Nigeria prevention brothels

No Comments » December 28th, 2006 posted by // Categories: HIV/AIDS-in-Africa Project

MSF intensifies fight against HIV-AIDS in Nigeria

Monday January 17, 2005

LAGOS (AFP) – The medical aid group Doctors Without Borders (news – web sites)
said it was intensifying its fight against HIV (news – web sites)-AIDS (news –
web sites) in Nigeria, where some four million people have already been caught
up in a spiralling epidemic.

Since November 2003, MSF has working with a government hospital in central Lagos
where it has about HIV/AIDS 250 patients enrolled under its project, the
organisation’s spokeswoman, Tracy Crawford, told a group of journalists.

“We are building capacity to fight the disease and encouraging people to get off
the streets and come forward voluntarily for treatment,” she said.

The programme hopes to establish a model of comprehensive care and support for
people living with HIV-AIDS and to reduce HIV-AIDS morbidity and mortality.

Between 200,000 and 490,000 adults and children died of AIDS in Nigeria in 2003,
according to a document jointly prepared by UNAIDS (news – web sites), UNICEF
(news – web sites) and WHO.

MSF will only leave Nigeria “when we are sure that the Nigerian programme, being
funded by the German office of MSF, will continue. For now, we have so far had
positive and fruitful relationship with the hospital,” she added.

She said that the international humanitarian agency has a team of 10 workers in
the hospital, five of them expatriates.

At least two of MSF’s Nigerian workers are HIV positive.

Ibrahim Umoru, 41, a father of two children and a peer health education officer,
said that he has been living with the HIV virus (news – web sites) for five
years and that he is no longer concerned about the social stigma of having the

His colleague, Mary Ashie, who advises patients on how to maintain their drugs
regime, said that she had become aware of her HIV positive status in 2000, after
her six-month-old son infected with the disease died.

She made fruitless and expensive visits to Christian pastors, herbalists and
local doctors before her health began to deteriorate until she was placed on
anti-retroviral (ARV) drugs, said the shy-looking woman.

“My job under the MSF programme is to let patients know the importance of taking
their drugs at the right time, educate them on drugs and the side effects of ARV,”
she said.

The MSF voluntary counselling and testing centre in the hospital, currently
wearing a new coat of paint, is scheduled to be formally commissioned on Tuesday
by Lagos State Health Commissioner Leke Pital, according to officials.

The centre provides medical care, nutritional support, laboratory services,
counselling, antiretroviral adherence counselling and referrals for other

MSF’s consultation and treatment at the centre is free. The patient only pays
150 naira (about one dollar/euro) to be tested.

Umoru said he had had to pay 21,000 naira (158 dollars) per month where he was
undergoing treatment before he joined MSF last year.

“This money I was paying was far above my monthly salary,” he said

Dose of Prevention Where HIV Thrives – Nigeria Brothel Is Test Site for New

By Craig Timberg
Washington Post Foreign Service
Wednesday, December 22, 2004; Page A15

IBADAN, Nigeria — Crude paintings of women and rows of dimly lit bedrooms make
clear the purpose of a shabby building just off a main road in this sprawling
city. But for the next year, this brothel will have another function as well:
testing a drug that could help stop HIV infections before they begin.

About 125 prostitutes here are pioneers in a U.S.-funded study that will
ultimately involve 5,000 volunteers in seven nations. The study seeks to
determine whether a single daily dose of an AIDS drug called Tenofovir can
prevent infection from taking hold in healthy people, the way birth control
pills prevent conception.

If the pills work — and if such high-risk groups as prostitutes, soldiers and
truck drivers can be persuaded to take a pill every day even though they are not
sick — researchers said it could slow a disease that is devastating Africa and
much of the developing world. There are roughly 40 million people with HIV, the
virus that causes AIDS, and there were 5 million newly infected people in 2003,
according to the United Nations.

“Even if it works for 20 percent of the population, it’s an improvement over
nothing,” said Isaac F. Adewole, provost of the University of Ibadan College of
Medicine, who is overseeing the drug trial.

The drug raises a number of scientific and ethical questions, any one of which
could prevent it from ever being widely administered. But Adewole and other
researchers say if those questions can be resolved, Tenofovir could dramatically
curb the spread of HIV by blocking infection in people who are most likely to
catch the virus and pass it on.

A 1995 trial using Tenofovir blocked the transmission of the simian strain of
HIV in monkeys. A similar approach has already succeeded in preventing infection
in rape victims and medical workers exposed to HIV.

