AS WE CELEBRATE WORLD AIDS DAY

Dr Paul John..discusses HIV and AIDS as we celebrate world AIDS Day...enjoy.

The first world AIDS day was held about 26 years ago( 1988) after health ministers from around the world met in London and agreed to such a day as a way of highlighting the enormity of the AIDS pandemic and nation's responsibility to ensure universal treatment,care and support for people living with HIV and AIDS. The idea was conceived in 1987 by two public information officers,James Bunn and Thomas Netter, who were workers of the WHO's global programme on AIDS  but the final approval was given by Dr Jonathan Mann ,former head of the Global programme on AIDS but now known as UNAIDS . It is observed annually on the first day of December.  It is recognized by UNO and all her affiliate international organisations and member countries.

BRIEF HISTORY AND DESCRIPTION
In 1981,medical practitioners in USA discovered a strange illness among a small number of gay men. The illness was given several names until it was finally called HIV AIDS. It is one of the leading causes of death globally.

HIV progressively infects cells of the immune system ,breaking down the body's ability to fend off some infections and other diseases whereas AIDS is the most advanced stage of HIV infection,defined by the occurrence of any of the more than 20 opportunistic infections or related cancers.

MODES OF TRANSMISSION
HIV can be transmitted through: transfusion of contaminated blood and blood products; unprotected vaginal or anal sexual intercourse ; oral sex with an infected person ; transmission between an infected mother and her baby during pregnancy,childbirth and breastfeeding ; sharing of contaminated sharp instruments and the use of contaminated and unsterilized hospital equipment such as needles and syringes.

STATISTICS AND DATA
At the end of 2013, about 35 million people were living with the virus,adults constituting about 31.8 million while children (less than 15 years) made up of about 3.2 million. Among the about 31.8 million adults living with virus,16 million were women.
Also,out of these about 35 million people living with the virus globally,about 32.6 million were in low and middle income countries like Nigeria. 36% of these  32.6 million people living with the virus in low and middle income countries ,which is about 11.7 million,had access to anti- retroviral medications in 2013.Recently, UNAIDS estimated that by June 2014 about 13.6 million HIV patients had access to the medications which was a huge step towards ensuring that 15 million people have access to anti-retroviral medications by 2015.About 2 million people newly enrolled on anti-retroviral medications in 2013 making it the largest number ever recorded since the HIV pandemic started.
Regrettably,about 2.1 million people were newly  infected in 2013, out of which ,about 1.9 million people were adults while about 240,000 million people were children less than 15 years . The virus with its related conditions has killed 39 million people ever since it started with 2013 alone recording about 1.5 million deaths,adults constituting about 1.3 million while children less than 15 years constituted about 190,000. Out of the 1.5 million deaths recorded in 2013, about 360,000 deaths occurred among people living with HIV and Pulmonary Tuberculosis .Also,majority of people( about 78% )  living with both HIV and Tuberculosis reside in sub-Saharan Africa.
Meanwhile ,in 2013, 7 out of 10 pregnant women living with HIV received anti-retroviral drugs.

THE WAY FORWARD
Going through this mind-boggling statistics without providing the solutions will be an act of utter folly. For us to maintain an HIV free generation,the following must be considered and properly implemented:

ATTITUDINAL CHANGE
Nigeria and other African countries should abhor some obnoxious cultural and personal practices that help in the spread of the virus. On May 8th 2006, a Johannesburg High court acquitted Jacob G. Zuma,the current president of South Africa and current president of the governing political party,African National Congress (ANC) ,of rape charge brought against him in December 6th 2005. The accuser( the victim),a daughter of Zuma's decreased friend was known to Zuma to be HIV positive. President Zuma argued in court that he had shower immediately after having an unprotected sex with the known HIV patient to cut down the risk of contracting the dreaded disease .The court finally dismissed the case on the grounds that the sex was consensual but Zuma's defence of having showers after the unprotected sex with a known HIV patient was condemned by health experts,AIDS activists and the general public.

Also, a former president in that country once said that the happiest day in his life was the day he was circumcised . Although from medical perspectives, circumcision reduces the rate of HIV transmission ,the way people were circumcised in South Africa accounted for their high rate of HIV infection. The circumciser used the same knife to circumcise all the 'candidates' billed for a particular circumcision ceremony  hence if the knife was used for an HIV positive 'candidate' , the subsequent boys would be infected with the same knife.

In Nigeria today , Many of the circumcisions  performed in our rural settings  are done with unsterilized sharp instruments and mainly by quacks. Also,many Nigerians believe that HIV AIDS does not exist in the first place while some gullible ones believe that the full meaning of AIDS is American Ideology for Dodging Sex.

