By Belinda O’Donnell
From June to August, I was a peer collaborator for the Mandela Washington Fellows, based at Howard University in Washington D.C. There I met the remarkable Dr. Victor Popoola, an HIV clinician and 2016 Fellow.
The Mandela Washington Fellowship is the flagship program of President Obama’s Young African Leaders Initiative (YALI) and a highlight of the President’s efforts in Africa. The program began in 2014 and provides 1,000 leaders between the ages of 25 and 35 from across the continent with the opportunity to hone their skills over six weeks of intensive leadership training, professional development, and peer-to-peer discussions.
Victor is dedicated to moving Nigeria closer to universal access to HIV care and treatment. He is also a strong advocate for the rights of children and sees improving child welfare as part of a broader effort to address social determinants of disease. In his day-to-day work as a clinical coordinator for the AIDS Healthcare Foundation, Victor oversees state-level implementation of antiretroviral therapy (ART) and prevention services in Kogi State, a three-hour drive from Abuja, Nigeria’s capital.
I asked Victor to share his thoughts on Nigeria’s efforts to scale up access to HIV prevention, care, and treatment, a conversation that started over tacos in Georgetown and continued via email and WhatsApp between Washington D.C. and Kogi State.
Belinda O’Donnell: Young women and adolescent girls account for more than 70% of new HIV infections in Africa. What do you see as the most important steps to take in order to make sure Nigeria’s young women have access to the knowledge they need for HIV prevention, have the ability to know their status, and have access to treatment?
“An educated girl stands a better chance of becoming an empowered woman.”
Dr. Oluwatobi Victor Popoola: An educated girl stands a better chance of becoming an empowered woman. With the necessary information passed across, especially on issues bordering on reproductive health, women and girls will have the courage to protect themselves, have a say in their reproductive health rights, and have the courage to access HIV testing and treatment services.
Some of the key things I think we can do include improving access to education for girls, introduction of reproductive health into schools’ curriculum, and supporting women’s empowerment.
You decided to move from the city to a rural area to practice medicine where your skills were most needed. Tell me more about your decision and why more health professionals should consider serving rural communities.
Moving to a rural community to practice is not an attractive one, but I must say that it is very rewarding. Looking at the concept of inverse care law, most people in need of medical services, especially those in the rural areas, do not have access to them. Rural areas have fewer health facilities and even much fewer health workers. Conversely, the reality is that the health challenges of both rural and urban communities are both enormous and resources should be allocated proportionately.
The rewarding part of working in a rural area is that health workers serve more people and have much more widespread impact than their counterparts in urban centers. Having all these factors in mind contributed significantly to my decision to move to the rural community where I work at the moment. This has helped the community members live healthier lives and also helped in improving the overall treatment outcome of people living with the virus.
To address this disparity in access to good medical care, it is imperative that more qualified health care workers move to rural areas as that is one of the major ways to improve Nigeria’s health indicators and the life expectancy of its citizens.
What do barriers to obtaining HIV care and treatment look like in Kogi State, where you work?
A lot of people still do not have access to correct information on HIV and how to access testing and treatment services. HIV is still highly stigmatized in several communities and this prevents people from being tested or even accessing treatment in the event that they turn out positive.
Nigeria has a relatively low prevalence of HIV compared to the hardest hit African countries, but because of its large population, around 3.5 million Nigerians are living with HIV. That makes the management of ART (antiretroviral therapy) roll-out in Nigeria a huge task. How is Nigeria doing in terms of scaling up access to ART?
Over the last few years, there has been a significant improvement in HIV programming. Some of the things Nigeria has done well include placing more people on life-saving ARVs, [antiretroviral medication] testing more people, increasing the number of ART and PMTCT [Prevention of Mother-to-Child Transmission] sites, as well as reducing prevalence and the number of new infections.
We still have a treatment gap of over 60 percent. However, what is evident is that there has been considerable progress over the years. This is largely due to the effort of international partners and local experts that have seen to the progressive growth of the [national] program, as well as the review and implementation of national guidelines on prevention and treatment.
What do you see as the key reforms that you want President Buhari’s government to tackle to make Nigeria’s public health system stronger, particularly when it comes to meeting the needs of people with HIV?
The Nigerian health system currently faces a lot of challenges that are not only affecting HIV programs, but all other health programs. The government should be held accountable in ensuring that corruption and misappropriation of funds is brought to the barest minimum. They should also make necessary plans to prevent the recurrent strikes by aggrieved health workers.
For the present administration to make significant progress in meeting the needs of people with HIV, it needs to show commitment by allocating more resources; ensuring transparency in program planning and implementation; and encouraging and enforcing accountability in terms of program record keeping, human resource management, resource allocation, and judicious use of scarce resources.
Q&A has been edited for length and clarity.
Title image: Young women in Abuja, Nigeria, by Mark Fischer via Flickr.
Belinda O’Donnell (Harvard ’11) is a Washington-based writer and researcher with a focus on US-Africa ties.