“The lockdown affected my access to care because I cannot get to the clinic for my drugs and I was also scared of going to the hospital because of the pandemic.”

These were the words of Mrs. Patience, a person living with Human Immuno-deficiency Virus (HIV). Patience, mother of three, who discovered her status in 2011.

According to her, the first time she found out, it was something else but she summoned the courage and with help from the family, especially the husband.

She continued: “When we found out about my status, it was towards our wedding. There was an overnight meeting in the church asking my husband not to marry me because he was negative and if he married me that he was going to die but he stood by me. Where will I start? The stigmatisation at the meetings, they said a lot of things. When I gave birth, my baby was negative, they started arguing whether I was truly positive. All my children are negative and my husband too.”

The mother of three said, HIV is not a death sentence, rather people should endevour to know their status and access care immediately to avoid complications.

Meanwhile, another patient, Christopher Lee said he discovered his status in 2000 when HIV came newly to the country.He lamented on the high-level stigma associated with HIV as at that time.

Lee said: “When I discovered my status, I started going to the hospital for treatment and monitoring, before then, I was having loss of appetite, I lost weight, I was having catarrh and my CD4 as at then was around 200. I have been taking drugs since then and I am okay.”

Lee disclosed that he got the infection from the wife. However, during the lockdown, Lee travelled to his village in Kaduna State where he visited the general hospital to access care.

He said: “I went to the clinic because of the lockdown my drugs were about to finish. They asked me the name of my drugs, I told them, and they now gave me drugs for three months. I called my clinic and told them that I have picked my drugs from another hospital.”

Lee said that presently, the stigma still persists, though he has disclosed his status with some of the church members, family and a lot of people know about it but many are dying because of ignorance. He admitted that the lockdown did not affect his access to care to care and treatment.

Professor of Haematology and Blood Transfusion, Lagos University Teaching Hospital (LUTH) Idi-Araba, Alani Akanmu, said there was the disruption of services during lockdown because it was not convenient at all for patients to access the services that were available due to the issue of transportation. He said that as a foremost institute, they had to keep in contact with patients through phone conversations and zoom and with support of a Non Governmental Organisation (NGO) that established a drug collection centre for the members of the community.

Deputy Director of Prevention, Care and Treatment, Institute of Human Virology Nigeria (IHVN), Dr. Helen Omuh, said due to the initial mitigation measures instituted by the government, access to HIV services by people living with HIV (PLHIV) was affected and most patients could not visit the health facilities for their drugs and laboratory tests due to movement restriction and fear of COVID 19.

She said that poor quality data and low capacity for data management had persisted despite improvement observed with the electronic medical records system. Good quality data is required to guide decisions, policies and research. Though the drugs are free, there may be some out of pocket expenses with the national health insurance system covering less than 10 per cent of the eligible population. Political commitment for sustained funding and effective co-ordination is also a crucial challenge in managing HIV,” she said.

Despite efforts by the National Agency for the Control of AIDS (NACA) to end Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) before 2030, no fewer than 560,000 persons living with the virus are not on treatment. This comes as Nigeria joins the rest of the international commuity to mark the World’s AIDS Day (WAD).

Latest figures from NACA showed that, of the estimated 1.8 million Nigerians living with HIV, only 1.24 million are currently on treatment. According to NACA’s 2020 Quarterly FACTSHEET VOL 1, 13 of every 1000 persons are likely to test positive for HIV.

The report noted that Nigeria needs to invest $2.4 billion to identify and treat additional 540,000 Persons Living With HIV (PLWH) to reach the Joint United Nations Programme on AIDS (UNAIDS) target for epidemic control in the next three years.

According to the report, the estimated number of tests needed to identify these additional persons with HIV is 50 million persons.

The implication that 560,000 persons with HIV in Nigeria are not on treatment is dire. According to the World Health Organisation (WHO), there were an estimated 38 million people living with HIV at the end of 2019 and due to gaps in HIV services, 690,000 people died from HIV-related causes in 2019 and 1.7 million people were newly infected.

The report noted that COVID-19 has affected provision of HIV services and caused 45.5 per cent drop in viral load testing, clinical activities and in Anti Retroviral (ARV) drug refill rate.

It also noted that six months interruption in HIV treatment due to lockdown might lead to 900,000 deaths as opposed to 430,000 deaths in Sub Saharan Africa.

The NACA report also showed that Akwa Ibom has the highest burden of HIV/AIDS in Nigeria. It is followed by: Benue, Taraba, Anambra, Abia, Cross River, Edo, Enugu, Nasarawa, Rivers, Bayelsa, Delta, Imo, Plateau, Federal Capital Territory (FCT) Abuja, Ogun, Lagos, Gombe, Adamawa, Borno, Kaduna .

Others include: Ondo, Osun, Oyo, Ebonyi, Kogi, Kwara, Ekiti, Kebbi, Kano, Niger, Bauchi, Sokoto, Yobe, Zamfara, Jigawa and Katsina with the lowest burden and least affected.

Among adults age 15-64 years, HIV prevalence varied by zone across Nigeria, with the highest prevalence in South South Zone (3.1 per cent) and the lowest prevalence in North West Zone (0.6 per cent).

