The Director-General, National Agency for the Control of AIDS, Dr Temitope Ilori, speaks on the disturbing statistics of Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome among Nigerians, especially children. She also reveals plans to reduce the prevalence in this interview with BIODUN BUSARI
The HIV/AIDS epidemic has been a persistent health challenge in Nigeria. As the DG of NACA, what are the most pressing issues currently contributing to the spread, particularly among women and children?
As DG, I would say it has been interesting, educating, and enlightening, and I have also learnt a lot. Though, I will not say I’m a stranger in the medical field. I am a medical doctor and a consultant family physician.
Even before I came here, clinically, I was seeing patients with HIV/AIDS.
I have served as the Commissioner for Health in Osun State and also headed the State Agency for the Control of AIDS in Osun State.
All these experiences came to bear when I got here at the federal level. But, of course, it’s been a learning curve. The HIV space is quite vast, and huge. Not only do we have local partners, but we also have international donor agencies. These were the people and agencies that we worked together at the state level. It’s not a one-man show. We are all learning from one another, rubbing minds together, and sharpening one another all in a bid to make things better for the country.
Based on reports, more Nigerian women are living with HIV/AIDS. What contributes to the statistics?
In Nigeria, our national prevalence of HIV/AIDS is 1.3 per cent. Women account for 59 per cent of this population, which is more than males.
Young people from 15 to 49 years of age account for most of the new infections. It’s popular among the younger generation. Of course, 15 to 49 years is the reproductive age for women especially. That’s when they start their sexual debut, relationship, and all that.
We’ll say it is popular among women biologically because of the way the woman’s body is. In terms of sexual intercourse, their reproductive system makes them a bit vulnerable, and with this, the virus can enter their body system.
And, of course, we have socio-economic issues too. In many societies including Nigeria, women cannot negotiate for sex even with their partners whether married or unmarried.
In boyfriend and girlfriend relationships, the females cannot negotiate for sex to wear condoms or other protective measures. Also, the socio-economic effect is when they don’t have the income to cater for themselves, they become dependent.
Even with commercial sex workers, women are more vulnerable. The early girl marriage is also a factor. We have so many biological and socio-economic factors that make the girl-child or woman very vulnerable to HIV infection. And that’s why there is such a high rate among women and young adults.
Do these factors have a connection with the report that Nigerian children are among the highest with HIV infection?
Yes, we are recording new infections. For instance, going by the 2023 data, we realised that we had about 22,000 children born with the HIV/AIDS.
That’s for new infection among those children. And if we look at the trend, there’s not much decline from over the years.
Among adults generally, we recorded about 75,000 new infections in 2023 alone. But when we plotted the graph coming from previous years, for both male and female adults, there has been some decline in the new infections.
But among the children, we are not seeing that significant decline in the new infection. That’s why we are worried. This means we have a significant proportion of children born with HIV/AIDS.
What that is telling us is that pregnant women who have HIV/AIDS either don’t know their status, or are not getting tested.
For those who have tested positive, it means that they are not accessing medications.
If such people are accessing medications and using them regularly, the viral load will be low.
And if the viral load is low, they won’t be able to transmit these infections to their children whether in pregnancy or when born alive.
So, the most significant information we want to put out there is that everybody should get tested and know their status. When you know your HIV status, you can seek help.
Anyone can know their status, especially pregnant women. You can go to either the primary or secondary healthcare facilities or teaching hospitals.
HIV tests are available in government health facilities for free.
You can get tested and then be put on medications after your status has been confirmed.
We are also working with other non-conventional partners like trained birth attendants and mission homes.
We have trained traditional birth attendants in different communities, who are meant to tell the people all they need to know about the disease and to let them know their status.
The truth is that we’ve told ourselves that by creating awareness and through treatment, we will be able to reduce the number of pregnant women who are HIV-positive and who can transmit the infection to their children.
What mechanisms and approaches have been put in place to drastically reduce the number of children born with HIV infection?
Parts of the strategies were revealed just a few months ago when the Minister of State for Health and Social Welfare, Dr Tunji Alausa, launched a committee on the prevention of mother-to-child transmission.
It’s like an acceleration committee that will oversee all the partners – both domestic and international, including agencies at the national and sub-national levels (states and local governments), to ensure they get feedback that everybody is doing what they need to do. Their function includes finding pregnant women both in the community and the health facility levels to ensure they are tested, and those found to be positive are put on treatment.
They also have the responsibility to encourage them to stay on the treatment.
We also have counsellors and mentor mothers. These mentor mothers are those who tested HIV positive and received treatment for a while. Many of them are mothers, who have been using the drugs, and their viral load is so low and they have children that are HIV-negative.
They share their success stories and encourage new pregnant mothers to get tested for HIV infection.
They give them hope, letting them know that the treatment is real and that the outcome can be very encouraging.