LACK OF STRICT LEGISLATION AND POLITICAL WILL
Many of our women get to know their HIV statuses during antenatal visits where it is mandatory in all  government hospitals and in some privately-owned hospitals for all pregnant women to be tested for HIV. The aim is to prevent  mother to child transmission of HIV .The question is ,who infected who in our marriages ? In majority of the  cases,it is the men that infect the women,though this observation is not absolute. In my few years of medical practice ,I have not seen a HIV negative woman who remained negative after having an episode of unprotected sex with an HIV positive man but I have seen several HIV negative men who remain negative after having episodes of unprotected sex with HIV positive women though that is not a reason for the practice of unprotected sex by men . Many of our religious houses still wed two intending couples without making premarital HIV testing compulsory.

The pathetic story of a 27- year old  Ghanaian actress cum singer,Joyce Dzidzor Nartey, who was infected with the virus by her own church member. According to her,the church member was aware of his HIV status but mischievously decided to infect her. Such incident is possible in Africa where the law is vague and weak when it gets to the strong and strong where it gets to the weak . I read a story in one of our national dailies sometime last year where a girl was raped and when the mother wanted to make a case against the rapist,people advised the mother not to bother herself since her daughter was not a virgin before she was raped,what an error in reasoning? Such piece of advice can be likened to Zuma's defence of having showers after  an unprotected sex with a known HIV patient. There are millions of rape cases that go unreported daily in Africa,especially in Nigeria because the victims are aware that majority of cases are won not by saying the truth but by hiring the services of a 'good' lawyer who is skillful at twisting facts and navigating safely through the technicalities of the law.

In developed and saner societies,Can an HIV positive man sleep with an HIV negative woman without disclosing his health status ? If an HIV positive man infects any HIV negative lady,the damages the man will pay will make him insolvent and at the end he will still be jailed but here what do we have,a known HIV positive man may decide in what I call 'census exercise ' such that he will be infecting at least three ladies per day. Even if he is caught, under which section of the law will he be prosecuted? It will be like when some insurgents were captured but could not be prosecuted because there was no anti-terrorism  law under which they could be prosecuted but we waste huge sums of money practising bicameral legislature in our national assembly .That is the result of having myopic leaders who are improvident. As the anti-stigmatization and discrimination  bill is being passed , is there any punitive measure for rapists and for HIV positive men who intentionally infect innocent women and ladies?

DECEITFUL RELIGIOUS PRACTICES
HIV infection was first reported in USA but today Africa is leading the rest of the world . The reason is simple,after the discovery of the disease in USA,the Americans followed the scientific  pieces of advice from health experts and no religious leader claimed or claims to have the spiritual power to cure the dreaded disease but in Nigeria and many African societies we have religious leaders who claim to have powers to cure all sicknesses but they travel abroad now and then to check their blood pressures and blood sugars among other clinical appointments. These religious leaders cash in on our near-lawless society and the high level of illiteracy among Nigerians to unleash their religious 'terror' and scam . Many of them advertised members who were cured of HIV infection without any scientific proof and confirmation before and after the miracle (or do I call it magic).

SEX EDUCATION AND CORRECTING OUR SEXUAL ORIENTATION
WE Africans are victims of circumstances as we are like bats,we don't belong to the arboreal or terrestrial beings. Westernisation of our culture is one of the reasons for our high rate of HIV infection. We are neither  holding tenaciously to our culture nor fully embracing the western culture .  It is still a taboo for African  parents to teach their children about sex. In fact,is is an abomination for either of or both of  the parents to discuss sex matters with their children. That is typical African culture where the girls are expected to remain sexually naive and marry as virgins but today the issue of preserving one's virginity has been overtaken by events. I was a guest speaker,in a campus programme recently,as I digressed a little to talk about the need for one to preserve one's virginity until marriage,I noticed that more people were leaving the hall and the few remaining were either 'pinging' or chatting with their friends through one of the social media .

When I enquired at the end of the programme,a lady confided in me that nearly all the ladies in that programme had lost their virginities,one of the products of westernization of our culture.  In fact that reminded me of one of my friends who lamented that when he was about to marry,it was then that he knew that majority of the so-called 'born-again' ladies were(and are still) not innocent of premarital sex as he could not find a virgin among many of his beloved and holy religious sisters . Meanwhile,there are two schools of thought,the few and Africanized  group believes that  virginity should be preserved until marriage while the larger and westernized  group  attaches no importance to virginity before marriage arguing that many men don't marry as 'virgins' hence why should ladies be vilified for not remaining as virgins until marriage? .This 'western' group goes on to list other causes of loss of virginity other than sexual intercourse which include,but not in any way limited to,congenital absence of hymen,vigorous sports,rape etc

We should not allow ourselves to be victims of circumstances .The western parents believe that people between the ages of 15 and 44 years are very sexually active hence they teach their fledgling children on what is expected of them. It is  common to see condoms in the purses of western girls because they are aware that majority of personal visits between opposite sexes end in the bed .If the Ghanaian actress cum singer had visited the church member with packs of condom in her purse,she might not be infected. Now think about it, If such sexual relationship could occur among  religious 'brethren' who believed in the sanctity and  salvation of man's soul, what do we expect from the secular world?

