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In this interview by SADE OGUNTOLA, the Project Manager of Oyo state Agency for the Control of AIDS, Dr Olukayode Ogunkunle, speaks on the inequalities that are making ending HIV spread difficult and the persistence of stigma and discrimination still overshadowing the prevention of the viral infection.
World AIDS day 2022 theme talks about equalising some factors to end AIDS; what are those inequalities holding back the end of AIDS?
Looking at the World AIDS day 2022 theme for this year, Equalise to end AIDS, and Nigeria focusing its celebration on Equal access to treatment and HIV prevention services, is a call to action because it is to say all of us should make sure that people have equal access to HIV testing, treatment and services. This includes access for pregnant women and children so that we can have an HIV-free generation. We equally want to look at the issue of acompaning stigma and discrimination against people living with HIV.
Still, people, due to their gender, lack free access to testing and adolescents are castigated when they visit health facilities for services and so they tend to withdraw. So, we want to remove all those hindrances and barriers to people, regardless of their age, having access to HIV testing and services.
How do you rate the current access of Nigerians to essential HIV services, starting from Oyo State?
In Oyo state, as of the end of December 2021, we have about 29,744 who were on treatment for HIV. By June 2022, it has leapt to 32,417 people that are in treatment. Breaking it down, we have 22, 965 females and 9,455 males who are presently accessing ART services in Oyo State.
By projection, what is the number of people that are supposed to be on HIV treatment?
Currently, the state’s HIV prevalence rate is 0.9 per cent. So with the state’s population of about 7.8 million, it is projected that about 70,000 should be placed on treatment, so certainly there is a gap in terms of the number of people that should be on treatment.
It is when people know their HIV status that we can put them on treatment. Due to our drive-on testing, we were able to bridge some of the gaps. This accounted for the surge from 29,744 people at the end of December 2021 to 32,417 people by June 2022.
So, we are working on making sure that everybody from that estimate who is living with HIV is picked up and placed on HIV treatment, that they adhere to treatment to ensure that they are virally suppressed and they then will not be able to transmit HIV. We are looking at ending HIV; we don’t want new infections again.
Currently, the state is working on ensuring access to testing, care and support services as well as treatment for HIV. Free test kits are provided and distributed all across the 227 facilities offering HIV testing services within the state. Of course, there is a standby arrangement to ensure that test kits are always available in the healthcare centres across the state to ensure anybody wanting to test can do so.
Secondly, we make sure that everyone that tests positive is linked to a treatment centre and placed on treatment the same day, regardless of where they reside. We have 21 ART offering centres across the state while 86 centres run services for the prevention of mother-to-child transmission of HIV. These are all to bridge the gap in access to testing, treatment and prevention of mother-to-child transmission of HIV.
How easy is it getting pregnant women to access PMTCT services in the state given its importance in ensuring HIV-free -babies?
it is very easy, there are 227 facilities designated as PMTCT centres, however, since people can get tested for HIV in all health facilities whether it is primary, secondary or tertiary in the state., pregnant women who test HIV positive in non-designated PMTCT facilities are promptly referred to the nearest facilities that offer such service.
At this World AIDS Day, the International community‘s focus remains on ending the HIV/AIDS epidemic by 2030. How far has Nigeria gone in achieving this?
If you look at the UNAIDS target of 95 by 95 by 95 by 2030, what does it mean? The first 95 means that by the year 2030, at least 95% of everyone must have known their HIV status. The second 95 stands for 95% of those who know their HIV status should be on treatment. The third 95 means that 95% of those on HIV treatment would have achieved viral suppression by the set target year.
Currently in Nigeria, some of these targets have been surmounted in adults; the first 95, we have achieved 90%; the second 95, we have achieved 98% and the third 95, we have achieved 95%. However, there are also gaps in the case of children. Children, less than 15 years living with HIV are difficult to find and place on treatment.
For children, unlike what we have for adults, we have the following: First 95; 34% of children under 15 years living with HIV know their status; also the second 95; 100% of those who know their status are on treatment and the third 95; 81% of those who are on treatment have achieved viral suppression.