Aside from this, we also work with civil society organisations, non-governmental organisations, partners, religious bodies, and traditional rulers, and this is to ensure we are passing the right message across to as many people as possible.
Some months ago, the agency and the National Assembly partnered to reduce the number of people living with the infection beyond 2023. What role do federal lawmakers play in this?
There is a global target to ensure that HIV is no longer a public health threat by the year 2023. And what we mean by that is we want to reduce to the barest minimum new infections.
Of course, people who are already positive can’t do anything to make it go away but it can be treated. It is just like having high blood pressure or hypertension, they will not go away, but we can use drugs to lower them. It is the same thing with HIV, where we use drugs to suppress the virus. So beyond 2030, people who have the virus will still be living positively with it. But we’re saying we want to reduce the transmission of new infections of the HIV.
Where the National Assembly comes into play is that now as we speak, most of the funding that we are using to sustain the national response is coming from our international partners.
We need to have what we call domestic funding and have the right appropriation from the National Assembly.
We all know that it’s the National Assembly that appropriates the budgetary allocations. The executive will send the budget to the National Assembly for final approval.
The interaction was meant to educate them and also for us to have an advocate that will help them understand what NACA is all about being a government agency saddled with the responsibility to coordinate the multi-sectorial response to HIV.
As I said, we don’t work in isolation. Our engagement with the National Assembly is to first educate them about what we are supposed to do, and what the HIV national response is all about and make necessary advocacy for domestic funding and domestic resource mobilisation. With this, we as a nation can have what we refer to as personability.
We can sustain the national response and we are not just relying on donor partners, rather, as a government, we have our sustainability agenda and plans.
To make sure that we can take this further, apart from the appropriation bill aspect, part of what we are doing is working on technology where we can have our domestic local production of some HIV commodities.
What do I mean by HIV commodities? We want to start local production of condoms because as we speak, we’re importing condoms.
We want to start local production of test kits to determine if someone is HIV positive or negative.
Even we want to start the local manufacturing of anti-retroviral drugs. All these as we speak are imported, and you know the issue about forex; it will make them very expensive.
And subsequently, it makes it very expensive for the government to sustain. We are already talking to relevant government agencies, the private sector, industries, and financiers on how they can start the local production of these items.
The cost will be cheaper for the government to procure and it will be able to sustain the national response.
Will you say the current economic condition has contributed to the prevalence of HIV infection among women?
Definitely. As I stated earlier, there are some things we call social determinants of health such as economy, cost of living, education, employment, trade, girl-child education, women empowerment, and other socio-economic factors that have roles to play.
They work hand-in-hand, and we have to address some of these things to reduce new HIV infections.
There is also the role of the key population I earlier mentioned – the commercial sex workers, use of injected drugs, and many other risky behaviours that may also contribute to the increase in new infections. That’s why we have some preventive measures. We have to continue to preach prevention, which is better than cure. This will make people have safe sex with the use of condoms.
We also have what we call pre-exposure prophylaxis medication, particularly for the key population, who are the people more at risk of this infection.
There is also post-exposure prophylaxis for people who have been exposed to the infection. We also let them know that abstinence is very important, especially among our youths. All these are the things we preach to reduce the infection rate.
Is stigmatisation against people living with HIV/AIDs still high?
Yes. It is still there. I want to use this juncture to appeal to our people to stop the stigma and discrimination. We will be doing ourselves more harm than good when we stigmatise these people.
When we discriminate against them, they won’t be able to come out to get tested, while those who are tested will not come to the hospitals to get medications.
With this, the viral load will be high and they will keep infecting other people.
I think we should encourage them as much as possible. We have to emphasise that living with people with HIV, shaking their hands, hugging and being in the same office with them cannot cause HIV infection. But unfortunately, stigma is still very much with us.
However, there are anti-discrimination laws at the federal level. Some states have also replicated these laws. There are fines attached to some of these practices. People who discriminate against people living with HIV/AIDS can be fined or jailed if they are found guilty of discrimination.
We are encouraging the populace to stop the stigma and discrimination against people living with the virus because with that, the whole country will gain from it.
If they are not discriminated against, they will go to hospitals to get drugs and won’t spread the virus.
There are cases of MPox in the country, and you recently said that those living with HIV infection are more prone to the disease. What is the connection?
Well, MPox is a virus. So far, it can be very mild. In our country, the Nigerian Centre for Disease Control and Prevention has given some figures for the number of people tested positive to MPox.
I know the population of HIV-positive children is high but. But over time, you will discover that the severity is higher among adults all over the world.
The incidence of MPox is higher among immuno-suppressed people, particularly those who have HIV infection and found out that when they have the infection, the severity is worse.
Some people may have MPox and just have fever and rashes, and they get over it without complication.
But for some people with severe infections, the complications are worse. Those with HIV, who are immuno-suppressed might not have the necessary immunity to fight the infection.
