Today, across the globe, the World Health Organisation (WHO) encourages all to join in the fight against the spread of the dreaded Acquired Immunodeficiency Syndrome (AIDS). In doing this, it seeks to close the gap between people who have access to HIV prevention, treatment, care and support services and people who are being left behind. But SADE OGUNTOLA reports the ambivalence of frustrations and hopes of victims and their inaccessibility to care and treatment.Michael Emmanuel is a success story of Nigeria's HIV treatment programme and no wonder his passion now is to find partners for people living with HIV/AIDS. He first discovered that he was positive in 2003.Running God's Perfect Health Foundation, a non-governmental organisation (NGO) that finds partners for people living with the virus, he knows first-hand the psychological trauma persons living with the virus go through and this knowledge helped him shape his approach and strategy when he became an advocate.He found courage in being an active member of my church and the society I belonged to and having come across people living with the same condition and counselling them had a consoling effect on my resolve to begin this initiative, 'Michael is one of Nigeria's estimated 3.4 million people living with the virus for over a decade. He, however, moved on as he reached out to others like Aisha (real names withheld) who had tried to fight the stigma and unsuccessfully so. Like many others, Aisha initially at diagnosis lost the needed enthusiasm to live. She concluded that contracting the virus was a death sentence.'The first thing that came to my mind when I was diagnosed of HIV was that I would die. I lost interest in everything and with myself. Today, my life is different. I have not only got my hope back after two years, I now have a partner who loves me for who I am and soon we will be married,' Aisha stated.Oba Oladapo is among the thousands like Michael Emmanuel and Aisha living with HIV/AIDS, who have been given a chance to live, to attain their goals in life and also find acceptance again. But Oba, a computer system expert and a politician aspiring for a seat at Oyo State House of Assembly, like many others, is pessimistic that the ARV therapy gains Nigeria recorded, some years back, may soon be eroded due to diminishing funding for HIV/AIDS programmes both by international development partners and the Nigerian government.'All the over the world, talks are on about achieving zero deaths from HIV, zero new infections and zero stigmatisation of people living with HIV and AIDS. But currently, the number of people in attendance at antiretroviral drug clinics is on the decline by almost a third because people are now been asked to pay for tests,' Oba spoke regretfully.He added that the re-introduction of fees for such services as monitoring tests for those on ARV, supportive care of opportunistic infections and other facilities have become responsible for denying infected victims from accessing treatment. This, for him, would dim the hope of curbing the HIV pandemic by the year 2030 being targeted by the World Health Organisation.Oba, who has been tested positive to HIV since 2002, added that 'the administration of HIV services at the PREPAR clinic at UCH agreed to bring down the cost of monitoring tests by asking people to pay N1,000 per month, but how many people can afford this' Now many people have stopped coming for treatment because without these tests, they cannot access ARV drugs.'When a person stops taking ARV drugs, the virus will become resistant and if this happens, they will have to change to other drugs to continue the treatment. Unfortunately, such alternatives are more expensive; they are extremely difficult to administer and often not available. So, it is like a death sentence.'Moreover, Oba added that a full complement of ARV drugs that were available in HIV treatment clinic have also been narrowed down to few ones, thus the need for some people's prescription to be changed and as such medical doctors having fewer options of ARVs to use in treating their patients.He declared that the declining access to HIV voluntary counselling and testing in communities is responsible for the inability of many infected persons in knowing their status.'When talking about preventing new HIV cases, it starts with every individual getting tested for HIV. The advantage of that is that when you know your HIV status early, you are better managed. But now, more often it is when you are sick that you become aware of your HIV status,' he added.Oba, who was pessimistic about the handling of HIV, said the latest global AIDS report corroborated Nigeria's poor handling of a possible looming epidemic of new HIV cases and deaths from the virus.'Today, I am aspiring to be in the Oyo State House of Assembly because I am a success story of Nigeria's ARV programme, which has succeeded to a