Gikin-de-gikin: Unsafe sex habits fuels HIV epidemic in Nasarawa
In 2013, 23,719 pregnant women enrolled for the Prevention of Mother to Child Transmission of HIV in Nasarawa State.
By October 2015, the number of pregnant women seeking same treatment was 175,755.
This two-part story reports that aversion to condoms, unsafe sex among other factors are increasing the spread of HIV/AIDS in the state
No one knew the source of his sickness or what was wrong with him. From getting unusually weak on the football field after few minutes of playing to missing other matches, Badamasi Uba, an up-and-coming soccer star in Lafia, the Nasarawa State capital, suddenly faded into oblivion.
After exhausting many treatment options for his sickness, sometimes through repeated and stronger medications with no result, Uba in 2014, was advised to go for HIV test which showed that he was positive. The result marked a turning point in his life.
He gradually began his journey of recovery by using ante-retroviral drugs.
Going down memory lane, Uba says he was reckless with his sex life.
'I remember it was always 'gikin-de-gikin'(sex without condoms) with a lady I was in love with. So, I won't be surprised if I got it through unprotected sex.
'Then, I decided not to use a condom because if I used a condom, I won't enjoy the sex and it means I don't really like the lady. Sex with condoms seems unnatural,' he told SUNDAY PUNCH.
Another HIV patient, 41-year-old mother of four, Mrs. Hannah (not real name), told our correspondents that the men she had affairs with detested condoms.
'After my husband died, I was in other relationships. They (men) will say they don't enjoy sex with condom. After I contracted HIV, one man insisted he must have sex with me without using a condom but I refused. He never knew I was HIV positive and that I was only trying to protect him,' she said in an interview with SUNDAY PUNCH.
Uba and Hannah's stories represent a threatening trend as aversion to condom and casual sex have become the norm in Nasarawa State, ranked among the top four states in Nigeria worst hit by the Human Immuno-deficiency Virus.
According to the National Agency for the Control of AIDS, Nigeria has the third highest burden of HIV/AIDS in the world with an HIV prevalence of 3.4 per cent while it is second in Africa after South Africa. Among the states worst affected by the disease in Nigeria, Nasarawa is unique because the state has consistently recorded antenatal care HIV zero-prevalence rate higher than the country's zonal and national average.
Gikin-de-gikin, a Hausa phrase which translates literally as 'skin to skin', is a popular expression in the state. The phrase is used by the locals to mean sex without condoms. This dangerous sex habit, which has become the fad with a cultural backing to it, is one of the major pitfalls of checking the spread of HIV in the state.
Also commonly referred to as fata-de-fata among the locals, many residents of the state admitted that they were not at ease with condom during sex, hinting that using it would deprive them of maximum sexual satisfaction.
According to them, using condom during sex make it 'looks unnatural.'
Many of the residents prefer to take chances and get treatments for HIV in the hospital if they contract the dreaded virus. Although this act portends great danger for the state, efforts to nip it in the bud has been poorly coordinated as most residents take solace in the expression, 'God cares.'
Adamu Danjuma, a 40-year-old farmer, said before he contracted the dreaded virus, he never knew there was anything called condom.
While sharing his story with our correspondents, he said, 'In 2009, I fell sick. I was confused and didn't know what was wrong with me. My family was disturbed and I was taken to a hospital and a test was conducted; the result showed I have HIV. Before then, I never knew what condom meant. My belief is that God cares.'
The immediate past state Chairman of the Nigeria Medical Association, Dr. Friday Omolei, says aversion to condom is harmful and condemned the unsafe sex habits of the residents.
The former NMA boss advised residents of the state, especially those who are not married, to desist from casual sex.
'Those who cannot be faithful to their partners should desist from having sex without condoms. Aside from pregnancy which is not planned for, such individuals who have sexual intercourse risk contracting HIV/AIDS, hepatitis and gonorrhea,' he said
The Executive Director, Nasarawa State AIDS Control Agency, Dr. Zakari Umar, said the state recorded an increase in the number of pregnant women enrolling for Prevention of Mother to Child Transmission of HIV, otherwise known as PMTCT, from 23,719 in 2013 to over 175,755 by October 2015.
As of 2008 in Nasarawa, data obtained from NASACA showed that there were an estimated 68,000 HIV-infected people in the state: 16, 000 of these were youth (15-24 years) and 6, 000 were pregnant women. The state's cumulative death due to AIDS was put at 78,000 with 51, 000 AIDS orphans accounting for 37.4 per cent of the total orphans in the state. But the figure has increased.
