HIV/AIDS here to stay – Dr. Dosunmu

HIV/AIDS here to stay - Dr. Dosunmu

Speaking in an exclusive interview with our Correspondent CHINWE MADUAGWU, Dr. Adedoyin Dosunmu, a Consultant Hematologist with the Lagos State University Teaching Hospital, LASUTH, said the demographic of the disease has been changing from distance truck drivers and people living in barracks who were most at risk to health workers and hair dressers.

Dr. Dosunmu, however, cautioned that individuals and nations should not be relaxed about HIV/AIDS, insisting it was still as serious a health issue as when it was initially discovered years ago and stressed that nobody could totally say he or she could not contract the disease.

Dr. Dosunmu also revealed that self-stigmatization was keeping many living with HIV/AIDS from seeking treatment.

Category: Top news/ Interview

TNE: December 1, every year is marked as World AIDS Day. For this year, the theme is ‘My Health, My Right.’ What do you think informed the choice of theme?

I think it is the duty of every individual to take care of his health and, of course, one should take responsibility for his health. But it goes beyond that because health matters are more of a communal effort; that is when you talk about prevention, environmental involvement, access to treatment etc, it becomes a societal/community effort.

I think the theme is to emphasize the need for community involvement and to tell individuals that they have to be responsible for their health despite the fact that the community has a major part to play.

TNE: A few years back, hardly a day would pass without a HIV/AIDS getting a mention in the media but that is not the case anymore. What does that say to us?

It is so because other issues have overwhelmed the nation and probably people feel that HIV is no longer an issue. It could also be because people think those living with the disease are taken care of, people have changed their ways and some think that by their status now, they shouldn’t be worried about HIV, but that is not true.

We need to sustain the awareness, we need to sustain the risk involved because younger people are growing up and if we don’t sustain the awareness, the epidemic will increase. It is here to stay, it is already a pandemic and we cannot just wish it away.

Initially, when the virus was first discovered, we thought it could be eradicated but now it’s almost like we have to live with it, therefore, we have to sustain the awareness, we have to take care of those who already have it, it reduces the possibility of spreading it or transmitting it, we have to identify those who have issues so they can go for treatments to have the viral load reduced thereby reducing the risk of transmitting it. We need to create awareness so that people will continue to test themselves even those who think they are not at risk.
Those of us in the medical field need to continue to raise awareness among the youths, and people who are exposed to it. Bear in mind that these days there are assaults on children, youths in the campus etc.To reduce the burden of HIV in the society, the awareness has to be sustained.

I am not saying that we can’t eradicate it, probably when the vaccine comes we can talk about eradication but as long as we have people who are reluctant to take the test, those who test positive but go into denial, those who due to self-stigmatization fail to access the treatment centres; whenever something is in the society and there is no way of stopping it. The awareness and education need to be sustained. It is never too much.

TNE: You talked about a successful vaccine that will probably eradicate HIV. Often times we hear that researchers and scientists are close to finding a cure for the disease, how close are we to actually finding a cure?

I think that if there is a cure now it will be very expensive and cannot be generalized. We have seen cure in transplant, those who have transplant for other reasons and they are able to get cured. For peculiar reasons they are able to have it eradicated, but that is very expensive and it cannot be generalized.

There are vaccines for some stereotype of the virus but that too cannot be generalized and vaccines are preventive not curative. It can also not be generalized. We don’t have a cure that can be generalized but there are drugs that can actually suppress it. The problem is that it has to be taken regularly and for life.

TNE: Still on anti-retroviral, early in the year there were reports that people living with HIV/AIDS were dying because they switched to a locally manufactured anti retroviral drug. How true is this?

I’m not aware of that. There could be a switch to a locally packaged drug resulting to more side effects and people stopped using their drugs. But the ideal thing would be to report to the doctor, let him be aware, then he will investigate and find out what is causing it and the drug will be changed.

If one just stays back and stops using his/ drugs, anything could happen. But I don’t have any incidence where people died as a result of the drug because we are very much aware of the need to monitor and quickly change the drugs if there are side effects.

Side effects are very obvious and patients are empowered to know the side effects and report back unless those who are receiving treatment at centres without proper counselling. The ideal thing is that once you start taking the drugs, you report to your doctor at regular intervals until it is ascertained that the drug is good for you. Even then, we still monitor for side effects every six months or yearly.

