CREATING AWARENESS AMONG PHYSICALLY CHALLENGED NIGERIANS ON THE REALITIES OF HIV/AIDS

BY
ADEBAYO ADEBUKOLA SHEHU
POLITICAL AND ADMINISTRATIVE RESOURCE CENTRE (PARC)
DECEMBER, 2006.
INTRODUCTION
I see as a golden opportunity to be here as a guest speaker to this august
gathering. I am indeed very grateful for the organizers for deeming it fit to
invite me. The topic before me is a very special topic. So special that it is
one which has drawn the concern and attention of the entire world for close
to three whole decades and yet we are still quite far from any permanent
solutions to it. This is why it is now the talk of the town.
Over the years, government at both national and international levels have
committed huge resources towards solving this problem. Other stake
holders alike have equally been using all means available to them to fight
this problem. However, instead of recording a decrease, what we have is
constant increase. You'll then ask where is the way out? This is what I have
tried to do in this paper. I have not really wasted much time trying to tell
you who a physically challenged person(s) is. Rather, I have chosen to go
strait to the subject matter so that I can within the limits of time and space
cover all that is very essential as far as this crucial topic is concerned. I have
looked at the HIV/AIDS phenomenon: its causes, its effects, its treatment
and prevention and other very essential issues bordering around the creation
of proper and extensive awareness on the issues of HIV/AIDS.
The HIV/AIDS crisis in Nigeria has reached a pandemic proportion.
Estimates from the 2001 sero prevalence survey carried out by the Federal
Ministry of Health shows that Nigeria has crossed the five per cent
threshold, signifying the point where HIV infection rates gallop at alarming
progressions.
1
From this assertion, AIDS may become the leading cause of death among
Nigerians. AIDS may also become the major causative factor of all deaths
due to malaria or tuberculosis. Although malaria, tuberculosis and nutrition related
ailments are currently the leading causes of death, AIDS has the
capacity to take advantage of these ailments to worsen Nigeria's disease
burden.
The Federal Government of Nigeria has responded to the crisis by setting up
the National Action Committee on AIDS (NACA), situated in the
Presidency, as the main response agency to lead the campaign against the
pandemic and its consequences. This national structure is also replicated at
the state and local government levels, through the State Action Committees
on AIDS (SACA) and Local Action Committees on AIDS (LACA).
In April 2001, the Federal Government launched the HIV/AIDS Emergency
Action Plan (HEAP), which is the national medium-term battle-plan to arrest
the spread of HIV in the country. The HEAP defines various strategies for
confronting the epidemic, particularly reducing the rate of infections and
providing care and support for people living with HIV.
One of the key strategies of the HEAP is creating awareness by the removal
of information barriers. The media (print and electronic) and other
stakeholders have a key role to play in this regard.
In the past few years, science has made significant advances in the
development of effective treatment for HIV/AIDS and related opportunistic
infections. Though no cure has been found yet, the development of lifeprolonging
treatment, especially anti-retro viral drugs, has given great hopes
and improved the quality of life of people living with HIV/AIDS.
While scientists continue to explore further research towards finding a cure
for HIV/AIDS, we should come to acknowledge that, in the absence of a
cure or a preventive vaccine, the most potent weapon available to deal with
it for now is awareness creation through information that will lead to
behavioural change.
So stakeholders and other professionals in the information dissemination and
entertainment fields, have an indispensable role to play. Without such
professionals, critical information about HIV/AIDS prevention measures,
2
consequences of infection, available treatment, etc cannot reach the intended
audience.
HIV/ AIDS: THE FACTS, THE MYTHS
Many people still confuse HIV with AIDS. Besides, medical knowledge and
opinion about the virus are constantly changing. When experts disagree,
public fears, myths and bigotry often come to the fore with the potential of
sensationalisation of the issues in the media.1 There is, therefore, a need for
journalists and communicators to make a distinction between the virus, HIV,
and the syndrome, AIDS.
HIV means Human Immunodeficiency Virus. It is the causative agent of
AIDS, and has the ability to destroy the body's immune system, which
normally fights disease.
Human means the virus is transmissible only between human beings, and
affects only human beings.
Immunodeficiency refers to the fact that the immune system, which
normally protects a person from disease, becomes weak or deficient.
Virus is a microscopic organism that causes disease in the body.
AIDS stands for Acquired Immune Deficiency Syndrome, the eventual
condition when an HIV-positive individual experiences a number of adverse
medical conditions and diseases.
AIDS is not a disease by itself. It is a condition that occurs when the body's
immune system does not work optimally or anymore, and the body cannot
protect itself from diseases.
Acquired means it is not hereditary, but transmitted from one person to
another through a specific behaviour.
