HIV and Ebola virus. This is so because female circumcision has been postulated to increase the likelihood of AIDS transmission via increased exposure to blood in the vaginal cana,” she said.
Another harmful practice, which can also aid the transmission of HIV/AIDS, is the tattoo craze, which Nigerians, seem to have caught. Among those who have heard about HIV/AIDS, most (62.7% of the men and 37.3% of the women) believe that HIV/AIDS could be transmitted through the tattoo incision. But despite this, The Nation gathered that most people are still willing to adorn the tattoos and allow their wards wear them.
In tandem with the foregoing facts, Mrs. Orenuga is of the opinion that practices involving the use of shared instruments (injection of medicines, ritual scarification, group circumcision, genital tattooing, oral tattooing, other body tattooing, tribal markings and shaving of body hair with unsterilised blades) lead to HIV/AIDS transmission.
Similarly, almost all (97.8%) of the women said they like their tattoos. But the question is how safe are the instruments being used for the process?

We’re committed to eradicating HIV by 2030 LSACA boss Speaking on its efforts to curb the HIV spread, the Chief Executive Officer, Lagos State AIDS Control Agency, LSACA, Dr. Oluseyi Temowo said the agency has mobilised its HCT trucks to all the nooks and crannies of the state to conduct free HIV Counselling and Testing. This, he said, would enable every Lagos resident to be aware of their health status.