Most of the drugs were given rapid licensing and so the long term side effects were not seen but those that are seen to have serious side effects have been withdrawn and they were withdrawn quickly. Yes, there were times when we saw serious side effects from some drugs but we know them and overtime people have learnt about them.

TNE: You talked about self stigmatization; we know that in the past, there was societal stigmatization towards people living with HIV/AIDS. Is that still the case?

You can’t totally remove stigmatization as long as you are dealing with infectious disease. What we preach is moderation, tolerance, understanding and empathy. These are the things we should emphasize. There was stigmatization because the disease is infectious and people felt it was untreatable and going to lead to death. But now people are living longer, the disease can be managed like hypertension and diabetes so the heavy load of stigma is reduced.

The other reason for stigma is that the disease is sexually transmitted and people feel those who have it are promiscuous, which is something we cannot totally remove, but the fact is that there are other means of transmitting it which is not through sex and of course, sex is innate to us. We cannot remove it unless we don’t want to procreate. Also, once people have been educated to the point of understanding that it is not contagious or air borne stigmatization has greatly reduced.

The other side of the coin though is self stigmatization. People ask, ‘why me?’ Some of them drop out from their treatment, they don’t want to go to the hospital so that somebody who knows them will not see them and know of their condition. It’s still all about awareness; that this disease is manageable. When people self stigmatize, they are the ones not allowing people to help them and it is a disadvantage to them. It takes time to get someone off self stigmatization because you have to engage the person over and over.
However, I don’t think it is possible to totally eradicate stigma.

TNE: From your experience as a medical practitioner, which category of people present more with HIV/AIDS?

I really don’t have the statistics but I can say the demography of the disease is shifting. Initially, we felt those who live in the barracks acquire it more but now we have the incidence lower in the barracks than the outside community. We also thought those involved in long distance driving were more at risk, but now with education the incidence has reduced among them. The demography continues to shift.

Now we see probably, and not to stigmatize, health workers, hairdressers, people in that line of trade. Initially, it was high among students, now it has shifted to professionals especially those that deal with sharp objects. They, therefore, need to be well educated and protected.

TNE: I read from the Internet that according to the United Nations, as at the end of 2016 about 36.7 million people were living with HIV/AIDS world wide. What’s the statistics now?

I really don’t have the statistics but I am sure it would be that high if not higher world wide.

TNE: What of in Nigeria?

It varies from region to region but I think it’s about 4.6% of the population. I can’t be specific because it keeps changing but I can say it is reducing. In Lagos, I know it reduced from 6% to about 4%.

TNE: From those who present with the disease, between the males and females, which group is more affected?

Females ironically, but it does not mean females are more promiscuous. But because they are more receptive they are more at risk because they receive the semen of the man, they are likely to have injuries during sexual activities. Females are more at risk than men.
Again, females are detected more because when they are in the child bearing age, they want to get pregnant and once they get pregnant, they are screened and if positive, they come for treatment. Most of the patients we have are females because they screen more and women take care of their health better than men. Women are more responsive and they seek medical treatment better than men.

TNE: Is mother-to-child transmission preventable?

Definitely. Once the mother realises she is positive and she starts treatment, the chances that she will transmit the virus to the child is reduced – something like from 40% to less than 2%. It depends on the viral load at the time and how long it took for her to start the treatment. Also, the child is placed on treatment for another six weeks after birth to prevent transmission. Once all these are done, it reduces the chances of transmission. We have had a lot of successes with that type of care in the prevention of mother-to-child transmission.

TNE: In all these, is HIV/AIDS still an issue?

AIDS is a health problem. It can never stop being an issue. It is a serious health issue. It is one of the top ten causes of death in our country. It is among the top ten attendance at hospitals, in both morbidity and mortality it ranks high, maybe it is among the top five, it’s still an issue. Nobody can totally say I cannot have HIV and the cost of treatment though it is free is very expensive. If not for the funds we are having, our health care system might not be able to cope with it. Assuming that the foreign intervention leaves, imagine the cost to the nation taking care of the patients with HIV/AIDS. It is an issue, we can’t wish it away, we can’t totally eradicate it, and I have not seen any nation that has successfully done it.

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