A health worker dispenses ante-retroviral drugs to a patient with HIV
Counselling session against stigmatisation of people living with HIVAIDS
Prof. John Idoko, NACA DG
• Nurse divulges patient’s status
• NACA promises legal aid to stigmatised patient
One of the key issues addressed by the 2009 revised National Policy on HIV/AIDS is the right of people living with HIV /AIDS in Nigeria. Specifically, the policy spells out the right of individuals living with HIV/AIDS to life, to be treated when they are ill and visit hospitals/clinics for treatment, to be treated equally before the law and be given access to the best medical care available. National Mirror’s health correspondent, TOBORE OVUORIE, however, discovered a total disregard for this policy when she went undercover and visited some private hospitals in some states as a person living with HIV in search of medical attention. Contrary to the provision of the policy, her investigation reveals a high level of stigmatisation by health workers, especially nurses.
“Dis girl, na wetin? I don tell you say we no dey treat dat kain disease for here abi na me give you the thing?” These were the words of a nurse at Kowa clinic, Isoko road, Ughelli, Delta State in disgust over the reporter’s insistence and plea for access to the doctor. Her offence? She was supposedly HIV positive and asked to see the doctor in the clinic for treatment. She never saw the doctor as the nurse ignored her thereafter.
At Ketu, a Lagos suburb, this reporter was not only treated shabbily when she disclosed her supposed status at Deji Clinic as she was prevented from seeing the Medical Director. The nurse didn’t stop at that, she divulged her (the reporter’s) alleged status to a male friend (reporter’s) whom she thought was dating her.
This was the general trend in most of the hospitals visited by our reporter in Lagos, Delta, Bayelsa and Edo states over a six month period. Though discrimination against people living with HIV/AIDS has been reported to be on the decline in most parts of the country, National Mirror’s investigation reveals that this could be a hasty conclusion as it seems to be the order in several private hospitals across the country. And it is perpetrated by people who should know better: health workers, especially nurses! Out of 13 hospitals across the country visited by this reporter, only three health care giversan elderly nurse and two doctors-showed some form of understanding and willingness to treat her.
Although Nigerians confidently mention the various ways of contracting HIV and supposedly state all the time that not all people get it through unprotected sex, these seem to be lip service as some, if not most health care givers still believe it is contracted only through sexual intercourse.
At St. Peter’s Hospital, Amarata, Yenegoa, a nurse on hearing this reporter reveal she was HIV-positive and needed the services of a doctor who could manage her condition immediately told her: “how a whole educated fine lady like you go do am without condom? Abi you wan tell me sey you no know sey AIDS no dey show for face and cure no dey for am?
Like her counterpart at Kowa clinic, she refused returning the reporter’s friendly gesture by even refusing to disclose her name. Rather, she hastily declared there was no need for the reporter to see a doctor at the hospital as they “do not treat such disease”. When the reporter insisted on seeing a doctor, she remarked:
“Why are you stubborn? Go to Lagos, they can treat you there. Doctor is not around and if he were, we treat other sicknesses, not that one. Please, I’ve to go and attend to my patients” she said and walked away.
It was Easter and Nurse Juliet (she had mentioned her name) excitedly wished this reporter “Happy Easter beautiful sister” as the latter arrived Gloryland I.N.R.I Medical Centre, hospital junction, Yenegoa. She openly admired and complemented the reporter’s hairdo, skin, and make-up. This, however, changed immediately the reporter disclosed her HIV positive status and asked to be allowed to see a doctor to help manage her condition privately. Suddenly, Nurse Juliet’s smiles changed and she became placid.
Silent for some seconds that seemed like eternity, Juliet regained herself and calmly said: “I would have directed you to the doctor, but take my advice, it’s better to go to Federal Medical Centre, Asaba; I hear they give treatment free of charge there and there are so many things you’ll benefit if you go there. Go to FMC, my sister because you’re not supposed to pay for HIV drugs, but private hospitals will go there, collect them free and sell to you at very high rate”.
Nurse Julliet seems to have a point. At St. Nicholas Hospital, Lagos Island, one of the front desk officers told the reporter who would need to register with N25,000 to see one of the hospital’s General Practitioners who would then refer her to the visiting specialist after more tests. She also advised the reporter to go to the Nigerian Institute of Medical Research, NIMR, Yaba.
“Why waste money when you can go to NIMR? All the Professors and doctors you’ll pay so much to see at SNH, are some of the persons you’ll see free of charge if you go to LUTH, NIMR, VCT clinic, and even Mainland Hospital, Yaba.
I’m not saying you should not come to SNH, but after that N25,000 I told you, you’ll continue the cycle of payments for what you’re to get free were you to go to the appropriate place, besides, these outsourced consultants don’t come regularly.
