PLWHA and Treatment Access in Nigeria

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					PLWHA and Treatment Access in Nigeria

Last week, a coalition of NGOs representing people living with HIV/AIDS
called on the Nigerian Government to provide free anti-retroviral drugs to
those who need it. Since that call, there have been lots of reactions from both
HIV/AIDS activists and other Nigerians. Some of these reactions while
possibly well intentioned seem to be missing some crucial issues about the
use of anti-retroviral drugs. While I do not claim to be an expert in Nigerian
Economy and Health care system, I believe that the issue of anti-retroviral use
goes beyond the routine economics of health care funding. Never in the
history of the world has such a strong alliance between rich and poor
countries come together to fight a common enemy as we are witnessing with
HIV/AIDS. This is because HIV/AIDS is a serious threat not just to the poor
countries but also to humanity in general. One can therefore state that
HIV/AIDS places us in a very awkward situation; combating it therefore
requires ingenious, if you like, extra-ordinary solutions.

I do not believe that ARVs in Nigeria have been subsidized enough. While it is
true that the Nigerian government should be commended for even agreeing to
subsidize ARVs, albeit reluctantly, it has not done enough. Presently it costs
about N1000 a month to purchase ARVs in Nigeria. That means about
N12000 a year. At first look, this might seem a very small mount. However, it
would be important to remember that purchase of ARVs is only one of the
problems. This amount excludes the cost of treating opportunistic infections. It
excludes the cost of personal maintenance. Because of the peculiarities of
HIV, a person living with HIV/AIDS needs to take extra care of himself or
herself. This includes adequate nutrition, personal hygiene, other ancillary
drugs like multivitamins among others. This N1000 a month also excludes
cost of investigations. Because of the properties of ARVs, it is important that
those taking it should undergo occasional laboratory investigations. This is
also needed to monitor response to treatment.

Assuming that on the average, a PLWHA has one episode of oral candidiasis
(oral thrush) lasting two weeks in a year and requiring treatment with Nystatin;
lets assume that to treat this he requires about N200 (being conservative). To
avoid Pneumocystis carini pneumonia, he has to constantly be on co-
trimoxazole prophylaxis. At a dose of two tablets a day that gives us about 28
tablets a week. Let us assume that he uses 20 tablets of co-trimoxazole
(septrin) a week at the rate of N2 a tablet. That is N40 a week or N2080 a
year on septrin alone. Let us assume too that he has to undertake a detailed
clinical assessment once every 6 months. This ideally involves clinical
consultation, physical examinations and laboratory investigations. At the
minimum, the laboratory investigations should include a full blood count and
liver function test. However, a CD4 count would be important. Let us assume
he spends about N3000 for all the investigations including cost of clinical
consultation. This makes it N6000 per annum. Then there are other hidden
costs that he still has to take care of.
At the end of the day cost to the PLWHA attributable his/her condition will be
close to N30, 000 per annum that is assuming he or she does not have any
major events during the year like developing a major illness like tuberculosis
or any of the other associated illnesses. We must not lose sight of the fact that
these are human beings with family responsibilities to cater for. Most of these
people have dependants. In a family, there may be more than one person
living with HIV/AIDS and requiring treatment. In such a situation, you need to
multiply the cost by the number of PLWHAs. So assuming that there is a
family with 2 HIV positive persons requiring treatment. We are talking of about
N60,000 per annum for treatment alone – excluding cost of education for the
children, and other family responsibilities.

Without boring you further, the point I am making here is that HIV is a big
burden for those infected and affected. We all don’t have to become infected
or affected to properly appreciate the plight of these our brothers. As an HIV
physician, I know the burden on even the well offs in the society. I therefore
strongly believe that the demands of the PLWHAs in Nigeria for free treatment
are not only legitimate but are essential. I completely support their demand
and call on the government to give it the serious consideration it deserves.

Two issues I would want to refute are that if PLWHAs are given free drugs it
will end up under the bed and that Nigeria is too poor to afford free ARVs.
While it is true that many patients who receive free medical care do not value
such care, I strongly believe that with HIV we are dealing with an entirely
different situation. HIV is such a serious condition that I do not believe that
any PLWHA who has the privilege of a life saving drug will toy with it. In any
case, we do not have to throw away the baby with the bath water. That others
have misused opportunities given to them does not mean that every other
person will behave the same. Let us give our brothers and sisters a chance to

On the second issue, I firmly believe that Nigeria has the wherewithal to
provide free ARVs to every Nigerian needing it. We are all witnesses to the
Jamboree going on in Abuja. We are all witnesses to the unnecessary waste
of resources in the various states of the country. We are not unaware of the
price of crude oil, which has remained above $40 per barrel for months. In a
country with conscience, and respect for human life, I do not believe the issue
of free ARVs should be a topic for discussion. It should only be natural. It
should be a human right. Nigeria has nothing to glory about considering the
proportion of people on ARV compared to those who actually need it. The
travelling allowance of just one member of the house of representative would
be enough to provide ARVs for at least 20 PLWHAs a year. If all the
legislators should forgo one trip each a year, all the PLWHAs needing ARVs
will be catered for. We have to face the fact. It is either Nigeria is ready to
cater for her citizens battling for survival or she is supporting euthanasia.

Thank you for your time
Dr. Chidi V. Nweneka
Technical Adviser
Pro-Hope International

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