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From Obinna Odogwu, Awka
The Executive Director of the Anambra State AIDS Control Agency (ANSACA), Dr. Nkem Okeke, has said that he’s doing everything within his powers to stop the spread of the Human Immunodeficiency Virus (HIV) in the state and also bring those who tested positive to it to care.
He said that the move was in line with the mandate handed to him by the state governor, Prof Chukwuma Soludo, whom he said had expressed his resolve to stop the spread of the virus in the state.
In this interview with Sunday Sun, Okeke revealed that the governor wants the HIV issue to be made a daily household conversation, arguing that such awareness will help to maximally reduce the spread. Excerpts…
What are your plans and programmes for this agency and how far have you gone in implementing them since you came on board a few months ago?
First, let me appreciate Mr Governor for seeing the need to strengthen the HIV response in the state. Prior to his second term assumption of office, he made some changes in the health sector, and amongst them was my appointment as Executive Director of this agency. So I appreciate him immensely for having the interests of Ndi Anambra in mind. So coming on board, I had to study what is on ground in the agency, review the reports on status, and then know where we are as a state in HIV response. So my team and I began a journey to Abuja on a high-level advocacy where we visited offices at NACA and then the Federal Ministry of Health, as well as Institute for Virology Management. From there, we headed to Lagos State AIDS Control Agency (LSACA) to also equally understudy what they are doing differently. Then after that, we came up with a document that will serve as the work plan to direct all the programmes, projects, and activities of this agency for the next three years. So we called it the State Strategic Transformation and Sustainability Plan. So this State Strategic Transformation and Sustainability Plan, SSTSP, will span between 2026 to 2028. It’s anchored on eight pillars, and these pillars will include the activities, projects, and actions that we’ll carry out. So each of the pillars has its actions, and those actions will be translated into programmes. So before now, the national impact survey report we have from NACA and Federal Ministry of Health as of 2018 has it that the prevalence rate of HIV for Anambra State is 2.4, and that of the national is 2.1 per cent. And that has placed us as the state with the highest HIV burden in the Southeast, and then number five in the country. So with that in mind, and with targets to achieve the global target of 95, 95, 95 by UNAs, and to achieve a zero new HIV infection by 2030, we designed this SSTSP so as to align ourselves in achieving that global target. So by 2028, we’ll stop. We’ll review. We’ll not really stop, per se, but we’ll review progress and then see how far we’ve gotten closer to achieving this target. And of course, the SDG goal number 3.3, which is eliminating HIV as a public health threat. So one of the pillars we have in the SSTSP is prevention. So we intend on carrying out comprehensive prevention of HIV infection in the state.
Talking about prevention, what steps are you taking currently to reduce…
And one of the activities we’ve started rolling out in that regard is a comprehensive awareness programme. If you watch the conversation on-going on social media, you see that we have started again to talk about HIV. And that’s one of the key drivers of this agency, that one of the key impacts and the achievement that the agency has made as a quick way to bring back conversation on HIV which COVID-19 dealt a huge blow on us. The emergence of COVID-19, you know, kind of changed the conversation towards COVID-19 from HIV. And most people think that the disease is no longer in existence. So with that as well, then of course, we started our moonlight testing.
What is moonlight testing and how has it contributed to the fight against the spread of HIV in Anambra?
Moonlight testing is a hotspot key population-based testing that we carry out between 7pm to 1am in the night. We’ve done it in a couple of local governments. So far, we’ve tested about 900 persons so far within this couple of weeks that I took office. And of course, we have those that are positive and we have those that are negative, and that’s confidential. Yeah, I’m very much aware of the data that are making the social media waves and all that. But what I want to tell people is, these are unconfirmed data. As professionals, we have regulations and ethics that guide our disclosure of such information that are very sensitive. So you’re not going to see any professional that will have such information and disclose them to people. So neglect them, look down on them. But however, have it in your mind that HIV is still living very much with us and the burden is still reasonably high. And why Anambra State is where it is, as the state with the highest HIV burden in the South East, is one that is due to a proactive action that the state is taking. The State Ministry of Health, led by Dr Afam Obidike, and of course, myself on the ANSACA front, we are making reasonable impact in terms of testing. Because one is, it is only when you are tested that your status will be known. And when your status is known, that is when the numbers are affected. So when you are tested and you are positive, it means that the incidence, which is a new case coming on board, will increase the prevalence and that is how it begins to increase. So if you are not tested, your prevalence will continue to be low. Your incidence will not increase. So for the states, most of the states that have a very low prevalence, it does not mean that they do not have the burden of the disease. For the states that have a high number of prevalence, implies that there is proactive testing and preventive measures on-going in the state and that is why Anambra State is topping. However, that is not to say that we don’t have the disease with us. It shows our proactive measures in HIV response within the zone. So when you are tested and you are positive, you are quickly linked to care. Index tracking will roll in immediately. And then of course, when you are linked to care, we expect to have a very, very significant retention, which will ultimately lead us to achieving the U equal to U, which is undetectability and untransmittability.
