FEATURE ARTICLE

E O EkeFriday, September 7, 2012
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AIDS IN NIGERIA THE FORGOTTEN EPIDEMIC

t was in 1987 or there about, while I was rotating through dermatology that I first saw a patient with AIDS. I was running a clinic in Wesley Guild Hospital Ilesha with Professor Femi Soyinka when I was asked to see a very chronic ill looking and emaciated young man in his 30s. He told me that he had had fever that would not stop, and it was as if there was a pipe connecting his mouth with his anus as everything that enters his mouth passes out through his back passage in no time. He stated that he felt very weak and was fearful that he was about to die. He asked me if I thought he would survive and what was wrong with him. Before that time, I had not seen a case of AIDs. However, I had read about the disease in Time magazine and how it destroyed the San Francisco homosexual community in late 70s and early 80s and felt that AIDS could be a one of the possible diagnosis. .


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After I presented the case to Professor Soyinka, we agreed that AIDS was one of the differential diagnoses and it was left for me to take blood from the patient for the necessary investigations and effect his admission. Not surprising, few days after he was admitted, he died and the test later left us with no doubt that he was suffering from AIDS. To the best of my knowledge, this was the first case of AIDS in Obafemi Awolowo University Teaching Hospital Ile Ife. Since then, we know more about AIDs, its mode of spread, nature of its causative agent, prevention, treatment and prognosis. We also know that it is essentially a sexually transmitted infection and one of the blood borne viruses. Its prevalence has become a reflection of sexual habit, education, practice of safe sex of the individual, attitude of the community to sex and quality of healthcare service and development of a country.

The scourge of AIDS continues to decimate Africa in general and Nigeria in particular. It is arguably currently the greatest killer of young Africans. Since the time I first saw a patient with AIDS, twenty five years ago, I have lost many friends, and relatives to the disease, some of who contacted the infection through blood transfusion and some from reckless sexual habits and practices. If my experience is anything to go by, AIDS has indeed, killed millions in Nigeria. In this article I will focus on AIDS in Nigeria, and how a combination of religion, ignorance, a culture of secrecy, dishonesty, lack of robust public health policy and practice, and government corruption are aiding it to destroy the future of Nigeria and prime the country for extinction. There is no doubt that in African Aids is an essentially a sexually transmitted infection rooted in ignorance, perpetuated by religion, tradition and incompetent corrupt and inhuman government, while in the west, it is a disease of sexual perversion, poverty, promiscuity and drug addiction.

The question remains, why a significant population of Africans choose to engage in sex in ways that endanger, the lives of women, and promote the spread of diseases? Why is AIDS spreading in Africa in spite of enough knowledge to stem its spread by change of sexual habit and practice? Why is AIDS spreading in Nigeria when its prevalence is decreasing in developed countries essentially because of adoption of safe sex?

Most of the poorest countries in the world are either in Africa or populated by people of African ancestry. They are usually very corrupt with very high rate of crimes. Women in these countries have very high and unacceptable maternal mortality rate which could be drastically reduced by change of attitude and culture. They are also male dominated. Paradoxically these countries also tend to be countries with abundant natural resources where the people are very religious and at the same time very corrupt. Examples are Nigeria, Zimbabwe, Democratic Republic of Congo, Haiti, Jamaica, Sudan, Kenya etc.

It is claimed that the prevalence of AIDS in Nigeria is about 3%. However; most people in this field know that it is a gross underestimation of the true prevalence. Up to 95% of AIDS infections in Nigeria are as a result of heterosexual sex and the usual reasons are lack of clear evidence based information about sexual health, low level of condom use, and high levels of sexually transmitted disease. However, this is not competeletly true. For instance how can high levels of sexually transmitted diseases be a cause of AIDS, when Aids itself is a sexually transmitted disease? The correct thing would have been promiscuity and all other factors that aid the spread of sexually transmitted disease, like absence of culture of safe sex. A very important source of the spread of AIDS in Nigeria which is 100% under the control of the government but not often highlighted, is blood transfusion. The government’s failure to regulate and modernise blood transfusion services remains an unnecessary preventable source of transmission of AIDS and other blood borne viruses. the government can achieve this by good policy, change of practice and legislation.

Many people I know or grew up with, have died of AIDS. Some of them in very unfortunate and sad circumstance. From receiving unscreened infected blood, and being injected with contaminated needles in government and private hospitals in Nigeria, to engaging in unprotected and reckless sex; Aids have spread in Africa like wild fire and now threatens the survival of its people. The continent is awash with millions infected with AIDS who literarily have death sentence hanging on their heads and are a great danger to unsuspecting public. The government is not doing enough to address this epidemic. In spite of this unfortunate reality, African governments have failed to prioritize the war against AIDS (WAA) enough and the epidemic has worsened. Effort by foreign organisations to help African countries fight the disease has been marred by corruption, while the people have embraced the opium of religion. Instead of pursuing the cultural and attitude change by ensuring that the people are equipped with the knowledge and understanding to take personal responsibility for their sexual health, habit and preferences, those responsible for these programs are more interested in channelling the aid fund into their private pockets. They have failed to do the most important thing needed to stem the spread of AIDS in Africa which is to saturate the continent with correct information about AIDS and Change the black man’s attitude to sex.

