Features
HIV Test and Treat: How Feasible?
Over the years, awareness in HIV/AIDS issues such as prevention, treatment, care and support have developed from stage to stage across the globe, Nigeria inclusive. In fact, approach to HIV-related issues has been diversified, including Prevention of Mother-To-Child Transmission (PMTCT) of HIV. One of the most recent approaches is what is popularly called “Option B” and “Option B+”.
The crux of the matter in PMTCT is to prevent the transmission of HIV to an unborn child from the infected mother as a fetus during pregnancy, delivery and while breastfeeding. This has been widely executed successfully globally.
PMTCT, which is a clinical intervention, has lowered new infection rates among newborns to nearly zero in many parts of the world’s developed countries. As a developing country, Nigeria had first adopted “Option B”, a clinical protocol, which provides antiretroviral therapy to HIV-positive pregnant and lactating women, and allows for HIV-free newborns.
Under Option B, the extent to which a woman access antiretroviral therapy depends on certain biomarkers, including CD4 count. Consequently, some women discontinue the medication, only to restart when their CD4 count drops below a certain level.
Newer protocols by the World Health Organisation (WHO), however, recommend that lifelong antiretroviral therapy be provided to all pregnant and lactating women living with HIV, regardless of CD4 count. This protocol, known as “Option B+,” is less complex and more efficient than Option B.
Option B+ requires increased antiretroviral therapy financing throughout a mother’s life (as well as the accompanying clinical monitoring), but ultimately saves the lives of women of reproductive age and their children.
It offers all HIV-positive pregnant or breastfeeding women life-saving Antiretroviral Treatment (ART) for their entire lives. Option B+ simplifies the ART regimen to one pill once a day making it much easier for the patient to take and far easier to implement.
Not only does this approach help to ensure mother-to-child transmission is reduced to less than 5 percent for all future pregnancies, it also maintains the mother’s health, reduces HIV transmission to uninfected sexual partners, and prevents all of her children from becoming orphaned.
The implication of Option B+ being executed effectively is that ART regimen has to be readily available at all times in all facilities. This means that necessary funds has to be available, as well as HIV test kits. The concern would thus be availability of funds to enhance procurment and distribution of the ART regimen to the various health facilities in the country.
Currently, in Nigeria, major funding to HIV/AIDS response have been donor-driven, with the President’s Emergency Plan for AIDS Relief (PEPFAR) contributing a high proportion.
At the 2016 National HIV/AIDS Prevention Conference held in Abuja, Nigeria, the Country Director, U.S. Centre for Disease Control and Prevention, Dr. Hank Tomlinson, said the U.S. Government spent 4 billion Naira in HIV response (prevention, care and treatment) in Nigeria.
Among other contributions, he said, currently PEPFAR alone has provided life-saving ARV therapy for 700,000 Nigerians. This does not include what other international donor agencies have done in this wise.
Meanwhile, the Minister of Health, Professor Isaac Adewale, said during the 2016 World AIDS Day (WAD) celebration in Abuja that over 800,000 Nigerians are currently on ARV therapy.
When this is placed pari passu with the fact that while PEPFAR alone takes care of the ARV therapy of about 700,000 Nigerians, and other international donor agencies are also key contributors, the level of contribution by the Nigerian Government in terms of funding becomes cause for concern.
This is in view of the fact that test-and-treat strategy, which is the crux of Option B+, involves an aggressive expansion of HIV testing to identify HIV infected persons, and immediate initiation of antiretroviral therapy.
For those diagnosed HIV positive, they are immediately placed on ARV without waiting for the results of laboratory investigations such as the CD4 count. That is, patients are started on ARV drugs irrespective of their CD4 count result as stipulated by the 2013 WHO PMTCT guideline.
This being the case, the question that readily comes to mind, if Option B+ must be a success, is, if the bulk of HIV response in Nigeria is donor-driven with Nigeria’s financial contributions virtually negligible, what would be the country’s fate in the face of gradual withdrawal by donor agencies in terms of funding, or what Dr. Abiola Davies calls “matching programme with funds”?
In other words, how can Nigeria sustain the demands of Option B+, or Test and Treat, in the face of inadequate financing of HIV/AIDS commodities by the government?
Dr. Davies, the UNICEF representative and HIV specialist for care cum team leader for PMTCT and Paediatrics Programming in Nigeria, believes that this scenario should not be cause for alarm because Nigeria has what it takes to make Option B+ work.
