2009 WORLD AIDS DAY: NIGERIA’S JOURNEY SO FAR, THE FAILURES OF ABC, AND BETTER WAYS OUT
In what is fast becoming an annual tradition, on every 1st day of December, Nigeria joins the rest of the world in commemorating the day set aside by the United Nations and other international societies, agencies and governments to address HIV/AIDS-related issues. As usual, there will be rallies, lectures, symposia and interactive sessions geared towards better equipping governments, researchers, HIV- infected individuals, and concerned members of the public with the latest weapons in the fight against the scourging HIV/AIDS infection. Unlike other parts of the world, Nigeria’s case is annually different and this year’s might not be an exception.
When the world woke up to another global health challenge during the mid 1980s when HIV was first discovered, the relevant agencies, spearheaded by the World Health Organization with its headquarters in Geneva, Switzerland, saddled their researchers with the sole responsibility of finding ways to contain the infection and prevent its spread to distant locations, especially those parts of the world where it has not birthed. This was however impossible as the virus swam across seas, and flew above hills and mountains to get to the most interior parts of the world, including the Holy cities.
There are uncertainties and extensive inter-collegial disagreements over the first HIV/AIDS case in Nigeria but the fact remains that the virus is here, and is eating deep into our nation, way beyond what our governments are aware of.
In line with the practice of foreign lands, government assembled its brilliant minds and saddled them with the duty of coming up with strategies that best suit the Nigerian nation. The result of the extensive overviews and understudies were the popular ABC methods- Abstinence, Be Faithful, and Condom usage. As far as the policy makers were concerned, these are the best that the nation could have. However, several decades later, it is evident that prevention and control of HIV/AIDS in Nigeria is not as simple as ABC.
According to one report, Nigerians are the most sexually active people on earth, based on the large volumes of condoms used daily. It is therefore not out of place to say that like our creator who made us, sex is part of us. Being a religious nation, the Holy Books are also in support of good sexual activities between properly married couples. Our traditional beliefs also frown at abstinence which is seen as a sign of impotence, making it an option that is impracticable and unadoptable for the nation. Youth exposure to sex is also another issue.
In a recent study carried out on several Nigerian institutions of higher learning, about 65% of the students claimed to have had sex before their 21st birthday. This shouldn’t come as a surprise owing to the early exposure to pornography, readily available illicit materials, sexually over- ambitious adults, the World Wide Web, and skimpily dressed ladies whose attires speak less of modesty. In the light of these, it is reasonable to say that even at the youth level, abstinence is not effective.
Being faithful to a single sex partner is the second method of safe sex and HIV/AIDS protection. The shortcomings of this are quite unfortunate and very disheartening.
While working at a HIV Screening Center, I came across a lady who just tested positive to the virus. She swore that she never had sex with anyone except her husband. In my capacity as a medical personnel who knows the numerous modes of acquiring the infection, I tried to counsel and inform her on the other routes of contracting the infection. Few days later, she encouraged her husband to come for the test. Like his spouse, he also tested positive after which he confessed to infidelity. Stories like this abound and are daily encountered in medical laboratory practice.
Being faithful is not just about an individual, but the couple being committed to one another. In a country like Nigeria where polygamy practice preponderates in some areas, it becomes imperative to find a better means of protecting faithful individuals who are committed to unfaithful partners. This brings us to the use of condoms.
Latex condoms are the most popular types found on Nigerian pharmaceutical shelves. While they’ve been found to be potent enough in conferring protection on users against certain sexually transmitted parasitic infections and unwanted pregnancies, their potency at preventing HIV transmission is extensively debated- both in the markets, and at the research institutes of reputable ivory towers.
The major reason for this reasonable disagreement is the pore size of the condoms. It is said that the size of the HIV virus is smaller than the diameter of the pores (tiny holes) of the latex condoms. In this regard, individuals who had sex with HIV- positive partners but remained HIV- negative were uninfected due to low viral load, or mere sheer luck.
