Interview with WINIFRED OGBEBO
The fear of HIV/AIDS, that debilitating disease, remains the beginning of wisdom for everyone. A recent report that HIV infection was on the increase in the country was not well received.
But in this interview with WINIFRED OGBEBO, the director-general, National Agency for the Control of AIDS (NACA), Prof. John Idoko debunks such claim, while giving reports of the activities of the agency.
A recent report in one of the newspapers said HIV infection is on the increase. How true is this?
Let me start by telling you how some of these figures are arrived at. What has happened is that through our ante natal surveillance report of 2010, UNAID has used that and many other agencies, like CDC etc to model how many new infections there are in Nigeria, basically also, using the population. As you know,one of the things that has happened is that Nigeria’s population continues to rise on an annual basis. So if you are using that and putting other issues like number of people on treatment and all that, you tend to get a figure for something like Nigeria which population is expanding at a very rapid rate to continue to grow up.If you look at where we should be, if you look at the UNAID figures, it shows that new infections in this country are actually on a downward trend.
But we have seen some of these figures that tend to go up but we have a challenge with it for many reasons. We know clearly that in many of the areas, we have made tremendous improvement, particularly, in the last one year. For the first time, we were able to put 150,000 in a year on drugs. We know clearly that that has a profound effect of cutting down new infections. We have also seen that the number of women who receive interventions, this is the highest since we started r HIV/AIDS response, 57,000, still far from where we need to be, but we have seen the number of people accessing HIV grow from a mere 30 percent a year to 46 percent of those who require those drugs. We have also seen PMTCT rise from 20 percent to 30 percent, still far from where we are supposed to be, but all these are supposed to cut down on new infections. So certainly, one is not sure that new infections are rising as being proposed by some people.
What about the issue of paediatric AIDS?
Clearly, the big portion of paediatric AIDS is modeled and thought to be coming from transmission from mother to child and the point I am trying to make is that it is true we are certainly not as much as we should be, ideally, our target for 2015 is 80-90 percent. But I am just seeing that in one year, we have made more progress than we have made in the previous four years. I remember clearly that in 2009, we were around four percent, now we are at 30 percent. So it is true, it is one of our biggest burdens but certainly not near where it was, two or three years ago.
How far have you gone with integrating HIV services in Primary Health Care centres?
That is ongoing and that actually is where we are driving a lot of our expansion right now because it takes HIV management closer to the people and we are actually integrating not only HIV but TB services and PMTCT services. The reason for that is that first,it takes the services closer to the people. Secondly, because the drugs are not a cure, you have to take them on a continuous basis. You want to make sure that a patient doesn’t drop out of his treatment. So services that are close to the people through the PHCs make a lot sense and therefore, keep the patient in retention and reduce infection. So adherent is a lot better.
Are the pregnant women still accessing care in PHCs?
Yes, they are. Where we have issues are structural issues. For example, if you look at PMTCT issues, there are two sides to it, the supply and the demand side. The supply side relates to service provision, facilities, human resources, drugs and equipment. Where we have issues which we are also addressing is the supply side.
Why do we have all these and the women are not going to access PMTCT either in the PHCs, private clinics or even in the secondary and tertiary hospitals?
So we find for example, cultural issues. Many of the women believe that it is better to deliver at home, in the mosque or in the church,and then you have traditional birth attendants. So those are the things that are driving women away from various health centres and also the attitude of the staff in the health centres. We are trying to look at all that.
How many HIV positive Nigerians are currently on treatment?
We have 642,000 Nigerians on treatment. It’s a huge margin to what we had last year. That is why we went ahead to develop the president’s comprehensive response plan so that we can quickly ramp up the number of patients on drugs.
In National Response, what are your priority areas?
We have four co-interventions, treatment. Treatment is very key because you can keep people alive and even more importantly, you can interrupt transmission. Countries that have had so many people on drugs have had a dramatic drop in the number of new infections. That is actually what we need to do. There’s a point called the tipping point when the number of people on drugs overtakes the number of new infections, you start having a huge drop. We need to test people too. In this society, so many people are HIV positive, they don’t know their status and they are transmitting.
Now that the anti stigma and anti discrimination HIV Bill is passed, what are your expectations?
We are very delighted about it because as you know a lot of people are getting turned down either in schools or in jobs.So it now ensures that people can be prosecuted because they have refused to engage somebody who has HIV. It’s a very good advocacy point for everyone who has HIV but beyond that, I think it is important for us to also ensure that it takes our fight against stigma and discrimination to the provision of services and that for me, is also key because the expansion of HIV services cannot happen in the face of thriving stigma. So it’s a very good omen for us in terms of trying to ensure that we expand prevention, care and support.
How far about our efforts to develop our own vaccine?
It’s a very good point that you have raised. Remember that we developed HIV vaccine plan about two years ago. In that plan, we ironed out about 12 next actionable points, part of which we are gradually implementing. For example, by last year, we had printed out the vaccine plan, the next thing we need to do is to now see how we can train people to start looking at some of the studies that are also important in terms of engaging in vaccine study. There are a number of community studies, there are a number of things that can happen in the laboratory and there are a number of capacities that we can build either in collaboration with other institutions, that is what is happening.Nigeria, through NACA is one of the five countries that is involved in a demonstration study for pre-exposure Prophylaxis. In fact, between July and November last year, we did the formative study, which is like the behaviour component of the study where we interviewed so many people round the country, to find out from them whether or not this is important and the answer was a resounding yes.