But this, as she hinted, would require some level of discipline and prudence in resource generation, distribution and management by various levels of government in the country, not just the Federal Government.
“There is non-availability of funds which has to do with domestic funding. We need to bring our domestic resources, not just at the national level, because Federal Government is putting in some money which is inadequate.
“But if you come to the level of the State and Local Government, the proport on of funding is very minimal. So, to all tiers of government, we really need to see how they can mobilise funding to finance the (HIV) response”, she said.
This is very pertinent, considering that Test and Treat means that test kits and sundry HIV consumables need to be readily available at all times in all approved health facilities in the country.
What this amounts to is that for Option B+ to succeed, the necessary test kits and HIV drugs have to be available in the about 22,726 health facilities across Nigeria, and be made easily accessible to people living with the virus. All of these boil down first to the availability of the required funds.
Taking a cue from other countries, Dr. Davies recommends that Nigeria can earmark a given percentage of crude oil sales to HIV response in the form of taxation.
“Let me say that countries that don’t have as much money like Nigeria have been able to finance it (Option B+). We look at the areas where we call innovative financing.
“In some countries they have tax. To get as much HIV/AIDS funds, you might have tax attached to petrol as well as HIV funding”’ she said.
Given the fore-going, Nigeria has two options towards making Option B+ work for its citizenry: the first is to toe the line of the new Director General of the National Agency for the Control of AIDS (NACA), Dr. Sani Aliyu, who expressed the belief that Nigeria should impress it upon international donor agencies to continue in their donations.
“I implore them all (donor agencies) not to relent in their financial and technical support to HIV prevention programmes in Nigeria”’ Dr. Aliyu said at last year’s National HIV Conference in Abuja.
On the other hand, the country can be more proactive by adhering to the reasoning of Dr. Davies to ensure a systematic means of raising funds for HIV response, not dependent on the whims and caprices of any individual, and efficient management of such funds.
“There is a need for more improved efficient management of coordination of structures, and efficient use of funds. That’s one of the major areas we need the government to improve on”, she said in an exclusive interview with The Tide.
The question is which of these options will the Government feel more comfortable with or willing to embrace?
Soibi Max-Alalibo
From the fore going, the fight against drug trafficking should be treated as an international challenge with open collaboration, if the world leadership must win the fight!.
The circumstances or should I say the improvement on drug related activities are modifying and updating on daily basis. A close friend of mine in the United States of America who recently visited Jamaica, came with a lot of complicated information about drug trafficking and transaction. Being a qualified Nurse in US and on a visit to the Reggae Country (Jamaica), she said she was put aback when a man approached her and introduced himself as a Pharmacist. According to her, she immediately picked interest due to her professional background. To her, a business partner is birthed. But she was shocked to the narrows on learning that drug dealers or traffickers and subriquited Pharmacist in that Country. From her account, they ( The Jamaican Pharmacists), are the first set to people to meet and greet you at the Airport. No government or authority challenges them in the open due to the sophisticated nature of their transportation
Come to think of it, who would want to attack a Pharmacist on duty? Nigerians are not left out in the improvement on drug deal. A chat with a confident in the National Drug Law Enforcement Agency ( NDLEA) Rivers State Command, so revealed. The Officer draw my attention to the movement of Dispatch Riders. He said part of the reasons they ride with almost speed equivalent of the thunder lightning, is to meet up with the appointment of delivering hard drug consignment to a client of theirs. According to him, those guys popularly referred to as Yahoo Boys are the ones who now payroll dispatch riders so that they can deliver their consignment ( hard drugs) on schedule no matter the sort of traffic or weather condition. The fear of loosing rich clients and that of the unknown treatment that may come of the Boys, as the officer puts it, drives the Riders crazy thus the reason to speed even at the expense of their lives.
The account of a prominent Party Promoter, Wayne Anthony, as obtained online recently, also pointed out that ‘No Legislation Will Stop Clubbers From Doing Drugs’ Party promoter, Wayne Anthony, arrived in Ibiza, a Spanish Island in 1988, at the same time as dance music and the party drug ecstasy. Despite hallucinating badly enough to make him give up the lifestyle forever, he says laws will never stop clubbers taking drugs. “I don’t think you can control these things,” said former party promoter Wayne Anthony. He arrived in Ibiza in 1988 and began setting up club nights and raves in some of the island’s most iconic venues. In the years that followed, the sleepy Spanish island turned into a raver’s haven of clubbing and hedonism, with party drugs like ecstasy commonly found. “What Ibiza represented was this beautiful, hot island which was visually stunning and we knew you could party there quite legally,” said Wayne. “You didn’t have to look over your shoulder. You could just be as free as you possibly could be.”
