A medical sociologist, Ifeoma Idigbe, has called on Nigerians to stop the stigmatisation and discrimination against people living with HIV, as it often affects their emotional well-being and mental health.
Idigbe, who heads the Counselling Unit, Clinical Scientist Department of the Nigeria Institute of Medical Research, made the call in an exclusive interview with PUNCH HealthWise in Lagos, in commemoration of the World AIDS Day 2020.
She said such practices are capable of contributing to continuous spread of the disease, as it could lead to delays in diagnosis of high risk patients and failure in seeking further treatment by those already living with the virus.
“Stigma and discrimination is a big issue when it comes to being HIV positive.
“It makes them to often internalize the stigma they experience and begin to develop a negative self-image and self-worth.
“We deal with these individuals on a daily basis. They have peculiar issues and you need to walk them through the issues as they arise during counseling sessions.
“Psychological support and counselling should be provided to further reduce the impact of stigmatization and discrimination against PLWHA,” she said.
The research fellow called for formulation of policies and strengthening of existing laws to deter stigmatisation, adding that it could help to eliminate the culture of secrecy and silence among PLWHA.
According to the Centres for Disease Control and Prevention, HIV (human immunodeficiency virus) is a virus that attacks the body’s immune system.
It noted that if the virus is not detected and treated on time, it can lead to AIDS (acquired immunodeficiency syndrome), which currently has no effective cure.
“Once people get HIV, they have it for life. But with proper medical care, HIV can be controlled.
“People with HIV, who get effective HIV treatment can live long, healthy lives and protect their partners,” the CDC stated.
The World Health Organisation revealed that HIV infection is spread primarily through sexual contact with an infected person during unprotected sex and in other ways including sharing of needles with an infected person.
It explained that the infection can also be contracted by transfusions of infected blood or other blood components.
The WHO noted that despite having no cure, treatment with antiretroviral drugs (ARVs) has led to an increase in life expectancy and improved quality of life.
Availability of ARVs, the WHO said, has changed the course of HIV/AIDS from a rapidly fatal disease to a chronic and more manageable disease which invariably improves quality of life of PLWHA.
According The Joint United Nations Programme on HIV/AIDS (UNAIDS), Nigeria has the second largest HIV epidemic in the world and one of the highest rates of new infection in sub-Saharan Africa.
UNAIDS estimated that around two-thirds of new HIV infections in West and Central Africa in 2019, occurred in Nigeria.
Speaking on management of HIV, Idigbe disclosed that over 20, 000 ‘clients’ access treatment and care at NIMR, while on an average day, over 150 persons are attended to by medical personnel.
She said beyond getting a confirmatory test, an HIV positive person needs to be personally guided to navigate emotional realities that might set in with time.
She said, “I would rather use the term ‘clients’ instead ‘of patients as a social scientist.
“A typical day counseling these clients could be hectic and emotional, but most of us working with them have grown to be very passionate about the job.
“The care we give could be doctor’s consultation, going to the laboratory to get tested or picking up medications.”
“The starting point for these clients is at the HIV testing services (HTS).
“They could be coming in for either regular test, where it is confirmed that they have the virus or might have been referred from another facility to do a confirmatory test.
“When a test comes out positive, the client is given options on where to enroll. Several factors come into play like proximity, funding, and where they are comfortable with.
“If they decide to enroll in our facility, they are referred to the clinic for treatment and care.
“After a folder is opened in the records department, they are sent to the counselor to discuss the various aspects of treatment and care they might wish to explore.”
Idigbe, however, said before PLWHA are treated in any facility, their consent as regards treatment must be sought.
“When they enroll in care, they need to make a decision and then sign a consent form.
“Without the consent form that assures that they want to be enrolled and committed to treatment, they can’t access the nurses and physicians for treatment and care,” she added.
On how personalized counseling impacts on the mental wellbeing of PLWHA, Idigbe said some days could be a rollercoaster of emotions, as most of them actually face a herculean task accepting the realities of their status.