Immune Deficiency is the weakness or breakdown of the immune system
used to fight diseases.
Syndrome is a collection of signs and symptoms of disease.
3
As the body's defence system has been compromised, a group of infections
which are responsible for the eventual illness and, or death afflict the
individual.
HISTORY OF HIV/AIDS
The Acquired Immune Deficiency Syndrome (AIDS) was first recognized in
1981 in the United States of America (USA). Since then it has become a
major worldwide pandemic. Abundant evidence indicates that the Human
Immunodeficiency Virus (HIV), which was isolated and tagged in 1983,
causes the destruction and, or, functional impairment of cells of the immune
system, notably CD4 + T cells. HIV progressively destroys the body's ability
to fight infections and certain cancers, thereby causing AIDS.
A marked increase in unusual infections and cancers characteristic of severe
immune suppression was first recognized in the early 1980s. This was
among homosexual men who had been otherwise healthy and had no
recognized cause for immune suppression. An infectious cause of AIDS was
suggested by geographic clustering of cases, links among cases by sexual
contact, mother-to-infant transmission, and transmission by blood
transfusion. Isolation of the HIV from patients with AIDS strongly
suggested that this virus was the cause of AIDS.
In Nigeria the first diagnosed case of HIV was reported in 1986. Since then
the prevalence has risen steadily over the years - 1.8 per cent in 1993; 4.5
per cent in 1996; 5.4 per cent in 1999; and 5.8 per cent in 2001, 6.4 per cent
in 2003 and 7.2 per cent in 2006 respectively. The prevalence towards the
end of 2006 represents a figure of about 9.5 million Nigerians already
infected with HIV. The highest prevalence, however, is in the age group 15
to 34 years, which is a reproductive and economically productive segment.
HIV-AIDS CONNECTION
Over the past years there has been an accumulation of overwhelming
scientific evidence that HIV infection is the cause of AIDS. This evidence
has, however, been muddled up in inaccurate media reports largely sourced
from a school of thought that disagrees with the mainstream evidence, and
continues to actively promote the idea that AIDS is not caused by HIV.
4
In Nigeria and other parts of Africa, the lack of consensus on the
relationship between HIV and AIDS has led to people avoiding
responsibility for preventing HIV transmission, or discourage HIV-infected
individuals from seeking appropriate treatment.
Before HIV infection became widespread, AIDS-like syndromes occurred
rarely, and almost exclusively in individuals with no causes of immune
suppression, such as chemotherapy and underlying cancers of certain types.
PROGRESSION FROM HIV TO AIDS
During the course of HIV infection, the crucial immune cells are disabled
and killed. These cells, sometimes called T-helper cells, play a central role in
the immune response, signalling other cells in the immune system to
perform their special functions. A healthy, uninfected person usually has 800
to 1,200 CD4 + T cells per cubic mill litre (ml) of blood, but the number of
these cells in an infected blood progressively declines.
When a person's CD4 + T cell count falls below 200/ml, he or she becomes
particularly vulnerable to the opportunistic infections and cancers that typify
AIDS, the end stage of HIV disease.
The time frame between infection with HIV and development of the array of
symptoms that represent AIDS varies from about 10 years to as short as
three to four years. This is due to availability and accessibility to drugs for
managing the syndrome.
People with AIDS often suffer infections of the intestinal tract, lungs, brain,
eyes and other organs, as well as debilitating weight loss, diarrhoea,
neurological conditions and cancers such as Kaposi's sarcoma and
lymphomas.
Many scientists think that HIV causes AIDS by directly killing CD4 + T
cells and by triggering other events that weaken a person's immune function,
thus impairing a person's ability to fight other infections.
MODES OF HIV TRANSMISSION
There are four major ways that HIV can enter a person's bloodstream:
1. Sexual intercourse (vaginal, anal or oral);
5
2. Transfusion of contaminated blood and blood products, and
transplants of tissues and organs;
3. Use of contaminated needles, syringes, razors and other piercing
instruments. The risk of getting HIV through a needle stick is 1 in 300
if that needle had been used on a person who was infected with HIV.
Keep in mind that the risk increases with the frequency of needle
sticks (i.e. particularly where needles, syringes or sharp objects are reused
without sterilisation);
4. Mother-to-child transmission (in the womb, during birth or through
breastfeeding). The risk of mother-to-child transmission of HIV is
approximately 25 per cent. The risk decreases to less than 10 per cent
if the mother takes AZT during labour and delivery.
Other body fluids have been shown to contain HIV, but they do not contain
enough of the virus to infect a person. These fluids include saliva, tears and
sweat. Therefore, it is not dangerous to come in contact with these fluids of
an HIV-positive person.