The law of identity states that things are what they are whether we like it or not. In our contemporary world, many of our girls lose their virginities before 15 years and there is high rate of sexual intercourse among our young boys and girls. This is a known fact,whether we like it or not.I was passing a place one day,I saw how people where running helter skelter along the street .I was intent on finding the cause of the imbroglio. The news had it that one 'stupid' boy paid for  the services of a commercial sex worker for a night 'duty' ,as the girl was drunk,the man went in without making us of any  condom despite having enough packs with him. When the girl realised herself ,she was so annoyed that she stabbed the man .  From that illustration,many of these commercial sex workers may be 'safer' than our usual self-righteous street girls and religious sisters ,who may be the real vectors of this dreaded disease.  This is because many of these commercial health workers are visited by some health practitioners who teach them on how to prevent HIV and other sexually transmitted infections and many of these commercial sex workers have made a fortune out of this age-long 'profession' hence they will not like to die of HIV infection or any other sexually transmitted infections without enjoying the fruits( the wealth) of their 'hard' labour. They see any of their customers /clients as a potential HIV patient hence appropriate safety precautions should be applied but our self-righteous street girls and holy religious sisters still have unprotected  sex as was the case for the Ghanaian actress cum singer.

When my twin brother ,a lawyer practising in the UK ,was coming back to spend a particular holiday with us,the wife, a staunch christian, gave him a pack of condoms under the strict instruction that on no account should he sleep with any lady while in Nigeria without making use of the condoms even if it were her own sister( that is,our sister-in-law).When I heard that ,I went down memory lane on how my twin brother met his wife while in the university. While still in the university,she was a very good christian who preached against   pre- and extramarital sex affairs but few years in the UK had changed her perceptions of sex . In the UK and other developed world,people tend to believe in things that are more feasible than unreliable miracles. His wife reasoned the way every sane person should reason and my twin brother never misconstrued that as being labelled promiscuous by his wife .In our society today ,the reverse is the case,it is even an abomination for the wife to think in that direction and religious sisters are presumed innocent of premarital sex but many of them marry as non-virgins. In our larger society ,under-aged and pre-marital pregnancy is still on the increase while sex education is still a taboo. In many of our African societies ,it dawns on the parents that their presumed sexually-naive daughters have been eating the 'forbidden fruit' when the daughters come down with premarital pregnancies.

Finally,let me hurriedly point out to inadequate  hospital testing equipment as one of the reasons for the high rate of HIV infection  in Nigeria and some African societies  .Is it not disheartening to find out that many of our tertiary hospitals are still certifying units of blood meant for blood transfusion fit  without the use of polymerase chain reaction(PCR) machine? In 2006,the then minister for health,Professor Eyitayo Lambo, sacked three senior hospital officials of Lagos state University Teaching Hospital (LUTH) in which the chief medical director was among them .The reason for sacking them was that one baby Eniola tested positive to HIV after an Exchange Blood Transfusion was carried out on the baby, when none of the parents was HIV positive. Believe you me,the units of blood that were used in that Exchange Blood Transfusion were certified HIV 1 &  2 negative by the medical laboratory scientist on duty that day. Also,between 2010 and 2011, I visited a friend working at the National Hospital Abuja. There was this case of a unit of blood that was certified HIV negative by one of the government district hospitals in the FCT but when it was procured to be transfused to a patient at the National Hospitals,it was retested and was found to be HIV positive hence the management of National Hospital made it compulsory that all units of blood from outside must be re-screened despite being certified by renowned medical laboratory scientists. Now,if many of our tertiary hospitals do not have PCR machines,what will be the fate of lower hospitals like the General hospitals and Primary Health centers?

It is a known fact that HIV infection can be transmitted through contaminated  blood from a donor who is  still in the window period of the HIV infection .Regrettably,our crude method of testing for the virus in this country ,the use of HIV strips,does not detect the infection at the early stage,it only detects the infection when the person has sero-converted which may take weeks,months etc. It is only PCR machines that can detect HIV infection at any stage of the infection. More unfortunate is the fact that the sensitivities and specificities of many of our HIV test strips vary hence an individual may test HIV positive in one laboratory while another laboratory gives a negative result of the same individual in the same day.

More facts about this dreaded disease will come our way in my subsequent series under this topic.

REFERENCES

(1)Kumar and Clark's Clinical Medicine,8th edition
(2)Davidson's Principles And Practice Of Medicine,21st edition
(3)Oxford Handbook Of Clinical Medicine,9th edition
(4) http://news.bbc.co.uk/2/hi/africa/5242076.stm
(5) http://www.who.int/features/factfiles/hiv/facts/en/
(6) http://en.m.wikipedia.org/wiki/Jacob_Zuma_rape_trial
(7)
http://www.ghananewsreport.com/ghanaian-actress-tells-how-she-contracted-hiv-on-dstv/

Dr Paul John
Port Harcourt,
Rivers state.
08083658038
mazipauljohn@gmail.com