They have failed to target the real culprits in the spread of AIDs in Africa which is African men. Men are the people who spread AIDS. They are the butterflies who visit many flowers. They are the ones who patronise prostitutes and engage in multiple sexual conquests. They give it to women and women just hold on to it for the next man to come and carry it to the next innocent woman and then a man will come and transport it to the next woman. To control the spread of AIDS in Nigeria in particular and Africa in general, African men must be made to take responsibility for their sexual habits and behaviour. Like family planning, the focus has been on women while the real culprits is left to feel they have very little to do with it. The government has to get serious by enacting tough legislations against those who infect people with aids as is the case in many western countries.

Everywhere one looks in Africa, one sees the way and manner, corruption, disdain for honesty and transparency, traditional thinking, religion and ethnic nationalism are crippling the nations and perpetuating ignorance and making extinction inevitable. Today, Aids and tuberculosis are killing Africans and endangering her future and all that the people can do is pray, pray and pray. A look at AIDS in Africa reveals a sorry, sad and unfortunate picture. In British white population, Aids tends to occur amongst drug users, sex workers and homosexuals, suggesting that it is essentially a disease of poverty, ignorance and reckless sexual life style. In the British Black population, AIDS tends to occur amongst heterosexual, educated people, professionals who are neither drug users nor have alcohol problems. I have often wondered the reason for this variation. On reviewing some of the data, it is difficult not to finger the other variable in the African community which do not seem to exist in the white community.

In Africans, It would seem to be a disease of ignorance mediated by traditional and religious beliefs and attitudes? Its presence in normal Africans in heterosexual relationship, who are well educated, have good jobs, do not use drugs and actually very religious raises very serious question about their attitude to sex, information processing and use of evidence to reach conclusions. Why should a disease which is seen in unemployed drug addicts, people with pervasive sexual orientation and prostitutes amongst whites, occur in Africans who claim to be very religious, in traditional family relationships and who neither abuse drugs nor alcohol remains a mystery? The question that has puzzled my mind is, why this stark epidemiological variation in the population of white and Africans who suffer from Aids. After many years of observation, anecdotal evidence would suggest to me the religiosity; traditional thinking and a culture of secrecy may be blamed. I am persuaded that the traditional and religious attitude of Africans to sex is perhaps the most important fact aiding the spread of Aids in the continent and beyond. May be, the Africans’ internalisation of ‘Be fruitful, and multiply , and replenish earth’, understanding of fornication and adultery; are where the misconception about sex resides and may be the greatest obstacles to the control of AIDS and other sexually transmitted infections among them.

The Christian and Islamic religions are very hard on sex, yet they are very obsessed with it. They prescribe very severe punishment for ‘sexual offences’ and accept sexual practices like polygamy and Child marriage which the West would consider unjust, criminal or outright immoral. This primitive attitude of Africans to sex encourages the use of repression, and denial in addressing sexual matters. The failure of Africans to recognise that human beings are sexual beings, and that in fact, sex in itself is not a sin, has made it impossible for them to focus on the most important aspect of sex; which is ensuring that it is engaged in, in a safe, secure and consenting manner. Instead of concentrating on safe sex, African tend to overvalued its morality and created a culture where the emphasis in on who and how one has sex, instead of, whether one practices safe sex irrespective of who it is with. This is not promotion of promiscuity as human beings are already promiscuous. The existence of sexually transmitted disease is the clearest evidence that human beings are sexually promiscuous by nature and that the emphasis should be on safe sex and not on its morality. The evidence of sexual abuses by Roman Catholic priests and Muslim Imams etc. is the clearest evidence that the need for sex can be like the thirst for water or hunger for food and human beings cannot avoid these urges simply by repression and religious morality alone.

The result of this misunderstanding of sex is that amongst Africans, there would seem to be obsessesion with the morality of sex, while developed countries concentrate on safety of sex. The result speaks for itself. While the incidences and prevalence of sexually transmitted disease are failing in the west, and tend to concentrate in population that are deprived , it is rising in Africans in a population that is supposed to be enlightened.

For instance, the Roman Catholic Church teaching on sex has condemned a lot of people to early and unnecessary death and the Islamic teaching on sex is not helping either. The stance of the major religions in Nigeria on family planning and birth control has ensured that having many children perpetuates poverty and its attendant social disadvantages in many religious African countries. In fact I am persuaded that one of the factors perpetuating corruption in Nigeria is having many children. The opposition of the Catholic Church to the promotion of wide use of condom to protect against sexually transmitted infections (STI) would one day be rightly regarded as at par with the opposition of the abolition of slavery, and rejection of the first studies that suggested that perinatal deaths were linked to infections. Birth control and prevention of the spread of STI should never be viewed from only a moral perspective. There are other aspects which are equally important which are ignored in the need to do what some people believe an unseen God wants. There are social and economic facets of sex which rely on empirical evidence to reach reasonable conclusions. We now have enough evidence and understanding of human nature and behaviour to allow people the freedom to make individual decisions about safe sex. Until Christianity and Islam changes their understanding and attitude to sex, and allow their understanding and what they believe about sex to be informed by knowledge, many honest, sincere normal Africans would be condemned to early death because of what religion thought them about sex. to be continued.

E O Eke is qualified in medicine. At various times he has been a General medical practitioner, Medical missionary, Medical Director and senior medical officer of health in Nigeria. He specializes in child, Adolescent and adult psychiatry and lives in England with his family. His interest is in health, religion philosophy and politics. He cares for body and mind.

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