We need to equalise access to essential services, particularly for children, pregnant women as well as the key population and their partners. To do this, we must in a consistent manner, address and remove all structural barriers that impact negatively on access to HIV services.
Coming back to Oyo State, what progress has been achieved in HIV control?
If you look at the HIV prevalence rate in Oyo state, it is 0.9 per cent. At one time it was 3.5 per cent; at a time it dropped to a little above 2 per cent. So, the prevalence has been dropping gradually, evidence that we are winning the battle in the state.
Is stigma still overshadowing HIV prevention in Nigeria 40 years down the line from when the virus was first discovered?
This year’s World AIDs Day theme is a call to action to have free stigma and discrimination against people living with HIV. Stigmatisation and discrimination against people living with HIV are still rife in Nigeria and we want to tackle it headlong. Even the learned people are still discriminating, recently two schools in the state refused admission to persons living with HIV because their medical tests for school placement turned out positive for the virus.
In another incident, a teacher was sacked and SACA took the case up, linked up with the Ministry of Justice wrote the school and the teacher’s case was settled out of court.’
We had to intervene to let them know that HIV is only transmitted through blood contact and not by staying in the same classroom or hostel. That a person living with HIV cannot stay in the hostel with others or attend classes with them does not even arise at all, it is just like any other chronic illnesses like diabetes and hypertension that you can treat with drugs. It is not curable but through adherence to HIV drugs, they can live normal, productive lives without being a danger to themselves or society.
People discriminated against or stigmatised because of HIV need to speak out. If they don’t speak, then the state cannot fight to ensure their right is not trampled upon. The anti-stigmatisation law in Oyo State is in operation and individuals or institutions found guilty are liable to pay a fine of N250,000 (individuals) and N500,000 (institutions) or imprisonment for a term of not less than one year or both.
Oyo SACA is making sure that there is no free discrimination and stigmatization for people living with HIV and that is part of the reason for the continued sensitisation of people on HIV. With the advent of diseases like COVID-19 and Lassa fever, people have forgotten that HIV is still with us. It is a case of a pandemic in another pandemic. So, we need to put it back into the consciousness of Nigerians.
Currently, what counts as a high-risk sexual behaviour that is contributing to new cases of HIV?
Eight out of 10 people that are infected with HIV had it from unprotected sex. Many adolescents and young ones are experimenting with sex; they indulge in different forms of sex like anal or oral sex. This is on the increase. The other is rape. Many cases of rape are not reported. Reporting would have allowed post-exposure HIV prophylaxis. Even if the rapist had HIV, by taking the drugs for post-exposure HIV prophylaxis for 30 days, one is sure that the person will be free of the infection.
The use of condoms correctly and consistently during sexual intercourse, even if they are involved with someone living with HIV is protective against HIV infection.
Much more than ever before, parents should give their children and wards sex education. Sex should wait till marriage. That is the teaching even in religious gatherings. But we know that some youths due to peer pressure will still want to experiment with sex, and then they should make sure they use condoms correctly and consistently. If we are going to win the war against HIV, then let everybody go and get tested. If you are not tested, you will not know if you already have the virus or not.
So where does self-care HIV testing kit does come into all of these, especially because many still fear being stigmatized due to HIV?
The whole idea of a self-testing kit is to ensure that people that want to have the test can do so. The essence of it is that the discriminatory attitude in health facilities does not allow adolescents, including key populations like men who have sex with men and people who inject drugs access testing. They can have the test in the corner of their rooms. Of course, there are toll-free numbers that they can call to be linked with the nearest treatment facilities close to them.
Certainly, a future with no HIV is feasible, starting with everyone in Oyo State knowing their HIV status and they are put on treatment to ensure viral suppression if they test positive for the virus. By being virally suppressed, they cannot transmit HIV to other people. That will bring an end to the transmission of HIV and we wouldn’t have new HIV cases.
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