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Given that situation, in what way is the government supporting this agency with funds?
We thank God that the Governor, Prof. Chukwuma Soludo, is also giving us all the necessary support that we need to achieve this. Then, another thing we also look at is data. If you don’t have a good grasp of data, you will not be able to know how to channel your interventions. So one of the things that we look forward to doing, we’re already doing, is to establish an effective data framework, data collection framework, reporting system, and then, of course, to ensure quality and the management. So at every point in time, we should be able to come in handy with the data of whatever that is going on across the local government, across the 326 wards in the state. Then another thing we also look at doing is on the aspect of institutional strengthening and governance. So boosting the agency’s operational framework by introducing new units to enhance efficiency and productivity, that has already been done. So many institutional reviews have been done, activities that have not been on before have been now initiated in the agency. So that is also a novel idea that we have done, and one is through the wife of the governor, Dr. Mrs. Nonye Soludo, Healthy Living with Nonye Soludo. This Healthy Living is a kind of support group owned by Her Excellency, through which she reaches out to the communities and the grassroots on encouraging them in healthy living lifestyles. So we wanted to leverage the already established structure to introduce a comprehensive HIV response scheme, and that has already been inaugurated a few weeks ago, and it’s called the Healthy Living HIV Control Initiative with Nonye Soludo. So we are positioning Anambra State as a top tier state in terms of HIV response globally, and that was the signing of the pledge to achieve a zero new HIV infection by 2030. So that signing was done by the stakeholders in the state, the traditional rulers, the partners in the state, the Ministry of Health, of course the agency, and of course the government representative through the wife of the governor to ensure that by 2030, Anambra State must have achieved zero new HIV infection case in the state. With that initiative being inaugurated, we’ll have 42 coordinators across the local government that will be liaising with the structure of the Healthy Living to ensure that whatever activities of the Healthy Living with Nonye Soludo that is carried out at all levels, that HIV response, awareness, testings, activities, are equally done altogether. Another thing that we’ve also achieved and is in the process of being inaugurated is the introduction of HAB.
What is HAB, and in what way will it contribute to the efforts being made to stop the spread of HIV in this state?
HAB is HIV Awareness Brigade, and it is a 1, 693 volunteer-based structure spread across the 326 wards in the state. Each of the wards boasts of five volunteers drawn across from the youth wing, the women wing, the traditional institution, the faith-based institution, and the primary health care in the ward. So their job will be to carry out HIV awareness, counselling, testing across the whole 326 wards in the state. This structure is already on ground. The unit of the HAB has been established in the state here in ANSACA, and then we already have these persons. So their training is on-going, and after the training, the proper inauguration will be done by Mr Governor, and they will be sent into the wards to begin to test and then reach out to the people on the HIV response. I said on a television network that it is necessary, and Anambra State is moving towards the direction of bringing back HIV as a family conversation. We need to have HIV back as a family conversation, strategically positioned such that it will help to curb the menace of the infection and achieve epidemic control over HIV. Of course, towards the target of eliminating it as a public health threat. So the more we begin to make it a peculiar conversation is a gateway towards achieving this epidemic control over the disease. So HAB is here in Anambra State to reach out to all the nooks and crannies of the state, both the hard-to-reach areas, the riverine areas, the rural areas, too.
How many HIV testing facilities do we have in this state and how accessible are they to those who may want to use them?
