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 cotrimoxazole 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 live. 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 phin@pro-hope.kabissa.org www.pro-hope.kabissa.org