· Decades on, stigmatisation, mother-to-child transmission, awareness below target
· PMTCT coverage remaining below 33 per cent
· 1.3 million new infections recorded in 2022 globally
As Nigeria joined the world in commemoration of the 2024 World AIDS Day on December 1, DAVID MAXWELL writes that even after all positive efforts and results recorded so far, it is still not yet Uhuru for Nigeria.
The first cases of AIDS in Nigeria were reported in 1986 though they were diagnosed in 1985. These index cases were a 13-year-old sexually active girl and a female commercial sex worker who arrived in Lagos State, from a neighbouring West African country.
The news of the first cases caused panic and disbelief in the country since very little was known about the ailment at the time except that it is a killer disease without a cure.
From just two, the number of people infected with HIV and AIDS in Nigeria has increased rapidly. For instance, in 1992, 367 new cases were reported, yet by 1994 that number had risen to 1,490 by 1994.
Almost five decades into the pandemic, it is not yet Uhuru for Nigeria even though some other countries including a few in Africa have made considerable and quite commendable progress.
Dr Temitope Ilori, Director-General of the National Agency for the Control of AIDS (NACA), though gave a ray of hope. According to her, the country has made notable progress in shaping “our response and strategies to address the HIV/AIDS epidemic in the country.”
At a news conference ahead of the 2024 World AIDS Day, she said about two million people were living with HIV in Nigeria, with approximately 1.6 million out of them currently receiving treatment.
The 2024 World AIDS Day with the theme, “Take the Rights Path: My Health, My Right!” is a rallying cry for accessible, rights-based healthcare that empowers those affected by HIV/AIDS to live vibrant and fulfilling lives.
But despite the ray of hope painted by Dr Ilori, UNAIDS’s Country Director, Dr Leo Zekeng, painted a gloomy picture, saying the level of progress made to eradicate HIV in the country was not encouraging.
Zekeng disclosed that the world made a commitment to reduce new HIV infection by 83 per cent; that is new infections to 370,000 by 2025, “but the data for 2022 suggests that we have 1.3 million new infections.”
According to him, about 11 countries, mostly from the east and southern Africa, have attained a 66 per cent reduction in HIV infection based on pre-2025 target assessment.
He said the progress attained by the 11 countries served as a testimony and had reinforced the hope that reducing HIV infections was achievable with determination. Zekeng then noted that achieving the set target by Nigeria was achievable with renewed commitment, political will, increased funding and strengthened efforts at prevention by states and Federal Government.
One of the challenges in AIDS control in Nigeria, according to Ilori, is the prevention of mother-to-child transmission of HIV, PMTCT, with coverage remaining below 33 per cent.
Ilori, who also referenced the stigma barrier, urged Nigerians to join hands with NACA to break the stigma, jinx and embrace equity, to drive collective action to stop HIV, especially among children. “We must empower every individual, especially women who are most vulnerable to contracting HIV, and other vulnerable populations, to access life-saving services and live with dignity.”
Also, many young Nigerians lack essential knowledge about HIV prevention, the Nigeria Demographic and Health Survey, NDHS, 2023-24 report reveals. It indicates that only 30 per cent of women and 22 per cent of men aged 15-24 understand effective ways to avoid the virus, thus contributing to the spread of HIV among youths who were particularly vulnerable due to limited access to accurate health information and misconceptions about transmission.
The Network of People Living with HIV/AIDS in Nigeria, NEPWHAN, decried the high rate of stigmatisation faced by persons living with the virus. NEPWHAN’s Edo chapter chairman, Mr Christopher Osayande said stigmatisation remained a significant challenge for Persons Living With HIV/AIDS (PLWHA) in society. “Stigmatisation is still high and as a result, persons living with the virus are being denied meaningful employment. For those in business, once people know they have the virus they stop patronising their businesses,” he said.
He also cited inadequate support, lack of care and empathy, as well as lack of access to resources/finances to become self-sufficient as some of the inhibiting factors.
“There are still new cases of HIV in the state and the number of people needing care is increasing due to lack of food and transportation. As an association, we are trying to see that the viral load reduces, but because most PLWHA do not have means of livelihood, the viral load remains high,” Osayande said.
