Nigerians Living With HIV Struggle To Stay On Treatment As COVID-19 Crisis Persists

Life has not been the same for Nigerians living with the Human Immunodeficiency Virus (HIV) since the coronavirus pandemic started taking a huge toll on commerce and transportation in Nigeria.

Many complain of not having easy access to their regular dosages of antiretroviral (ARV) drugs, while some who have drugs are threatened by hunger.

Ejiro Joy, who works as a mentor mother with the Network of HIV Positives (NHIV) programme in Ondo State, paints a grim picture of how the condition of these vulnerable Nigerians has worsened.

“Many of them can’t get money to transport themselves from their houses to the hospitals to pick up their drugs and so many of them do not have food to eat. The situation on ground is not pleasant at all,” she told HumAngle.

Many who live in rural communities do not have nearby facilities that provide antiretroviral drugs and often have to move to urban areas such as Akure, she said.

One woman recently said she spent between N1,200 and N1,500 on transportation to the state capital but did not have up to that to spare even though her life depends on it, Joy said.

“Someone who cannot feed herself properly can she raise that amount to travel down to this place?” Joy asked.

For others, the need to travel to Akure is not influenced by the absence of nearby facilities but the desire to avoid stigmatisation from those within the neighborhood.

An Akure-based hairstylist, who asked not to be named, told HumAngle she usually got her medicines from a supplier in Lagos.

What she has now will only last till Wednesday, May 13, and she is increasingly afraid she might have to visit the state hospital instead, the lady said.

Joy herself, a single mother of three children, has been having a tough time getting basic needs, including food. Her youngest child fell ill about two weeks ago and it took the support of a benefactor before she could buy drugs worth of N4, 300, she recalled.

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), there are up to 1.9 million people living with HIV (PLHIV) in Nigeria and out of that, 53 per cent are currently on antiretroviral therapy. Without constant treatment, PLHIVs will not be able to suppress the viral load in their systems to enable them to lead healthy lives.

It is not only in Ondo that Nigerians living with HIV are struggling to live.

In Kebbi State, hunger is a primary concern. The problem is created by increases in the prices of commodities and the loss of livelihoods.

In addition, because of fuel scarcity, it has also been difficult for people to visit the hospital to get much-needed drugs.

The Executive Director of Kebbi State Association of Women Living With HIV/AIDs, Esther Hindi Mallaim, explained that most people faced the dilemma of spending little money on them to feed with their families or on transporting themselves to healthcare centres.

“People around here always depend on daily earnings. They go out every day to get what they will provide for themselves and the family. So if work stops totally, issues here will be really difficult,” she said,.

Mallaim said that the problem was made worse by a predominantly polygamous culture, adding, “About two or three of them have called me from different places, I would just tell them to manage and let’s see what will happen.

“If this situation escalates, it will really be bad. And there is nothing the government is doing to support. We have heard plans but we’ve not seen them manifest. We’re still waiting and still advocating to see if anything can be done.”

Regularly missing doses of HIV treatment causes the viral load to increase and can lead to the virus becoming resistant to medication. In other words, the drugs will no longer work even if the person resumes treatment, according to experts.

Drugs on an empty stomach

Although antiretroviral drugs are provided free in Nigeria, for poor Nigerians who live with HIV, they still have to bother about getting sufficient food to complement treatment. Many PLHIVs have no choice but to regularly take the drugs on an empty stomach, an experience Gloria Ogodo likens to “drinking poison”.

Ogodo, who is the regional coordinator of the International Committee of Women (ICW) Living with HIV/AIDs in West Africa, stressed that food was the greatest need of PLHIVs as many could not work and earn money during the lockdown.

“Drugs without food are poisonous and highly toxic,” she said. “We lost someone about two years ago. Because of financial hardship, he kept taking drugs on an empty stomach. He eventually had kidney failure and died. So, this is why we are afraid this lockdown will affect us seriously.”

While it is not compulsory to take all antiretroviral drugs simultaneously with food, for some, such as tenofovir disoproxil, genvoya, eviplera, it is recommended that the user eats while taking them.

Taking the drugs on an empty stomach has also been found to make people feel sick and worsen side effects such as headaches, stomach pain, tremors, dizziness, energy loss, fainting, sweating, and rapid heartbeat. Generally, good nutrition is advised for the drugs to be effective.

Ogodo, who resides in Abuja, said she had received reports from women living with HIV who were chased off the street by officials of the Joint Task Force enforcing the stay-at-home order. Two weeks ago, she had to go and get bail for one of them who violated the directive out of desperation by selling tomatoes in Kurudu.

“She told me that since morning she had nothing at home to drink, even garri. I had to convince my husband to let us give her some rice, beans and yam tubers,” Ogodo said.

“Many of our women are going through a serious hard time especially people who are into petty trading. It is a bad time. With the lockdown, many people have used up their capital and resources. Even when they lift the lockdown, tell me, where are they going to start from?”

It has also been difficult for PLHIVs in Abuja to get drugs from the AIDS Healthcare Foundation in Jabi since commercial vehicles generally do not operate within the area.

Not enough to tell them to wash their hands

Last month, the National Agency for the Control of AIDS (NACA) charged people living with HIV to stay safe by adhering strictly to instructions from the Nigeria Centre for Disease Control (NCDC).

“People living with HIV must continue to take all the necessary precautions given by WHO and NCDC with special emphasis on adherence to ARV medications, minimising exposure to COVID by staying at home, hand washing and personal hygiene, and social distancing,” the Director-General, Gambo Gumel Aliyu, said.

But it is not clear if the agency has taken any steps in helping PLHIVs tackle peculiar challenges that have come with the pandemic.

Attempts to get a reaction from NACA have been unsuccessful. The agency’s head of public relations and protocol, Toyin Aderibigbe, asked HumAngle to call back on Thursday so she could connect the reporter with an official in a better position to provide answers. She has, however, not answered multiple calls or replied texts since then.

Iwatutu Joyce, a gender equality activist and reproductive health advocate, said it was not enough to tell PLHIVs to wash their hands and use face masks as there were other things required to meet their needs. She urged the government to find ways of reaching out to Nigerians living with the virus in their various communities with confidential treatment and services.

“Healthcare facilities have data of people who are scheduled for treatment. We can reach out to them directly and give them antiretroviral medicines for at least three months,” she suggested.

“We also need to remove all financial barriers such as user fees because people living with HIV have decreased financial opportunities during the pandemic.”

Joy cannot wait for the government to finally intervene. Almost tearfully, she appealed to the agencies in charge to offer help.

“They should please give us something to eat. That is what we want,” she said. “We need food. We need food. That is what we need for now. Little assistance can go a long way in our lives.”