point. But the reality of this is that there are people today that have been sent to their untimely death because they had no access to treatment,' he said.The national coordinator, Network of People Living with HIV and AIDS in Nigeria (NEPWHAN), Mr Edward Ojenyi, was also not certain it was the best of times for AIDS response in Nigeria given that on the average 2,000 persons living with HIV die monthly from HIV-related causes.With 1.8 million Nigerians eligible to be on ARV treatment and currently 649,000 only benefiting from this life saving medications, Ojeniy said the President Comprehensive Response Plan on HIV/AIDS, which was to put additional 600,00 children and adults on ARV treatment is yet to commence.'None of its targets, including the activation of 2,000 ARV centres and 2,000 Prevention of Mother to Child transmission of HIV sites across the 36 states and the FCT, is yet to be implemented since January, 2014. So Nigeria is not just far from achieving zero discrimination against HIV, zero new HIV cases but also zero deaths from HIV related deaths,' he said.Ojenyi added that accessing HIV care was becoming a problem in Nigeria, especially at PEPFAR supported HIV treatment centres with the withdrawal of free laboratory component of HIV treatment and drug pickups as well as people living with HIV now having to pay for consultations and enrolment as HIV treatment centres.'HIV treatment in Nigeria before was free, but now people have to pay. But a good number cannot pay and have no option than to stop their treatment. The main issue now is not the attainment of zero stigmatisation or new HIV infections; it is about preventing an epidemic of resistance in individuals on treatment which Nigeria does not have the capacity to handle.'The government must wake up and fund the President Comprehensive Response Plan for HIV in Nigeria in order to bridge the treatment gaps and that is when we can be talking about achieving the theme of the 2014 World AIDS day celebration of 'Getting to zero: Zero New HIV Infections, Zero Discrimination and Zero AIDS-related deaths.'He argued that Nigeria should stop putting the fate of people living with HIV/AIDS in the hands of funding partners, declared that 'Nigeria is rich; it is just a matter of priority. I believe if President Goodluck Jonathan channels all energy into HIV as was done in the case of Ebola, we can actually combat HIV in Nigeria.'He stated that persons living in HIV were no longer forthcoming in declaring their HIV status, saying it was a sign that something was fundamentally wrong with Nigeria's response to HIV/AIDS and the low ebb in HIV's awareness campaign and education programmes.Nonetheless, Director General, National Agency for the Control of AIDS (NACA), Professor John Idoko, on a monitored radio programme on Saturday stated that the advent of ARV drugs and human faces to HIV had helped to demystify the virus.Professor Idoko, who remarked that HIV still has no cure, said that ARV medication had changed HIV in being seen like other diseases such as diabetes which are manageable.'Scientific evidences have proven that a person living with HIV can live a completely normal life till old age,' he stated.However, he argued that stigma and discrimination remain a challenge to achieving zero new HIV infections, zero discrimination and zero AIDS-related deaths.'Stigma is an obstacle to prevent, treat, care and support for HIV. It is a reason why many people will not get tested. If they are tested and found positive, they will not disclose such to their partners and why people will not be linked to the treatment,' he said.However, he lamented that Nigeria was making a very slow progress in the prevention of HIV from mothers to their children, linking this to many pregnant women refraining from accessing antenatal services in places that also offer services to protect babies from contracting the virus.Nonetheless, he stated that in ensuring that more babies are born free of HIV, services to prevent mothers passing the virus to their newborn babies were been decentralised such that a woman does not need to go far in accessing antenatal care and where facilities are also available to ensure she has an HIV-free baby.However, he pointed out that there was the need for increase in funding and increasing the resources of the President Comprehensive Response Plan for HIV in Nigeria so that it can achieve its goals, saying this would ensure the attainment of the Millennium Development Goals.According to him, increasing HIV testing centres from the initial 1,000 to 30,000 centres was also to ensure that more Nigerians get tested for HIV.'Last year, 5 million people were tested for HIV, but if you look at the re-launched President Comprehensive Response Plan for HIV in Nigeria, the vision is to test about 40 million people this year. I am confident we are going to test far more than we did last