Also, latest figures from UNAIDS showed more than 12 million people are still waiting to get on HIV because they could not access essential services.

On his message to Nigerians on WAD, Director General, NACA, Dr. Gambo Gumel Aliyu, told The Guardian: “We have 1,240,000 that are now on treatment.

“…My message is help us contribute to controlling HIV/AIDS in Nigeria by testing yourself to know your HIV status today. If your status is positive, call us or meet our health workers anywhere in the country to make sure they help control this virus in you and to make sure this virus does not leave you. We have been doing that and will continue to do that. If your status is negative you can still call us at 6222 to learn how you remain negative for the rest of your life and this is our responsibility to make this information available.

“Please do not disenfranchise yourself from the services that are free and that are there waiting for you, take advantage of it. Know your status, if you are negative learn how to remain negative for the rest of your life. If you are positive, it is not an end to this road, it is the beginning of a journey to healthy living with HIV.”

Regarding the impact of COVID-19 on efforts to end AIDS in Nigeria, Aliyu said: “Particularly, the lockdown period has impacted in such a way that it has denied us the opportunity to identify newly infected people in terms of every month, every year, we go after the remaining people that are unidentified. We identify them and bring them for treatment that is the only way you have to control HIV and end AIDS. So, our numbers reduced in the month of April and May this year simply because of the lockdown. Apart from that, it has also competed with HIV in certain things simply because, when it came first, most of the laboratory infrastructure that do the testing for COVID19 are HIV laboratories and even now they still provide those services. So, we run HIV during the day, at night we ran COVID-19. It was not easy for our staff nationwide.”

Executive Director, UNAIDS, Winnie Byanyima, in her WAD 2020 message said: “World AIDS Day 2020 will be like no other. COVID-19 is threatening the progress that the world has made in health and development over the past 20 years, including the gains we have made against HIV.

“Like all epidemics, it is widening the inequalities that already existed. Gender inequality, racial inequality, social and economic inequalities. We are becoming a more unequal world.”

MEANWHILE, at the United Nations High-Level Meeting on Ending AIDS in 2016, countries pledged to increase the number of people living with HIV on treatment to 30 million by the end of 2020.

Treatment scale-up has been impressive, with more than twice the number of people on treatment than in 2010, but as of June 2020 there were only 26 million people on HIV treatment, four million short of the target for the end of 2020.

The global AIDS response was off track before the COVID-19 pandemic hit, but the rapid spread of the coronavirus has created additional setbacks. Modelling of the pandemic’s long-term impact on the HIV response shows that there could be an estimated 123,000 to 293,000 additional new HIV infections and 69,000 to 148 000 additional AIDS-related deaths between 2020 and 2022.

Over the past decade, the world has witnessed unprecedented scale-up of antiretroviral therapy (ART), which has saved the lives of tens of millions of people. As of December 2019, 25.4 million people out of an estimated 38 million people living with Human Immuno-deficiency Virus (HIV) were receiving ART globally.

Increased use of ART has, not unexpectedly, been accompanied by the emergence of some degree of HIV drug resistance, the levels of which have steadily increased in recent years.

HIV drug resistance can jeopardise the efficacy of antiretroviral drugs used for both HIV treatment and prevention of the infection and is associated with an increased number of HIV infections and HIV-associated morbidity and mortality.

Combating antimicrobial resistance (AMR), including resistance to HIV medicines, is a global priority that demands coordinated action across all government sectors and levels of society.

The Global Action Plan on HIV drug resistance 2017–2021, aligned with World Health Organisation’s (WHO’s) global action plan on antimicrobial resistance, defines key actions for the country and global stakeholders to prevent, monitor, and respond to HIV drug resistance and to accelerate progress towards achieving the global targets for HIV epidemic control by 2030.

The key actions are:
Prevention and response: implement high-impact interventions to prevent and respond to HIV drug resistance.

Monitoring and surveillance: obtain quality data on HIV drug resistance and HIV service delivery from periodic surveys, while expanding routine viral load and HIV drug resistance testing.

Research and innovation: encourage relevant and innovative research, which will have the greatest public health impact in minimising HIV drug resistance.

Laboratory capacity: support and expand the use of viral load testing and build capacity to monitor HIV drug resistance.

Governance and enabling mechanisms: ensure country ownership, coordinated action, advocacy, and sustainable funding are in place to support action on HIV drug resistance.

Also, antimalarial drug resistance has emerged in recent years as a threat to global malaria control efforts, particularly in the Greater Mekong sub-region. The much-anticipated Report on antimalarial drug efficacy, resistance, and response: 10 years of surveillance (2010–2019) will present a decade’s worth of data on drug efficacy and surveillance and recommendations to protect the efficacy of malaria treatments in the decades to come.

Meanwhile, a study has warned that children may be more likely to suffer from chronic illnesses like allergies, asthma, eczema, and obesity if given antibiotics before the age of two.

The full findings of the study were published in the journal Mayo Clinic Proceedings.

United States (U.S.) researchers analysed the health records of 14,500 children and found a correlation between chronic illness and early antibiotic use.

