Ongoing strike action has disrupted HIV treatment across Nigeria
This week, the ongoing strike action embarked upon by Nigerian health workers under the umbrella of the Joint Health Sector Unions (JOHESU) would be 4 weeks old. Even though the end is not yet in sight, there are strong indications it could worsen the country’s HIV/AIDS indices, particularly Nigerians living with the HIV virus whose treatment plans are now interrupted as a result of the strike action.
This development is of particular concern in Nigeria where only 24% of citizens with HIV have suppressed viral loads according to UNAIDS.
According to US Department of Health and Human Services, discontinuation of antiretroviral therapy (ART) may result in viral rebound, immune decompensation, and clinical progression.
Nigeria accounts for the world’s second largest HIV epidemic and its response is guided by the National Strategic Framework 2017–2021, which aims at ending AIDS by achieving zero new infections, zero AIDS related deaths and zero discrimination.
HIV clinics in Nigeria that offer free antiretroviral drugs are located within public hospitals and healthnews.africa gathered that citizens with the virus visit the clinic monthly to collect drugs that they will use for the next one month. But with the strike action affecting the hospitals, HIV patients will not be able to get the drugs they need to reduce the viral load and improve outcomes.
In a chat with healthnews.africa, a doctor attending to HIV patients in Ibadan, southwest Nigeria revealed that several patients with the virus are defaulting even before the hospitals were on strike. But with the strike action not ending anytime soon, the expert said the patients now have a good excuse for not coming to the clinic.
“They always give excuses for not coming to the clinic and the strike has given them a very valid excuse,” the doctor said.
Recounting the experience of the last strike action embarked upon by health workers at the public hospital, the doctor said gatemen at the main entrance sent patients back home at the gate even though the clinics were open during the period.
“During the last strike, security operatives sent patients away even though the HIV clinic was working, the patients were sent back leading to lots of treatment defaulters,” the physician said.
Even though the impact of not receiving treatment could be dealt with if the strike is called off on time, healthnews.africa gathered that many patients will not come to the clinic immediately the strike is called off until there are complications.
“Many of the patients that defaulted during the last strike were brought back to the clinic when they started having complications. When asked why they did not come to the hospital immediately the strike was called off, they said they weren’t informed about the suspension of the strike action.”
Nigeria’s treatment default problem
In addition to strike actions, experts said another major reason why HIV-positive Nigerians default in their treatment is the perception that they have been healed.
People who are informed of the “undetectable viral load” result when they go for testing are quick to jump to the wrong conclusion that the virus is no longer in their blood, that they are therefore no longer sick and no longer have need for treatment – and then default on their treatment.
An HIV counsellor said that when a patient has an undetectable viral load, it does not mean the HIV virus is no longer inside their body. It just means that their medication is working and that the amount of virus particles in their blood has dropped so low that they cannot be counted, and they are said to have an “undetectable viral load”.
“For most tests used clinically today, this means fewer than 50 particles of HIV per milliliter of blood. Reaching an undetectable viral load is a key goal of ART. An undetectable viral load means a person is about 96% less likely to transmit the disease,” the expert said.
In 2016, Nigeria had 220,000 new HIV infections and 160,000 AIDS-related deaths. There were 3.2 million people living with HIV in 2016, among whom 30% were accessing antiretroviral therapy. Among pregnant women living with HIV, 32% were accessing treatment or prophylaxis to prevent transmission of HIV to their children. An estimated 37,000 children were newly infected with HIV due to mother-to-child transmission. Among people living with HIV, only 24% had suppressed viral loads.