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The where, how & cost of HIV drugs in Nigeria

HIV drugs in Nigeria
Drug management is one of the treatment, care and support modalities of people living with HIV/AIDs in Nigeria. Drug treatment of people living with HIV/AIDs in Nigeria is known as anti retroviral therapy.

What is anti retroviral therapy?

This is the type of treatment for HIV or AIDs. It is not a cure but it can stop people living with HIV from becoming ill for many years. The treatment consists of drugs that have to be taken every day for the rest of your life. The drugs which work against HIV infection itself by slowing down the reproduction of the virus in the body are referred to as anti retroviral drugs (ARV), anti – HIV drugs or HIV antiviral drugs. Most of these HIV drugs in Nigeria are highly subsidized by the federal government. Hence, they are provided free in most health institutions or you may be required to pay for them.

What are ” Combination Therapy” and HAART in Nigeria?

For antiretroviral treatment to be effective for a long time, more than one antiretroviral drug needs to be taken at a time. This is what is known as “Combination Therapy”. If one drug is taken on its own, it has been found that, over a period of time, the drug stops working. HIV reacts to the drug in your body and changes, so that the virus is no longer affected by the drug. The virus then starts to reproduce itself the same way as before. This is known as the virus becoming resistant to the drug. If two or more antiretrovirals are taken together it will reduce the rate at which resistance develops. The term Highly Active Antiretroviral Therapy (HAART) is used to describe a combination of three or more anti- HIV drugs.

Classes/groups HIV drugs in Nigeria

There are 4 main groups of anti-retroviral drugs in Nigeria. They are the following:

1) Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)- table below showing the generic and brand names of NRTIs. Lamivudine, zidovudine and stavudine being the most popular ARVs in Nigeria. Stavudine was banned by NAFDAC because of its fatal side effects

2) Non-nucleoside reverse transcriptase inhibitors (NNRTIs). Check table below. Efavirenz and nevirapine are the most commonly used in Nigeria.

3) Protease inhibitors (PIs). Table below showing the generic names and brand names of HIV drugs in Nigeria. These groups of ARVs are known as protease inhibitors. Indinavir is the most popular of these drugs.

4) Fusion or entry inhibitors. New drug in town

There are currently more than 20 NAFDAC approved HIV drugs in Nigeria. As you can see above, the drugs are referred to by their research or chemical names and less often in their brand names, for example AZT (zidovudine). The second name of the drug is the common name for all the drugs with the same chemical structure, for example AZT is also known as Zidovudine. The third name of the drug is the brand name given by the pharmaceutical company; in Nigeria, one of the brand name of zidovudine is Retrovir. Lastly, an abbreviation of the of the common might also be used such as ZDV, which is the fourth name given to zidovudine.

Getting medications, where to get ARVs in Nigeria

In Nigeria, out of the 3.4million persons living with HIV, only 750,000 are on antiretroviral therapy(ART). This is partly due to ignorance as most persons do not know that HIV treatment in Nigeria is FREE or infected persons do not know where to get the drugs.

HIV drugs in Nigeria
Getting your ARV in Nigeria. Getting treated.

Right now, increasing number of drugs are now being licensed by NAFDAC for treatment of HIV and opportunistic infections. In Nigeria, antiretroviral drugs are available on prescription in hospital pharmacies, community pharmacies and some religious houses. Apart from cost related issues, better sources of these drugs are all Federal Teaching Hospitals, Federal Medical Centres and PEPFAR (USA/Nigeria Partnership for HIV/AIDs Relief) project centres. Currently, the following hospitals provide free antitetroviral drugs under the PEPFAR project:

1. Charles Boromeo Hospital, Anambra State, Nigeria

2. Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra state

3. General Hospital, Calabar , Cross River state

4. University of Calabar Teaching Hospital, Calabar, Cross River state

5. University of Benin Teaching Hospital, Benin city, Edo state

6. Central Hospital Benin City, Edo state

7. Gwagwalada General Hospital, Abuja, Federal Capital Territory

8. National Hospital, Abuja, FCT

9. Wuse General Hospital, Abuja, FCT

10. Massey Street Children’s Hospital, Lagos, Lagos State

11. Island Maternity Hospital, Lagos, Lagos state

12. Mainland Hospital, Ebutte-Metta, Lagos state

13. Aminu Kanu Teaching Hospital, Kano, Kano state

14. Infectious Disease Control Hospital, Kano, Kano state

15. Muritala Mohammed Hospital, Kano, Kano state.

In Lagos, Edo, Anambra, Adamawa states, HIV drugs are available free of charge. But for some hospitals listed above, one month supply of the drugs is available for patients at #1,000 naira. Buying HIV drugs in pharmacy shops that is not under PEPFAR is very expensive.