WINIFRED OGBEBO is a Journalist with Leadership Newspaper
But in this interview with WINIFRED OGBEBO, the director-general, National Agency for the Control of AIDS (NACA), Prof. John Idoko debunks such claim, while giving reports of the activities of the agency.
A recent report in one of the newspapers said HIV infection is on the increase. How true is this?
Let me start by telling you how some of these figures are arrived at. What has happened is that through our ante natal surveillance report of 2010, UNAID has used that and many other agencies, like CDC etc to model how many new infections there are in Nigeria, basically also, using the population. As you know,one of the things that has happened is that Nigeria’s population continues to rise on an annual basis. So if you are using that and putting other issues like number of people on treatment and all that, you tend to get a figure for something like Nigeria which population is expanding at a very rapid rate to continue to grow up.If you look at where we should be, if you look at the UNAID figures, it shows that new infections in this country are actually on a downward trend.
But we have seen some of these figures that tend to go up but we have a challenge with it for many reasons. We know clearly that in many of the areas, we have made tremendous improvement, particularly, in the last one year. For the first time, we were able to put 150,000 in a year on drugs. We know clearly that that has a profound effect of cutting down new infections. We have also seen that the number of women who receive interventions, this is the highest since we started r HIV/AIDS response, 57,000, still far from where we need to be, but we have seen the number of people accessing HIV grow from a mere 30 percent a year to 46 percent of those who require those drugs. We have also seen PMTCT rise from 20 percent to 30 percent, still far from where we are supposed to be, but all these are supposed to cut down on new infections. So certainly, one is not sure that new infections are rising as being proposed by some people.
What about the issue of paediatric AIDS?
Clearly, the big portion of paediatric AIDS is modeled and thought to be coming from transmission from mother to child and the point I am trying to make is that it is true we are certainly not as much as we should be, ideally, our target for 2015 is 80-90 percent. But I am just seeing that in one year, we have made more progress than we have made in the previous four years. I remember clearly that in 2009, we were around four percent, now we are at 30 percent. So it is true, it is one of our biggest burdens but certainly not near where it was, two or three years ago.
How far have you gone with integrating HIV services in Primary Health Care centres?
That is ongoing and that actually is where we are driving a lot of our expansion right now because it takes HIV management closer to the people and we are actually integrating not only HIV but TB services and PMTCT services. The reason for that is that first,it takes the services closer to the people. Secondly, because the drugs are not a cure, you have to take them on a continuous basis. You want to make sure that a patient doesn’t drop out of his treatment. So services that are close to the people through the PHCs make a lot sense and therefore, keep the patient in retention and reduce infection. So adherent is a lot better.
Are the pregnant women still accessing care in PHCs?
Yes, they are. Where we have issues are structural issues. For example, if you look at PMTCT issues, there are two sides to it, the supply and the demand side. The supply side relates to service provision, facilities, human resources, drugs and equipment. Where we have issues which we are also addressing is the supply side.
Why do we have all these and the women are not going to access PMTCT either in the PHCs, private clinics or even in the secondary and tertiary hospitals?
So we find for example, cultural issues. Many of the women believe that it is better to deliver at home, in the mosque or in the church,and then you have traditional birth attendants. So those are the things that are driving women away from various health centres and also the attitude of the staff in the health centres. We are trying to look at all that.
How many HIV positive Nigerians are currently on treatment?
We have 642,000 Nigerians on treatment. It’s a huge margin to what we had last year. That is why we went ahead to develop the president’s comprehensive response plan so that we can quickly ramp up the number of patients on drugs.
In National Response, what are your priority areas?
We have four co-interventions, treatment. Treatment is very key because you can keep people alive and even more importantly, you can interrupt transmission. Countries that have had so many people on drugs have had a dramatic drop in the number of new infections. That is actually what we need to do. There’s a point called the tipping point when the number of people on drugs overtakes the number of new infections, you start having a huge drop. We need to test people too. In this society, so many people are HIV positive, they don’t know their status and they are transmitting.
Now that the anti stigma and anti discrimination HIV Bill is passed, what are your expectations?
We are very delighted about it because as you know a lot of people are getting turned down either in schools or in jobs.So it now ensures that people can be prosecuted because they have refused to engage somebody who has HIV. It’s a very good advocacy point for everyone who has HIV but beyond that, I think it is important for us to also ensure that it takes our fight against stigma and discrimination to the provision of services and that for me, is also key because the expansion of HIV services cannot happen in the face of thriving stigma. So it’s a very good omen for us in terms of trying to ensure that we expand prevention, care and support.
How far about our efforts to develop our own vaccine?
It’s a very good point that you have raised. Remember that we developed HIV vaccine plan about two years ago. In that plan, we ironed out about 12 next actionable points, part of which we are gradually implementing. For example, by last year, we had printed out the vaccine plan, the next thing we need to do is to now see how we can train people to start looking at some of the studies that are also important in terms of engaging in vaccine study. There are a number of community studies, there are a number of things that can happen in the laboratory and there are a number of capacities that we can build either in collaboration with other institutions, that is what is happening.Nigeria, through NACA is one of the five countries that is involved in a demonstration study for pre-exposure Prophylaxis. In fact, between July and November last year, we did the formative study, which is like the behaviour component of the study where we interviewed so many people round the country, to find out from them whether or not this is important and the answer was a resounding yes.
WINIFRED OGBEBO is a Journalist with Leadership Newspaper
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