Newswatch: You talked about 25 percent reduction rate. How did you achieve that and what is the incidence of AIDS in Nigeria?
Idoko: Nigeria is one of the countries that has attained 25 percent decline. There are two reasons: one is a natural progression for all of the disease and after some time they stabilise. But more importantly the combinations of the various preventive efforts, especially girls are having sex much later than they use to do. Let me also tell you that our prevalence now is 4.6 percent. In 2001, the prevalence was 5.8 percent. But if you want to know who are getting more infections, who do you talk to, you talk to young people between age 16 and 24 because most of those who are just starting sex are in that group. If you follow that group, you can determine whether new infection is going up or coming down. Prevalence is difficult because we have drugs now. You can have HIV in your system for 10 years. But when we look at this critical group, young people just starting sex, then we now know these are the people catching new infection. In 2001, the prevalence among them was six percent but in the last one year, it dropped to 4.2 percent. There is a definite decline but that decline needs to go down because we can now say we have halted HIV and we now need to reverse it.
Newswatch: There is this idea that AIDS is a long-term disease that takes time to kill people unlike malaria that a lot of people die from. It looks like more attention is being paid to AIDS than malaria that is wiping away young mothers and children at very tender age…?
Idoko: I have a different view to that. You have drugs for malaria that can cure it. Do you have drugs for HIV? Number two, HIV can bring malaria to you and kill you, once your immunity is knocked off particularly in pregnant women and children. Malaria is a major disease. We have started seeing things that we were not seeing with malaria for people who have HIV…destruction of the kidney. I have no doubt in my mind that malaria kills many people but mainly children. But here, it is not only killing children, it is killing their mothers, their fathers and creating orphans. It is a disease that we still don’t have a cure.
Newswatch: But there is a vaccine that….
Idoko: (Cuts in) There is no vaccine. I will come and tell you the story. You have now also a disease that affects every fabric of your life. You can transmit it to your unborn baby; it can affect your social life. There is nothing it cannot affect. But we have changed that paradigm. How are we changing it? HIV is the 6th millennium goal. It affects each of the eight. The first one is poverty and hunger, you know what poverty does. If you are hungry and poor, you will get it, and it will even make you more poor and hungry. Two is education, I have just told you, if you look at the report of the national population commission, those who have no education have no information. If you don’t have information on how to protect yourself and you think that it is witchcraft, you are inside it. Right now, 60 percent of those who have HIV are women. There are biological reasons but the major reason is economic. Social economic status of women in this country is very low. This is a place where even if a woman has HIV it would be inherited. And because women are marginalised, there is a lot of transactional sex so women are disadvantaged. Women are vulnerable. They have more HIV than men. Young girls are two, three times more at risk than young boys. Even giving women education is a major empowerment. The fourth one is child survival. In this country, until recently, almost 60,000 children are born HIV positive. More than half of them don’t see their first birthday. Almost all of them die before their fifth birthday. Which disease can be as more terrible? HIV is a major problem. Even women who have HIV, many of them die. Then you talk about environment. If you drink dirty water for example, you are gone. We are not trying to separate HIV from others, we are now saying it is a wonderful opportunity to put HIV there and let it be and that is why we are talking about prevention of mother to child transmission. How do we detect it? We encourage all women to go for antenatal. We encourage them to be tested. We encourage them to ensure that all their children are born in the hospital so that those complications you see at home are not seen. Isn’t that a wonderful way to drive the MDG?
Newswatch: Abstinence is one way to ensure that nobody catches the virus. But right now the Pope has made a kind of shift on the hard stance of the Catholic church on condom and he has now said that condom should be used by male prostitutes in order to prevent the spread of HIV. How do you see that impacting on Nigeria?
Idoko: It is a significant development. Up till now, condom is the only mechanical barrier or the major mechanical barrier that prevents transmission from one individual to another. But recently, there is a very good study that was done in South Africa with microbicytes. Microbicyte is a chemical that a woman can put in her private part that can block the transmission of HIV. A study was done among sex workers. It shows clearly that it can prevent transmission. Why is that important, I just told you, most of the time, women cannot decide when, where and how sex is carried out. It is the man who carries the condom. Now you are giving them the power. It is a major development.
Newswatch: Do we have such chemical in Nigeria?
Idoko: It is just a test study. It is a long way. The study shows that those who use it consistently have 51 percent chance of not being infected. We need over 60-70 percent for it to be reliable… There are 20 trials going on. And something else has just happened in Brazil. You know if you take anti malaria you can prevent malaria. Prevention of mother to child...We give the women antiretroviral drugs for the women who are HIV positive and it blocks the transmission of HIV from the mother to their unborn babies inside the womb. We are using the same mechanism to say if a man who is not HIV positive takes drugs and he has sex with somebody who has HIV, then it can block it and it is working. They gave it to a series of men, in Brazil, it shows that it is working and working very well. In the same vein, that is very important for us here, if you go to many of the clinics, there is what we call discordant couples. A man may be positive but his wife may be negative. It means that if you give the other person who is HIV positive drugs, you can now block the transmission of HIV. We don’t have a cure now.
