This is the concluding part of this piece on HIV/AIDS and “Getting to Zero” in Nigeria. See introductory part here.
3. Low and slow pace of coverage: Statistics show that Nigeria accounts for about 30% of the global PMTCT gap. Nigeria ought to play a centre role in the current global move to getting to zero new paediatric infections by 2015. On December 1st 2012 we all celebrated the gains we are making in the fight against HIV/AIDS but in reality, Nigeria is still lagging behind in the advancements although we have the potential to do so much more. As stated earlier, only about 25% of people who require ARTs currently get the treatment. While we are still grappling with managing existing infected people we recorded about 300, 000 new infections in 2012! We can do better than this. Technological advancements and our improved knowledge is making way for “Treatment as Prevention” but back here at home, we are still struggling with how to even get the Truvada to already infected PLWHA with a CD4 count below 350. In developed countries and even in South Africa, a person gets started on ARTs upon diagnosis of a HIV infection.
4. Corruption: As with many other sectors in Nigeria, corruption plays a very crippling role in this fight against HIV/AIDS in Nigeria. There are lots of bureaucratic bottle necks that hamper the supply chain system with intervention materials for HIV. These systems have become highly partisan and less transparent over the years. The end point is less effectiveness and inefficiencies in both purchases and distribution channels with minimal cost savings.
5. Stigmatization: On a general note, it is superficial to assume that stigmatization is not a major problem with our present age of increased information. However, from our everyday experience in the field, one peculiar pattern that we have noticed is that at several of our APIN centres, people would rather use a centre that is distant from their primary location instead of using the one that is close to their home or office. The reason being that they are too afraid of being identified within in HIV treatment facility to avoid any suspicion of being HIV positive. Unfortunately, this has a spill over effect of making consistency and follow-up even more difficult because of the cost implications associated with transportation.
Recommended Practical Solutions that can make us ‘Get to Zero’ in Nigeria
It goes without saying that with a HIV/AIDS burden like ours, taking deliberate and concrete steps is paramount to achieving any success of a HIV-free generation. Tackling corruption is obviously a critical factor in the big picture but on a much practical scale, simply limiting bottlenecks and bureaucracies associated with the supply chain system is key to improving access to ARV medications and treating opportunistic infections.
Nigeria as the country with the second highest number of PLHIV, we are long overdue to start the manufacturing of ARV drugs here at home. Not only will this improve the logistics issues and bottlenecks associated with importation, it will also improve the transparency of the entire supply chain system. For one, there would be much less occurrences of having to deal with less than optimal intervention materials that have been delayed at the seaports.
To reduce our dependency on international donor funding, one of the indigenous funding options proposed by the NACA boss, Prof. John Idoko is for the Federal Government to introduce AIDS Tax, specifically for Airline and Mobile phone users in Nigeria. The proposal awaiting President Goodluck Jonathan’s approval suggests a $1 to $6 tax by economy or business class passengers respectively on all domestic flights, and $12 to $60 on all international flights. A tax of $0.3 is proposed to be charged on mobile phone users and all these are expected to generate over N200bn between 2013 and 2022. A similar proposal is currently underway in Uganda and this has also been in practice in South Africa.