year, at least 10 million,' he added.The programme manager of the Oyo State Agency for Control of AIDS, Mr Kolawaole Bolarinwa, in an appraisal of HIV response in the state declared that new people living with the virus are not being enrolled for treatment by the HIV treatment centres that were supported by the global fund because the fund was winding up.He, however, declared that the Oyo State government through collaborative efforts of OYO SACA and Oyo State Ministry of health has put a programme to ensure new cases of people with HIV that require ARV drugs can access treatment at the 17 ARV centres in the state.In addition, he said the agency was considering subsidisng laboratory tests for old enrolees on ARV treatment that cannot afford the N1, 000 fee to ensure they continue to access their treatment.According to him, 'We may not all be infected by HIV, but we are all affected by HIV. As such, we must see the problem of HIV as a national problem which requires our collective effort to tackle.'The more we discriminate and we stigmatise them, the more they go around and have problems disclosing their HIV status as well as consciously or unconsciously continue to spread the virus. That will be a problem for all of us. HIV is like other chronic diseases like hypertension and diabetes.'He declared that the agency just engaged 30 NGOs all around the state to also work on creating awareness on HIV, adding that part of what they were supposed to do included provision of HIV counselling and testing.The HIV voluntary counselling and testing, he declared will be an addition to services already being provided in many hospitals for those interested in knowing their HIV status and HIV care.The United States decision to withdraw its funding of AIDS related programmes in Nigeria, implemented through PEPFAR, may have put Nigeria on the precipice in its fight against the dreaded HIV/AIDS.Really, funding, very often, unlocks the key problem associated with stemming the tide of HIV virus. The battle to contain the HIV/AIDS itself has been on for more than two decades. At the forefront of this fight is the United States Government. The US, through the President's Emergency Plan for AIDS Relief (PEPFAR), has contributed tremendously in preventing the spread of the pandemic across the world.Meanwhile, poor funding has continued to impede treatment of members of Network of People Living With HIV/AIDS in Nigeria (NEPWHAN).For instance, penultimate Monday, the association took their complaints in the form of protest to the doorpost of NACA in Abuja. According to its president, Edward Ogenyi and its Public Relations Officer, Samaila Garba, NACA's main responsibility is to cater to the treatment of NEPWHAN members as well create a synergy for prevention of the virus, which at the moment is failing.'NEPWHAN notes with great concern the miserable conditions of people living with HIV/AIDS in Nigeria as well as high number of people dying daily from AIDS related complications due to lack of access to antiretroviral drugs, and the ongoing withdrawal of funding support for HIV/AIDS to Nigeria by external funding partners.'It is no longer news that Nigeria has the second highest HIV burden in the world with 3.4 million Nigerians living with HIV. Only 649,000 HIV positive persons out of 1.8 million people that are eligible for treatment are currently accessing antiretroviral drugs. This represents only 30 per cent of the national need. Despite the huge investment made till date to stem the tide of the epidemic, about 20,000 people die of AIDS related complications monthly in Nigeria,' the group said.It maintained that the urgency of the situation caught the attention of His Excellency, Dr. Goodluck Ebele Jonathan, who, out of his usual concern and compassion, requested for the development of the President's Comprehensive Response Plan, to bridge the existing treatment access gaps.NEPWHAN thus expressed its concern on critical areas of HIV/AIDS programmes' implementation. It stated that 'none of the indicators and targets set for the PCRP has been achieved to date due to lack or paucity of release of fund for HIV/AIDS. Out of N140 billion budgeted for implementation of PCRP in 2014, only N8 billion, (representing less than 5.7 per cent of the estimated budget was appropriated for HIV/AIDS under the SURE-P which we hear is now targeted only Taraba and Abia States.'Professor Idoko said government is doing more to ensure funding does not become an obstacle to the fight against the HIV pandemic.To put the records straight, NACA DG told the protesters that 'I can assure you that the money that is going to be released is going to be transparently and accountably used. In fact, working with our partners, I am specific now, PEPFAR and the Global Fund, we are targeting to put 40,000 people on drug. This is unprecedented.
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