How stigma is affecting HIV treatment in Nigeria

Benue State University Teaching Hospital (BSUTH), Makurdi. [PHOTO CREDIT: Official Facebook account of BSUTH]
Benue State University Teaching Hospital (BSUTH), Makurdi. [PHOTO CREDIT: Official Facebook account of BSUTH]

“As a lady born with HIV, I have faced lots of stigma issues that made me feel people living with HIV are not humans.

“The worst of them all was when a laboratory scientist revealed my status to my friend and the entire community got to know about it.

“It was a depressing period for me, and the only thing that kept me going was my boldness.”

These were the words of Anita Ikwe, a 21-year-old woman.

Stigma and discrimination are considered major problems for people living with HIV/AIDS globally.

Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV).

People living with HIV often experience stigma, hostility, denial of gainful employment, forced resignation or retirement, delivery of poor quality treatment and segregation in hospital wards.

From the reporter’s findings, fear of rejection is rife amongst persons living with the ailment in Nigeria.

Miss Ikwe is one of the many Nigerians born with the virus.

“At age 10, I saw a doctor at the University College Hospital, Ibadan writing HIV positive and viral load on a form.

“While I was stepping out, I asked my mum. Do I have HIV? And her response was, yes; you have HIV. She said it carelessly, and that was how I knew about my status,” she said

Just like Ms Ikwe, millions of People Living With HIV (PLHIV) have to deal with stigma.

“Once people know you are positive to the virus, the stigma comes in consciously or unconsciously.

“Stigmatisation is nothing new to people living with HIV. If you do not experience it from family members, you will get it from health workers and society.

“As long as the society is concerned, once you have HIV, you have become a walking ghost,” says Ameh (the first name withheld).

However, unlike Ikwe, Ameh was not born with the virus.

“I was not born with HIV. I got to know of my status at age 22,” she said.

Global HIV Prevalence

The ailment is one of the world’s most serious public health challenges.

According to UNAIDS, about 36.9 million people worldwide were living with HIV/AIDS in 2017, of which 1.8 million were children.

The Nigerian HIV/AIDs Indicator and Impact Survey (NAIIS) indicates that about 1.9 million Nigerians are currently living with the disease, according to the National Agency for the Control of AIDS (NACA).

Globally, in 2017, about 21.7 million people living with HIV (59 per cent) were accessing antiretroviral therapy, an increase of 2.3 million since 2016 and up from 8 million in 2010.

AIDS-related deaths are also said to have reduced by more than 51 per cent since its peak in 2004.

In 2017, 940 000 people died from AIDS-related illnesses worldwide, compared to 1.4 million in 2010 and 1.9 million in 2004.

Stigma

According to the Executive Secretary of Civil Society for HIV/AIDs in Nigeria (CISHAN), Walter Ugwocha, the fear of stigma is one of the factors holding people back from getting tested.

Roselyn Adejo, a sex worker in one of the brothels in Kubwa, a suburb in the FCT, agrees that the fear of stigmatisation discourages people from getting tested for HIV.

“Some of my friends will not go to the hospital for testing because of the way the nurses react towards us.

“Once they know you are a sex worker, they discriminate, gossip among themselves and you will know from the way they look at you,” she said.

She, however, agrees that her choice of work puts her at a higher risk of contracting the diseases.

“You know how risky this line of work can be. Condoms break sometimes, but due to the way people discriminate out there, I feel reluctant going for HIV test,” she said.

According to UNAIDS, the key populations most affected by HIV/AIDS in Nigeria are sex workers, gay men (men who have sex with men) and people who inject drugs.

Although prostitution is illegal in Nigeria, the trade is still thriving in some parts of the country.

Denied employment

Miss Phils (first name withheld), a 28-years-old lady living with the virus was reportedly denied a bank job due to her HIV status.

“Out of so many people that came for the interview, I made it through to the final stage. We were later asked to come for medical assessment, and that was the last I heard of them.

“But I now have a federal job, which is okay for me,” she said.

She said she was not aware of the HIV/AIDS (Anti Discrimination) ACT, 2014, which frowns against employers denying PLHIV job opportunities.

Act protecting PLHIV

The HIV/AIDS (Anti Discrimination) Act of 2014, makes provision for the prevention of HIV/AIDS based discrimination and to protect the fundamental human rights and dignity of people living with and affected by HIV/AIDS.

The Act was enacted in 2014 to deter the general public from discriminating against people living with the virus.

The Act frowns against the ill-treatment of PLHIV in health facilities, religious places, schools, job denial, denial of access to communal places amongst others.

Part 1 (5) (1) of the Act states that; No individual, community, institution and employer or employee shall discriminate, directly or indirectly, against any person in the society based on the person’s HIV status or perception of same in employment, delivery of services and other benefits.

Sadly, despite the existence of this law, PLHIV still face discrimination regularly.

Ignorance

Ms Phils said at the time of the incident, she did not know about the act.

“The incident was like a year after I discovered my HIV status, so I did not know about the act then. I just wanted to live my life and survive at that time,” she said

Miss Ikwe also said at the time she experienced stigmatisation, she was unaware of the act.

“Only if I knew my rights then the way I know it now, it would have been a different story,” she said.

Stigma spreads the virus

Studies have repeatedly shown that, when HIV-infected people take their antiretroviral treatment correctly, their viral loads become suppressed.

This makes it almost impossible for them to transmit the virus to others.

“If stigma prevents HIV-infected people from getting on to treatment, the virus will be allowed to flourish. People who don’t know they are infected with HIV would not know that they require treatment,” Mr Ugwocha said.

Way Forward

Mr Ugwocha said stigmatisation ”is still very much around with us.”

He said ”from the health worker to the society, to the religious entity, stigma is still a very big issue.”

“Stigma is the attitude; discrimination is the action. It is a very big issue for people living with HIV in Nigeria. In Abuja recently, some people were refused treatment because of their HIV status.

“We lost someone about four weeks ago in Wuse General Hospital because of the person’s status; it was becoming difficult for the person to be given the appropriate treatment. The case became complicated, and she died.

“We also had issues of a couple preparing for their wedding in two weeks only for the woman to discover she is HIV positive. And the man refused to go ahead with the wedding, thereby pushing the woman into depression,” he said.

AIDS Agency speaks

In an interview with PREMIUM TIMES, the Director General of the National Agency for the Control of AIDS (NACA), Sani Aliyu, said the issues of discrimination and stigma in Nigeria is worrisome.

“You cannot get on top of HIV if we continue to have a stigma. People don’t have a choice when it comes to HIV.

“If you get it, it is because you accidentally ‘hit’ it. Nobody voluntarily goes out to ‘catch’ HIV. So why should you stigmatise that person?” he said.

He said the government would persecute employers requesting for HIV test results before employing people.

“As a government, we will not tolerate stigma and discrimination. We have done a lot of work in the recent past. People living with HIV, who have had issues with their employers, we have supported them and linked them with lawyers.

“And we will make an example of employers that we know are trying to commit this crime because it is unacceptable,” he said.

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