We currently have 176 HIV-free facility-based centres in the state that you can walk in and you get free HIV services. So we are encouraging people to take advantage of these free services so they will be able to know their status and their inequality key into treatment and others. Then as also part of the things we have that we want to achieve is in the area of empowerment of people living with HIV. Currently we have 97, 423 persons that are living with HIV in Anambra State. So most of these people suffer stigma, discrimination, and fear of people judging them. We preach that HIV is not attached to any name or a personality, so we should not judge people who have HIV. And one of the things we have already started doing to curb this stigma and discrimination is by one, having the bill establishing this as a law enacted by the state House of Assembly and awaiting the Governor’s assent. Then two, was to inaugurate a workplace review policy to review the HIV state workplace policy, which will address all the necessary concerns as related to stigma of people living with HIV in different workplaces. Most people ignore skills, prerequisite skills or primary skills required to get jobs done and be looking towards the person’s status before they give the person a job. No. In the new workplace policy that we are going to get on board very soon, the draft is really awaiting the final level of approval, is give people jobs not based on their status, but based on their primary skills. So these are one of the things we are also doing to curb this. And of course, awareness, integrated testing, and then ensuring that people key in. We are no longer preaching about testing only for HIV. We are also doing other tests that include Hepatitis, Malaria, Tuberculosis, and then the basic vital checks and all that. And other things we intend to do on the empowerment of people living with HIV is skill acquisition. Most of them are jobless. Most of them are unemployed. And then as such, increasing in societal menace. So we want to identify these people across all age groups, both those within the adolescent youth group, the women, the elderly people, empower them. Through skill acquisition, I want to announce that we’ve already started through the wife of the governor, who carried out an empowerment on sewing and the distribution of sewing machines and grinding machines with start-up kits and start-up funds for the MSMEs. And about 50 persons drawn from people living with HIV were involved. We’re also looking at establishing a skill acquisition centre for people living with HIV. So we’ll be able to mop them up, empower them, give them skills, and then equally empower them to flourish. So these are part of the things that constitute what we are doing.
What is this agency doing to sensitize traditional birth attendants, some of whose actions or style of practice may be contributing to the spread of HIV in this state?
Traditional birth attendants are not approved by WHO. And according to the Commissioner, Dr Afam Obidike, in the last state health review meeting that we had, he instructed the comprehensive mapping of the TBAs in the state. That is the first step Anambra State is taking already to ensure that we identify them. So first is to identify them; where they operate, and then we know how they operate, who they are and then we begin to disengage them on their operation. We are advising people to patronise the health facilities. The governor of Anambra State has made delivery to be free and safe in all public health institutions. At the level of the primary health care, at the level of the secondary health care, and at the level of the tertiary health care, you can access your delivery free. So we are advising Ndi Anambra to eschew from patronising TBAs, they are not professionals, they are not trained, they are not mandated to carry out deliveries. So for us, whatever we do here is according to global standard practises, according to World Health Organisation that has stated that TBAs are not approved professional birth attendants. So we have started the mapping to identify them wherever they are, and after the mapping we look forward to disengaging them, and then see how we can re-engage them in a different way that will be more professional than leaving them jobless and unemployed.
Lenacapavir, a long-acting injectable medication for prevention of HIV, was launched in Anambra recently. How safe is that medication?
The emergence of Lenacapavir, of course, is a welcome development globally. Lenacapavir is an injectable PrEP drug that provides a twice yearly protection against HIV infection. It is being rolled out only in eight states in Nigeria, which Anambra State happens to be amongst, and these eight states are globally funded states. So Lenacapavir is a HIV capsid inhibitor that acts on the capsid structure of the virus to prevent the multiplication of the virus. So what it does is, you take it 24 hourly. It’s a two pill taken in between 24 hours. So it provides protection against the infection. However, you must have been tested negative before you take it. It has passed through all the necessary clinical trials and has gotten confirmation to be used by human beings. So it is suitable for use. I myself have also taken the Lenacapavir PrEP and I am very okay. You can only experience minor adverse reactions such as pain on the injection site. It is taken intramuscularly, either you take it within your loin regions or abdominally. So you first experience pain on the injection site for a few days. Other mild symptoms like headache, dizziness, diarrhoea, minor gastrointestinal symptoms are what you experience. So my advice to people is to patronise it. However, because of the quantity and then the availability, we only advise people who are at high risk to take them; not just for everyone. Once you know that you are placed in a high risk area or have a high exposure, that is when you are advised to take the Lenacapavir and you must have been confirmed negative before you take it.