The team has speculated that the antibiotics — while used to help fight off ‘bad’ bacteria — can impact the beneficial microbes that make up our gut microbiome.

Allergies — which are the most common chronic disorder among children — affect more than one-in-four people in the United Kingdom (U.K.) at some point in their lives.x

Antibiotics are used to treat bacterial infections like urinary tract infections but are not effective against viruses such as the common cold or coronavirus.

“We want to emphasise that this study shows association not causation of these conditions,” said paper author and physiologist Nathan LeBrasseur of the Mayo Clinic in Minnesota.

“These findings offer the opportunity to target future research to determine more reliable and safer approaches to timing, dosing, and types of antibiotics for children in this age group,” he added.

In their study, Professor LeBrasseur and colleagues analysed the health records of more than 14,500 children — around 70 per cent of who had been treated with antibiotics before the age of two.

The team found that these children appeared more likely to develop chronic illnesses — including asthma, attention deficit hyperactivity disorder, celiac disease, eczema, food allergies, hay fever, obesity, and weight issues.

“While recent data show an increase in some of the childhood conditions involved in the study, experts are not sure why,” said LeBrasseur.

“Other than the issue of multidrug resistance, antibiotics have been presumed safe by most pediatricians.”

Those babies who had received multiple courses of antibiotics were more likely to have more than one chronic condition during their childhood, the team also noted.x

The types of illness suffered varied dependent on the child’s age, the kind of antibiotics they were on, and how many doses they were given.

“The ultimate goal is to provide practical guidelines for doctors on the safest way to use antibiotics early in life,” LeBrasseur added.

Although there are over 100 types of antibiotics, one of the most commonly prescribed is amoxicillin — used to treat assorted conditions including middle ear infections, strep throat, skin infections, pneumonia, and urinary tract infections.

Experts have called on the federal government and other stakeholders to invest more in efforts to prevent HIV infection human immunodeficiency virus, HIV prevention interventions while advocating for supportive policy and programmes.

They made the call at a media roundtable organised by AVAC Fellow 2020 in partnership with the Journalists Alliance for AIDS, JAAIDS on the role of media in HIV prevention advocacy with the theme: “Advocating for supportive policy and programmes for effective HIV prevention interventions”.

The Key Population Advisor, Heartland Alliance, Mr. Michael said there were funding gaps for interventions needed by the majority while interventions needed by fewer are funded most.

“We need more investment in prevention in order to match our investment in treatment because we cannot leave people to be getting infested and we are much more interested in putting money in treating them, so we need to move towards investment in prevention,” he said.

On her part, Executive Director, JAAIDS, Mrs. Olayide Akanni, said it is focusing on prevention because it remains the Achilles heel of the response, adding that evidence for success in prevention efforts includes sustained processes that are combining socio-behavioural interventions with biomedical and structural.

Also, she said that prevention interventions are still being underfunded as more emphasis has been laid on treatment over the years.

According to Akanni, UNAIDS 2018 data indicates that key populations and their sexual partners accounted for 64 percent of all new infections within the West and Central Africa region, while 160 young women aged 15 to 24 years become infected with HIV in the region every day.

She said Nigeria’s HIV prevalence stands at 1.5 percent in the 15 to 49-year-old population, saying: “The prevalence of HIV for key populations remains significantly higher: 27.4 percent for brothel-based female sex workers, 21.7 percent for non-brothel-based female sex workers, 17.2 percent for men who have sex with men, and 10.4 percent for people who inject drugs.

“Over the last years, Nigeria has focused a lot on treatment on HIV at the expense of prevention and we are explaining that you cannot continue to mop the floor when the tap is open. We need to turn off the tap of new infections as well as make sure there is treatment available. We still have gaps in prevention and there is not enough investment in prevention.

“A lot of our prevention tools are still not widely available and we are growing a generation of young people who have limited information on HIV prevention. That is why we need to revive the efforts in creating awareness on HIV prevention if we really want to address the epidemic to zero no infection by 2030,” she said.

According to the 2020 AVAC fellow, Ms. Josephine Aseme, the media roundtable was organised considering the role the media has to play in advocating for HIV prevention.

The Roundtable seeks to highlight the role of the media in sharing information that is accurate and consistent for public engagement in HIV prevention advocacy. It also hopes to help create demand and informed advocacy for increased government investment in HIV prevention intervention.

The 2020 AVAC fellowship programme is a community-centered policy advocacy initiative that focuses on advocating for supportive policy and programs for HIV prevention intervention, most especially pre-exposure prophylaxis, PrEP, the implementation for key populations in Nigeria.

Chevron has revealed that it is spending over $5 million (about N1.9 billion) to support the federal government’s fight against tuberculosis, malaria and HIV in the country since 2017.

Chairman and managing director, Chevron Nigeria Limited, Jeff Ewing, who disclosed this, lauded the 12-year partnership between Chevron and the Global Fund in the fight against the infectious diseases and building of resilient health system in Nigeria.

The Global Fund is an international financing and partnership organisation whose aim is to attract, leverage and invest additional resources to end the epidemics of HIV/AIDS, tuberculosis and malaria to support the attainment of the Sustainable Development Goals of the United Nations on good health and well-being.

