By Juliana Taiwo-Obalonye
Every December 1, the world commemorates World AIDS Day to raise awareness of the illness and to remind people and governments that HIV is still an issue. In this interview, Eduardo Celades, the Chief of Health in the UNICEF Nigeria’s Country Office, discussed the effects of this on maternal and child health, as well as the threat that brain drain poses to the nation’s healthcare system. He also discussed his favourite aspects of Nigeria, which is its cuisine, as well as the need to resolve security concerns in order to draw in investment.
According to a UNICEF report, since 2015, Nigeria has had 190, 950,000 HIV/AIDs infections, the second highest in the world. What would you say are the reasons for this?
In Nigeria, there were 1.9 million people living with HIV. We still have a very high number of infections. The country has made great progress, reducing that and now we have 1.7 million people on antiretrovirals (ARVs). And basically, as you know, with ARVs, we are able to actually prevent and treat at the same time. However, one of our main challenges and gaps is infections among children. We’re not making enough progress yet. And still, we have about 74,000 new infections every year. Most of them are among young people right now. So this is actually our main gap; we need to avoid the mums transmitting HIV to their children.
Why did your report say progress has been slow over the past few years?
Nigeria and the rest of the world have been improving in general. However, as you know, the last couple of years have been very challenging. We have on one side COVID-19 pandemic that hasn’t affected the health sector alone. But the society as a whole is also affected, the current economic crisis and competing priorities, etc. So, what we are seeing is like progress has slowed down or there is no progress. This is on top of all the other challenges that the response to HIV has, for example, the stigma and discrimination. Another big issue to reduce the number of children with HIV and to prove treatment is the lack of ARVs for children because there are very few formulations of that.
So would you say there has been any recent progress in eradicating the infection or suppressing the rate of cases in the country, despite the free treatment policy of the Federal Government?
If we look back 10 years ago, the progress is enormous. I mean, now, out of the 1.9 million people with HIV, 1.7 million people have access to ARVs. This is incredible, right? So, we cannot deny that. I think the government and the people of Nigeria need to be congratulated. We are still facing challenges, especially for mothers and children. To give you an example, every year, we have more than seven million women pregnant; two million of these women don’t have access to HIV tests. So, at the end, if they are positive, they are going to transmit the virus to their children. We don’t have enough early infant diagnosis, so that we can test children as soon as possible so as to put them in therapy. We don’t have enough point of care machines to do that. So, if you ask me, what will be the main priority moving forward, it will be PMTCT – prevention of mother to child transmission of HIV. And this is to ensure that all these mothers have access to tests and treatment; and for the children, early infant diagnosis and treatment as well.
Do you see Nigeria achieving HIV/AIDs free status by 2050 and the United Nations ambitious treatment plan to end HIV/AIDS by 2030?
I think we need to aim for that, and I think we have three main drivers. The first one of our objectives should be elimination. This would be our ultimate goal. And we need to put all the resources, all the efforts, the time, financial, and human resources to make it happen. The second one is like we need to innovate and we need to do things in a different way. One, of course, is integration. We need to take advantage of new technologies. So at UNICEF, for example, we are supporting this innovation that is called Yaah Naija (Youth Alive and Healthy). That is basically, in your phone. You can get information on what is the closest point to you for an HIV test, and you can do a self-test, you can test yourself? With 1.9 million people living with HIV in Nigeria, we need to empower them. If we don’t do that, we are not going to achieve our goals. So, yes, I think it’s feasible. At this moment, one of the biggest challenges for the health sector as a whole is human resources for health in Nigeria. We need to address that as well.
I would like to know, aside from your work in Nigeria, if you have moved around a lot. What would you say are the challenges in addressing some of these issues captured in your report?