HIV is NOT transmitted through:
• Hugging, touching or shaking hands;
• Mosquito bites or other insect bites;
• Sharing eating utensils or other objects;
• Toilets or showers;
• Coughing or sneezing;
• Swimming pools;
• Public phones;
• Sharing food or drinks;
• Kissing
HIV PREVENTION METHODS
HIV transmission can be prevented easily if a person knows how to change
high-risk behaviour. Following are some ways to prevent HIV infection:
1. Abstain from sexual relations
2. Be faithful to one sexual partner. Get to know your sexual partner and
talk about your sexual history. Go for an HIV test if there is a risk that
either you or your partner is infected. It is safe to have sex with only
one uninfected partner if that person is also uninfected and is not
having sex with anyone else.
6
3. Use latex condoms every time you have vaginal, anal or oral sex if: -
You engage in casual sex; or - You and/or your partner have not been
tested for HIV
4. Seek medical treatment if you have a sexually transmitted infection
(STI).
5. Do not share needles, razors or other piercing instruments. If you are
forced to share such instruments, clean them with bleach and water
and not other "safe liquids" that beauty parlours claim to have.
6. See a doctor if you are pregnant and feel that you may be infected
with HIV.
7. Emphasise dual protection where feasible, particularly in `legalised'
polygamous settings.
HIV TEST
The HIV test shows if a person has produced antibodies to the human
immunodeficiency virus. It is usually a blood test, but in some places it is
possible for the test to measure antibodies in the tissue of the mouth or in
urine instead of blood.
It is important to note that even though HIV antibodies can be detected in
the saliva and in urine, the virus cannot be transmitted from one person to
another through saliva or urine. This is because there is not enough of the
virus in saliva or urine to infect people this way. HIV needs to be present in
very large quantities in order for a person to be infected. The only body
fluids that contain enough HIV to be infectious are blood, semen, pre-cum,
vaginal fluids and breast milk.
The HIV test does not detect the virus. It only detects the antibodies that the
person's body has produced to fight the virus.
HIV test can be done at designated hospitals and major medical laboratories.'
TYPES OF NIV TEST
In Nigeria, various types of HIV test are available:
1. ELISA
2. Rapid test
3. Western Blot
7
4. CAVIDI
The first test a person receives is either an ELISA or a rapid test. Both of
them need to be confirmed by another test if they come back positive.
An ELISA is normally confirmed by a Western Blot. But in special
circumstances another ELISA may confirm it. This can be done with the
same blood sample, so the person does not need to give blood again.
A rapid test is normally confirmed with an ELISA test. This cannot be done
with the same blood sample, so the person has to give blood again.
It can take anywhere from a few minutes to a few weeks to get the result of a
test, depending on the type of test and the laboratory that is used to analyse
the result.
CAVIDI is a new inexpensive screening test that detects the reverse
transcription enzymes of the virus. The introduction of this test reduces the
window period to about 2 weeks.
UNDERSTANDING TEST RESULTS
A positive result means that:
A person has been infected with HIV and can infect others by exposing them
to infectious body fluids such as blood, semen, precum, vaginal fluids or
breast milk. All positive results are confirmed with another test, called a
confirmatory test.
A negative result can mean one of two things:
1. The person has not been infected with the HIV virus, or
2. The person could have been infected only within the last 3-6 months,
and the body has not yet developed antibodies. It is for this reason that
a negative result is not taken to mean a person has not been infected
until the test is repeated 6 months later. Even then, another negative
would be meaningful only if the person was not exposed to the
possibility of getting infected. During the waiting period the person
should avoid the risk of HIV infection and putting others at such risk.
An indeterminate result
8
An indeterminate result means that it is not possible to tell if the person has
been infected with HIV based on the test result. In other words, the result is
inconclusive. This does not occur very often, but it can happen to people
who:
• Have had multiple pregnancies or miscarriages;
• Have received multiple blood transfusions;
• Have recently received an organ transplant;
• Suffer from other autoimmune diseases, such as lupus or Grave's
disease;
• Suffer from kidney disease or are receiving dialysis treatment;
• Suffer from liver disorders;
• Suffer from some types of cancer.
People who get indeterminate results should be tested again in three months'
time, particularly if they engaged in high-risk activities. Those who are at
low risk of HIV infection may not need to be re-tested.
Remember that the HIV test does not test for AIDS A positive HIV test does
not mean that a person has AIDS. Only a doctor can make an AIDS
diagnosis based on T -cell levels and opportunistic infections.
THE WINDOW PERIOD
This is the time between the infection with HIV and the development of
antibodies. During this time the HIV test will be falsely negative because
HIV antibodies are not yet present in the blood even though the virus is. In
other words, the person is actually infected with HIV but the test will show
up negative.
