The tortured face, sunken eyes and emaciated body of Aids are images familiar all over the world. But HIV in Africa is largely anonymous, faceless in a shadowy world of innuendo, rumor and fear. To be HIV positive in Nigeria today is to live balanced on a precipice over the edge of which lies an abyss of merciless illness unchecked by treatment and a long downward spiral towards death.
"If there is anything that you can do for me, please help," was the frantic message that Dr Ugah received from Mike Ezeh at 8.30pm . When we walked into the Ezeh family home in Nnono village, Abia state, at 7.00am the following morning, the empty bed in the room adjoining the sitting room told an all too familiar story. For Mike, we had come too late.
Lovelyn Munaonye, blind since the age of ten, teaches social studies at a special school in Umuahia, Abia state's capital city. She and her husband, Jude, a driver with the Ministry of Health, discovered that they were HIV positive in 1999. The news, though initially overwhelming, galvanized Jude into becoming the foremost HIV activist in the state. He has made helping others with the virus his life's work. Without ever having seen an anti-retroviral drug he soldiers on, encouraging healthy life choices and positive attitudes to life. He and Lovelyn face each day with equanimity: "We rest well, eat fresh food and stay away from alcohol," says Jude. "I only have these stubborn rashes from time to time, for which I take antibiotics and my wife helps me to rub dusting powder."
Their quest for a future leads them on a constant search for something more powerful than antibiotics and dusting powder. In the absence of anti-retrovirals, in most of Nigeria , the desire for medicines to combat the virus is met by a plethora of herbal remedies. Prominent among these is the 'Lord Jesus Christ drug' made and marketed through 'divine' inspiration by prophet Paul Asonye. He says: "I was told of the secret in a dream, my processed herbs surround HIVs and deny them nourishment. They act very fast and give a complete cure from HIV and Aids. I have many, many testimonies to this." He asserts that his concoction is now packaged in New Jersey and sold extensively in Nigeria . "I would have introduced you to the first person I cured of Aids," he continued, "but it is unfortunate that he has since died."
Andy was a rising star in a public relations company in Lagos , the commercial capital of Nigeria . Engaged to be married, he was content with his life, so content that he devoted his spare time to voluntary work on social issues, particularly concerning deprived children and drug abuse. While visiting his parents in Nnono village in Abia state, he began to suffer fever and chronic headaches and went to a hospital for a check up. After what he thought was a blood test for typhoid, the doctor told him: "You tested positive for HIV. This is unfortunate but it is better that you go home and take time to accept that your life is over." Terrified and perplexed by this death sentence, he confided in his brother who, fortunately, had heard of Jude and his support group. "Talking to others in my situation gave me a roadmap for life," he said. However he has not found it possible to return to Lagos and his fiancee and he has withdrawn from his social circle, finding it "impossible to pull my weight economically, or imagine my next move in life."
When I asked His Royal Highness, Eze Jiaza, a prominent traditional ruler in Abia state, what traditional treatments existed for HIV, he sounded exasperated: "The only medicines we have are our grave diggers and their shovels. This is a new sickness. We don't know how it came but our boys and girls are dying. It starts from purging and rashes; then, at the dying hour, their faces look like animals and they become like skeletons. What we can do to protect ourselves is not to share our shaving sticks and to keep off public women."
That prescription is now well known to the members of Chief Jiaza's village health council in Nnono. The council is made up of local leaders who regularly gather to meet the local clinic's doctor; he visits them courtesy of a private non-profit health initiative to discuss community health issues.
Nkechi, the nurse at Nnono village health clinic says: "I just come here, sit and go away; no-one comes. Many people have illnesses and they come when we have drugs, but most of the time we have none, so they do not bother."
At the village clinic, Dr Ofoedu says: "There are many people here with HIV but the stigma is very strong and there is a lot of ignorance. We can get to them but we must have some help to offer."
Stigma and ignorance about HIV and Aids put new stress on extended families, already struggling to care for an increasing number of parentless children; private (and unregulated) orphanages are opening in many places.
This precious gift is only two days old, the fifth child of Ngozi and Obi, who bend over her, troubled. They discovered that they were both HIV positive a few months before she was born. Now, with no advice or information available, Ngozi is desperate to know whether or not it is safe to breastfeed her new infant.
The anxiety in Christian's deeply recessed eyes speaks more eloquently of his condition than the gurgle of words that he struggles to get out between coughs and wheezes from his fluid-filled lungs. A 27-year-old electronic equipment technician, Christian has only recently found out that he has the virus. It has left him defenseless against the infection that is ravaging his chest
Abigail Obeten's husband and church were very supportive during her pregnancy and through the birth of her daughter, Rachel. But when the hospital discovered that she was HIV positive, they informed the church; both church and husband abandoned her. Very ill, with only her mother's support and her abiding faith in God, she took all manner of menial jobs to sustain Rachel and herself. Her life continued to unravel; she was ostracized by her bible study group and her hairdresser while the nursery expelled Rachel. With Rachel now two and a half and in the daily care of a nanny, Abigail's worst fears came true. Her daughter developed an intestinal infection and, her immune system compromised, died. At the end of her tether, Abigail enrolled in a government-sponsored trial cure program. She and nine others attended the Amaya facility in the Lagos suburb of Festac. After four months, during which time her CD4 cell count dropped from 672 to 210, she withdrew from the program. "The government paid for me to be given poison," she said: "those who continued are not alive to tell the story."
Mr Kalu I. Kalu joined the government-subsidized anti-retroviral program in Lagos in February, 2002. He takes Lamivudine, Stavudine and Nevirapine twice a day. The drugs cost him one thousand naira a month (US$7), thanks to the subsidy, and he is doing well on the regimen. However, quarterly monitoring of viral load and CD4 count are obligatory if he is to continue in the program. The cost of the viral load test is N7,000 and the CD4 count costs N2,500. Both were supposed to be free as part of the program but in practice he has had to pay. The costs of these tests are prohibitive and explain the lack of public trust in official pronouncements. "Supplies of ARVs are low, so they are rationing them; the government made promises that more have been imported but nobody is sure of what they are saying. Even trying to make enough money for the tests to stay in the program is a big problem," he says
The government shows that it is aware of HIV through high-profile advertising in which the president of the country is shown standing shoulder to shoulder with young people. Unlike other African countries' campaigns in which prominent personalities are shown with HIV positive people, this billboard slogan is ambiguous and does little to reduce stigma.
What does the nation that 'cares' offer Chioma in her orphanage? Will she grow up in a world that provides health services so that, like basketball player Magic Johnson on the US ' billboards, she can say: "HIV changed my life, but it doesn't stop me from living."?
Or will she, at best, know the courageous but tentative world of Lovelyn, for whom billboards are not enough?
I owe a great debt of gratitude to all the people who let me into their lives during this project. They did it in the anticipation that some way, some day, their voices would contribute to winning support for people living with HIV; they had little hope that it would be in time for any of them.