When you go to these places, you’ll see other victims like you. You people will even become friends, and can marry yourselves” the lady said.
Though only trying to be of help, the young lady, like many health care workers, still lack the right skills and knowledge in relating with people living with HIV. In virtually all the hospitals, phrases like “your disease”, “your sickness”, “HIV-victim”, “can/should marry fellow HIV victims” are used freely not knowing they denote discrimination.
For instance, at Narrow way clinic located in Oduwawa, Benin, the three nurses at the hospital’s reception desk tried consoling this reporter on hearing she was HIV positive and needed a doctor to privately manage her.:
“Sorry about your sickness, don’t worry, you won’t die soon”, one of the nurses consoled the reporter.
“Don’t worry, you’ll get a husband of your own. HIV victims have associations and they even marry themselves there; you can locate them and join the group”, the second counselled while the third added: “They will treat you fine in the HIV association and a beautiful lady like you will quickly get one of the men to marry you”.
The “dirge” did not end there as it continued at Madona hospital, 60, Enerhen road, Warri; Winrose clinic, 6 Petibi Lane, off Enerhen road, Warri; and Veenel hospital 61, Okumagba Avenue, Warri respectively, when this reporter continued her search for a doctor who could manage her supposed condition, no matter the amount to be charged. Like hospitals, the nurses prevented her from seeing a doctor.
But at Sage Clinic, Okere/Ugborikoko road, Warri, a nurse told our reporter that: “We never treat that kain thing here before”. After a second thought, she went into an office to speak to a doctor. Unfortunately, this nurse returned with both a sad and discriminatory response. Her words: “doctor say make you go UBTH. He talk say him no fit treat HIV. Na UBTH and big, big government hospital dey do that kain work”. The doctor never came out or requested to see the supposed HIV positive patient.
Obviously, the nurse was quite ignorant about her discriminatory use of words. After a second thought, she walked up to our reporter on her way out pleading: “I hope sey we no vex you. But true true, we never treat that kain sickness before and doctor true true no fit treat am”. But when asked her name, all she said while reluctantly returning a handshake from this reporter was: “no worry about my name”.
The situation was not different at Fenoma Hospital, Forestry road, Benin City as the nurse at the hospital’s reception hastily dismissed this reporter on hearing about her health condition.
But one of the hospital’s patients who saw how the reporter was treated and how the nurse kept on looking at her (the reporter) from head to toe, joined the latter at the door when leaving the hospital premises. At a safe distance, she revealed that she was also HIV positive and the attitude of nurses towards her prevented her from telling anyone about it.
Ibinabo Pepple, a final year English language student in one of the universities in Edo State, disclosed: “I tested positive while I was in 200 level and like you, tried being responsible by seeking a doctor to manage me. Again, like you, I wanted to make it secret and would pay any amount for it. But you needed to see how the nurses I came across treated me.
“Don’t feel bad, these health workers are more ignorant than they should be. It was during my second semester while in 300 level that I met one doctor; one thing led to the other, we became close friends and I opened up to him. He’s the one who introduced me to APIN in LUTH and I’ve been on anti- retroviral drugs , doing my CD count and other things since then.
“My dear, forget these stupid nurses and baby doctors, I doubt if they even know their own status. Just go to APIN, at LUTH whenever you can, all you need is your transport fare to Lagos and back to Benin and you’ll live your normal life without anyone here in Benin knowing you’re HIV positive. My family members don’t know, so cheer up sweetheart”, she said.
The reporter was, however, able to locate a few health workers who showed some understanding towards her plight. At Fuja hospital, Lagos Island, Dr. Ajenifuja with so much warmth, continued chatting with this reporter the way he was doing before she broke the news that she was HIV positive.
As a matter of fact, he continued the maintenance of close contact with her and continued holding her hand, tapping her arm gently from time to time in a very friendly manner while educating her that she’s not a victim as HIV is just a condition which shouldn’t limit her from becoming who and what she wants to become.
Without being asked, he offered this reporter his phone number that she could call and ‘pop’ in anytime to see him after assisting her with names and contacts of hospitals where she could be properly managed for free.
Dr. Olumide Sanni, a General Practitioner with Hanoba Medical Centre, Boyle Street, Onikan, Lagos was as amiable as Dr. Fuja. He walked into this reporter at the hospital’s reception while an elderly nurse, Mrs. Nwanyanwu, was counselling her and assuring that the condition was quite manageable. When told by Nurse Nwanyanwu about our reporter’s supposed condition, the doctor swung into full action. He ushered her into his office, offered her a seat and some candies and cracked so much jokes which got this reporter laughing. Like Dr. Ajenifuja, he spoke at length about HIV, disclosed he had delivered pregnant women living with the virus but their babies are negative and went on to teach her about how she could care for herself. At the end of their discussion, he made her promise to visit NIMR (where he referred her to), take her drugs regularly and religiously keep to the appointments she would be given at NIMR. Without being asked, he supplied his names, contacts and has continued calling the reporter to find out if she’s taking her drugs and adhering to all medical appointments and instructions.
