The fear of HIV/AIDS, that debilitating disease, remains the beginning of wisdom for everyone. A recent report that HIV infection was on the increase in the country was not well received.
But in this interview with WINIFRED OGBEBO, the director-general, National Agency for the Control of AIDS (NACA), Prof. John Idoko debunks such claim, while giving reports of the activities of the agency.
A recent report in one of the newspapers said HIV infection is on the increase. How true is this?
Let me start by telling you how some of these figures are arrived at. What has happened is that through our ante natal surveillance report of 2010, UNAID has used that and many other agencies, like CDC etc to model how many new infections there are in Nigeria, basically also, using the population. As you know,one of the things that has happened is that Nigeria’s population continues to rise on an annual basis. So if you are using that and putting other issues like number of people on treatment and all that, you tend to get a figure for something like Nigeria which population is expanding at a very rapid rate to continue to grow up.If you look at where we should be, if you look at the UNAID figures, it shows that new infections in this country are actually on a downward trend.
But we have seen some of these figures that tend to go up but we have a challenge with it for many reasons. We know clearly that in many of the areas, we have made tremendous improvement, particularly, in the last one year. For the first time, we were able to put 150,000 in a year on drugs. We know clearly that that has a profound effect of cutting down new infections. We have also seen that the number of women who receive interventions, this is the highest since we started r HIV/AIDS response, 57,000, still far from where we need to be, but we have seen the number of people accessing HIV grow from a mere 30 percent a year to 46 percent of those who require those drugs. We have also seen PMTCT rise from 20 percent to 30 percent, still far from where we are supposed to be, but all these are supposed to cut down on new infections. So certainly, one is not sure that new infections are rising as being proposed by some people.
What about the issue of paediatric AIDS?
Clearly, the big portion of paediatric AIDS is modeled and thought to be coming from transmission from mother to child and the point I am trying to make is that it is true we are certainly not as much as we should be, ideally, our target for 2015 is 80-90 percent. But I am just seeing that in one year, we have made more progress than we have made in the previous four years. I remember clearly that in 2009, we were around four percent, now we are at 30 percent. So it is true, it is one of our biggest burdens but certainly not near where it was, two or three years ago.
How far have you gone with integrating HIV services in Primary Health Care centres?
That is ongoing and that actually is where we are driving a lot of our expansion right now because it takes HIV management closer to the people and we are actually integrating not only HIV but TB services and PMTCT services. The reason for that is that first,it takes the services closer to the people. Secondly, because the drugs are not a cure, you have to take them on a continuous basis. You want to make sure that a patient doesn’t drop out of his treatment. So services that are close to the people through the PHCs make a lot sense and therefore, keep the patient in retention and reduce infection. So adherent is a lot better.
Are the pregnant women still accessing care in PHCs?
Yes, they are. Where we have issues are structural issues. For example, if you look at PMTCT issues, there are two sides to it, the supply and the demand side. The supply side relates to service provision, facilities, human resources, drugs and equipment. Where we have issues which we are also addressing is the supply side.
Why do we have all these and the women are not going to access PMTCT either in the PHCs, private clinics or even in the secondary and tertiary hospitals?
So we find for example, cultural issues. Many of the women believe that it is better to deliver at home, in the mosque or in the church,and then you have traditional birth attendants. So those are the things that are driving women away from various health centres and also the attitude of the staff in the health centres. We are trying to look at all that.
How many HIV positive Nigerians are currently on treatment?
We have 642,000 Nigerians on treatment. It’s a huge margin to what we had last year. That is why we went ahead to develop the president’s comprehensive response plan so that we can quickly ramp up the number of patients on drugs.
In National Response, what are your priority areas?
We have four co-interventions, treatment. Treatment is very key because you can keep people alive and even more importantly, you can interrupt transmission. Countries that have had so many people on drugs have had a dramatic drop in the number of new infections. That is actually what we need to do. There’s a point called the tipping point when the number of people on drugs overtakes the number of new infections, you start having a huge drop. We need to test people too. In this society, so many people are HIV positive, they don’t know their status and they are transmitting.
Now that the anti stigma and anti discrimination HIV Bill is passed, what are your expectations?
We are very delighted about it because as you know a lot of people are getting turned down either in schools or in jobs.So it now ensures that people can be prosecuted because they have refused to engage somebody who has HIV. It’s a very good advocacy point for everyone who has HIV but beyond that, I think it is important for us to also ensure that it takes our fight against stigma and discrimination to the provision of services and that for me, is also key because the expansion of HIV services cannot happen in the face of thriving stigma. So it’s a very good omen for us in terms of trying to ensure that we expand prevention, care and support.
How far about our efforts to develop our own vaccine?