Yeah, I think a common challenge that in my experience in Africa I am seeing, and in Nigeria particularly is severe, is the issue of human resources for health. Normally what we are finding in most of the African countries is like there are no doctors, nurses, midwives. In Nigeria it is especially problematic because there is a huge brain drain of doctors and nurses going to the UK or to the US or even Canada. What we have seen is like most of the health facilities don’t have the human resources that they need. And those cannot provide the care that the people need. So this is an issue of the foundations of the system. And this is the appeal of UNICEF to the government and to partners on how we can increase the investments in human resources for health. This is not a short-term investment; it is a long term investment. It takes a lot of time to train a doctor or nurse. And what we are seeing is like in rural areas, they do not have attractive packages. I mean, maybe the salary for junior doctors in one state in the north is really low. So we need to address that as a foundational problem, if we need to have success. I will put that as priority number one. There is the Abuja commitment to increase investments in the health sector. The reality is that most of the state governments are struggling to achieve the Abuja commitment. And even when they allocate these resources, they don’t release the funding on time, or they don’t release the funding at all.
Aside work, how do you find Nigerian people, food, culture, music and how are you adapting? How long have you been in Nigeria?
I have been in Nigeria for one year now. Nigeria is a fascinating country. I have had the opportunity already to visit 11 states of the federation, with all the diversities the nation has. And from a public health leader, a public health practitioner, Nigeria is where you can change things. If we make things right in Nigeria, we can make things right in Africa and in the world. To give you an example, one year ago, one million doses of COVID-19 vaccines expired. I don’t know if you remember that. It was the one million Pfizer’s vaccines that expired. Nigeria was in the news everywhere in the world. Today, almost 70 million Nigerians have been vaccinated against COVID-19, no vaccines expired again. Nigeria is driving COVID-19 vaccination in Africa. Nigeria has the best public health practitioners in the world. So it’s really amazing for me, it’s really incredible to be here. It’s like a dream because you can really have an impact. So I’m quite happy.
What are the things you like? Have you tried the food? Do you like the music?
Yes. I like very much the fisherman soup from Bayelsa, pepper soup on Sundays and, of course, music from Davido to everyone. So yeah, this is really a cultural place. I mean, I’m very much into Nigerian history. Of course, I am very much into Nigeria’s literature from Chinua Achebe to Chimamanda, to Soyinka. This is really fascinating. And I have been to 22 countries in Africa. So I’m not new to the continent. I will be here for two more years. I really hope to continue enjoying it.
You said you have been to 11 states. Which one is your favourite?
All of them have a special place in my heart. I can tell you that I have been to Lagos three times and Kano twice. So they are the front-runners. And I’m really impressed that each state is different. I mean, it was really impressive in Gombe to see the cleanliness. You feel the clean air and clean streets. That’s amazing. So every state is completely different. I have been going through Nasarawa up and down and in Bayelsa is the fisherman soup. So, in Enugu you can see how vibrant Enugu is and how they are driving things. I think every state is different. In Maiduguri and in Yobe, I was impressed; there is this vast land. So, it’s really a fascinating country, I can tell you that.
You just said that Nigeria is in the news. And insecurity is one of the reasons. So you don’t get scared going to these states?
Of course, I mean, security is a big issue. And I hope that security will improve over the next few years. I would have loved to go to the Calabar Carnival, for example, to see the fishing festival in Kebbi and Sokoto but for security reasons, I can’t do that now. But I hope that this will improve. You know, normally our assignments in the UN are three years. That is 36 months. We have 36 states in the federation and I really hope to see maybe one state per month.
How long did it take you to adapt to Nigerian food because the food is quite spicy? Do you eat spicy food in your country?
No. I have to say that that is the most difficult part for me being in Nigeria. The spicy food because I don’t like spicy food in general, so, this is the most complicated
But you said you take pepper soup every Sunday and that you don’t like Jollof rice?
Not every Sunday, some Sundays. I like Jollof rice but it’s not my favourite. Yeah, the spicy food is the thing that is costing me more. That’s why I select my food very, very carefully.