When antiretroviral drugs (ARVs) were introduced in Nigeria in the early 1990s, they were only available to those who paid for them. With calls towards achieving universal access to HIV/AIDS beyond 2010, Alexander Chiejina calls for renewed political and funding commitments in the wake of ART usage.
Over the years, Human immuno Virus (HIV) epidemic has continued to remain a major global public health challenge with a total of 33.4 million people living with HIV globally. In 2008 alone, 2.7 million people were newly infected with HIV globally.
Coming home, the 2007 National HIV/ AIDS and Reproductive Health Survey (NARHS Plus) in Nigeria showed that the national HIV prevalence of people living with HIV and AIDS is 3.6 percent (females 4.0 percent; males 3.2 percent with increasing cases in the rural areas in some parts of the country.
Although HIV prevalence is much lower in Nigeria than in other African countries such as South Africa and Zambia, the size of Nigeria’s population (around 150 million) meant that by the end of 2010, over 4.5 million people will be living with the virus. With AIDS claiming so many lives, Nigeria’s life expectancy has declined significantly with latest figures suggesting that the figures had fallen to 48 for women and 46 for men.
Inspite of this shortfalls, since 2006 when United Nations Member States committed to scaling up services and interventions towards the goal of universal access to HIV prevention, treatment, care and support by 2010, the World Health Organisation (WHO), United Nations Children Emergency Fund (UNICEF) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) sought to monitor key components of the health sector response to the HIV epidemic worldwide.
The year 2009 saw continuing progress in expanding access to HIV testing, prevention, treatment and care in low- and middle-income countries. The report assessed HIV/AIDS progress in 144 low- and middle-income countries in 2009 stated the following: 15 countries, including Botswana, Guyana and South Africa, were able to provide more than 80 percent of HIV-positive pregnant women in need, the services and medicines to prevent mother-to-child HIV transmission; 14 countries, including Brazil, Namibia and Ukraine, provided HIV treatment to more than 80 percent of the HIV-positive children in need; and eight countries, including Cambodia, Cuba and Rwanda, have achieved universal access to antiretroviral treatment (ART) for adults.
Though the development of potent anti retroviral therapy (ART) has dramatically improved treatment of HIV, medical experts and stakeholders in the country have stressed the need delivering universal access must be scaled up even as strict adherence to ART medication is required.
Speaking at a recent program organised by Journalist against AIDS (JAAIDS) at Ikeja, Lagos, Deborah Igbokwe, a medical expert at APIN clinic, Nigerian Institute of Medical Research, NIMR, Yaba, Lagos said that adherence is a major issue in HIV treatment given the fact that it affects how well anti-HIV medications decrease the patient’s viral load as well as help prevent drug resistance.
Igbokwe stated that HIV treatment regimens can be complicated as most regimens involve taking multiple pills each day; some anti-HIV medications requires one to take medication on an empty stomach, while others must be taken with meals, and before or after doses of other medications.
In her words “This can be difficult for many people, especially for those who are sick or are experiencing HIV symptoms or negative side effects caused by their medications. Other factors that can make it difficult to adhere to an HIV treatment regimen include experiencing unpleasant side effects after taking one’s medications, travelling away from home, being too busy, forgetting to take medications just to name but a few.”
For Ogechi Onuoha, a member of JAAIDS, findings from an earlier project implemented in 2009 by JAAIDS with funding support from SIDACTION France revealed that people living with HIV/AIDS (PLWHA) faced challenges of long waiting time at clinics, inadequate doctor/client interaction, limited capacity of counselors and infrequent adherence counseling, as well as low knowledge level of the treatment received and how it works.
According to her “the project study which was carried out in Lagos and Oyo states in February 2010 revealed that only a few sites truly offer comprehensive ART services – all expense paid, some PLWH were sometimes unable to afford meals and transport to the clinic, some PLWH were deceived into abandoning their treatment to seek for “miracle cures” and positive mothers who are forced due to cultural influence to breast feed their infants and risk transmitting the virus to their babies and this seriously affected the treatment regimen spelt out by the physician.”
It is noteworthy to state that obstacles to scaling up HIV treatment include funding shortages, limited human resources, and weak procurement and supply management systems for HIV drugs and diagnostics and other health systems bottlenecks which persists in most countries. It is believed that one third of countries reported at least one or more cases when supply of HIV medicines had been interrupted in 2009.
In Nigeria, resources needed to provide sufficient treatment and care for those living with HIV in Nigeria are seriously lacking. A study of health care providers found many had not received sufficient training on HIV prevention and treatment and many of the health facilities had a shortage of medications, equipment and materials. The government's National HIV/AIDS Strategic Framework for 2005 to 2009 set out to provide ARVs to 80 percent of adults and children with advanced HIV infection and to 80 percent of HIV-positive pregnant women in 2010.
Currently, about 34 percent of people with advanced HIV infection are said to be receiving ARVs in the country this year. In the revised framework (from 2010 to 2015), the treatment goals were set back to 2015. Going further, availability and safety of blood and blood products continue to be a concern for HIV prevention. While 99 percent and 85 percent of blood donations in high- and middle-income countries respectively were screened in a quality-assured manner in 2009, in low-income countries the comparable figure was 48 percent. And the list is endless.
No doubt, steps towards achieving universal access beyond 2010 calls for a clear set of actions to be taken by Nigeria and the international community includes renewing political and funding commitments to achieve universal access to HIV/AIDS prevention, treatment and care; improving integration and linkages between HIV/AIDS and related services such as tuberculosis, maternal and child health, sexual health and harm reduction for drug users.
More importantly, special approaches remain necessary to address the particular circumstances and needs of those populations at greater risk for HIV infection. Programmes must be designed and delivered in ways that ensure equity in access, including for children and women. There is no gain saying that only such a combined commitment to programme planning and delivery, built upon a solid primary healthcare framework can fully capture synergies between interventions, ensure programmatic sustainability and maximize coverage and impact.
No comments:
Post a Comment