In 2016, Nigeria had 220,000 (150,000 – 310,000) new HIV infections and 160,000 (110,000 – 230,000) AIDS-related deaths. There were 3200,000 (2,300,000 – 4,300,000) people living with HIV in 2016, among whom 30% (19% – 42%) were accessing antiretroviral therapy. Among pregnant women living with HIV, 32% (22% – 44%) were accessing treatment or prophylaxis to prevent transmission of HIV to their children. An estimated 37,000 (22,000 – 56,000) children were newly infected with HIV due to mother-to-child transmission. Among people living with HIV, approximately 24% (18% – 32%) had suppressed viral loads.
Sounds like too many details to process?
Well, let me interest you with a little story:
It was two years ago when I met Rachel (Pseudo-name) at an HIV Clinic in Lagos where I was an intern. On a sunny Friday, when most of the staff had begun packing up and heading home for the weekend, I had particularly been longing for the weekend as there were two birthday parties slated I was very much interested in.
I was getting ready to leave when someone knocked faintly on the door and uninvitedly walked in. A tall light-skinned girl with furry eyebrows. She looked frail and held the walls for support. She came for an RVS (Retroviral screening). Ordinarily, I would have asked her to come back on Monday as it was past clinic hours, but her frailness temporarily dispersed whatever birthday thoughts preoccupied my mind.
Rachel tested positive, the fifth positive patient for that day but unlike the others before her, she had a viral load that was out of the roof; a staggering 88,000 viral cells per ML of blood and a CD4 cell count that was dangerously depleted, a meager 150 CD4 cell count.
It’s Better To Know Than To Just Live and Die
Are you lost on the figures? Well, the viral load is the amount of the HIV virus present in 1ml of blood. The CD4 cells are immune cells responsible for detecting and fighting off infections. The HIV virus depletes this cell and thus exposes the body to all possible infections, these are known as ‘opportunistic infections’ because they take advantage of the weakened immune system this usually occurs when the CD4 cells drop below 200 per ML of blood.
I attended the birthday party at the beach the following day; Olamide would have flayed me if I did not, but all through the fun I could not get Rachel out of my head. A CD4 count of 150 was indicative of an immune system on the brink of collapse. Her life was literally hanging by a thread. I fervently prayed that she would get better.
A month later she returned to the clinic to refill her drugs. She was looking much stronger and full of life, although I did notice she had developed jaundice. This time I did not hesitate to speak with her at length. It turned out the jaundice was the least of her reservations with her ‘lifesaving’ drug.
HIV medications are known as ‘Highly active antiretroviral therapy’ (HAART). They work by preventing the replication of the HIV cells in the blood by blocking their attachment to a CD4 cell or synthesis from the cell. They are highly active but also highly discomforting.
The side effects range from hallucinations to severe headaches, nausea, fatigue, sweating at night and even insomnia. For Rachel, it felt like being between a rock and a hard place. Here was a drug meant to keep her alive and make sure her ‘dormant’ HIV does not metamorphose to the killer cousin, AIDS, but at what cost?
Every night for the rest of her life she had to swallow a pill two hours after a meal, if she took it right after a meal the side effects are ten times more pronounced. The hallucinations become more ferocious, the headaches pound her skull from every corner and she wakes up with a ‘hangover’.
‘The drug has changed me. If I don’t eat before 8 pm I don’t get to eat for the rest of the night because I take my drug by 10 p.m. I don’t stay out at night anymore either, the side effects begin to manifest about an hour after I take the drug.’
It was heartbreaking for me to watch her as the tears spilled from her eyes while she narrated her ‘ordeal’. ‘I’m just 19; it feels like my life has ended even before it began.’ Six months later she ran a second viral load test, the virus had reduced to a paltry 20 per ml of blood far below the threshold for infection.
There are millions of people like Rachel around the world. People who by virtue of birth or mistake contracted the virus whose cure still eludes scientists more than thirty years since it was first identified.
For these people, until a cure is found, the only option to life is to ingest these pills every day. Some side effects like the headaches wear off with time others like the fatigue and ‘hangover’ remain. But it’s a bitter pill they have to swallow. It’s a price they have to pay for a drug that kills to save.
One pill a day can keep you strong and alive for the people who love you, it can sustain your life as far as it should last and above all, it keeps the community safe and healthier
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