Chibuzo Odigwe gives his perspective on alternative options for management and "cure" open to people with HIV and AIDS in Nigeria

Nigeria is the most heavily populated country in sub-Saharan Africa, and HIV and AIDS are a huge public health issue. In Nigeria, orthodox management of HIV and AIDS is in line with the standard practice worldwide. Most of the anti-HIV drugs like the reverse transcriptase inhibitors and the protease inhibitors are largely available. Unfortunately, although drugs are available, they are not affordable. Most Nigerians are so poor and the anti-HIV drugs so expensive that the drugs might as well be non-existent.

Any need for an alternative?

Given the problem of cost, a great need exists for an alternative approach to solving the HIV and AIDS problem. In Nigeria, society expects individuals to be healthy, willing, and able to work. People with HIV and AIDS cannot fulfil this demand. In Nigeria, we have no effective social security service for the welfare of people who cannot help themselves. So people explore alternative solutions.

People with AIDS carry a huge social stigma in Nigeria. Few people will shake hands with someone who they know is HIV infected. This maintains financial impoverishment because after they lose their jobs it is hard to get another.

In Nigeria, alternative options of treatment abound in various forms. They all boast feats perceived as unattainable by orthodox medicine. They are the long awaited saviour for Nigeria's hopeless citizens who are infected with HIV.

Alternative options

Spiritual homes and churches

Ever since Nigeria's orthodox medical community designated HIV and AIDS as incurable, thousands of people have besieged spiritual homes and churches in search of miraculous healing. Many Nigerians believe that HIV and AIDS have a spiritual dimension and that the illness could be caused in an individual as a result of spiritual attack by evil supernatural forces. Because of this, some people feel the most appropriate place for the treatment of HIV and AIDS is in spiritual homes and churches. A couple of positive results have purportedly emerged from some of these spiritual homes. Some patients with faith have supposedly had their AIDS cured and their HIV status changed. Some patients have gone on television to buttress these claims and some of them brandish results of laboratory tests conducted before and after the miraculous healing. This continues to generate deep controversy in Nigerian social circles as an ever increasing number of people continue to search for a solution.

African traditional healers

African traditional healers still attend a number of medical problems in rural areas of Nigeria. Their attendance to HIV and AIDS cases is also due to the link that has been established by the lay public between HIV and evil spirits. They make use of undisclosed herbs, concoctions, and charms alongside ritual worship and animal sacrifice to heal their patients. Patients sometimes report an improvement in their symptoms, but because there is little or no documentation, the claims of cure or symptom relief are not substantiated.

Homoeopaths

Nigerians also use the services of homoeopaths--self proclaimed doctors with little or no medical training. These homoeopaths claim extensive and sometimes exhaustive knowledge of all human diseases and always emphasise that all ailments have a definitive cure. They are unique in that they appear to practise a hybrid of orthodox, pseudo-orthodox, traditional, and spiritual medicine. Some prescriptions include common substances with believed but as yet unconfirmed medicinal value such as garlic, aloe vera, and mistletoe --to quite bizarre ones like urine therapy. The attraction is the measure of hope they instil in the psyche of the patient. To the
person with AIDS, he or she has offered a definitive cure where the orthodox doctor has offered little more than palliative treatment.

The pseudo-orthodox option

By far the most controversial of all the alternative options for managing HIV and AIDS is what I refer to as the pseudo-
orthodox option. This is as a result of its peculiar feature, namely that of an orthodox practitioner with an unorthodox approach to health care delivery and scientific innovation.

Here is an example. In late 1999, a Nigerian doctor, Jeremiah Abalaka, of the Medicrest Specialist Clinic, Abuja, announced in the Nigerian press that he had developed both a preventive and curative vaccine for the HIV virus. This raised a lot of questions in Nigerian medical circles. The first was about the decision to announce this supposed scientific breakthrough on the pages of local newspapers in a country where medical journals are published and medical congresses are held regularly. The second was for the proof and evidence that such a vaccine had actually been developed and that it worked. To the first question, Abalaka himself and a few of his apostles thought that his ideas would be stolen if he decided to put it through the scientific method. In answer to the second question, the Nigerian government constituted a panel made up of respected medical experts under the dual auspices of the Nigerian Medical Association and the Nigerian Academy of Science. Their mission was to verify Abalaka's claims.

Although their report, which did not favour Abalaka's claims, was submitted and partly published it has remained a source of controversy. Numerous claims in support of the Abalaka vaccine came from several sources including the Nigerian army and a couple of private health outfits. Recently, information in the Nigerian media about Abalaka's vaccine has been scarce, although some unconfirmed reports maintain he still administers the vaccine at his clinic in Abuja.

Whether these alternative options are worthwhile and capable of helping is controversial but they will remain as long as differences exist in people's understanding and perception of illness, spirituality, and medicine. Although alternative treatments seem to be needed, current evidence does not appear to justify their existence. In my opinion, the claims and counterclaims are a calculated attempt to exploit desperation, ignorance, and fear.

1. UNAIDS. Report of the global HIV/AIDS epidemic. Geneva: UNAIDS, 2000.