It’s a very good point that you have raised. Remember that we developed HIV vaccine plan about two years ago. In that plan, we ironed out about 12 next actionable points, part of which we are gradually implementing. For example, by last year, we had printed out the vaccine plan, the next thing we need to do is to now see how we can train people to start looking at some of the studies that are also important in terms of engaging in vaccine study. There are a number of community studies, there are a number of things that can happen in the laboratory and there are a number of capacities that we can build either in collaboration with other institutions, that is what is happening.Nigeria, through NACA is one of the five countries that is involved in a demonstration study for pre-exposure Prophylaxis. In fact, between July and November last year, we did the formative study, which is like the behaviour component of the study where we interviewed so many people round the country, to find out from them whether or not this is important and the answer was a resounding yes.
WINIFRED OGBEBO is a Journalist with Leadership Newspaper
Five promising steps forward in HIV science
9 July 2014, 2.40pm AEST
Article
The field of HIV treatment and prevention has been freshly energized by the findings from several recent clinical trials. Maintaining the momentum of scientific discoveries and breakthroughs is critical to preventing further HIV infections, improving care for the 35 million people living with HIV and because other critical global health priorities compete for funding in our fiscally-constrained world. While many breakthroughs in HIV research have happened over the past couple of years, I’m going to explore five of the most significant of these in recent times.
Treatment as prevention
In the area of HIV prevention, striking findings were reported recently by the European PARTNER study group. The study recruited gay and heterosexual couples who practice condomless sex where one partner was HIV positive (this means they are HIV “serodifferent”). To participate in the study, the HIV positive partner had to be on treatment that had fully suppressed the virus. This happens in approximately 90% of people who adhere well to their HIV treatment. Researchers reported the risk of HIV transmission was remarkably low: their findings suggest that over a 10-year period of practicing condomless sex, HIV transmission would occur in only 4%, or one in 25 couples. This research demonstrates the principle of “treatment as prevention” – where the treatment of HIV positive people prevents onward transmission. It provides long-awaited information to help HIV serodifferent couples navigate transmission risks during sexual intimacy.
Pre-exposure prophylaxis
Another important HIV prevention measure is known as pre-exposure prophylaxis. This involves people at risk of infection taking a daily antiretroviral tablet in conjunction with other HIV prevention measures, such as condom use and regular testing for HIV and other sexually transmitted infections. Over the past few years, several studies enrolling people who inject drugs, men who have sex with men as well as heterosexuals have shown that pre-exposure prophylaxis can reduce HIV transmission by between 44% and 75%. It’s also been showed to reduce risk of transmission among people who adhere to their daily medication by 99%. In Australia, pre-exposure prophylaxis is currently available in Victoria and will soon be available in New South Wales and Queensland, via demonstration projects where its use, effectiveness and acceptability will be studied. Antiretroviral therapy A number of combinations of antiretroviral agents are available for people living with HIV who choose to start this treatment. Several of these regimens require only tablet daily. This small pill burden and the relatively low toxicity profile of newer antiretroviral drugs make it easier for people living with the virus to adhere to their medications. To further enhance adherence, injectable long-acting antiretroviral treatments have been designed and are being evaluated in early clinical trials. These agents may last for up to 12 weeks and could theoretically be used for the purpose of HIV treatment and prevention.
Co-infection of HIV and hepatitis C
People who are co-infected with both HIV and hepatitis C are at risk of developing severe liver disease, and are at risk of more rapid development of cirrhosis of the liver. In 2012, approximately 9% of HIV positive people in Australia were co-infected with hepatitis C. In other countries, up to 80% of HIV positive people who inject drugs are co-infected with hepatitis C. Recent data from several studies have shown new treatments for hepatitis C are highly effective, with lower toxicity and shorter treatment durations (eight to 24 weeks) than older treatment regimens, which took up to 48 weeks. The efficacy of these agents in people who have both hepatitis C and HIV infection are being evaluated in several studies. One of the big challenges for using this approach is getting price reductions for both the older and new agents used for hepatitis C treatment.
Towards a cure
The chief obstacle to curing HIV infection is the virus' persistence in a latent form within certain cell reservoirs in the body. The main challenges for finding a cure for HIV infection then include preventing the virus from establishing latency in these cellular reservoirs during acute infection, and removing the latent virus from reservoirs during chronic infection. It’s possible the development of latent HIV reservoirs was prevented in the case of the “Mississippi Baby“ who received HIV treatment within 30 hours of delivery. This treatment was continued for 18 months, and tests have shown that even at 40 months of age, she has no virus detectable in her blood plasma. Initiatives to prevent HIV from establishing latency and to remove latent HIV from the reservoirs during chronic HIV infection, including boosting the immune system with vaccines, are planned or underway in several clinical studies. The community is waiting to hear their results.