“After getting an HIV positive diagnosis, a lot of things come into play and emotions could run riot.
“Some tend to ask questions like; how do I get married? Would I get a job? How do I report back to work now that I am positive? How do I get the opportunity to relocate or travel to other countries? Would I be given equal opportunities like other people?
“Others would just keep thinking of how they got infected and start blaming themselves.
“However, my aim as a counselor is to work through with them to see how to get the best out of the situation.
“Some of the problems that creep up might have solutions, while some might not, but it is always a work in progress.
“What I strive to achieve is not to let them leave the way they came.
“They have to leave feeling better and to know that there is more that life has to offer.
“Personalised counseling is meant to make them feel there is hope and that being HIV positive is not a death sentence, because there are other very serious health issues that other people are also going through.
“It is intended to make them know that what they make out of the situation is what counts, and that quality of care and life is very important.
“The good news is that most of them that were once distraught are proud of themselves now.
“I normally tell my clients that it takes one step at a time, and we will gradually and slowly get there,” Idigbe said.
The sociologist said HIV positive patients are not obligated to disclose their status to anyone aside from the key actors in their life, adding “These include healthcare professionals, spouses, and if they are elderly, their children just because they might need to know such basic health information.
“Based on the nature of our tradition, culture and religion, people tend to also confide in their religious leaders or preferred counselors.
“However, there should be an essence of providing such vital information, which might include, if that person would make life better and improve the quality of life for the HIV positive person.
“It is not just merely passing the information. It has to be because such a confidant would walk the individual through the process, and is ready to be a support base and lend listening ears.”
The expert said Nigeria still has a long way to go in the fight against HIV AIDs, especially in the area of habit reformation and increased testing capacity.
“Testing rate might be low. Lots of communities have not been reached in terms of testing.
“I have worked with and spoken to clients that are unaware of HIV and am left wondering.
“Most have heard stories about it, but have not internalized it.
“If you don’t know, you won’t know how to protect against it, get tested or even know if you are living with the virus.
“We need to improve testing capacity by reaching remote communities.
“Once an individual is aware of his or her HIV status, if it is negative, the person can go on to create awareness and become an advocate of safe sex and positive living strategies.
“On the other hand, if it is positive, there will be referral for treatment and care that include ensuring adequate protection for the person and significant others in the unit,” Idigbe added.
She pointed out that due to the heterogeneous nature of the Nigerian society, several factors tend to militate against eradication of HIV.
Idigbe said, “There is religion, culture, perceptions, sentiments, myths and fear of the unknown.
“Lack of information and awareness on HIV is a major factor. We need to provide information by raising awareness.
“If people know and understand the importance of getting tested, and are given real life examples to know they are not alone and that being positive is not a death sentence, we would have made quite a progress.”
The expert said because the country has amplified awareness on perinatal HIV transmission, mother-to-child transmission has declined, adding “The process of getting tested before and while pregnant has helped a great deal.
“There is more of sexual transmission and there are lots of drivers for that.”
The research fellow advised PLWHA to continue pushing to be the best and not lose sight of their dreams. She noted that the ‘World’s AIDs Day’ is meant to give them hope for living.
“They have their lives to live. People have health conditions and hope is not lost. Focusing on being HIV positive can be very limiting
“We have seen those living with the condition doing phenomenal things in the world.
“Go out and be the best version of yourself and keep living,” the medical sociologist advised.
Idigbe, also used the opportunity to call for formation and implementation of favourable workplace policies for PLWHA.
“Policies with regards to stigma and discrimination must be on the front burner, as these two factors tend to limit their potentials as humans.
“They can’t do certain things because they are unsure of how the society would perceive them. This is a general perception of people who live with HIV.
“They have their lives to live and should be allowed to make certain decisions, work and live positively in proper light while doing the right thing, and should have a voice,” she demanded.
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