You can visit one of the heart to heart centres in Nigeria for free HIV drugs, testing and counseling.

HIV/AIDS medications and dietary supplements in Nigeria

Although many people with HIV take dietary supplements, vitamins or herbal remedies in the hope of boosting or protecting their immune systems and general health, evidence that these have any beneficial effect is somewhat thin. It is important to to know that that certain supplements, such as large doses of garlic, can stop some anti- HIV drugs from working properly. Large doses of vitamin A can cause liver and bone damage, as well as vomitting and headache. Vitamin C doses above 1,000mg per day can cause kidney stones, diarrhoea and hardening of the arteries, and reduce the concentration or effectiveness of indanavir (crixivan). Vitamin E supplements should not be taken with amprenavir (agenerase). Above 75mg per day of zinc can cause the shortage of red and/or white blood cells. Large doses of selenium can suppress your immune system and excess doses of vitamin B6 cause painful nerve damage. Please watch the supplements!

cost of HIV drugs in Nigeria

The Nigerian government policy to provide antiretrovirals freely as part of HIV programs at the country’s health facilities has greatly improved the uptake of treatment. Excellent policy, but free drugs for HIV patients is not enough. It is well known that  HIV/AIDS increases a persons vulnerability to opportunistic infections, persons living with HIV in Nigeria often incur other expenses like non-antiretroviral drugs e.g antibiotics, non-routine tests, medical consultations, transportation, food, admission and hospital stay. These cost are not covered by government programs. Most of the patients are not on health insurance, so they do out of pocket treatment for these diseases. This makes treatment of HIV in Nigeria very expensive making most citizens seek the alternative (herbal ‘cure’).

Kudos to Anambra, Lagos, Edo, and Adamawa states that pay part of the treatment for opportunistic infections.

Please note the HIV/AIDS is NOT a death sentence. Get tested and treated.

Resources:

HIV/AIDS information for the Nigerian Community

social & economic impact of HIV in africa

Impact of HIV in Africa

What is the effect/impact of HIV in Africa?

The characteristics of HIV/AIDS and its mode of transmission are the principal determinants of its impact on the society. The impact extends beyond those living with the virus, as each infection produces consequences which affect the lives of the family, friends and the communities surrounding an infected person( society). Overall, the impact of epidemic encompasses effects on the lives of millions of people living with HIV/AIDS, and families and friends of those who have died from the disease. In Africa, poverty, abuse, violence, corruption, prejudice and ignorance have fueled the wealth of opportunities for HIV to thrive among tragic human conditions. Thus HIV has undermined economic, social,  demographic (population) development and decreased average life expectancy by 20 years, reversing decades of gains. It is important to point out that HIV/AIDS can deplete families and communities of the assets and social structures necessary for successful prevention and provision of care and treatment for persons living with the disease. Those must affected HIV in Africa are children.

READ ALSO: PREVALENCE OF HIV IN NIGERIA

The effect/impact of HIV in Africa can be divided in four broad areas, namely

1) Demographic impact

2) Economic impact

3) Social impact

4) Developmental impact

1.Demographic impact of HIV in Africa

HIV/AIDS will increase the morbidity (more people will die) and many of these people will be in their reproductive years. This could reduce fertility rates. However, it is not expected that the epidemic will stop population growth, or cause decline in Africa populations. What it will do in some regions, is to slow the rate of population growth and alter the structure of population. Since HIV/AIDS is highest in people between the ages of 20 and 40 years (the workforce), the number of people in this age group is expected to decline, resulting in increased dependency ratios. This is particularly important as these are the most productive members of the any society. Collectively this cohort embodies a substantial human capital investment, much of which will be lost. The number of children who will become orphans will increase and they will have special needs, especially as the numbers increase and extended families are no longer able to cope.

