Director-General, National Agency for the Control of AIDS, Dr. Gambo Aliyu, speaks on various issues relating to HIV as the World AIDS Day 2020 is marked globally. Excerpts
On injectable injectable PrEP which is said to be better in HIV prevention in women than daily pill
This is a novel development and it is commendable. When such studies take place, we examine the available global data to see where the medication has been used, for how long, how many patients were involved and how successful.
This is necessary on our part in order to make for due diligence before introducing it to our people. It is a very good idea because it makes life a lot easier for people who take pills everyday.
The downside is that they have to visit the healthcare facility every two months, compared to getting the pills for a few months at a go. When it is finally available in Nigeria, People Living With HIV/AIDS will be able to make a choice between the two choices of treatment.
HIV resistance to medications
Even after HIV is controlled, resistance is still going to linger, because it is an issue that borders on people having the discipline to continue to take medication and continue to subject themselves to periodic testing to see how this medication is helping to make the virus disappear.
If you have to quantify it, what is the burden of resistance or how well reported is it in Nigeria?
It is not very significant to an extent that it has become a public health issue. But our responsibility is to prevent that occurrence, ensure we don’t see it become alarming, and don’t even give that room for it to grow.
One area that is very important for us that are service implementers or service providers is to make sure there is no disruption in the supply of medication.
You may have a situation where patients are willing and are very ready to take this medication, but if you create an atmosphere where it become unavailable, then you are either consciously or subconsciously introducing an environment where such resistance can grow.
And it would be unfortunate if you have a significant proportion of your patients, especially in a place like here, where we have over one million individuals on treatment and are carrying this virus.
If you introduce an atmosphere where resistance grows, then your control mechanism is going to be challenging.
This is because one, you would see resistance develop, and secondly, in someone who doesn’t have resistance but has the virus.
Now, the virus is exposed to the medicine and the medicine later withdrawn temporarily or permanently. This would give an atmosphere or chances for resistance to grow.
An unfortunate thing is that if this person develops resistance and happens to transmit this resistant virus to someone else, that person is getting a new infection with virus that totally doesn’t respond to drugs that are available. That is the danger.
If we are getting significant proportion of them coming up, the implication is that we have a chunk, but we need more expensive drug to treat.
Three years ago, President Muhammadu Buhari, promised to add 60,000 HIV-positive persons to the treatment stream annually. How far has that been implemented and how many people are on treatment?
Let me correct that: it is 50,000 not 60,000 yearly. Last year, we had 50,000 patients on treatment by government of Nigeria. This year, we are having 100,000 on treatment by the government of Nigeria. Next year, we hope to make it 150,000, despite scarce resources. That is on course. So, this year, we have fulfilled the pledge.
So, overall, how many people living with HIV/AIDS are on treatment?
We have 1,240,000 now on treatment.
How about cut in global funding? We know that President Donald Trump and so many other international donors have cut their funding to Nigeria, as regards to HIV. How is it impacting on the organisation’s activities?
The cut in donor funding, the one we have experienced so far, has not been significant on the side of the US government. Maybe, the cut might come this year in preparatory for next year. But we received this year’s funding last year and there was only a drop by $20m.
We had $390m the year before and it dropped to $370m. That drop was well taken care of by money made available by other donors like Global Fund. And there is the fact that we are bringing ourselves together to align and make a single treatment programme or uniformed treatment programme for the country.
What that means is that we would look at what everyone is doing and what everyone of us is good at doing, the three major stakeholders — the government of Nigeria, the Global Fund and PEPFAR.
We don’t know for next year if the cut would be significant and severe. But we are hoping that even if it is going to come, it is something that can afford us what we need to take care of.
On the issue of domestic funding and budget for HIV, what percentage of the budget is for HIV?
The Federal Government has reacted to the issue of domestic funding. Last year, we requested for money to place 100,000 people on treatment for 2020. That money was made available and we have succeeded in placing them.
We are looking at other areas because when we say domestic, we are not only limiting it to government, it is both government and private.
On the private sector, we have made some progress in the sense that the private sector wing of the business community, we planned to have this HIV trust fund to raise money to support HIV programmes in the country.
In that area, we have recorded a situation where, at the moment, we have the trust fund registered and individuals interviewed for the chief executive, identified and hired, and would be ratified before the end of the year.
In the next quarter, beginning next year, we plan to launch the trust fund. So, the work is going.
We are also working on the area of getting contribution from the states, which means states contributing to the response, not by giving us money, but by making money available to state agencies to coordinate and control HIV response in their respective states.
This is simply because states are very vital in the control of HIV and for ending AIDs. This is also because over 80 percent of people that are on treatment now are state patients, while over 95 percent of the hospitals that provide services for HIV belong to states. Over 90 percent of the health workers that provide services in these facilities belong to the state government.
The Federal Government has less than 150,000 patients that we are treating now in our federal facilities.
It is important that we work with the states, so that they can take over the leadership response.
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