A 2011 survey conducted by NASACA, titled, Modes of HIV Transmission in Nasarawa State,' the most recent of such in the state, stated, 'About 70 per cent of the infections occur amongst persons practising 'low risk' sex. Because condom use in this group tends to be low, HIV infection acquired as a result of previous or present high-risk behaviours or relationships by one of the sex partners is easily transmitted to the other unsuspecting partner.'
Nasarawa State is located in the North-Central, a geopolitical zone at the centre of the country. It has a number of junction towns such as Mararaba, Keffi Akwanga, Lafia, and many others.
The NASACA report stated that these junction towns 'attracts commercial sex activities, which not only increase the risk of HIV transmission among long distance drivers, who are away from their homes and have disposable income but also among their wives and partners back home as well as the inhabitants of the junction towns.'
Along Jos Road, very close to the Christian Pilgrims Welfare Board in Lafia, there is a hidden string of buildings where people patronise commercial sex workers. Many men visit the place at night because they don't want to be identified by their friends and family.
The buildings are homes to commercial sex workers who daily satisfy the longings of their customers for money. Our correspondents gathered that the women usually charge as much as N10, 000 to as low as N1, 500 for short and long hours of sex.
One of our correspondents, who visited the area, had a chat with one of the commercial sex workers, Jessica.
Jessica stated that the sex workers were not lacking 'customers' and had increased their charges because there is 'recession in town.'
Spouses keep HIV status secret
Many residents of Nasarawa are from polygamous homes. In order to avoid stigmatisation, many of the persons in such relationships prefer to hide their status. The virus then spreads in such homes as the couples continue to have sex.
One of such cases is that of 45-year-old Halimat Isiaka. Isiaka said her late husband's first wife was diagnosed with HIV but never told her husband.
'This was unknown to my late husband. The first wife, who is now dead, was rushed to the hospital after failing to respond to treatment. My late husband also quickly went for a test and he was told he had contracted the virus.
'My husband and the first wife died. Later, I started feeling sick. Strange rashes appeared on my body and later when I went for test, I found out I had HIV. That was how I became a regular visitor at this hospital,' Isiaka told our correspondents.
Similarly, while speaking with SUNDAY PUNCH on how he contracted HIV, a 40-year-old man, Mr. Usman Umar, said when he met his wife in 2011, she told him that her first husband died some years back, but did not tell him what led to his husband death.
'She never disclosed to me she had any peculiar disease. It was after she got pregnant that she went for antennal care. Her blood sample was collected for HIV/AIDS test and she tested positive. With fear, I went for the HIV test. I was told I also have the virus. It was like I should commit suicide,' he said.
At one of the hospitals our correspondents visited, 30-year-old Jerusa Yohana, admitted that before she got married, she did not tell her husband she had the virus.
Yohana said she decided not to tell her husband because she was afraid of how he would react to the news.
She stated, ''Each time I wanted to take my medicine, my husband always asked me why I took the drug daily. At first, I could not open up to him, but later I summoned the courage to tell him. He was not happy at all.'
HIV patients exceed available drugs
At the Special Treatment Clinic wing of Dalhatu Araf Specialist Hospital, the biggest hospital in Lafia, the rows of seats reserved for the HIV patients, are often not enough. Some patients stand on the corridor while others rest their backs against the wall.
When SUNDAY PUNCH visited the clinic, a middle-aged man, who identified himself as Ahmed, said that unlike before, baseline tests, medical services and food supplements are no longer free.
A Consultant Medical Microbiologist at the clinic, Dr. Esther Audu, said the effect of the rise in HIV transmission is taking its toll on many hospitals in the state and that many cannot afford the most subsidised treatments.
The doctor stated that the hospital started giving treatment for HIV/AIDS patients in 2006 and so far, they have registered close to 14,000 patients.
She added that about 7,000 people were currently receiving HIV/AIDS drugs.
According to her, out of the numbers registered, some have died and others transferred to other hospitals and defaulted. Audu noted that the hospital enrols between 50 to 80 new HIV patients monthly.
Audu said, 'Our major challenge is that we have a large number of HIV patients and the personnel to attend to them are few. The more HIV test we conduct, the more the number of people who test positive in Nasarawa.
'What gives us more concern is the support in terms of the provision of drugs for the PLWHIV. The partners are withdrawing their support. If patients have to pay for their drugs, then what will become of the crowd of patients thronging the hospital who are too poor to buy drugs?