That freedom came with a price. Along with the lavish clubs, all-day-benders and hot Spanish sun came drug cartels and crime. The city transformed into one the world’s most vibrant party capitals, “fuelled by a dangerous and lucrative drugs trade which drew as many criminals to its shores as it did party animals”. Wayne, one of the contributors to the documentary, spoke to Sky News ahead of its release.”I’m not going to sit here and say the cartels aren’t there. They are all there and they’ve been there from the ’90s,” said Wayne. But he said most people tried to ignore the organised crime going on around them. According to Wayne, clubbers usually took the approach of: “‘Give me 10 E’s . Behind the scenes of the filming of Ibiza Narcos with Wayne Anthony. Behind the scenes of the filming of Ibiza Narcos with Wayne Anthony. Hallucinating giant spiders Although he described the Balearic island as the “motherland”, it was eventually a bad experience with drugs that convinced Wayne it was time to leave Ibiza.
He’d been partying for days when he realised he’d taken too many drugs. A friend told him to drink cough medicine, dangerous advice that he now says could have killed him. “I saw the worst hallucination I’ve ever seen in all of my life. I ended up locking myself in the villa with all the shutters down. When he sobered up, he realised he had “come to the end” of his party life on the island. “I never looked back. I never took another drug. I got away from the club world.” ‘I don’t think you’re going to be able to stop it’ Despite his life-changing experience, he doesn’t think criminalising drugs is a good idea – or particularly effective. “If you’re old enough to vote for who’s going to be a world leader, if you’re old enough to put your name down on debt for 25 years, I feel like you should be old enough to govern what you put inside your own body, you know?” said Wayne.
Back to Nigeria, some illicit drugs worth over N30billion seized at Onne Port in Rivers State.
This blood chilling development forced the Federal Government to declare a state of emergency at the Onne Port, following what authorities described as repeated incidents of importation of dangerous cargo, including arms and ammunition through the said port. To this effect, the government said it was immediately implementing emergency protocols at Onne Port for the next three months by conducting thorough examinations of all suspected containers in the premises.
The Comptroller-General of Customs, Bashir Adeniyi, in charge of the port via a press conference, said it henceforth, unveiled the seizures of illicit goods by the Nigeria Customs Service, Area 2 Command, Onne in Eleme Local Government Area of Rivers State. In defence for his action, Adeniyi said the recurring incidents posed a threat to national security, adding that the health of citizens at the Onne Port is increasingly being used as a destination for dangerous and illicit cargo, describing it as a disturbing trend.
The customs boss stated, “Earlier today, I joined numerous stakeholders to take a significant step towards the cause of trade facilitation through the inauguration of upgraded facilities provided by the West Africa Container Terminal, Onne. “As I express delight that trade facilitation is getting traction in Onne Port, I cannot help but call your attention to a grave concern. This has to do with the repeated incidents of national security breaches unfolding in Onne Port. I appreciate your presence, as we all have a shared responsibility in safeguarding our national security. As we are all aware, the policy thrust of Mr President supports the re-energising of our business environment to drive faster import clearance and grow our capacity for exports, Our emphasis has been to promote initiatives that speak to Trade facilitation and economic development. “It is a matter of regret that criminal elements in the international supply chain are exploiting our pro-trade stance to commit atrocities bordering on national security breaches”.
“The attempts to test our will through the importation of dangerous cargo through this port has necessitated the declaration of a state of emergency in Onne Port, coming on the heels of a seizure of a huge cache of arms a couple of months ago. It is disheartening that perpetrators have not backed down on their illegal acts. Recent intelligence and seizures have revealed a disturbing trend; Onne Port is increasingly being used as a destination for dangerous and illicit cargo. The scale and nature of these illegal importations pose a significant threat to our national security and the health of our citizens. Today, we are here to showcase yet another series of significant seizures made by the diligent officers of the Area 2 Command. On display are twelve containers of illicit goods intercepted through a combination of intelligence gathering, inter-agency collaboration, and meticulous physical examination. Seizures on Display include: Three (3) x 40-feet containers: Containing 562,600 bottles of 100ml cough syrup with codeine and 3,150 pieces of chilly cutters, with a Paid Duty Value (DPV) of N4,716,573,846.