Jeff in a statement made available to LEADERSHIP yesterday explained that the partnership between Chevron and Global Fund is an example of how Chevron is contributing strategically to the development of Nigeria by helping to improve the health of its people.

He affirmed that Chevron has been one of the largest Global Fund corporate partners and its partnership focuses on capacity development initiatives, joint advocacy and communications campaigns, and other local initiatives. “Chevron also encourages its staff to share their skills with the local programmes to help improve grant reach and performance,” he added.

He stated that Chevron’s $5 million investment from October 2017 has supported the national HIV and TB programmes in Nigeria.

Chevron’s intervention since 2019 has supported more than one million people living with HIV on antiretroviral therapy and over 42,000 HIV-positive pregnant women have received antiretroviral therapy during pregnancy to prevent passing the virus to their babies.

He said in addition more than one million HIV-positive patients were screened for TB in HIV care or treatment settings and over seven million people tested for HIV and received their results, during the period.

“More than 2.8 million pregnant women knew their HIV status from the intervention fund,” the Chevron chairman said.

The federal government has received $890 million as grants from the Global Fund to fight HIV/AIDS, tuberculosis and malaria.

The Minister of Health, Dr. Osagie Ehanire, said yesterday that the fund would be used to implement programmes aimed at eradicating the diseases over a three year period, from 2021 to 2023.

Ehanire said that the Global Fund also approved a grant of US$21.9 million to support Nigeria’s COVID-19 response.

He said: “The purpose of this press briefing today is to announce the receipt of a grant, made to the Federal Republic of Nigeria by The Global Fund to fight HIV/AIDS, tuberculosis and malaria, amounting to $890 million, over an implementation period of three years, beginning from 2021 to 2023.”

The minister noted that the grant, which is the largest given to any country in this funding cycle, is sequel to a successful funding request made by the Nigeria Country Coordination Mechanism (CCM).

The Global Fund for the fight against HIV/AIDS, Tuberculosis and Malaria (GF) is an innovative international financing mechanism that was established by the United Nations in 2002, with its headquarters in Geneva, Switzerland.

The fund is made up of global partnership of governments, civil societies and private donors and established for the purpose of attracting, leveraging and investing resources to fund public health interventions that would accelerate the eradication of HIV, tuberculosis and malaria in affected high burden countries to further goals of Sustainable Development Goals (SDGs).

The Global Fund has committed the sum of USD$2.586 billion since 2002 to operations in Nigeria, which are split into four program areas: HIV/AIDS, tuberculosis, malaria and the Resilient Systems Strengthening for Health, (RSSH).

Nigeria has accessed $2.436 billion, which represented 94 percent of the committed amount.

The minister said the grant would complement the investment of the government of Nigeria and of other Development Partners in HIV/AIDS, tuberculosis and malaria programmes, including the Resilient and Sustainable System for Health, over the period 2021-2023.

He said the approval of the grant came following the review of the proposal that the CCM Nigeria submitted on March 23, 2020, which was adjudged to be technically sound and strategically focused by the independent Technical Review Panel of the Global Fund.

Ehanire said: “This grant will support access to malaria prevention, diagnostic and treatment services in 13 states. The States include Adamawa, Delta, Gombe, Jigawa, Kaduna, Kano, Katsina, Kwara, Niger, Ogun, Osun, Taraba and Yobe States.

“Access to HIV/AIDS and tuberculosis services across all the 36 states and the FCT; Improvements in our health system, particularly, provision of infrastructure for warehousing and distribution of health commodities, laboratory services, data management and capacity building for our healthcare providers, including support to community system.”

The minister said the implementation of the grant would specially target the poor, the most vulnerable and disadvantaged, and those at higher risk of the target diseases, to promote equity in access to health care services.

He further said: “With regard to Nigeria’s COVID-19 response effort, The Global Fund gave approval to repurpose the sum of US$6.2 million out of our on-going grants for HIV, tuberculosis and malaria to support the implementation of our initial Incident Action Plan (IAP) for COVID-19.

Scientists have discovered a way to track changes in sound processing in the brains of people with HIV. Their test provides a simple technique for studying how HIV affects the central nervous system.

Due to advances in antiretroviral drug treatment over the past 20 years, most people with HIV can now expect to live long, healthy lives.

However, even if treatment successfully brings the virus under control, people can experience cognitive issues as a result of HIV causing damage to their central nervous system.

Up to 45% of people with HIV may develop these difficulties, which are known collectively as HIV-associated neurocognitive disorder (HAND).

Although the cause of HAND remains unknown, scientists have several theories. They speculate, for example, that it may be the result of chronic inflammation, lingering damage from the initial infection, or a toxic effect of antiretroviral drugs.

Alternatively, low levels of the virus may persist in the brain as a result of the blood-brain barrier limiting the passage of antiretroviral drugs into the brain.

The signs and symptoms of HAND can be subtle, which makes it challenging for doctors to diagnose early and monitor.

Understanding speech

One of the problems that people with HIV sometimes report is difficulty understanding speech in the presence of background noise.

