Dr Aliyu Sani is the director general, National Agency for the Control of Aids (AIDS), in this interview, he emphasised the need for a nationwide survey to ascertain HIV prevalence in the country. PATIENCE IVIE IHEJIRIKA, was there.
What changes have taken place since you assumed office as NACA DG as regards Nigeria’s response to HIV?
We have made a lot of progress in certain areas, and there are areas where we will like to further improve on. For instance, when I assumed office, we had about 800,000 Nigerians on treatment, but now, we have about 1, 66,000 people on treatment. That is a huge progress in a way because a million is not a small figure, but havent said that, we estimate that we have about 3,000,000 Nigerians with HIV that need treatment. So, in as much as we already have a million, we still have about 2,000,000 yet to be covered. That is something that we are currently working on and we will like to hasten the progress. Back in September, 2017, President Muhammadu Buharu announced that government will be putting 50,000 on treatment every year, in addition to the 60,000 we already had in Taraba and Abia. That in itself is another progress, we will like to see more government involvement in HIV management. At the moment, the 95 per cent of the million plus who are on treatment are being handled by the US government and global partners. In that same respect, we have made remarkable progress in terms of getting the commitment of the state governments to key into the HIV response. for example, we presented to the National Economic Council back in June last year and again we did another presentation in January where we got the governors to commit to 0.5 to 1per cent of their federal monthly allocation towards HIV.
If they can do that, it will allow us to have enough funding to put another half a million Nigerians on treatment courtesy of the federal government and the states rather than having external donors doing this. one of the things that we have done in the last one year which is just about to start is the need for Nigeria to establish the true prevalence of HIV in the country because even though we know HIV is there and we have estimates, we need precision in order to enable us deliver our programmes more efficiently and in a more cost effective manner especially for our donors. so, we will be doing the national HIV survey, it will be largest HIV survey ever done in the world and it will start hopefully in June, and it will cover the whole of the country and it is going to last for about seven months. Hopefully before the elections, we will start having a clearer idea of the true prevalence of HIV in the country; where the main issues are and where we need to redirect our resources accordingly. In addition to that, in terms of other things we have done in the last one year, we have restructured NACA. When I came, the president gave me a specific assignment to reorganise NACA so that it fit. In with its mandate.
NACA is the main government agency that is responsible for coordinating HIV response programme but the problem is over the years, we have been concentrating mostly on the health sector to the detriment of other issues that have to do with HIV including prevention, advocacy and media. We have been concentrating mostly on the health aspect which is the treatment side but thze treatment side is actually part of the Federal Ministry of Health responsibility, we have identified that and we are now working closely with the minister of Health to change that so that the federal ministry of health runs the treatment together with states ministries of health, they will be able to engage more effectively with members of the community We hope to launch a national treatment programme towards the end of the year, hopefully with the Federal Ministry of Health and that would completely change the treatment programme. We will have more government involvement and we will be able to channel funds more effectively and we will be able to harmonise the different budgets that comes. I think overall, the people living with HIV will have a much better service.
Nearly 1/3 of the people with the virus are on treatment, would you admit that Nigeria has actually failed these people?
No, I wouldn’t because all we need to do is to look at where we were even 15 years ago, just look at where we were just five years ago in terms of the number of facilities at the moment currently providing HIV care in terms of the number of people on treatment . In terms of the number of people going on treatment, there has been an acceleration in the last three years, five years ago, we had less than a million people, and yes we wish we can go faster but you see, Nigeria is a complex country. HIV management, in as much as it might appear to be relatively cheap compare to other complicating medical conditions, it cost about 50,000 per patient in a year, but if you have three million Nigerians on treatment, 50,000 multiply by three million, that is N150billion. what was the budget of the Federal Ministry of Health last year, so effectively, if we were to look after all those living with HIV, we will take up to 60 per cent of the ministry of health’s budget to deal with one disease condition, so you can see were the challenges are, the number of people is significant and the cost itself is not insignificant and therefore, we need to have a better way of funding the response. the way I see it in the long run is that HIV needs to be integrated into the healthcare system rather than being treated as a separate issue, so that if you go to a clinic, the same physician that is looking after the person who has hypertension will look after you with HIV and then the next patient might be diabetes but HIV needs to be integrated into the normal healthcare system in the country, we cannot continue.
In practical terms, how many people have been put on treatment and what is the criteria that will make up this 50,000?
We haven’t selected them yet, but remember that the budget is yet to be passed. So what we have within our budget at the moment is to accommodate those 60,000 patients on treatment. Those 50,000 will need to be added and that is why the survey is so important because identifying where the hotpots are is really critical. It shouldn’t be difficult for a country like Nigeria to get 50,000 people on treatment because even if you look at the number of new infections alone, it will exceed 50,000 but we have to also be clever on how we get those 50,000 people
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