Like other antiretroviral drugs, Tenofovir works by keeping HIV from
reproducing. Researchers say that a daily dose could interrupt the crucial first
step of HIV, when the virus turns host cells into factories that make millions
of copies of the virus.

Tenofovir trials are beginning in Nigeria, Ghana, Cameroon, Malawi, Botswana and
Thailand, as well as in Atlanta and San Francisco.

Among the most appealing aspects of a drug taken daily to prevent HIV, say
researchers, is that women could take it privately at a time of their choosing,
without a husband or other sexual partner knowing. Married women — even those
who are monogamous — are among those most vulnerable to AIDS because husbands
who have sexual relations with other women may be unlikely to take precautions
or alert their spouses.

“World over, it is much more difficult for somebody in a long-term, supposedly
faithful relationship to use a condom,” Helene Gayle of the Bill & Melinda Gates
Foundation, which has contributed $6.5 million to Tenofovir trials, said from
the foundation’s headquarters in Seattle.

The most difficult questions about Tenofovir research concern the safety and
practicality of a long-term daily drug regimen for healthy people, particularly
in Africa and other parts of the developing world where regular use of medicine
is uncommon. Taking the drug sporadically, researchers say, might provide only
partial protection and could encourage mutant strains of HIV to develop.

There have also been strenuous objections from AIDS activists concerned about
the ethics of a study in which half of all subjects receive a placebo rather
than a drug that could save their lives. During research in Cambodia, where 900
prostitutes were being recruited for the trial, an organization of sex workers
protested, pushing the government to suspend the study there this past summer.
Hun Sen, the nation’s prime minister, was quoted as saying, “If a trial is
needed, please do it on animals and don’t use Cambodians.”

Complaints have also come from advocates of traditional vaccines and
microbicides who regard the study as a costly diversion from other research.
Microbicides are applied to the vagina or rectum before a sexual encounter to
kill the virus before it can cause infection. Supporters say that approach is
more practical than taking a pill every day.

“I’m not saying that nobody is going to take it,” said Morenike Ukpong of the
Nigeria HIV Vaccine and Microbicide Advocacy Group. “I’m saying [the number] is
very low.”

The worldwide research project is projected to cost as much as $50 million, with
the expense divided among the U.S. Centers for Disease Control and Prevention,
the National Institutes of Health and the Gates Foundation.

The first answers to some of the questions about Tenofovir will come from the
prostitutes in Ibadan, who were recruited from several brothels and have been
taking pills since July. Prostitution is legal here, and the brothels attract a
steady supply of women from the surrounding countryside looking for a way to
finance schooling, assist struggling families or save money to start a business.

Two of the prostitutes, who spoke on condition of anonymity, said they were
aware of the dangers of HIV and eager to protect themselves with the condoms and
pills provided by the researchers. Both women, in their early twenties, said
they had experienced no side effects.

“I take the medicine every day now,” said one of the women, leaning over a
brothel balcony. She was wearing a tight red dress and had coiled her hair into
tight, spiky braids. Her friend, clad in a sheer black top, cooled herself with
a plastic fan. “I take my medicine and I use condoms, so I think I’m safe,” she

But like everyone else in the study, these women did not know whether they were
taking Tenofovir or a placebo. The prostitutes are counseled and given unlimited
access to condoms, but in a city where 22 percent of all sex workers have HIV,
researchers expect some to contract the virus during the study.

That is the crux of the ethical dilemmas facing the Tenofovir trials. At an
international AIDS conference in Bangkok in July, an activist group, AIDS
Coalition to Unleash Power, organized protests and posted signs reading: “Tenofovir
makes me sick.”

Among the demands of AIDS activists is that anybody who contracts HIV during the
study should be guaranteed lifetime medical treatment. Researchers have agreed
to arrange for antiretroviral therapy though national public health systems, but
have argued that to guarantee lifetime medical care would drive the cost of the
study so high that it would become impractical.

Ward Cates, president of Family Health International, a nonprofit group in North
Carolina, is overseeing several of the trials around the world. He said past HIV
research showed that even those who received placebos in such studies were less
likely to become infected than the general population because they also received
counseling and condoms.

The first results from the study are due in 2006. If Tenofovir is found to be
safe and effective, it could become available for daily use soon after because
it has already been approved throughout much of the world for treating AIDS.
Some even imagine Tenofovir one day being packaged with other medicines taken
daily, such as birth control pills, to make it even easier to use.

“There’s not a one-size-fits-all approach for trying to attack the virus,” Cates
said in a telephone interview from his office. “We need a full range of HIV
prevention measures.”

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