“Others are, three x 40-feet containers containing 380,000 bottles of 100ml cough syrup with codeine, 24,480,000 tablets of Royal Tramadol Hydrochloride, 5,350,000 tablets of Tapentadol and Carisoprodol, and other items, with a DPV of N17,432,506,000 were seized”.
According to the report, more seized items were, “Five (5) x 40-feet containers; Containing 892,400 bottles of 100ml cough syrup with codeine, 1,300,000 tablets of 50mg Really Extra Diclofenac, 7,250,000 tablets of 5mg Trodol Benzhexol, and other items, with a DPV of N8, 128,568,295,90. This very action of the Nigeria Customs Service, further complicated the hope of how soon the fight against drug trafficking could be brought to a halt owing to its high profile nature.
Another hair-raising report of the illicit drug deal has it that when NDLEA bursted a Snake-Guarded Shrine Used For Storing Illicit Drugs sometime ago in Edo State. This very news report was published in The Tide Newspaper on June 24, 2024. According to the report, NDLEA said its operatives uncovered a shrine, guarded by a snake, being used for storing illicit drugs, during an operation in Edo State. The Agency in a statement by its spokesperson, Femi Babafemi, added that its operatives discovered a specially constructed large hole in a wall, hidden behind wallpapers and fetish objects used for drug storage. It further noted that methamphetamine, Loud, Colorado and Arizona, all strong strains of cannabis with a total weight of 8.743kg among others, were recovered from the shrine.
To be cont’d
King Onunwor
The persistent clash between farmers and herders in Nigeria has been a longstanding issue. These conflicts, often, over resources like land and water, have led to loss of lives, destruction of property, displacement of large numbers of people, deep-seated mistrust between communities and insecurity. Herders, traditionally nomadic, move their livestock in search of grazing land and water. Farmers, on the other hand, require the same resources for their crops. This competition often leads to clashes, especially in areas where land is becoming increasingly scarce due to population growth, climate change, and environmental degradation. As these clashes intensify, there has been a growing call for sustainable solutions. Two weeks ago, President Bola Tinubu took a bold step towards tackling the issue by inaugurating the Presidential Committee on Implementation of Livestock Reforms and creating the Ministry of Livestock Development.
The committee which has the president as the chairman and the former Chairman of the Independent National Electoral Commission (INEC), Professor Attahiru Jega as the deputy chairman has the mandate to address obstacles to agricultural productivity and open up new opportunities which benefit farmers, herders, processors, and distributors in the livestock-farming value chain as well as propose recommendations aimed at fostering a peaceful co-existence between herders and farmers, ensuring the security and economic well-being of Nigerians.The establishment of the Ministry of Livestock Development was part of the recommendations of the National Livestock Reforms Committee. Part of the 21 recommendations submitted to the president include: “This agenda should include the establishment and resuscitation of grazing reserves as suggested by many experts and well-meaning Nigerians and other methods of land utilisation.
“Create the Ministry of Livestock Resources in line with practice in many other West African countries. In the alternative, Federal and State Governments should expand the scope of existing Departments of Livestock Production to address the broader needs of the industry,” among others. Experts in the agricultural sector have posited that the livestock industry can create millions of jobs directly in farming, processing, and distribution, and indirectly in related sectors like feed production, veterinary services, and marketing. It provides livelihoods for rural populations, helping to reduce poverty and improve the quality of life in rural areas. It also increases the Gross Domestic Product (GDP) and foreign exchange earnings through the exports of livestock and livestock products such as meat, dairy, wool and leather.
According to them, a well-funded livestock industry supports the growth of agro-processing sectors, such as meat packing, dairy processing, and leather manufacturing, adds value to raw products and creates additional economic activity as well as stimulates the development of supply chains, including logistics, packaging, and retail, contributing to broader economic growth. It enhances economic resilience by diversifying the agricultural sector and providing a buffer against crop failures or other agricultural shocks and many more. Some other agriculturists have also opined that the livestock industry in Nigeria is currently underdeveloped and that by the creation of the ministry of livestock development will open up the industry which will be a huge money spinner for Nigeria.