These five areas are just some in the ways HIV science is progressing. We expect to hear the results of several of these and other studies at the 20th International AIDS Conference to be held in Melbourne July 20 to 25.
Edwina Wright Associate Professor at Monash University
Article
The field of HIV treatment and prevention has been freshly energized by the findings from several recent clinical trials. Maintaining the momentum of scientific discoveries and breakthroughs is critical to preventing further HIV infections, improving care for the 35 million people living with HIV and because other critical global health priorities compete for funding in our fiscally-constrained world. While many breakthroughs in HIV research have happened over the past couple of years, I’m going to explore five of the most significant of these in recent times.
Treatment as prevention
In the area of HIV prevention, striking findings were reported recently by the European PARTNER study group. The study recruited gay and heterosexual couples who practice condomless sex where one partner was HIV positive (this means they are HIV “serodifferent”). To participate in the study, the HIV positive partner had to be on treatment that had fully suppressed the virus. This happens in approximately 90% of people who adhere well to their HIV treatment. Researchers reported the risk of HIV transmission was remarkably low: their findings suggest that over a 10-year period of practicing condomless sex, HIV transmission would occur in only 4%, or one in 25 couples. This research demonstrates the principle of “treatment as prevention” – where the treatment of HIV positive people prevents onward transmission. It provides long-awaited information to help HIV serodifferent couples navigate transmission risks during sexual intimacy.
Pre-exposure prophylaxis
Another important HIV prevention measure is known as pre-exposure prophylaxis. This involves people at risk of infection taking a daily antiretroviral tablet in conjunction with other HIV prevention measures, such as condom use and regular testing for HIV and other sexually transmitted infections. Over the past few years, several studies enrolling people who inject drugs, men who have sex with men as well as heterosexuals have shown that pre-exposure prophylaxis can reduce HIV transmission by between 44% and 75%. It’s also been showed to reduce risk of transmission among people who adhere to their daily medication by 99%. In Australia, pre-exposure prophylaxis is currently available in Victoria and will soon be available in New South Wales and Queensland, via demonstration projects where its use, effectiveness and acceptability will be studied. Antiretroviral therapy A number of combinations of antiretroviral agents are available for people living with HIV who choose to start this treatment. Several of these regimens require only tablet daily. This small pill burden and the relatively low toxicity profile of newer antiretroviral drugs make it easier for people living with the virus to adhere to their medications. To further enhance adherence, injectable long-acting antiretroviral treatments have been designed and are being evaluated in early clinical trials. These agents may last for up to 12 weeks and could theoretically be used for the purpose of HIV treatment and prevention.
Co-infection of HIV and hepatitis C
People who are co-infected with both HIV and hepatitis C are at risk of developing severe liver disease, and are at risk of more rapid development of cirrhosis of the liver. In 2012, approximately 9% of HIV positive people in Australia were co-infected with hepatitis C. In other countries, up to 80% of HIV positive people who inject drugs are co-infected with hepatitis C. Recent data from several studies have shown new treatments for hepatitis C are highly effective, with lower toxicity and shorter treatment durations (eight to 24 weeks) than older treatment regimens, which took up to 48 weeks. The efficacy of these agents in people who have both hepatitis C and HIV infection are being evaluated in several studies. One of the big challenges for using this approach is getting price reductions for both the older and new agents used for hepatitis C treatment.
Towards a cure
The chief obstacle to curing HIV infection is the virus' persistence in a latent form within certain cell reservoirs in the body. The main challenges for finding a cure for HIV infection then include preventing the virus from establishing latency in these cellular reservoirs during acute infection, and removing the latent virus from reservoirs during chronic infection. It’s possible the development of latent HIV reservoirs was prevented in the case of the “Mississippi Baby“ who received HIV treatment within 30 hours of delivery. This treatment was continued for 18 months, and tests have shown that even at 40 months of age, she has no virus detectable in her blood plasma. Initiatives to prevent HIV from establishing latency and to remove latent HIV from the reservoirs during chronic HIV infection, including boosting the immune system with vaccines, are planned or underway in several clinical studies. The community is waiting to hear their results.
These five areas are just some in the ways HIV science is progressing. We expect to hear the results of several of these and other studies at the 20th International AIDS Conference to be held in Melbourne July 20 to 25.
Author
Edwina Wright receives funding from a research grant from NIH, a Career Development Fellowship from the National Health and Medical Research Council of Australia, research funding from the Victorian Department of Health and unrestricted research funds from Gilead, Abbott, Janssen Cilag and Boehringer Ingelheim. She has also received funding that has been used for research purposes only from ViiV, Merck, Gilead, and Abbott for consultancy work, payment for lectures from ViiV and payment for developing educational resources for ViiV and Gilead. The study drug for the VicPrEP study has been donated by Gilead Sciences.