Newswatch: There is a vaccine that they say that has been invented.
Idoko: It is a light at the end of the tunnel because the vaccine shows that only 30 percent of the people were protected. In order for a vaccine to be accepted, the study must show clearly that it can prevent more than 60, 70, and 80 percent. Thirty percent is the lowest unit. It just shows us that it may be possible in the near future and that is not in the next five years. It could be 10 years or more.
Newswatch: To what extent is NACA helping to make these antiretroviral drugs readily available and affordable?
Idoko: Well, we are doing a lot. Treatment is very important in many ways. It is the way you can keep people alive. The way the drugs are now, they are different from how they were produced in 1995 and 1996. They are more potent. They are more convenient. They have less side effects. When it started, people in the late 1990s took like 18 tablets a day. Now some of them just take one tablet per day. When Nigeria started its treatment programme in 2002, they were just like 14,000. Today, we have 400,000 people on drugs. We have over 450 centres where drugs are given. We still have challenges. We have three million people who are infected.
Newswatch: With these efforts, where are we as regard the MDG target?
Idoko: Well, if you read the report by the senior special assistant to the president on MDG, HIV is one of the areas that it is presumed that we may be able to achieve our target. We are working hard. Like I told you, we have achieved 25 percent reduction already. We are thinking how we can push it down.
Newswatch: In the past, stigmatisation was a great problem. How are we addressing it now?
Idoko: It is still a problem. But it is a lot less. In the past, HIV was a death sentence. I know and if you cast your mind back, many people who were HIV positive died. But things have changed. You can have HIV and live a normal life. In this country now, we have almost over 1000 HIV positive support groups made up of men and women. That brings human face to HIV. More importantly, all those services are helping, treatment, care and support. All those things tend to be diffusing the fears that people have. As you might have being hearing, we are also trying to put together a partnership with the civil service, human rights commission. We have been trying to get the National Assembly to approve the anti stigma bill. We are hoping that before the life span of this administration, the bill would be passed. We believe that if it is passed at the centre, there would be a sort of rapid response.
Newswatch: Some years ago, we did a story which we titled feeding fat on HIV. Is NACA moderating the activities of these NGOs?
Idoko: There is a concern by everyone about the proliferations of NGOs. Some of the NGOs are NGI. NGI means Non-Governmental Individuals. Some are Non-Governmental Families. Government is really worried about that. What we are trying to do now is to see how we can review their operations. If you say you don’t want NGOs, then you don’t want people to work. It is the NGOs at the level of the community that do the work. They create the demand for services. They help to implement services, they help to monitor services. They do the care and support. We really need them. What we are saying is that if we give money to NGOs; let the money not go into salaries and workshops. Let it go to development activities. In line with what many of our partners that are providing these funds want, we have agreed that come next phases of funding NGOs, we will make sure that the funding for their administrative components and the funding for their workshops are things that we need to monitor because that is where the hidden monies are.
Newswatch: You mentioned the funding challenge; from what you have said, it appears a lot of foreign organisation are bringing money to NACA. There have been some allegations concerning the management of these funds. What do you have to say?
Idoko: Well, in Nigeria there will always be allegations. Let me tell you how the funds work. The presidential emergency plan for AIDS relief brings $500 million to this country. We are not only monitoring the money, but we monitor what the money is doing. We also have the global fund. They give the money to NACA. We don’t use the money. We are like conduit pipe. They also have a very strict mechanism. Every month, they send their auditors. Every year, you must get 80 percent. If you get less than 80 percent, it will be cancelled. It happened to Nigeria. We lost in 2004. Contrary to what people are saying from outside, there are rigorous ways of which foreign monies are being monitored. People are getting worried. We need to start looking and saying that we can make the money work to produce less HIV.
Newswatch: You said you were excited when given the job. In the 20 months you have been in NACA, has anything happened to dampen your excitement?
Idoko: The good thing is that what excited me to come, we are already doing it. We have funding for it; we are doing it in five states now. We will go to 13 states next year. You can now see that we are extending our programmes, taking it from big towns like Lagos to the hinterlands and integrating it to ensure that women who are pregnant benefit from these services. Of course, where I was working was all science, but now you have a mixture of politics. I have to listen to several people. You have pressure from partners, you have pressure from people living with HIVAIDS, and you have pressure from government.
As you enter an African market place, you must get to know the people that make it a market in the first place. They are not as extravagant as you would envision seeing in a Western marketplace. Neither are their clients. Although they do go through inconceivable pains to make their products attractive, they know that at the end of the day, the point is not to sell their wares, but to sustain their families.