Researchers at the Geisel School of Medicine at Dartmouth in Hanover, NH, led a team that studied the hearing of a group of people with HIV in Dar es Salaam in Tanzania.

They collaborated with scientists from the Muhimbili University of Health and Allied Sciences in Dar es Salaam and neuroscientists from Northwestern University in Evanston, IL.

“Initially, we thought we’d find that HIV affects the ear, but what seems to be affected is the brain’s ability to process sound,” says study co-leader Dr. Jay Buckey Jr., a professor of medicine at Geisel.

To test this idea, they used scalp electrodes to monitor the brain waves of 68 people with HIV and 59 people without as they listened to sounds.

Specifically, they recorded a brain response known as the speech-evoked frequency-following response (FFR).

Certain features of brain waves, such as their timing and amplitude, reveal how faithfully the brain encodes an auditory stimulus. The FFR has proven particularly useful for investigating how the brain processes information in highly complex sounds, such as music and speech.

The precision and accuracy of the FFR can improve as a result of experience, such as in trained musicians, or worsen as a result of illness or damage, such as concussion.

“There are many acoustic ingredients in speech, such as pitch, timing, harmonics, and phrase,” says study co-leader Nina Kraus, Ph.D., a professor of communication sciences and neurobiology at Northwestern.

“The FFR enables us to play speech sounds into the ear of study participants and figure out how good a job the brain is doing processing these different acoustic ingredients.”

Common speech sounds

The researchers recorded the FFR while the study participants listened to common speech sounds, such as “ba,” “da,” and “ga.”

They looked at how well the signal encoded two acoustic features of speech, known as the harmonics corresponding to the first formant and fundamental frequency.

The harmonics corresponding to the first formant identify the units of sound, or “phonemes,” that differentiate one word from another, whereas the fundamental frequency reflects the frequency at which the vocal cords vibrate, which helps identify the speaker.

The brains of people with HIV had similar responses to the brains of people without HIV at processing the fundamental frequency.

They also performed well on standard tests of hearing, but the FFR revealed that the brains of people with HIV were worse at encoding the first formant.

In other words, they had normal hearing thresholds, but their brains could not distinguish between the sounds of different words as accurately.

“When the brain processes sound, it’s not like a volume knob where all of the acoustic ingredients are either processed well or poorly,” Kraus explains. “With the FFR, we’re able to see which aspects of auditory processing are affected or diminished and ask, ‘[I]s there a specific neural signature that aligns itself with HIV?’”

The researchers have published their study in the journal Clinical Neurophysiology.

Early aging

The researchers note that as people get older, even if their hearing remains normal, their brains get worse at processing the same speech features that the brains of people with HIV seem to struggle with.

They write that HIV-associated cognitive problems may therefore be akin to early aging.

In the future, they hope that other scientists will use the FFR not only to study brain dysfunction associated with HIV, but also other conditions, such as concussion and Alzheimer’s disease.

Standard tests of cognitive function involve giving people tasks, such as solving math problems or remembering a list of words. However, these are dependent on the language people speak and their culture.

“What’s significant about our results is that the test doesn’t require any actions on the [subject’s] part. It’s recorded passively — subjects can even sleep or watch a movie,” says Dr. Buckey. “We think the FFR holds a lot of promise as a way to assess the brain easily and objectively.”

In their paper, the researchers note that the test could prove particularly useful in parts of the world with the most HIV infections and limited healthcare resources.

They write, “While previous neuroimaging and electrophysiological studies have shown differences between HIV+ and HIV- individuals, these approaches are difficult to transport to resource-limited settings such as sub-Saharan Africa, where >70% of the world’s HIV+ population lives and where there is some evidence that neurocognitive symptoms are more severe.”

“Thus, the FFR holds promise as a research tool to further study [central nervous system] health, particularly in resource-limited settings.”

The study authors acknowledge that research projects involving more participants will be necessary to confirm their results. They say that it would also be interesting to track changes in the FFR from the early stages of infection onward.

Finally, in light of evidence suggesting that different strains of the virus may have differing neurological effects, they would like to see studies that compare FFR tests in different populations around the world.

Encephalitis is a rare condition that is most often caused by viruses (viral encephalitis). It can also be caused by non-infectious diseases, such as systemic lupus erythematous and Behcet’s disease (an autoimmune disorder). The leading cause of severe encephalitis is the herpes simplex virus.

Other causes include: enterovirus infections or mosquito-borne viruses; Eastern equine encephalitis (EEE); Western equine encephalitis (WEE); Venezuelan equine encephalitis (VEE); Japanese encephalitis; and Zika virus.

The very young and the elderly are more likely to have more severe encephalitis.

Exposure to viruses can occur through breathing in respiratory droplets from infected people, certain insect bites, and direct skin contact.

What are encephalitis symptoms and signs?
The signs and symptoms of encephalitis can range from very mild flu-like symptoms to potentially life-threatening events. Signs and symptoms of encephalitis include: sudden fever, headache, vomiting, visual sensitivity to light, stiff neck and back, confusion, drowsiness, unsteady gait, irritability, loss of consciousness, poor responsiveness, seizures, muscle weakness, sudden severe dementia, and memory loss.