Reports have shown that a Livestock Ministry can play a pivotal role in mitigating conflicts between farmers and herders by implementing policies and programmes aimed at fostering coexistence and sustainable resource management. The Ministry can work towards clearly demarcating grazing routes and farming areas. This would reduce instances of trespassing and accidental crop destruction, a common flashpoint for conflict. While introducing rotational grazing systems can ensure that land is used sustainably, preventing overgrazing and land degradation, establishing water points and boreholes specifically for livestock can reduce competition for water resources. Similarly, promoting the development of pasturelands through reseeding and controlled burns can improve grazing conditions.
According to a veterinary doctor, Dr Andrew Obadiah, by providing training for herders on sustainable livestock practices and for farmers on conflict resolution, both parties can understand the importance of coexistence. He said that extension services of the ministry can offer advice on improving livestock health and productivity, reducing the need for large herds and extensive grazing. “Setting up local committees involving both farmers and herders to mediate disputes can provide a platform for dialogue and peaceful resolution. Encouraging community-based conflict early warning systems can help prevent clashes before they escalate”, he emphasised.For Mrs. Stella Ugwu, a farmer, having a ministry dedicated to the development of the livestock industry can help in diversifying income sources for both farmers and herders and in turn reduce dependence on land.
”For instance, promoting agro-pastoralism can provide farmers with livestock and herders with agricultural produce”, she explained, adding that providing incentives for adopting sustainable practices, such as subsidies for fodder production or crop insurance, can ease economic pressures. Ugwu was however of the opinion that the creation of a new ministry to handle livestock affairs was uncalled for, since the job can effectively be done by the Technical and Service Department of the Federal Ministry of Agriculture and food security and its equivalent on the states level.In some countries, the establishment of a Livestock Ministry or similar bodies has shown promising results. For example, Ethiopia’s Ministry of Agriculture includes a dedicated department for livestock which has successfully implemented programmes to improve pastoral livelihoods and reduce conflicts.
In Kenya, the establishment of the National Drought Management Authority has helped manage resources better, thus reducing clashes between herders and farmers during dry seasons.The president of Miyetti Allah Cattle Breeders Association of Nigeria (MACBAN), Othman Ngelzarma, sees the Ministry of Livestock Development achieving the same feat for Nigeria in the near future. He told newsmen that, “MACBAN expresses its deepest appreciation to the Federal Government for creating a ministry of livestock to unlock the trillion-naira livestock economy and create qualitative and productive jobs across the value chain to improve the Nigerian economy. With this development, MACBAN believes the hope of the Nigerian pastoralists is now achieved under the Renewed Hope Agenda.
However, the Middle Belt Forum took a different view of the proposed Ministry of Livestock Development, saying it was not enough to sustainably resolve the decades-long farmers-herders crisis in the country. According to the National President of the association, Mr. Bitrus Pogu, what is needed to end the perennial farmers/herders clashes is a deliberate action by regulatory bodies and the government to stop criminal elements from carrying out deadly attacks on innocent Nigerians, mainly farmers. Hear him: “If the reason for creating the Ministry is to stop clashes, I think it is wrong because all of these attacks and killings that are happening have nothing to do with conflicts between farmers and herders. “Farmers have never connived at any given time to go and attack herders, but rather, criminals who happen to be Fulani gang up and attack farmers, kill, maim and chase them out of their ancestral homes.
“Then, the Fulani will come and occupy them. So, it is more about invasion, criminality, and terrorism. And the majority of those they hire to do these evils are not even those who have cattle. So, a deliberate action has to be taken by the government against the perpetrators, which will address the criminality.” Mr. Pogu suggested that the government should adopt ranching for productivity and enduring peace between the pastoralists and farmers in particular and the entire country in general.While the establishment of a Livestock Ministry presents a viable solution, it is not without challenges. Funding constraints, bureaucratic inefficiencies, and corruption can hamper its effectiveness. Additionally, deeply ingrained cultural practices and mistrust between farmers and herders can be difficult to overcome.
Critics argue that without a holistic approach that includes land reform, climate change adaptation, and broader economic development, a Livestock Ministry alone may not be sufficient. Therefore, it must work in tandem with other governmental and non-governmental bodies to ensure comprehensive solutions. “A dedicated Livestock Ministry, with its focus on sustainable resource management, conflict resolution, and economic incentives, offers a promising avenue to address the root causes of these clashes. However, its success depends on effective implementation, adequate funding, and the cooperation of all stakeholders involved. With the right strategies and commitment, devoid of any political or selfish interest, it can play a crucial role in fostering peace and prosperity in affected regions”, they advised.
Calista Ezeaku