Impact of HIV in Africa
HIV affects us all either directly or indirectly.

2. Economic impact of HIV in Africa

HIV is only one of a number of pressing problems faced by policy makers  in developing countries especially Nigeria. At the household level, the cost of medical care and related areas will increase. In addition, if the infected person is an adult, then production and income of the household will diminish. National economies may also be affected through the illness and death of producers and the diversion of resources from savings (and eventually, investment) to health care. Applying HIV epidemic and the economic trends, it has been estimated that the economic impact of HIV in Africa will probably reduce the rate of economic growth to a significant point over a period if 20 years. This means that the implications of the macro-economic impact are far from clear and not really usable- other than to note the need to prevent the epidemic and plan for its effects.

3. Social impact of HIV in Africa

The social impact of HIV in Africa  is often  a product of the illnesses and death of individuals, and the consequent effect on the family, community and broader society. Obviously critical to this impact will be who falls ill and dies in terms of their role in the family and community. The death of an adult male, who is the income earner, will affect the family’s access to resources. The death of an adult female may result in children receiving less care and females being taken out of school.

4. Developmental impact of HIV in Africa

In Nigeria, Africa and the world, development is seen as more than economic growth and increases in Gross Domestic Product (GDP) per capita. The impact of the HIV epidemic is expected to be felt, first and worst in aspects such as longevity, standard of living, infant, child and mortality and distribution of income. The indicators of life expectancy, infant mortality rates, child mortality rates and crude death rates are particularly vulnerable. AIDS reverses hard won development gains in Africa and makes its people and nations worse off. In addition, it makes further developmental attempts much more difficult as the HIV/AIDS hurdle has to be surmounted in to the other pressing developmental problems. These effects may possibly last for decades.

This article also cover similar topics like effects/impact of HIV in Nigeria.

Resources:

HIV/AIDS information for the community by Erah and Kubeyinje

Wikipedia

Hiv statistics in Nigeria: why the increasing prevalence?

Hiv statistics in Nigeria

I will start this article with the following albeit controversial and shocking headlines.

Nigeria ranks largest HIV epidermic nation- vanguard

600,000 persons are living with HIV/AIDs in Benue- Vanguard

16, 000 persons living in Borno died of HIV in 3 years- Vanguard

It is estimated that  36.7 million people are living with HIV/AIDs, 25.5million of these people living with HIV are in sub- sahara Africa. As at 2016, it was estimated that 3.2 million nigerians are living with HIV with one-third of the persons between the ages of 15-24 years. Half of the new cases of HIV in Nigeria each year occurs in youths under age 25. Of all HIV positive people world wide, 90% are in the developing world. It is estimated that each day 16, 000 more people are infected with HIV. More than 22 million people, including 3.6 million children, have died from AIDs since the start of the global pandemic. In 2004, nearly 14 million children have become orphans due to AIDs.

who is affected by HIV/AIDs in Nigeria?

HIV/AIDs mainly strikes adolescents, young adults, and those in early middle age, killing people in the prime of their lives. It has no regard for culture, tribe, colour, social class or religion. Unfortunately, most Nigerians are unaware they are infected with the HIV virus. Young women are more vulnerable  than other age groups.

what is the prevalence of HIV in Nigeria?

In statistics, prevelance of a disease or any health related events means the total number of old cases (people already living with the disease) and new cases ( people newly diagnosed) of the disease usually in a year. The official HIV prevalence as published by UNAIDs in  2014 is 3.2% meaning a total of  between 3.2 -3.4 million Nigerians are living with HIV/AIDs. 