How do health care professionals diagnose encephalitis?
A health care professional diagnoses encephalitis after performing a thorough history and exam. The exam will incorporate special techniques to look for signs of inflammation of the membranes that surround the spinal cord and brain (meninges). The doctor will order specific tests to help determine the diagnosis.

Tests that evaluate individuals suspected of having encephalitis include cerebrospinal fluid analysis, brain scanning such as computerized tomography scan (CT or CAT scan)/ Magnetic resonance imaging (MRI) scan, and an evaluation of the blood for infection and the presence of bacteria.

The most common method of obtaining a sample of cerebrospinal fluid (or CSF) for examination is a spinal tap. A spinal tap, or lumbar puncture (LP), involves the insertion of a needle into the fluid within the spinal canal. The needle goes between the spine’s bony parts until it reaches the CSF. A medical professional then collects a small amount of fluid to send to the laboratory for exam. Evaluating the CSF is necessary for a definitive diagnosis of encephalitis and to decide on the best treatment options.

Abnormal spinal fluid results confirm the diagnosis and, in the event of an infection, by identifying the organism that caused the infection.

What is the treatment of encephalitis?
People require urgent treatment with antibiotic and/or antiviral medications if a physician suspects that person has encephalitis. Patients may need to take sedatives for irritability or restlessness. Doctors may administer other medications to decrease the fever or treat headaches.


Basic steps to avoid spread of infections (hand washing, covering mouth when coughing, etc.) can help prevent encephalitis.
*Dr. Nwaoney is an epidemiologist, Chief Executive Officer (CEO) and Medical Director of Richie Hospital and El Shaddai Group.

Dental implants are artificial structures that a dental surgeon inserts into a person’s jawbone. A person may need an implant if they have lost one or more teeth.

Keep reading to learn about the types of implants and associated risks. We also describe what to expect from dental implant surgery and how much the procedure may cost.

What are dental implants?

A dental implant is a structure that replaces a missing tooth. With screw-like devices, the surgeon inserts an implant into the jawbone, and it acts as an anchor for an artificial tooth, called a crown.

A device called an abutment connects the artificial tooth to the dental implant.

The crown is custom-made to fit the person’s mouth and match the color of their teeth. Crowns look, feel, and function like natural teeth.

Implants have several advantages over dentures, which are removable artificial teeth. Implants:

  • are more natural and comfortable
  • have a higher success rate
  • improve chewing function
  • lead to a lower risk of cavities developing in nearby teeth
  • lead to better maintenance of bone at the site of the lost tooth
  • cause decreased sensitivity in nearby teeth
  • do not need to be taken out and cleaned every night

However, dental implants are not suitable for everyone. The implanting devices must bond with the jawbone, so a person’s bones must be healthy before they can undergo implant surgery.


There are two types of dental implant: endosteal and subperiosteal.

Endosteal implants are the most common type. A surgeon embeds them in the jawbone, and each can hold one or more artificial teeth.

A surgeon affixes a subperiosteal implant on top of the jawbone. Dental surgeons choose this option for people who do not have much height to their jawbone.


According to the American Academy of Implant Dentistry, around 3 million people in the United States have dental implants, and this number increases by about 500,000 every year.

Dental implant surgery is safe when a qualified and experienced surgeon or dentist performs it. It is also the only dental restoration option that maintains the health of the person’s jawbone and stimulates its growth.


Some people are not eligible for dental implant surgery. It is not safe for dental surgeons to operate on people with:

  • acute illness
  • uncontrollable metabolic disease
  • bone or soft tissue disease or infection

If these issues are resolved, a person can have the surgery.

In some cases, dental surgeons refrain from operating on people with:

  • heavy smoking habits
  • parafunctional habits, such as tooth grinding or clenching
  • behavioral or psychiatric disorders
  • HIV
  • diabetes
  • osteoporosis
  • AIDS

If people with any of the above undergo dental implant surgery, there is a higher risk of the implant failing.

Dental surgeons may also choose not to operate on people undergoing the following treatments, due to an increased risk of implant complications:

  • bisphosphonate drug treatment for bone loss diseases
  • chemotherapy
  • radiation therapy of the head or neck

Potential complications of implant surgery

People who undergo this procedure may experience complications during or afterward. The issues may include:

  • nerve damage, resulting in altered sensation in the surgical area
  • an opening of the incision following surgery
  • movement of the implant
  • exposure of the implant above the gumline
  • infection of the implant

People who experience movement or exposure of the implant may need to undergo additional procedures to improve the health of the bone and gums or remove or replace the implant.

The following are some signs and symptoms that an implant placement has been unsuccessful:

  • the implant is excessively mobile
  • pus or other secretions come from the site
  • pain when tapping the implant
  • rapid, progressive bone loss


Each person is likely to have a different experience of dental implant surgery. Factors that may influence this include:

  • the number of teeth requiring replacement
  • the location of the implants within the jaw
  • the quality and quantity of bone at the implant site
  • the person’s underlying oral and systemic health

Depending on these factors, additional procedures may be necessary. These can include:

Sinus augmentation

Placing an implant in the upper jawbone is usually difficult because of the location of the sinuses.