But Mr. Sam. Archibong, Head, Corporate Communications, National Agency for the Control of AIDS (NACA) could hardly believe that the reporter’s findings would come from Nigerian hospitals..
“These are things that used to exist and were very heavy, but I doubt today if they are as bad as they were then anymore. Today, the issue has mellowed down. Corporate organizations have been involved in the fight against HIV/AIDS”.
He didn’t rule out the possibility of such health workers still existing. “In all issues of life, you will find people who are deviants. Deviants will not go with what is expected of them. They will like to behave differently. This behaviour could be bad, but they may not feel it while the way somebody, somewhere is feeling it. That somebody could be your relative or mine, even our acquaintance. They may not know it, but somebody is paying for the results of the action that has been taken by other person somewhere, someday.
“We want to use this opportunity to restate that discrimination should be a thing of the past. Even employers of labour have stopped it. You often hear employers say: “If you are positive, that is not the end of life; you can still add value to what we are doing here as one of our workers. You are expected to receive all the entitlements. You are welcome to the job”. These are some of the good things we hear from employers of labour. We have campaigned against it. People living with AIDS have campaigned against it, too. People who are employers of labour have discovered that of as a matter of fact, that those who are positive could still add value to what they are doing. It also shows that such organizations have caring hearts for those who work for them”.
As regards private hospitals getting antiretroviral drugs free from designated HIV/AIDS management centres and reselling at very high prices to patients, Archibong said: “Well, I cannot answer this”.
According to him, the drugs are available in some hospitals, but not all due to the country’s high population of those using antiretroviral.
“Even we are aware that we have gone down in prevalence level, we are also aware that quite a number of people are yet to gain access to getting retroviral drugs as quickly as they will want it. Sometimes, the drugs are not available; that is true. But, I do not know that drugs are sold exorbitantly in hospitals. I do not have that information. That could be true; but you have a group of positive people living around the hospitals who try to ensure the drugs are sold at the expected price. They also ensure that if it is a hospital that is receiving drugs on percentage support from government, they know that the drugs will be cheaper. They know exactly how much they are. They also make sure that the hospital or the health centre is selling the drug at the expected price to the public” he added.
On the attitude of nurses not willing to protect patients. Archibong said: “This is a little strange to me at this point in time. Some few years back, yes, that occurred. We have dealt with the issue so much so that we hardly hear it now. But, we remember that there was a time when people were castigated if they were discovered to be positive. To hear now that individual’s status is being divulged, is a serious issue and deserves a serious reprimand. This might, however, be a misconception and one cannot be very sure that this is the situation. I am very surprised to hear that people could divulge such information; something we thought had ended. It happened years ago at a teething age. But now, I would want you to really investigate. NACA will give you necessary support because when you find out the truth, it will help us to position ourselves well when we are planning intervention activities. he said”
“Let me add that it is not enough to be aware of HIV. It is also important that the means of ensuring that the prevalence is reduced and there is a cure for HIV/AIDS is very important. So, this country supports all efforts, globally, to ensure that the vaccine that can help cure the disease is discovered and put the problem at rest once and for all. The government of Nigeria is supporting that call by making resources available in order to ensure that when it is possible, the world will discover a cure for HIV/AIDS. We would then all see the disease as what it had once been.
Across the world, there have been very heavy campaigns to ensure that those that are currently down with HIV/AIDS are given succour, care and support. It is important we let our people know that HIV is not anything one contracts and brings an end to one’s life. We need to always call those with the virus and encourage them that all is well. There are people with HIV who have lived for 20 years and they are still not down with AIDS”, he explained.
It was, however, a different picture at NIMR, Yaba Lagos. The reporter, still mixed freely with people living with HIV/AIDS who had reported at the institution for treatment. The health workers were not only professionals, but related freely with their patients. For over five hours of the two days this reporter observed activities at the centre, no caregiver acted or used any discriminatory words against any of the PLWH.
In a chat with one of the caregivers who simply identified herself as Susan, she emphatically stated that: “HIV is a condition, not a disease or death sentence. I don’t doubt your experience because you’re not the first person to tell me this, but all I’ve always told people and I will say it to you that go to only any of the centres designated for the purpose of rendering care in managing the condition, when you go elsewhere other than these places, there’s a possibility of being treated the way you were”.
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