Another issue that the use of condoms raises in this tropic part of the world is the retention of the strength of the condoms when subjected to the harsh weather conditions and unsafe storage. For instance, Nigeria’s most prominent condom manufacturing company is in Lagos from where it transports latex condoms to distant locations like Maiduguri in the far North, and Yenagoa in the south- south. Sometimes these condoms spend days while in transit, necessitating the need for proper transportation to ensure that the condoms’ optimum temperature for ‘maximum protection’ is not exceeded. With the several forces to contend with en route their destinations, only God knows the fate of the condoms.
The best condoms that are reliable and could confer protection from HIV infections are those made based on nanotechnology and at the last market survey, such condoms are not yet sold in Nigeria.
As shown in previous paragraphs, Nigerian HIV/AIDS control and prevention programs built around the ABC acronym for Abstinence, Be Faithful and Condom usage, are quite shaky, necessitating the need for us as a country to adopt a better plan that is more Nigerian.
A feature of such plan is extensive HIV screening. Although there are data available on HIV/AIDS prevalence, these are not a true picture of what truly obtains in the country. At a recent summit, a Nigerian HIV/AIDS epidemiologist complained on the reliability of the data available at government HIV/AIDS offices as most of these are doctored while those that were not doctored were gotten from HIV Screening centers. In the later case, the results are not representative of Nigeria’s HIV prevalence as many Nigerians live without knowing their HIV status. It is therefore imperative for the Federal Government of Nigeria, the state and local governments to collaborate with the Medical Laboratory Science Council of Nigeria on how to carry out nationwide (and statewide) HIV Screening Campaigns just like the National Census. It is worthy to mention that Kenya is adopting this novel initiative. Tests for other infections could be incorporated into these campaigns to help solve the problem of paucity of health data once-and-for-all.
Sex education is another issue that needs to be incorporated whether formally, or informally. Currently, most Nigerian parents feel insecure when sex- related questions are raised by their children. A recent survey showed that when parents fail to answer questions raised by their children, the wards turn to peers or older adults for answers. The answer providers are usually predators who prey on the ignorance of the children to perpetrate dastard acts or exploit their novelty to the chagrined amusement of the understandably inquisitive infants.
In developed countries of the world like USA where the children are more exposed to sex and other issues, the incidence of unwanted pregnancies and HIV prevalence is lower than those of t
he ‘morally right’ third world nations. Formally, school counselors should be allowed to educate children on sex matters without being obscene while parents should endeavor to answer their children’s sex- related questions without much chastisement or rebuke, but with parental affection and admiration knowing that whether they like it or not, answers will be gotten.
It is also worthy to note the widespread awareness campaigns on the HIV virus. But one issue is still begging for attention- stigmatization.
I recently came across a HIV- positive individual in Owerri. Before acquiring the infection, he worked in a government establishment in Lagos. When news of his sickness filtered in, he was laid off. To prevent further embarrassment and preservation of his reputation, he left Lagos for Owerri, where he planned to live his remaining years happily without anybody knowing the cause of his death. If incidences like this happen in government establishments, only God knows the fate of HIV- positive individuals in the private sector. Like many brilliant policies of the government, preventing stigmatization of HIV- positive individuals at places of work and worship shouldn’t just be ensured, but enforced.
It is also important for governments at all levels to support HIV researches especially in institutions where promising novel ideas are being pursued, and sponsor brilliant minds who are creative and knowledgeable on HIV. This becomes necessary in order to better position the future generation with the solid foundation to build their HIV/AIDS Control and Prevention programs on. In America for example, there are several HIV Research Trusts (and Scholarships) reaching out to these sets of students, including yours sincerely.
As we join the rest of the world in commemorating this year’s AIDS Day, we should celebrate the new rays of hope being seen in the latest HIV vaccine, although it still has a long torturous journey before making it to the clinics. We should also look into our plans as a nation and readjust them, where failing or ailing to better position them for the new challenges.
The rising incidence of drug resistance should also stimulate Nigerian HIV researchers to take on the bold challenge of developing a Nigerian HIV vaccine. With alacrity, diligence, sincerity, focus, collective responsibility and God on our side, we shall prevail. Happy 2009 World AIDS Day Celebration.