HIV SITUATION IN NIGERIA

HIV/AIDS is the most important pathogen of this century and has defied all odds to a level that it threatens human existence. Available statistics has shown that as at end of the year 2002, over 40 million people worldwide were infected with the HIV virus with about 90% of them living in the sub-Sahara Africa. In Nigeria, HIV/AIDS has reached an epidemic level, despite efforts to contain it. This is evident from the results of the various sentinel sero-prevalence studies carried out in the country between 1991 and 2001. HIV prevalence rates have continued to rise, from 1.8% in 1991; to 3.8% in 1993 to 4.3% in 1995 and 5.4% in 1999. The August 2001 study gave a prevalence studies carried out in the country ranks second within the Sub Sahara Africa for the number of HIV infected adults. With an estimated population of 120 million, the number of HIV infected persons in the country has risen from 2,160,000 in 1991 to about 6,960,000 in 2001 and unlessadequate national and regional responses are mounted, these figures will continue to rise. Over 80% of infections in Nigeria are believed to be from through sexual transmission while other modes are through blood transfusion and mother to child transmission as well as unsterilized needles and other skin piercing instruments.

HIV SITUATION IN LAGOS STATE

Lagos is the commercial nerve centre of Nigeria, with an estimated population of 15 million. The first reported case of HIV/AIDS in Lagos State (and in Nigeria) was in 1986. The sentinel survey carried out in Lagos has also indicated a steady and consistent increase in the number of HIV infected people. The prevalence for the year 2001 for Lagos was 6.5% and this was far in excess of the zonal average. The commonest mode of transmission is through sexual intercourse, but the incidence through blood transfusion is also high. The available data from the various categories of people screened in the laboratory at General Hospital Lagos shows an average prevalence of 3.8% among blood donors, 2.1% among Antenatal clinic attendances and 11.8% among hospital patients.

ASSESSMENT OF CLIENTS SEEN IN THE HIV CLINIC IN GENERAL HOSPITAL LAGOS.

The clients seen in the HIV clinic are: - Those that are diagnosed within the hospital - Referred cases from other general hospitals within the state - Referred cases from private hospitals Most clients are seen after testing during which time they are given post-testing counselling. However, efforts are currently being made to provide pre-testing counselling. The current practice of offering posttest counselling to only clients who are positive is being reviewed with the efforts to providing more trained counsellors. This will ensure that clients are counselled and made to understand that testing is voluntary and that it is only they who can decide weather they want to be tested or not. There is therefore a great need for training of more counsellors.

PLWHA CLINIC

A total of 728 patients were seen in 2001 with the number increasing to 829 patients in 2002 while the number for follow-up increase from 175 to 421 within the same period. The number for follow-up for 2002 increased in comparison to 2001 because a care and support group was started towards the end of 2001 and this actually encouraged more of the patients to come for follow up. The average cost of testing and treatment for an infected patient is approximately $300-$350 per month and this is far too expensive for an average patient to pay. The cost of treatment and the stigma associated with the disease has adversely contributed to curtailing the disease.

PREVENTION OF MOTHER TO CHILD TRANSMISSION (PMCTC)

All positive pregnant women are counselled on the possibility of their babies being infected and they are also informed on the available therapy. It has been noted that barely 5% of all positive pregnant women are able to purchase the ART needed for P-M-T-C-T. It is our wish that this drug if provided by Government or donor agencies "free of charge" or at a greatly reduced cost, will actually help in the prevention of mother-to-child transmission and so can help in the reduction of the number of people that will be infected.

COST IMPLICATION OF TESTING AND TREATMENT

All testing is subsidized by government, as most patients coming to public hospital cannot afford the cost of testing. All positively tested samples by the first testing techniques have to be retested using another test kit with a different technique have to be retested using another test kit with a different technique. However, charges for one test technique is all that is paid by patients and for confirmatory testing test charges is just about half of the actual cost of test.

POST-EXPOSURE PROPHYLAXIS (PEP) FOR HEALTH WORKERS

Health personnel working in countries/areas with high background prevalence of the HIV have a low, but measurable risk of HIV infection after accidental exposure to infected blood or body fluid. Both the medical staff, which is in regular contact with the patients and the non-medical staff laboratory (staff waste and cleaning personnel) are at risk of exposure to blood. This exposure can either be through any injury with a needle or sharp object, contaminated with blood, or through direct contact of infected blood with mucous membranes, cutaneous cuts or skin abrasions. However, health personnel are being trained and retained in the universal safety precautionary measures. A lot still needs to be done on this area.

PROTOCOL FOR POST-EXPOSURE

Reporting and Documentation: All cases of needle injury and other forms of exposure should be reported to the designated need to be properly documented.

PROJECTION OF HIV POSITIVE PATIENTS FOR GENERAL HOSPITAL LAGOS.

Comparing the available statistics of 2001 and 2002, it was noted that there was about 25% increase in the number of patients seen in 2002 against the one of 2001. If this is to be maintained it is estimated that over 1,500 patients are likely to be seen in the disease begin to have appreciable impact. With increase in the number of positive patients will also be an increase in the cost of treatment.

TRAINING OF HEALTH WORKERS

In view of the stigma still attached to HIV/AIDS, there is need to train health workers on the various preventive ways to curb the rapid spread of the disease in the community. There is also the need to involve all cadres of staff in the fight against HIV/AIDS in the state. A way of achieving this is to organise workshops and seminars to educate the various cadres of healthcare providers.

TRAINING OF COUNSELLORS

There is currently acute shortage of trained counsellors and since voluntary counselling and testing provides an entry into care and support services and will ultimately lead to the prevention of infection, there is the need to train more counsellors who should be able to provide the need services to the people. It is also believed that provision of trained counsellors as well as VCT centres, will enable those infected to gain access to care and support services.

BLOOD TRANSFUSION SERVICE

The hospital has the headquarters of the State Blood Transfusion Centre situated within its complex. The centre strives to provide blood that is safe for transfusion. However, the non-existence of voluntary donors usually hampers this service. The BTC depends to a large extent on relative donors and has in us the ELISA testing technique to screen for TTI"s (Transfusion Transmissible Infections). One of the many equipments needed by this service is a cold centrifuge for the separation of blood into components. Most patients in needed of blood products are most times transfused with other blood components that they don't need as well due to lack of facility to prepare the specifically needed components. Please feel free to give suggestions, contributions to us as to ways that can be used in ensuring the availability of safe blood for our patients.