By Aminah Carew
Dr Ray Ezekiel is a senior resident of the Department of Pediatrics in University of Ilorin
Teaching Hospital. In this interview with Nature News, he gives insight into what are happening to the HIV/AIDS services following the outbreak of the coronavirus.
NatureNews: Do you think enough awareness has been given on this disease and have people been able to efficiently prevent themselves from catching it?
Ezekiel: No, I don’t think enough awareness has been given on this disease although there has been improvement in the level of awareness over the years.
There is still deficiency especially in the rural areas as these people don’t have access to the media or information that can save their lives. Several studies have reported different prevalence of HIV among the young adults. Some of the outcomes of such studies are not optimal because a great percentage of people are not aware of HIV, its method of transmission and other important things.
Due to lack of awareness, people cannot prevent themselves efficiently, which is why HIV prevention and services are key areas in which most people are looking into especially prevention of maternal-child HIV infection and also usage of condoms and other prevention methods.
There are also lots of risky behaviors perpetrated by youths which are due to the fact that they are not fully aware of what HIV is all about. For example, sharing needles to abuse drugs, engaging in risky sexual behaviors and in that manner the prevention services have not been really efficient.
However, I must state that HIV prevention service has gone up in recent years, and the rate at which people were getting infected has actually declined as indicated by the prevalence rate in Nigeria.
It was formally about 2.8% but in 2019 the prevalence rate was about 1.4% and this has been attributed to the fact that HIV prevention services have received major attention and people are now beginning to prevent themselves, but there is still room for improvement especially in rural areas and those who know what HIV is about but do not have complete information about HIV testing services or preventive services.
There are also some myths which people still have and would need to be debunked.
All this which contributes to the level of awareness and full awareness can only be reached after getting to the UN’s target.
NatureNews: As a medical doctor and comparing with statistics, can you say enough tests are being carried out?
Ezekiel: In Nigeria currently, enough tests are not being carried out. Part of the UN target is that 90% of individuals should know their HIV status by 2020 and that is the first of its 90/90/90 target.
There are studies that have showed that less than a quarter of the population in Nigeria has never tested for HIV/AIDS and a fewer percentage has tested in the last one year and there are a lot of people with HIV infection who don’t know their status.
Based on these statistics, I think it can be agreed that the testing being done is inadequate and a great population of people in the rural area don’t know where to go for testing. They don’t know about symptoms or major things that could make them go for a test.
One of the major things is the logistic problem and inaccessible areas. Also getting supplies of test kits. It has worsened due to the lockdown for coronavirus pandemic.
We need to scale up testing services, we need to be able to access areas where it has been difficult for people to get tested.
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NatureNews: Part of the essence of the World AIDS Day was to show support for people living with HIV. Do you think the UN has been able to achieve this aim?
Ezekiel: The UN has been in the forefront of the fight against HIV epidemic and over the years a lot has evolved. Currently, they are working on the 90/90/90 target which means that 90 percent of people should know their status, be on antiretroviral therapy and 90% should have been virally suppressed.
The UN has been supporting country-led responses to HIV. It has been in the forefront of advocacy, sourcing for funds, providing educational and scientific materials, organizing lectures for youths.
It also provides support by facilitating access to treatments, ensuring that the patient is adhering to treatment, prevention of HIV from a person to the other and preventing stigma.
UN has done well and mobilized a lot of resources to the cause and we are all working towards the eradication of HIV virus very soon.
NatureNews: Do you think Coronavirus has shifted the campaign from AIDS?
Ezekiel: Since the coming of the Coronavirus, different measures have been put in place to combat the virus such as the lockdown of many countries which had a lot of economic effect, thereby making countries which were not financially buoyant to be less buoyant.
With the advent of Covid-19, it has been seen that domestic public financing, private out of pocket spending for HIV have declined. Many donors have responded to Covid-19 by mobilizing additional funds to respond to the pandemic such as Covid-19 vaccine development effort.
In channeling such, other aspects fund such as malaria, tuberculosis, HIV might suffer for it. As countries are entering recession, official development assistance which is a measure of the donor funding gotten into the country could get cut off.
An example of this is the global fund releasing a note that allowed recipient countries to use HIV, tuberculosis and malaria grant to fight Covid-19.
Some of the funds are being used to provide personal protective gears for the workers.
Because of the shrunken economy, private domestic funds for HIV have also declined which have affected the fight for HIV in many ways.
NatureNews: What area do you think the Nigerian government can contribute on the awareness and prevention of AIDS?
Ezekiel: They can contribute via policy making and budgetary allocations to HIV response service.
They can also help to foster increased finances locally from private donors, non-governmental organizations, multinationals and pull them into the National HIV trust fund where more fund is available for HIV prevention services and other HIV services.
They can also strengthen state responses to HIV and continue to support the foreign donors who are the major financiers of HIV programs across the country.
NatureNews: What’s the progress of finding a cure for this disease?
Ezekiel: The cure for HIV is still in the pipeline. There had been tremendous progress before the Covid-19 pandemic that caused national lockdown and many people who were involved in the search for an HIV cure were remobilized towards the fight for the Coronavirus pandemic and also resources which were meant to be channeled towards HIV cure have been diverted.
Covid-19 has caused a lot of issues. However, there is still steady progress.
Cure for now has not yet been discovered but there are two aspects to HIV cure which are the functional and the sterilizing cure.
The functional cure focuses on reducing the virus to a level that is undetectable. Sterilizing cure has to do with the fact that HIV is eradicated.
There are promising prospects that are still in the pipeline. The search for vaccine is still on and effective gene therapy.
There has also been a case in Berlin where HIV was eradicated from a patient via a transplant. I strongly believe that with time, a cure will be found and that will help in mitigating the effect of HIV and eradicating the disease worldwide.
NatureNews: What’s your advice for those who have been diagnosed with this disease?
Ezekiel: My advice for those who have been diagnosed with the disease is that they should not lose hope because HIV can be effectively managed. Once they are diagnosed, they should ensure that they get into a facility where they are enrolled into HIV care and commence antiretroviral therapy.
They should be adherent to their medications. With that, a lot of people have lived a very large number of years.
We have been able to prevent HIV from mothers infecting their children. A lot of people have very low viral load because they have been adherent to their treatment.
If you have been diagnosed with HIV, I can assure you that it is not a death sentence, you can live your life normally like other human beings.
You just need to start your medications and be adherent to it.
You also need to be sure of your psychological status, that is address underlying mental issue and speak to a doctor who can refer you to different types of services that will meet your needs.
With great support from everyone, you will be able to live a normal life.
