Joan, a lady in her late 20s, makes a living by having sex with people she barely knows; some she has never met before.
Joan lives with some of her friends in Kubwa, a suburb town in the Federal Capital Territory (FCT).
She said she had no choice than to start life as a sex worker after she lost her parents at age 18.
In the last six years, Joan says she has had sex with over 100 men in different locations within the country.
She said she travels most times to meet some clients based on their request.
As a sex worker, Joan does not know what Pre-Exposure Prophylaxis (PrEP) is, and the only prevention method she knows about is the use of a condom.
She, however, said the condom is not reliable as she still gets to treat some ‘major’ STIs (sexually transmitted infections) sometimes.
“I use condoms always but the truth is, condoms have a mind of their own so they burst when they want to and that I cannot control.
“I sleep with different men every day so I know I’m at risk of contracting sexually transmitted infections each time I have sex,” she said.
Illegal, but thriving
Though the sex trade is illegal in Nigeria, there is no doubt the trade is still thriving.
Just like Joan, many sex workers PREMIUM TIMES spoke with have not heard of PrEP or know the importance of the drugs.
Gloria, a 26-year-old sex worker, insists she is not a full-time sex worker as she also works as a secretary in a private firm.
She lives with her siblings in an unpainted one bedroom apartment in the Jabi area of Abuja.
“I have multiple sexual partners, but I don’t take any drugs before sex or after to prevent infections.
“I use condoms when needed but not always because I have some partners I trust so much. So I don’t use condoms with those; they prefer it without condoms,” she said.
Pre-exposure prophylaxis (PrEP) is the use of a pill called Truvada to prevent the acquisition of HIV infection by uninfected persons.
Truvada is the combination of two antiretroviral medications (Tenofovir + Emtricitabine) to prevent the virus from spreading through the body.
Studies have shown that Truvada can prevent HIV infection in up to 90 per cent of cases if the pill is taken daily at more or less the same time.
In 2014, the World Health Organisation (WHO) first recommended offering PrEP to only men who have sex with men.
However, based on further evidence of the effectiveness and acceptability of PrEP, in September 2015, WHO recommended people at substantial risk of HIV infection should be offered PrEP as an additional prevention choice, as part of comprehensive prevention.
These people include sex workers, people in a mixed-status relationship (a relationship where one partner is infected by HIV and the other is not) and men who have sex with men.
Human Immunodeficiency Virus (HIV) is one of the world’s most serious public health challenges.
According to UNAIDS, about 36.9 million people worldwide were living with HIV/AIDS in 2017, of which 1.8 million were children.
The Nigerian HIV/AIDs Indicator and Impact Survey (NAIIS) indicates that about 1.9 million Nigerians are currently living with the disease, according to the National Agency for the Control of AIDS (NACA).
Globally, in 2017 about 21.7 million people living with HIV (59 per cent) were accessing antiretroviral therapy, an increase of 2.3 million since 2016 and up from 8 million in 2010.
AIDS-related deaths are also said to have reduced by more than 51 per cent since its peak in 2004.
In 2017, 940 000 people died from AIDS-related illnesses worldwide, compared to 1.4 million in 2010 and 1.9 million in 2004.
PrEP use globally
In 2015, South Africa became the first Africa country to approve the use of Truvada as a form of PRep, followed by Kenya.
According to PrEP watch (https://www.prepwatch.org/), an estimated 16,000 people are currently taking PrEP in South Africa. In Uganda, an estimated 12,000 people are on PrEP, and about 8,700 people are on it in Zimbabwe.
In Tanzania, an estimated 7,800 people are currently taking PrEP and in Kenya, an estimated 53,000 people are on PrEP.
However, In Nigeria, where about 1.9 million people are living with HIV, only an estimated 400 people, ‘at high risk of the infection’ are currently using PrEP.
This places Nigeria at the bottom of Africa countries that recommend PrEP in its national HIV guidelines.
PrEP: Unavailable in hospitals
When this PREMIUM TIMES’ reporter visited some government-owned hospitals in Abuja, it dawned on her that the drugs may be expensive as none of the hospitals had PrEP.
A nurse who spoke on condition of anonymity at the Kubwa General hospital said “You can hardly get PrEP in this country. It’s very rare and if you eventually get it in private hospitals, it will be expensive.
“We have Post Exposure Prophylaxis (PEP) (used to prevent infection after exposure) in this hospital, and it’s free of charge, but we do not have PrEP,” she said.
A visit to some private hospitals in the Nigerian capital also showed the product is ‘scarce’.
None of the private hospitals had PrEP as at the time PREMIUM TIMES visited.
A matron at one of the hospitals said: “I advise you check clinics specifically meant for HIV patients. You can get it there, but it will be at a cost,” she said.
In an interview with the Director General of the National Agency for the Control of Aids (NACA), Sani Aliyu, he said the federal government cannot fund PrEP due to the cost involved.
Director-General of the National Agency for the Control of HIV/AIDS, NACA, Sani Aliyu
The drug costs about $1,300 (N468,000) per month in the U.S.
“Pre Exposure Prophylaxis refers to people going on HIV drugs, for those who are repeatedly exposed to HIV,” Mr Aliyu said.
“Particularly, men who have sex with men and female sex workers who do not use condoms.
“If they are on HIV drugs for a prolonged period, even though they are repeatedly exposed to the virus, it’s unlikely they will catch the virus.
“Ideally, it should be used together with condoms because HIV drugs can only prevent HIV, they will not stop you from catching other STI,” he said.
Mr Aliyu added: “because of the cost involved, the government cannot fund PrEP but some of our partners are funding this,” he said. He did not elaborate further.
PrEP ‘unrealistic’ in Nigeria – Expert
Steve Aborisade, the advocacy and marketing manager, AIDs HealthCare Foundation (AHF) an NGO, said the distribution of PrEP in Nigeria is unrealistic and “may not be possible anytime soon.”
He said the drug is too expensive and “will be an extra burden for a country like Nigeria still trying to put people on anti-retroviral”.
“The main challenge with PrEP is that it is expensive; in a country like Nigeria and other Africa countries trying to treat people living with HIV free of charge, it is like an extra burden.
“Nigeria is still trying to breach the huge gap in the treatment of people living with HIV. Making PrEP available now will seem like we are not focused. The priority should be to get everyone who needs Anti Retroviral (ARV)on ARVs.
“Government cannot fund the procurement of PrEP alongside the ARVs.
“To be realistic, the resources to put people on it is not available,” he said.