The surgeon may need to perform a sinus augmentation — a procedure to lift the floor of the sinuses to allow more bone to develop so that the implantation can be successful.

Ridge modification

Some people have a jawbone abnormality that prevents enough bone for an implant from developing. In such cases, a surgeon may need to perform a ridge modification.

This involves lifting the gum to expose the area of deformed bone. The surgeon will then use a bone or bone substitute to repair and build up the area. This improves the quality of the jawbone in preparation for dental implant surgery.


After a person has undergone dental implant surgery, they must continue to brush and floss their teeth regularly. Artificial teeth require the same care and maintenance as regular teeth.

The surgeon or dentist will also schedule follow-up visits to monitor the implants and make sure that the teeth and gums are healthy. It is important to return to the dentist every 6 months for professional cleanings.


The cost of dental implant surgery varies, and the following factors can influence it:

  • the number and types of implants required
  • the location of the implants within the jaw
  • whether there is a need for any additional procedures to prepare the mouth for surgery

A dentist or another oral health professional can estimate the cost of dental implant surgery during an initial examination.

Some dental insurance policies cover a larger portion of the cost.

Other tooth replacement options, such as bridges, may be less expensive. However, bridges are harder to keep clean and often require replacement and repair, increasing the overall cost. Dental implants may provide longer-term benefits if a person takes care of them well.


Dental implants are fixtures in the bone that replace missing teeth. Implants have a high success rate and can provide long-term benefits.

Some people need additional procedures to prepare their mouth for dental implants. These will add to the overall cost. The number and type of implants required can also raise the cost.

Anyone considering dental implant surgery should ask their dentist whether it is right for them.

As the world marks the 2019 World Aids Day today, stigmatisation and discrimination against Persons Living With HIV/AIDS (PLWHAs) remain the twin factors frustrating a successful fight against the dreaded scourge.

Not only have they prevented people from coming forward to know their status and consequently commence early treatment where result turns out positive, these factors also pose a threat to meeting the 2030 global target to end AIDS.

For PLWHAs, the constant psychological trauma they contend with at treatment centres and in communities where they live further makes life difficult. In fact, the reality of living with a life-threatening ailment finds expression daily in the discriminating and stigmatising behaviours directed at them within their environment.

For instance, “You this dead woman, a living corpse, leave my house!” was how Funmi Okafor, a mother of four children was welcomed as she returned home from the hospital after receiving the news that she tested positive to Human Immunodeficiency Virus (HIV), after weeks of constant sickness that defied treatment.

Okafor, who was squatting with a friend, (alongside her kids) after the death of her husband, met her belongings outside, drenched in rainwater, while her friend stood by the door post yelling at her to move away with her children.

With nowhere else to put up, she was forced to move into an incomplete building as her new home.

The mother of four’s journey to this sad realisation started when she noticed rashes on her body, while she was constantly ill and began to lose weight in the process.

With the constant illness, which she thought was malaria fever (as many people would think first), she, however, decided to visit a nurse, whom she told about her constant “malaria fever.”

The nurse took her blood sample to the laboratory to carry out malaria, typhoid, and HIV tests. And on confirming the cause of Okafor’s ailment, the nurse, due to lack of knowledge about patient’s right to confidentiality, refused to inform Okafor that she tested positive to HIV, but rather spread the news around the community where she lived in Edo state.

Determined to know the ailment that has caused her to emaciate, with rashes all over her body, Okafor visited a general hospital, where after the test she was pronounced HIV positive.

“I went to a nurse and told her that I had malaria fever. She took my blood sample to the laboratory. But instead of her disclosing my condition to me, she told my friend, who spread the rumour around. I still was not aware of my status because she did not disclose it to me. It was only after I went to the general hospital that I knew my condition.

“The day I was supposed to be placed on drugs, it rained heavily, and by the time I returned to where I squatted with my children, my host had thrown out all my belongings. After yelling at me and calling me names, I packed what was left of my property and moved,” she recalled.

Before long, Okafor became the butt of jokes in the community where she lived in Edo State, and others avoided contact or any relationship with her. Since she could not stand being ostracised like that, she relocated to Lagos with her children.

She lamented: “It is not easy to cope with life when you are HIV positive. My father and husband are late, while my mother and siblings are in the village. But I was almost alone in the world before I relocated to Lagos because everyone started deserting me,” she said.

CHINWE IKE was pregnant when she discovered that she was HIV positive. She felt like taking her life and for several nights thoughts of suicide assailed her, especially because she did not know what the virus was all about, as people kept saying different things about it.

At the early stage of her pregnancy in 2006, she was on admission to a hospital for one week before she was transferred to another hospital for further treatment.

However, when she went into labour, her HIV status was confirmed in a private hospital, and the doctor in charge of the case requested that she invited a trusted relative over, who would thereafter break the news to her in a calm manner, and get her to accept her condition.