It can take anything from 3 to 6 months for the antibodies to show up in the
blood. However almost all infected people - 99 per cent develop antibodies
within 3 months. Some testing sites now have more sophisticated tests that
are able to `shorten' the window period. In other words, they can detect
antibodies within a much shorter period of time - approximately 25 days
after infection.
Where this new test is not available, a person who has got a negative test
result and has recently engaged in risky activity should be tested again 3-6
months after the last time he/she engaged in risky behaviour. For instance, if
9
they had unprotected sex one month ago they should be tested again in 2-5
months' time.
The only way a person can be certain that he/she is not infected is if he/she
was tested at least 6 months after the risky event, and since which there has
not been any risky activity.
IMPORTANCE OF PRE- AND POST TEST COUNSELLING
Anyone who wishes to go for an HIV test should receive professional
counselling before and after the test.
Pre-test counselling helps to prepare the client for the HIV test, explains the
implications of different test results, and explores ways of coping with a
positive status. It also explores sexuality, relationships, risk behaviours and
HIV prevention.
Post-test counselling helps the person to understand and cope with the HIV
test result. This includes preparing the client for the result, giving the result,
and providing further information or referrals as required.
Counselling before and after the test is important because standard medical
procedure requires that a person gives informed consent before being tested.
Pre-test counselling gives the client the opportunity to get information and
support to make this decision.
HIV/AIDS AND SPECIAL POPULATIONS
Women, persons living with disabilities and children, as well as a number of
other groups and sub-groups in the society, by the nature of what they are or
do, present a special challenge in the matter of proper awareness on the
realities of HIV/AIDS. Such groups include the physically challenged i.e.
(the visually impaired, the deaf, the mentally retarded as well as the
physically handicapped persons), military, long distance drivers, commercial
sex workers, refugees (including internally displaced persons) and youths.
On account of this, it is up to all stakeholders involved in the fight against
10
HIV/AIDS such as the government, NGO’S, various associations of the
physically challenged persons such as the National Association for the Blind
NAB, to draw attention to the special problems of such special population
groups, with a view to ensuring that policies to address them are designed
and implemented. This is because strategies for most HIV/AIDS prevention
and control programmes are hampered by lack of considerations for special
populations.
The purpose of this section is to equip ourselves with the knowledge to
appreciate the wider implications of HIV/AIDS for different segments of the
society. Increased knowledge will give them the vital information to
appraise these programmes.
Organizations of physically challenged persons need to avail themselves
with current information and developments on issues bordering on the
HIV/AIDS with a view to educating their members. More of such
programmes as this one should be frequently organized and such
programmes must not be limited to only one geopolitical zone in the
country.
In addition, intellectual materials on HIV/AIDS should be reproduced in
formats that will be accessible to physically challenged persons especially
the visually impaired. Such materials for the visually impaired should be
available in Braille or produced in soft formats for those who are computer
literates.
Meanwhile, organizations of physically challenged persons should make
effective use of the mass media to further spread its campaigns to the loops
and corners of the country.
It is important to also acknowledge that in view of the general social
discriminations faced by physically challenged persons, if such persons
become unfortunate to contact the HIV/AIDS, convincing such persons to
accept such realities and pursue relevant counselling may be very difficult.
This is why it is very necessary for the society to avoid any forms of
discriminations against the physically challenged if we are to encourage
those living with the HIV/AIDS infections to feel accepted in the society.
However, if this stigmatization and discrimination against physically
challenged goes unchecked, we may be sending wrong signals to our brother
and sisters living with the HIV/AIDS infection and as such it will be
11
difficult to control the spread of the virus. Since we have acknowledged that
stigmatization and discrimination are very essential problems militating
against successful curtail of the disease, government, NGOs, all social
institutions including the educational sector must do all they can to stop
further discriminations and stigmatization of all physically challenged and
vulnerable groups.
Finally, let me draw the curtains on this lecture by advising our friends and
colleagues living with one form of disability to eschew all forms of moral
decadence and maintaining discipline and high sense of moral values in their
social lives. As we all know, abstinence and mutual fidelity are the best
principles which lovers or married couples must uphold. Similarly, it is my
hope that the various areas of concern touched by this paper will be noted by
all participants here present such that they do not fall victim to such
vulnerable practices like blood transfusion and sharing of sharp objects.
That one is physically challenged is no excuse to claim ignorance of the
reality of HIV/AIDS. Even the stack illiterates are now admitting the reality
of the disease. While the government and other stakeholders are doing their
best, we too should ensure that we stay alive by complying with useful
information which forums like this bring to our awareness.
Thank for listening.