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By Dr. C. Kaduru

Talking to a group of young people about HIV/AIDS screening in September 2012 made me admit Nigeria has a long way to go in educating the populace to acheieve a ZERO level HIV/AIDS infection rate. Answers such as ‘Ignorance is bliss’ ‘what you don’t know cannot kill you’ ‘HIV screening is only for those who have had unprotected sex’ ‘I don’t sleep around so why should I go for screening?’ coming from educated adults only made my heart break. Is a ZERO generation of new HIV infection really possible?

The devastating impact of HIV/AIDS in the third world and among our women and young people is alarming. According to the World Health Organization, about 95% of people infected with HIV are living in the developing world. Sub-Saharan Africa is the worst hit region, bearing the biggest burden of HIV in the world. Around 22.9 million or nearly 68% of all people living with HIV worldwide live in Sub-Saharan Africa. Women comprise 59% of people living with HIV in this region. There were an estimated 1.9 million new infections in the region in 2010, representing more than two thirds (70%) of all new infections globally.

Young people aged 15-25 yrs., account for 45% of new cases of HIV infection worldwide. Most of the people infected with HIV/AIDS are within the age bracket of 15 to 35 years. This group is the main work force and the potential leaders of any nation. It has been estimated that 80% of the infected group are aged 20-29 years.
In 2011, the number of people living with HIV stayed stable at 34 million and we saw some substantial reductions of new infections and deaths globally. There seems to be progress, but we cannot slacken efforts.

Zero AIDS-related Deaths
The magnitude of the AIDS crisis has drawn attention to the fact that millions of people in the developing world do not have access to the medicines they need to treat disease or alleviate suffering. The high cost of AIDS medicines has focused attention on the relationship between patent protection and high drug prices. An estimated 30% of the world population does not have access to the medicines they need (WHO 2004). The reasons for this situation are manifold, but price is a major issue. A Médecins Sans Frontières (MSF) survey of 122 people on AIDS treatment in Nigeria found that 72% had experienced treatment interruption, with financial difficulties as the leading cause (MSF 2005).

In May, 2000, US President Clinton issued Executive Order 13155, supporting sub-Saharan African countries in using measures such as compulsory licensing to allow production and import of generic AIDS drugs, without fear of trade retaliation. This subsequently led to Multinational drug companies announcing price reductions for AIDS drugs. This was a key step towards enhancing access to essential HIV/AIDS medicines in sub-Saharan Africa.

In 2003, with the road already paved, thanks to the Executive Order signed by President Clinton and the Doha Declaration on Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and Public Health of the World Trade Organization, President George W. Bush launched the US President’s Emergency Plan for AIDS relief (PEPFAR).

Most of the ARVs currently available at affordable prices come from India, thanks to allowances of the Doha declaration. In 2008, an estimated 3 million people in low and middle-income countries received ARV therapy for HIV/AIDS. It is estimated that approximately 60% of the ARVs come from India, including up to 80% of first-line treatments (Nguimfack, personal communication, 2008). Furthermore, in 87 developing countries, 70% of the treatment for patients purchased by the United Nations Children’s Fund (UNICEF), International Dispensary Association (IDA), the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and the Clinton Foundation, comes from Indian suppliers. MSF purchases 80% of its ARVs in India for projects in over 30 countries. The purchase by the US President’s Emergency Plan for AIDS Relief (PEPFAR) of Indian ARVs resulted in cost-savings of up to 90%, and 91% of the generic ARVs approved by the US Food and Drug Administration (US FDA) for PEPFAR are from India (MSF 2007).

PEPFAR has indeed made a huge difference in HIV/AIDS treatments, and continue to reduce the impact of price on access to essential HIV/AIDS medicines in Nigeria. According to the UN Annual report, progress over the past decade has cut the death toll for the disease, mainly due to better access to drugs that can both treat and prevent the human immunodeficiency virus (HIV), which causes AIDS.

To reach our established goal of ZERO AIDS-related DEATHS however, we must all stand up and continue to advocate for trade laws and policies that allow generic medicines to flourish. If generic medicines flourish, the price of the needed drugs will stay low due to competitive pricing, and PEPFAR, UNICEF, Global Fund and the millions of other CSOs can continue to acquire medicines and make them available to the poor, who cannot afford them!

Zero New Infections
According to new data in the 2009 AIDS epidemic update, new HIV infections have been reduced by 17% over the past eight years. Since 2001, when the United Nations Declaration of Commitment on HIV/AIDS was signed, the number of new infections in sub-Saharan Africa is approximately 15% lower, which is about 400 000 fewer infections in 2008.

Knowing your HIV status is a step in the right direction for preventing the spread of HIV infection to the unsuspecting. If you have engaged yourself in any sexual activities with someone who is not your spouse or with multiple sexual partners, you may have contracted HIV. It is very important that you go for HIV testing to determine your current status.

HIV counseling and testing provides a gateway for care, support and treatment. These services are available free of charge for anyone in most Health Institutions in Nigeria.

Many people are still afraid to know their statuses. Even the most educated people and the wealthy. We can however not succeed at creating a generation with ZERO NEW INFECTIONS, if we do not know our statuses.

KNOW YOUR STATUS. It is the only swag available to us, young people. And after you know your status? Abstain, Be faithful, and use a Condom, as the case may be.

Let us be that generation with ZERO NEW INFECTIONS.

Zero Discrimination
More than the virus, more than a lack of access to medicines, more than a lack of comprehensive care in certain localities, discrimination continues to be touted as the biggest killer of People Living With HIV/AIDS (PLWHA)!

Working with patients on a day-to-day basis, across different departments of the hospital, you come into close contact with many PLWHA. Through interactions with them, you realize that their biggest fear is not that they will one day die because of the virus. Their biggest fear tends to be that their spouses do not know yet and may incidentally find out, or that their colleagues at work may find out, or that the schoolmates of their children may find out.

You look into the eyes of these patients, and you know for sure that discrimination and the fear of discrimination is impinging on their quality of life. The discrimination is killing them faster than the virus.

Our target of ZERO DISCRIMINATION has to be more aggressive. And it starts from educating people about HIV/AIDS, in a bid to institute a paradigm shift. It starts from offering equal opportunities to everyone, irrespective of their statuses. It starts with instituting policies to protect the infected and all other vulnerable members of our society, against all forms of discrimination.

December 1st is here, and it’s World AIDS Day. Our goal continues to be Zero AIDS-related deaths, zero new infections, zero discrimination. The scramble to zero is the biggest challenge facing us today. We do however have the potential to get there. Let World AIDS Day 2012, be another corner stone for a ZERO GENERATION.

Let’s put in our all and get to ZERO!


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