On ways to end AIDS, Dr Patrick Dakum, Chief Executive Officer of the Institute of Human Virology , IHVN, advocated sustainability, renewed political commitment, and collaborative action to address the challenges ahead.
Funmi Adesanya, Nigeria Country Coordinator for the U.S. President’s Emergency Plan for AIDS Relief, PEPFAR, called for the expansion of preventive efforts to end HIV/AIDS and to look beyond 2030. Adesanya stressed the need to scale up evidence-based prevention strategies, such as Pre-Exposure Prophylaxis and harm reduction services to often-overlooked populations like children.
“Invest in resilient and inclusive healthcare systems that ensure uninterrupted access to antiretroviral therapy, even in crisis situations. Address social determinants like stigma, discrimination, and structural inequalities that hinder access to care, particularly for marginalised groups,” she said.
She also emphasised the importance of investing in research and development, supporting innovative vaccine development, and creating long-acting treatment regimens to improve outcomes and reduce transmission. A ray of hope in that direction is the recent proposal by the House of Representatives Committee on HIV/AIDS, Tuberculosis, and Malaria, ATM, of allocation of one per cent of the Federal Government’s Consolidated Revenue to address HIV/AIDS and other public health diseases.
Chairman of the committee, Hon. Amobi Ogah, at the end of the committee’s retreat with the National Agency for the Control of AIDS, NACA, said the decision was aimed at reducing dependency on foreign aid to sustain the fight against public health diseases.
Ogah also called for the amendment of the NACA Establishment Act of 2007 to restructure NACA into a multi-sector agency, enabling it to effectively coordinate responses to HIV/AIDS, viral hepatitis, tuberculosis, buruli ulcer, leprosy, and malaria.
According to him, the committee is committed to reviewing the Anti-Discrimination Act of 2014 to address stigmatization. “Other key decisions reached at the retreat that will help toward the goal of ending AIDS include, promoting local production of HIV drugs, ensuring accountability of NGOs, and enhancing NACA’s oversight capabilities,” he said.
“The need to prioritise comprehensive sex education, alongside continuous community and schools sensitisation, is important,” says Dr Ehey Ijezie, Country Programme Director, AIDS Healthcare Foundation, AHF.
Prof. Oliver Ezechi, the Director of Research at Nigerian Institute of Medical Research, NIMR, advocates youth’s involvement in proffering solutions to some health challenges including HIV/AIDS. “It also serves as a platform to harness the power of young people and local knowledge to tackle some of the country’s biggest health challenges like Hepatitis B, HIV, hypertension and other diseases that are common in Nigeria.”
For Prof. Juliet Ezekwe, a Professor of Medicine from Washington DC, USA, “Empowering communities will also aid in the fight to manage and stop HIV/AIDS. Communities have the first-hand experience, the knowledge, and the resilience to combat health challenges. Experts and doctors can provide guidance, but true progress hinges on empowering communities through the youths.”
Illori said NACA had implemented various strategies including combination prevention therapy, HIV self-testing, harm reduction initiatives, treatment as prevention, and the re-evaluation of Nigeria’s HIV epidemic through the NAIIS in 2018, among others. “Among other initiatives, is the advancement of PMTCT programme in Nigeria, which is key to eliminating new HIV infections among children.
“The federal government has adopted a comprehensive approach for the implementation of PMTCT and this includes: Primary prevention of HIV infection among women of childbearing age. NACA has developed the Global Alliance Action Plan to End AIDS in children and established a national-level acceleration committee to track implementation.
“The agency has also engaged stakeholders to co-create a sustainability roadmap, ensuring that gains in the HIV response are sustained and government-mandated structures are in place. Also, a new initiative to expand Health Insurance Project access for vulnerable Nigerians including Persons Living with HIV (PLHIV) and TB patients, is on ground, to run from 2024 to 2026, across five Nigerian states, namely, Kwara, Gombe, Ebonyi, Anambra, and Lagos,” she said.
In all, it is obvious that improved multi-sectoral coordination, accountability, and adoption of global best practices in HIV response, is vital to ending HIV/AIDS and prevention of its resurgence.