Opinion: Don’t let insurers degrade HIV coverage
BY KEN RAPKIN, Special to the Miami HeraldJuly 7, 2014 In May, several Florida insurers became the target of an administrative complaint filed by the National Health Law Program and the AIDS Institute alleging that they are charging “inordinately high co-payments and co-insurance for medications used in the treatment of HIV and AIDS.”This is particularly disturbing given the fact that people who are diagnosed with HIV/AIDS have a much better chance of living longer than they did even 10 years ago thanks to scientific advances being made and the drugs that have become available as a result. An estimated 60,000 Americans living today have had the HIV virus for 25 years or more and half of the HIV-positive population in the United States will be over the age of 50 by 2015. Meanwhile, the costs associated with their care will only continue to rise as this population ages.Excluding or making it difficult for those with HIV/AIDS to procure full medical coverage is extremely dangerous. Making it harder for people with HIV to access medical care, and life-saving/life-extending drugs does great harm. The mental and emotional anguish of being discriminated against or denied proper insurance coverage is especially taxing and creates additional hardships.The most recent published estimate of lifetime HIV treatment costs was $367,134 in 2009 dollars. according to the CDC. In 2012, the U.S. spent nearly $15 billion on HIV care and medication.Why should South Floridians care? Miami has the highest HIV/AIDS rate in the country with 37.2 per 100,000 people, or a total of 64,573 people living with the disease, according to the U.S. Census Bureau and the Centers for Disease Control and Prevention. Private sector contributions are becoming increasingly important, as government funding, not only for care and treatment of the disease but also for research, has dried up in recent years. Many private nonprofits, including the Elton John AIDS Foundation and the Bill and Melinda GatesFoundation, focus on providing direct patient care services and AIDS prevention education. For the past 19 years, the Campbell Foundation has filled a crucial niche for up-and-coming researchers, as well as proven labs around the U.S. that otherwisemight not be able to obtain funding for projects that could lead to a cure.Since 1995, The Campbell Foundation has given away more than $8 million dollars for more than 130 research projects throughout the world. Another $1 million has gone to direct services for those with HIV/AIDS.The foundation provides seed money to those on the cutting edge of research designed to eradicate the virus. Thanks to one of our grants, a Lauren Sciences research team at Ben-Gurion University of the Negev in Israel was able to overcome the “blood brain barrier” that prevents the HIV-fighting drug Tenofovir from passing into the brain to fight the disease.Scientists have come a long way toward finding a cure, and in the process many of those afflicted with the disease are living much longer than in the past. It’s the incremental steps made by researchers around the world that have gotten us this far. As the Campbell Foundation prepares for its 20-year anniversary next year, we hope that one day our mission is accomplished and a cure for AIDS is discovered. In the meantime, even though AIDS is not in the news every day, we must continue to find ways to financially support those who are battling the virus as well as those in search of a cure. Ken Rapkin is program officer for the Campbell Foundation, a nonprofit organization based in Fort Lauderdale thatprovides funding to scientists around the world working to find a cure for AIDS. www.campbellfoundation.net
Nigeria Is Largest Recipient of U.S Aid On HIV and Aids Prevention - Entwistle
Nigeria is the largest recipient of the U.S President's Emergency Plan for Aids Relief (PEPFAR) in the world, U.S Ambassador to Nigeria, Mr James Entwistle, has said. Entwistle made this known at a reception to celebrate the 238th anniversary of U.S Independence in Abuja on Friday night.According to him, Nigeria is receiving 458 million dollars support each year to help prevent diseases such as malaria.He said a large portion of the money was also used to treat and help prevent diseases such as Tuberculosis and HIV andAIDS.The ambassador used the occasion of the July 4 celebrations at the expansive U.S embassy compound in Abuja to highlight U.S priorities and commitment to peace, security and rapid development in Nigeria.
7 July 2014, Source: Vanguard
7 July 2014, Source: Vanguard
Preventing HIV Transmission
There are a number of effective tools available to help prevent HIV infection.
These include
- · condom use
- · male circumcision
- · PrEP (pre-exposure prophylaxis --the use of anti-retroviral (ARV)medication in HIV-negative people at high risk for HIV) and
- · post-exposure prophylaxis (which involves taking ARV medication as soon as possible after exposure to HIV).
For people who inject drugs, syringe exchange programs and substance abuse treatment are important elements of HIV prevention.
Furthermore, the appropriate use of ARV medications by people who are HIV positive can lower viral load and reduce HIV transmission to their HIV negative partners by 96 percent.
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