Below is a table showing the prevalence of HIV in Nigeria over the years stating from 1991:

1991 (1.8%)

1993 (3.8%)

1995 (4.5%)

1999 (5.4%)

2001 (5.8%)

2003 (5.0%)

2005 (4.4%)

2008 (4.6%)

2010 (4.8%)

2014 (3.2%)

Key: figures in brackets represent HIV prevalence

Comments and Observations on the  table showing the Nigeria HIV prevalence above:

  • HIV prevalence study in Nigeria is done every 2-3 years by the National Agency for the Control of AIDs.
  • The survey started in 1991. HIV/AIDs was discovered in Nigeria in 1986, meaning valuable data from 1986-1990 are not available. Also you will notice that no study was conducted between 1995-1999. All these lapses and inconsistences makes data on HIV statistics in Nigeria controversial and highly disputed.
  • There was a steady rise of HIV prevalence in Nigeria from 1991 to year 2003. What could be responsible for this? Maybe lack of awareness and poor enlightenment programmes couple with lack of actionable plans/target on the part of government in curbing the menace.
  • Nigeria has had a steady decline in HIV prevalence from year 2005 till 2014. This is commendable and probably due to increased aware programs from the government, non-governmental organizations, religious houses and civil society organisations

In Nigeria, it is estimated that every 5 out of 100 persons (5%) has HIV/AIDs. The number of people living with HIV various from 1 to 12 in every 100 persons in the 36 states of the country.  Contrary to widespread belief, Nigeria is NOT the country with the highest HIV/AIDs prevalence in the world, it is South Africa. According to the country’s HIV/AIDs agency,  10.9% of South African population are HIV positive. Nigeria has the second highest HIV prevalence in the world. India which used to be the first is now ranked third as 0.3% of the their adult population are HIV positive ( remember their population is in billions).

Now we are going to see the estimated number of people living with HIV in each of the states in Nigeria. First, we will look at the 2004 state by state HIV prevalence data and then the 2014 data. This will enable us know how well our state government, the federal government and other bodies are taking the fight against HIV/AIDs in our home states and in Nigeria.

State by state HIV prevalence in Nigeria, 2004 estimate

  1. Cross River (12.5%)
  2. Benue (10%)
  3. FCT  (8%)
  4. Adamawa (7.5%)
  5. Akwa Ibom (7%)
  6. Niger (6.9%)
  7. Lagos (6.7%)
  8. Gombe (6.5%)
  9. Rivers  (6.4%)
  10. Nasarawa (6.2%)
  11. Plateau (6%)
  12. Kaduna (5.8%)
  13. Taraba (5.6%)
  14. Kogi (5.5%)
  15. Delta (5.4%)
  16. Enugu (5.3%)
  17. Bauchi (5.1%)
  18. Ebonyi (5%)
  19. Sokoto (4.9%)
  20. Edo (4.8%)
  21. Kano (4.7%)
  22. Bayelsa (4.5%)
  23. Yobe  (4.4%)
  24. Oyo  (4.3%)
  25. Anambra (4.2%)
  26. Abia (4.1%)
  27. Zamfara (4%)
  28. Borno (3.6%)
  29. Imo (3.4%)
  30. Katsina (3.2%)
  31. Kwara (3%)
  32. Kebbi (2.7%)
  33. Ondo (2.5%)
  34. Ekiti  (2.2%)
  35. Jigawa (2%)
  36. Ogun (1.8%)
  37. Osun (1.4%)

Above list is the 2004 estimate of  States ranking of HIV/AIDs prevalence in Nigeria. Figures in brackets represent percentage prevalence.

Hiv statistics in Nigeria
Hiv statistics in Nigeria: Symbol of HIV/AIDs.

Between 2009 and up till 2014, Benue state took “lead” of the state with the highest HIV rate in Nigeria. In 2015, HIV statistics(prevalence) in Nigeria changed with survey and study conducted and reported by NACA.

HIV statistics in Nigeria- states with the highest HIV rate in Nigeria

  1. Rivers (15.2%)
  2. Taraba (10.5%)
  3. Kaduna (9.2%)
  4. Nasarawa (8.1%)
  5. FCT (7.5%)
  6. Akwa Ibom (6.5%)
  7. Sokoto (6.4%)
  8. Oyo (5.6%)
  9. Benue (5.6%)
  10. Yobe (5.3%)
  11. Cross River (4.4%)
  12. Ondo (4.3%)
  13. Gombe (3.4%)
  14. Abia (3.3%)
  15. Bayelsa (2.7%)
  16. Osun (2.6%)
  17. Imo (2.5%)
  18. Borno (2.4%)
  19. Plateau (2.3%)
  20. Lagos (2.2%)
  21. Jigawa (2.1%)
  22. Adamawa (1.9%)
  23. Kogi (1.4%)
  24. Kwara (1.4%)
  25. Kano (1.3%)
  26. Enugu (1.3%)
  27. Niger (1.2%)
  28. Anambra (1.2%)
  29. Ebonyi (0.9%)
  30. Edo (0.8%)
  31. Kebbi (0.8%)
  32. Delta (0.7%)
  33. Bauchi (0.6%)
  34. Ogun (0.6%)
  35. Zamfara (0.4%)
  36. Ekiti (0.2%)