'This means we are back to the era where HIV patients, unlike the ones we have here, would be easily identified because they are too weak due to lack of drugs.
'The month that there is a delay in supply of drugs, the patients increase. At times, it gets so bad that we would collect drugs from some patients who have excess and give it to others, just to keep them going.'
The National Action Committee on AIDS' Senior Programme Officer and Partnership Coordinator, Mrs. Chidiebere Ezeokafor, buttressed the concerns raised by Audu.
According to her, there is a call for concern because majority of the HIV/AIDS control strategies in the state are funded by international donors.
'We are soliciting more funding for HIV control programmes because the bulk of the funding is donor-driven and the World Bank-assisted project will end in April 2017, hence the need to urge state governments across the country to increase their counterpart funds,' she said.
Ezeokafor warned that if there was no serious effort to provide support before the end of 2016, the infection rate would soar in Nasarawa State.
Some patients shun medication
Findings by our correspondents showed that many HIV patients in the state were avoiding medication; a development that experts said should be quickly checked to curb the rise.
When our correspondents visited Lafia-East Primary Health Care where some of the HIV patients receive medication, one of the nurses, who spoke on condition of anonymity, said many of the patients refuse to come for their medications because of the distance between their homes and the hospital.
The nurse said since many of them could not afford the transport fares from their homes to the hospital, hence stopped going to the hospital.
Dr. Audu confirmed that owing to poverty, some of the patients no longer come for treatment because they also have to pay for their cards and some baseline tests.
She said, 'Before we place patients on ART, they are supposed to go through some baseline test, so that we know how their body will react. Many of them cannot afford the costs. Poverty is also responsible for the rise of HIV/AIDS in the state. Communal crisis in the state also discourages HIV/AIDS patients from seeking treatment at the hospital, besides most of the primary health centres in the state are not functioning as expected.'
One of the patients currently receiving treatment at the PHC, 28-year-old Mrs. Liatu (not real name), said apart from not having money for transport fare, some of the HIV patients, holding to the belief that God would care for their sickness, shunned treatment.
Experts urge more funding
While estimating the cost of treating an HIV+ patient yearly, Dr Umar, said it ranged from $20,000 to $40,000, adding that the burden was too heavy for the government to bear.
The NASACA boss explained that multiplying the estimated figure by the thousands of people currently receiving treatment in the state was unimaginable.
'Currently, the lifetime treatment cost of an HIV infection is estimated at $379,668,' stated a report by the Centre for Disease Control and Prevention.
Umar urged the Federal Government to seek a patent licence to produce the HIV drugs in Nigeria.
He said, 'The US massively produces their HIV drugs in pharmaceutical companies. We don't have the companies here. The way forward is to emulate India. India sought patent license for this drug from the US and currently produces them at home. Their pharmaceutical industries now produce the same drugs although with a different name.
'The way forward is get more drugs to suppress the virus so that there won't be a further transmission of the virus. So many HIV patients are not on treatment. If you have five HIV patients who are not on drugs, they will go and transmit the virus to 15 more people while the figure would increase. Sometimes, the governments spend up to N2bn to buy drugs. They simply can't afford that owing to what accrues to the state. The result is that we have to continue to seek help from the partners.'
Earlier in the year, the Director-General, National Action Committee on AIDS, Prof. John. Idoko, had asked the government to increase funding to tackle the menace.
In an interview with one of our correspondents, Idoko said, 'The current bottlenecks that exist can be resolved much faster if the government increases her investments in HIV treatment. For now, funding for HIV/AIDS care is borne up to 95 per cent by international donors. The majority of the treatment sites that provide ART services in Nigeria receive support from Global Fund and PEPFAR, a United States government funded programme.'
Idoko urged government at all levels to increase their investment in HIV services.
The Nasarawa State Commissioner for Health, Daniel Iya, declined to be interviewed by our correspondents.
But in an interview with SUNDAY PUNCH, the Chairman of the state House of Assembly Committee on Health, Muhammed Opkede, has expressed the readiness of the state government to curb the rise in the transmission of the virus in the state.
He said plans were underway to embark on an oversight visit to all the primary health care centres across the 13 local government areas and development areas of the state to review the challenges in tackling the virus.
He also said the Assembly would channel enough funds to the health sector and create more awareness on the dangers of HIV/AIDS and other diseases in the state.