Rivers State Has the Highest HIV/AIDS prevalence?

Sunday the 8th of December 2013 was a lovely day for me until I happened upon this article in the Punch. I was shocked on reading the article, more so from the comments. I had to read a bit on this matter to learn more about it.

**SURVEY DETAILS

The Federal Ministry of Health that is responsible for the broadcast commendably made public the process through which it arrives at its figures. Find excerpts of the details beneath.

“**_For Government to monitor the spread of the HIV and AIDS epidemic including programme planning, monitoring and evaluation in the country, it instituted 3 types of HIV and AIDS surveys, namely:

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**_National Sero-prevalence Sentinel Survey: Antenatal Clinic Attendees are subjects in this survey.

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**_National HIV/AIDS and Reproductive Health Survey plus (NARHS): This monitors HIV distribution in the general population and the behaviours driving it. It also monitors other sexual and reproductive health parameters.

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Integrated Biological and Behavioural Surveillance Survey (IBBSS): This monitors the HIV distribution among the most- at- risk population and the behaviour influencing the HIV epidemic among them.”

N.B.: The Punch article only referred to the National HIV/AIDS and Reproductive Health Survey plus (NARHS).

Excerpt is from “About 3.1 million people infected with HIV in Nigeria – Health Minister”. Full details on conduct of the survey are available in this portable document of the 2010 National HIV Sero-prevalence Sentinel Survey. Note that surveys are subject to statistics and statistical analysis.

**HIGHEST RECORDED CASES VERSUS PREVALENCE

Earlier this year (in May), this Vanguard article stated that there are a total of about 145,000 adults and 15,000 HIV/AIDS cases in Rivers state (the statement was made by Priscilla Shu, Coordinator of the Rhema Care Integrated Development Centre. This made Rivers State the state with the highest recorded number of persons affected by HIV/AIDS. The 2005 population estimate of Rivers State is about 6.7million people. Relating the recorded cases to the population estimate (as at 2005), one would arrive at a 2.40% HIV/AIDS prevalence with respect to recorded cases.

Months later, the Federal Ministry of Health announces a 15.2% HIV/AIDS prevalence in Rivers State and the State Ministry of Health rebuffed the claim.

Why did the Rivers State Government deny the claim?

**STATISTICAL CORRELATION

As mentioned earlier, the surveys use sample populations. In addition, in 22years of carrying out such surveys, growth or/and decline rates should now be available.

The 2010 survey resulted in 6.0% prevalence in Rivers State. For 2012, the 15.2% prevalence reported gives a 153.33% increase (in 2years). That is way beyond any reasonable growth margins except in the situation of an epidemic. Is Rivers State having a HIV/AIDS epidemic?

Perhaps you may not have the time to study the 2010 survey documents; if that is the case, a graphical representation of its findings is in Figure 1 underneath.

**Fig. 1: HIV/AIDS Prevalence by State (2010)

Figure 2 is a graphical representation of the trend of HIV prevalence in the South South Zone by States between 1999 and 2010 while Figure 3 is a tabular representation of the trend of HIV prevalence in the country by State between 1991 and 2010

**Fig. 2: Trends of HIV Prevalence in the South South Zone by States (Graph)

**Fig. 3: Trends of HIV Prevalence in the Country by States (Table)

The figures announced have a massive reduction in the Prevalence in several states and a massive boost in Rivers State. This questionable deviation of 9.2% within two years is why the Rivers State Ministry of Health has challenged the results.

**FULL DISCLOSURE

Full disclosure is a term used to require the dissemination of all information on a subject matter to avoid misleading those involved. In this case, those involved are the Federal Ministry of Health and the public. The Federal Ministry of Health conducts such surveys and is accountable to the public to educate them on the manner of conduct of the surveys. This is to avoid misleading the public on the accuracy of its surveys.

The State Ministries of Health and AIDS offices are partners in the survey conduct; at least such can be garnered from the 2010 report. Why do we have complaints from the State? Is there a possibility that the State wasn’t part of the surveys conducted in 2012? If this is the case, the State Ministry of Health and AIDS offices should make public the details they have available. From discussion with contacts in the State Health sector, I learnt that the prevalence has dropped in Rivers State. I have documentation from Programmes on HIV/AIDS conducted within this year.

The Federal Ministry of Health also should disclose how and where the surveys were conducted and if they were conducted in partnership with the State AIDS office as due process requires.

Clarity is required from all parties as is their duty to the public.

PERSONAL THOUGHTS

What indicators can one use to judge progress in the fight against HIV/AIDS?

Awareness and Testing Indices: Surveys, Hospital and Laboratory Records of HIV/AIDS tests done are useful tools. Compare between records of years past and present records to judge progress. Primary healthcare facilities are useful in this regard.
Access: Improved access to testing facilities in the rural and urban areas is also an indicator of progress.
New cases: The term used “prevalence rate” indicates a time change in prevalence with respect to time. The Punch article tagged it wrongly. New cases discovered would indicate a good effort on the part of a government in increasing access to tests and proper healthcare.

These details can be compared over time as a better indicator of progress.