Above are the states with the highest HIV rate as published in 2015 by NACA.

Rivers is now the state with the highest hiv prevalence in Nigeria followed by Taraba,  Kaduna, Nasarawa and Abuja.

Benue used to be the state with the highest HiV prevalence rate in Nigeria, but due to dedicated and collaborative efforts of Benue State Action Against Control of Aids (BENSACA) and other partners, the state had dropped to the 9th spot in the country.

What about you home state on the the list? Has it dropped or climbed the ladder?

Nigeria has made progress in reducing its HIV prevalence but analysts and even the Director General of NACA, Dr Sani Aliyu,  thinks we can do better. In his words:

Here in Nigeria, we have recorded a steady decline in HIV prevalence from a peak of 5.8% in 2001 to 3.2% in 2014. But this has not been an easy ride and challenges still exist- condom use is still too low and covers less than half of our need in Nigeria (Sub-saharan Africa). There is a dearth of knowledge on HIV among young people, with only a third having enough knowledge to safeguard themselves.

Dr Sani Aliyu, DG NACA

Why the steady/increasing prevalence of HIV in Nigeria?

Statistics of HIV in Nigeria published have shown steady or slow decline in HIV incidence or prevalence in Nigeria.

Below are reasons we are making slow progress in combating the menace:

1. Stigma and Denial

Some people may feel isolated and rejected. The social stigma associated with HIV prevents people from getting tested and knowing their status. The first step in curbing the spread of HIV and hence reducing the prevalence in Nigeria is by knowing your status and accepting your status and starting treatment immediately.

2. Civil strife and insurgency

The context of war and struggle for power spreads HIV/AIDs. For Bokoharam since its inception in North-Eastern Nigeria has lead to the increased prevalence of HIV in that region especially Yobe, Adamawa and Borno.

3. Cultural factors have made reducing the negative HIV statistics in Nigeria difficult

Traditions, beliefs and practices affect understanding of health and disease and acceptance of conventional medical treatment. Culture can create barriers which prevent people, and especially women, from taking precautions. For instance, pressure to breastfeed may expose more infants to HIV. Also, spousal inheritance in many African traditional settings may expose many people. Similarly, the pressure to bear children as we’ll as cultural and religious practices inhibits condom promotion in many places.

4. Poverty

Poverty can lead to lack of information needed to understand and prevent HIV in Nigeria. Poor nutritional status often results from poverty and increases the risk of contracting HIV/AIDs. Commercial sex for income and reduced access to health services have shifted the HIV statistics in Nigeria to the negative side.

5. Gender inequalities

In many cultures in Africa (Nigeria), men are expected to have many sexual relationships, unlike women. A woman may suffer the consequence of being sent packing out of her matrimonial home if she complains about her husband having an affair with another woman. Women suffer gender inequalities and it is often economic in nature. Women may not feel empowered to negotiate whether  sex happens at all or to negotiate condom use.

My summary of HIV statistics in Nigeria

Nigeria is a country of 170 million peoples.

Out of the 170 million Nigerians, 3.2 million are living with HIV/AIDs.

Out of the 3.2 Million  persons infected with HIV, only 750,000 (20%) are on anti-retroviral (ARV) treatment.

95% of those on ARV are on donor funding (free drugs and treatment)

Nigeria HIV prevalence is 3.4%.

Rivers state has the highest HIV prevalence in Nigeria.

Many Nigerians still don’t know their status.

The fight against HIV in Nigeria must be sustained by not only government but by everybody. Contribute your quota to reducing the negative HIV statistics in Nigeria.

Do know your status? Please check out where you can get tested in Nigeria here.

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