Funds paucity delays AIDS survey

A LACK of funds is delaying the proposed N247 million new model sero-prevalence or sentinel surveillance survey on the Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS).

The Director-General of National Agency for the Control of AIDS (NACA), Professor Babatunde Osotimehin, who disclosed this in an interview with The Guardian at the weekend also said a mini-survey conducted last year showed that HIV infection was rising among gay men and intravenous drug users in Nigeria, but falling in the Police and Military.

The case is not different in Hong Kong where experts warn that up to a third of gay and bisexual men may be infected with HIV by 2020 if prevention programmes to reduce new infections and promote safe sex fail to work.

The national sero-prevalence survey, designed to track magnitude and progression of HIV and AIDS in Nigeria, was scheduled to be carried out between November and December last year and the results published between February and March (2008). But seven months after the deadline for the release of the results, the survey is still ongoing.

According to Osotimehin: The Federal Ministry of Health (FMOH) that is giving leadership on the new sero-prevalence survey had issues with resources last year and so we did not start in 2007 as proposed. So nothing concrete was done in 2007. But we have been able to raise resources both internally and externally. The survey is ongoing as I speak and I expect that hopefully by the end of the year we should have it ready.

He said that a mini-survey conducted last year showed that the prevalence of HIV/AIDS in the country was going down.

His words: If you look at what we did in a biological survey last year, the data shows that we now have problems with men who have sex with men, we have problems with intravenous drug users. Small they might be, but they are higher than the national average. We have been able to demonstrate that among the Police and the military, the HIV prevalence is not higher than the national average.

Before now, the FMOH has been able to biennially monitor the HIV epidemic through several surveys including HIV/Syphilis sentinel surveillance survey among the antenatal clinic attendees (1991,1992, 1995/96, 1999, 2001, 2003 and 2005); National HIV/AIDS and Reproductive Health Survey (NARHS) conducted in 2003 and 2005; Behavioural Surveillance Survey (BSS) among high risk groups in Nigeria-first conducted in 2005; HIV/Syphilis survey conducted among Pulmonary Tuberculosis and Sexually Transmitted Infections (STIs) in 2001; and IBBSS proposed for 2007.

Since 1991, the FMOH has carried out a National HIV prevalence survey every two years. In the 2003 survey, the national HIV prevalence reportedly dropped to five per cent from 5.8 per cent in 2001. The last survey in 2005 showed that the overall HIV prevalence was 4.4 per cent.

Experts and stakeholders have been worried about the inability of the Federal Government through the FMOH and NACA to release the 2007 survey.

Assistant Director, project programmes of the National AIDS and Sexually Transmitted Infections Control Programme (NASCP) of the FMOH, Mr. Araoye Segilola, had told The Guardian that only N52 million of the funds would be provided by government, as international donors have pledged to provide the balance of N195 million. Money received from the international community will be spent on provision and distribution of test kits, equipment and reagents, protocol department, and technical meetings, he said.

Segilola said the new but costlier survey model was adopted to better reflect the number of People Living With HIV/AIDS (PLWHA) in the country.

The new model is termed Integrated Bio-Behavioural Surveillance Survey among high-risk groups (IBBSS). IBBSS measures HIV prevalence, behaviour and Sexually Transmitted Infections (STIs). The model, recommended by the World Health Organisation (WHO) and United Nations AIDS programme (UNAIDS), would be conducted into generalised epidemics with high prevalence levels.

According to UNAIDS/WHO Working Group on Global HIV/AIDS and STIs surveillance, IBBSS can and should be used if resources are available to measure the deseases and behaviour regularly.

The previous model of using women appearing for antenatal care in Federal Government hospitals - Teaching Hospitals and Federal Medical Centers - has been highly criticised. Some experts, including PLWHA, say it is not a true reflection of the true HIV/AIDS situation in the country.

Segilola told The Guardian: If you conduct a study among the high risk groups and at the hot spots, you will realise that the five or even 10 per cent prevalence is not reflective of the HIV/AIDS situation in the country. Conduct a study in any university and you will find that nothing less than 37 to 40 per cent of the population are HIV positive. The problem we are seeing on paper as 4.4 per cent prevalence is a tip of the iceberg. When you carry out studies with the high-risk groups, you will know we have a problem at hand.

Also, prevalence studies are scientific and you have to change protocol from time to time depending on the literature available world wide. Secondly, the people we are studying are the antenatal care women in Federal Government owned hospitals. What happens to those that go to state-owned general hospitals and private hospitals? What happens to the men and high risk groups such as sex workers, homosexuals, men in uniform, students in higher institutions?

A sub-national analysis of trends in HIV prevalence in Nigeria over 16 years analysis by Ihekweazu C.A. of the European Programme for Intervention Epidemiology, London, United Kingdom, indicated that the national prevalence rate of HIV in Nigeria in 1991 rose from 1.8 per cent in 1991 to 5.8 per cent in 2001, then dropped to five per cent in 2003 and further to 4.4 per cent in 2005. It was 3.8 per cent in 1993, 4.5 per cent in 1996 and 5.4 per cent in 1999. The reference population are people aged between 15 and 49 years and the method of surveillance is a biannual survey of pregnant women. HIV testing is carried out anonymously and unlinked.

Co-ordinator of the Policy and Advocacy Unit of Journalists Against AIDS (JAAIDS) Nigeria, Mrs. Bimbo Adewumi, said: Antenatal care survey is not the only mode of survey you can use. Some people have started talking about second generation surveillance. We are looking at other indications apart from women that are attending antenatal clinic. Some of the recommendations that have been made globally now is to let HIV/AIDS be like any normal disease, that is, if you are going to the hospital for a skin cut, you are getting voluntary counseling and if you want to get tested you are getting tested.

Once you enter into a hospital environment, you must have access to Voluntary Counseling and Testing (VCT) and other things that come with it. You know most men do not go to the hospital, they just drop their wives at the gate and go away. We will empower the gateman to deliver VCT to them, so that any interaction you have with the hospital, you get VCT, then you can now opt for testing or not.

Using the antenatal care model does not really capture the situation well. When you actually look at the survey, it could either be a reduction or an increment. When you use just antenatal care survey and when you look at the population of women that are pregnant in a year and how many of them go to the public hospital, they are not much. The antenatal care model we are talking about captures only the public hospitals. So the people that go to private hospitals are not included.

The current figure of 4.4 sero-prevalence, means that about three million Nigerians are living with the virus. But a PLWHA, Mrs. Linda Cynthia Omeka of the Organisation for Positive Productivity (OPP), told The Guardian that the rate of HIV infection in the country is increasing. This is contrary to the prevalence survey, which indicates that the infection rate has reduced from five per cent in 2003 to 4.4 per cent in 2005.

Go to the hospitals, go to the medical laboratories. They will tell you that more people are testing positive. You should not use only pregnant women going to hospital. How about in the rural areas where people deliver at home, how will they record that? Everybody should be tested. This is the only way we can get the true picture of how many Nigerians are living with the virus and be able to plan all towards providing care and treatment, she said.