“I decided to invite my friend, who is a nurse instead of a relative. Unfortunately, after she heard of my condition, she went about scandalising me to the extent that my landlady came to me one day and asked me to leave her house. It was afterward that I discovered that it was that my nurse friend that fed everyone with details of my HIV status. Since my landlady insisted that I should leave her apartment, I did,” she said.

Ike added that it was after she left the compound before she started understanding many things about the disease, her rights as a Person Living With HIV (PLWHA). “Just because I did not know anything I had to leave the compound because they were threatening to kill me. Since then I have been living with that stigma and picking up the pieces of my life.

“It is 13 years now and I am still alive. My friend told me then that I had dug my grave, but after some years, I went back to my former neighbourhood for them to see that I am still alive, and when they saw me, most of them were surprised. However, because of the scandal, I lost my job as a secretary/cashier at a company located at the Alaba International Market, Lagos.”

Since 2001 that Chika Nnoroka discovered that she and her 18-month-old son were HIV positive, she has faced extreme stigmatisation and discrimination, not only in her community but also at medical facilities.

She narrated, “The stigmatisation and discrimination got so intense that I did not believe that I and my son would survive. People were keeping away from us, even the doctors and nurses were all stigmatising people living with HIV to the extent that most of us were finding it difficult to go to the facility to access treatment.”

Nnoroka said women were more vulnerable to HIV/AIDS stigmatisation, as many that have lost their husbands were being denied by their family members and friends. Their rights and privileges are also denied.

“By the time I got information from the doctor that there was a treatment to suppress the virus, I was a little bit relieved, but I was afraid for my little son, who just came into this world. I was not bothered about myself,” she said.

Chika’s son, who is now a 20-year-old, is waxing strong with the help of the drugs.

Misconceptions On Mode Of Transmission
Okafor, who has lived with the virus for 19 years said, “most people think that all women living with HIV are prostitutes. My husband was the one that deflowered me; you can contract HIV/AIDS from anywhere.

“I want people to change the narrative that ladies living with HIV/AIDS are wayward, I believe that is why people do not want to come out to check their status or speak up that they have the virus.”

Okafor who narrated how she contracted the virus said, “It was late but the symptoms in my husband’s body showed that he had HIV and he lied to me that it was severe cough. His close friend was the one who disclosed to me that my husband was HIV positive and that his family is keeping it away from me. He said I should go and check myself if I also have the virus.

“I did my test and found out that I was positive. My husband was never a womaniser; I suspect he contracted HIV when he was stabbed him in the chest. He had internal bleeding in his lungs and the hospital asked us to get nine pints of blood, this was during the early 1980s. I strongly believe that it was then that he contracted the disease.”

Ike on her part said: “I am somebody that does not flirt around, I contracted HIV through my husband. It was when I got married to him that I discovered that I had the virus. Initially, I could not believe that I was down with that kind of health problem.”

According to the World Health Organisation (WHO), HIV can be transmitted through close contact with specific body fluids of persons living with the virus. Apart from fluids such as blood, semen, and breast milk; unprotected sex, body piercing equipment, or sharp objects are also vehicles of transmission. Transmission can also be done through mother-to-baby during pregnancy and through contaminated blood transfusion.

‘Cost’ Of Drugs Limiting Access To Treatment
With many of the people living with the virus jobless, and without hope of employment, affording the drugs for treatment and other medical procedures becomes difficult.

Ike said: “These drugs that we are taking are to sustain our lives and we have to eat well before taking them. What I am emphasising on is that the government should help us because right now, we are paying for drugs, and not everyone can afford it. We pay N2, 000 for consultation; N1, 000 for drugs and almost N3, 000 for laboratory. Not everybody that is HIV positive can afford it, so we are begging the government to help people living with HIV, by making drugs and treatment procedures free. It is laughable when we are told that the drugs are free of charge, and when we get to the hospital we are told to pay for the procedures that I have mentioned.

Findings by The Guardian reveal that because of rising stigmatisation, many people living with HIV/AIDS are staying away from hospitals, while those who suspect their status do not make themselves available for examination. Because of all these, and the inability of many to access treatment early, more people are getting infected and dying from the virus.

This is also why some cases have remained undetected, a development that poses more danger to the country, as those who are unaware of their status could infect others, thereby increasing the spread of the virus.

Ike, who revealed an earlier encounter, which nearly ended her life said: “When I went to a laboratory to do another test to confirm my status, the lab scientists told me that people with the virus can neither get married nor have children. With that impression, I refused to go to the hospital or any other institution for treatment. I concluded that I would commit suicide at home one day.”

Ike who lost her husband to the virus continued: “Because of this stigmatisation people find it difficult to disclose their HIV status because once they do, the news spreads so fast and then sooner than later they are shut out of their families and the society. Where I reside now, I have kept my HIV status a big secret.

“Some people do not even believe that there is something like a discordant couple, where either of the partners is negative, while the other is positive. The reality is that when two people are dating and then one discloses his or her HIV status to the other, the relationship breaks up immediately because they do not believe that those who are positive can have children who are HIV negative,” she explained.

Ike added that her refusal to take treatment cost her two-month-old her life after she developed cough and died. This made her summon courage and head to head to the hospital for treatment.