•As responsibilities shift to communities
From Fred Ezeh, Abuja
On December 1, 2023, Nigeria joined the rest of the world to commemorate the World AIDS Day (WAD). The day provided the opportunity to reawaken the consciousness of local and global leaders to the need to sustain the “onslaught” against HIV/AIDS in order to meet the global target of epidemic control and ending HIV/AIDS by 2030.
WAD gave opportunities for stakeholders involved in HIV response in Nigeria and beyond to assess the gains and losses, as well as gaps in Nigeria, and possibly makes input on way.
This time, the attention was shifted to the communities in line with the theme of this year’s event “Communities: Leadership to End AIDS by 2030.’’ The theme obviously emphasized the need for communities and its leaders to get deeply involved in the fight, so that the gains achieved over the years can be sustained, thus positioning Nigeria on the right path to achieve the Joint United Nations Programme on HIV/AIDS (UNAIDS) goal of epidemic control of HIV.
UNAIDS explained that communities in this case are the people living with HIV, at risk of contracting the virus, or affected by HIV; leading the frontline of progress in the HIV response, working alongside donor partners, government, public health systems and other societal institutions, for the success and sustainability of the global response to HIV.
Communities, having been making the difference, together with the broader civil societies, have played significant roles particularly in hard-to-reach areas where access to modern healthcare services are limited, and where the barriers of inequalities and the experiences of stigma and discrimination constrained access and uptake of HIV/TB and related health services.
In Nigeria, community-led interventions are often led by the Network of People Living with HIV/AIDS in Nigeria (NEPWHAN), Association of Women Living with HIV/AIDS in Nigeria, (ASWHAN), Association of Positive Youths, (APYIN), International Community of Women Living with HIV, West Africa (ICW-WA) and others, to support the implementation of global and national strategies in HIV response.
The Global Fund’s statistics show that community organizations in Nigeria reached more than one million people with HIV testing and counseling services in 2020, and these organizations also distributed over 5.5 million condoms and provided support to thousands of people living with HIV.
Expectedly, there were several activities organized by the National Agency for the Control of AIDS (NACA) with the support of the Federal Ministry of Health through the
National AIDS, Viral Hepatitis and STIs Control Programme (NASCP), all geared towards raising public awareness on the state of HIV/AIDS in Nigeria.
Voices of several local and international partners include the Network of People Living With HIV in Nigeria (NEPWHAN); umbrella bodies of Women and Youth living of HIV/AIDS, were made loud at different events that were used to raise awareness on the virus.
State of HIV/AIDS in Nigeria (Adult)
Report of the 2018 National HIV/AIDS Indicator and Impact Survey (NAIIS) indicated that Nigeria has 1.3 per cent prevalence rate. Stakeholders involved in HIV response in Nigeria said the prevalence rate was good compare to some countries with over 10 per cent. But the challenge was the size of Nigeria’s population which was why it was regarded as the country with the highest burden in the world.
However, data from Federal Ministry of Health through the NASCP indicated that there are 1.9 million people living with HIV/AIDS in Nigeria. And out of the figure, 1.6 million have been successfully put on treatment using the Anti-Retroviral Therapy (ART).
Interestingly, the number of new infections has declined from 111, 099 in 2015 to 39, 546 in 2023. Similarly, the number of HIV deaths has also declined from 64, 422 in 2015 to 32, 626 in 2023. This, they said, it’s an indication that there has been steady decline in annual HIV infections and AIDS related deaths.
Stakeholders said the decreases indicate accelerating progress of the HIV response in Nigeria as supported by local and international partners. They have demanded a sustained momentum to avoid gain losses.
State of HIV AIDS in Nigeria (Pregnant women and children)
As at the end of 2022, an estimated 159,923 children aged 0-14 years were said to be living with HIV in Nigeria, thus making Nigeria one of the countries with the highest paediatric HIV burden globally as further confirmed by the data released by NASCP.
The data further confirmed that 32 per cent of children in Nigeria know their status. While 100 per cent of the children that tested positive to HIV are on ART, 90 per cent of them are virally suppressed, thus making it difficult for them to transmit the virus to someone else.
Similarly, an estimated 96,517 HIV positive pregnant women are in need of Prevention from Mother-to-Child Transmission (PMTCT) services. Unfortunately, only 34 per cent were successfully enrolled on ART as also confirmed by data made available by NASCP; while 50,676 children below 15 years living with HIV were on treatment as the end of 2022. This represents 32 per cent of the estimated CLHIVs.
UNAIDS target
In 2014, the Joint United Nations Programme on HIV/AIDS otherwise known as UNAIDS set a 90-90-90 goal for itself. The target was expected to culminate in the eliminating HIV/AIDS by 2030. The target was for 90 per cent of people living with HIV to know their status; 90 per cent of people living with HIV who know their status being put on ART; and 90 per cent of people living with HIV and on ART treatment achieving viral suppression (being unable to transmit to virus to someone else).
Few years after, the target was reviewed upward and increased to 95-95-95 for whatever reason, but the content remained the same except that the bar was raised. The goal of the global target was to achieve epidemic control and ending HIV/AIDS by 2030.
However, Nigeria has aligned itself with the global community in the pursuit of the global target. From all indications, Nigeria is about to exceed that target six years to the end of the target. So far, Nigeria has achieved 94-90-96 of the target, as confirmed by the Federal Ministry of Health through the NASCP.
This means that Nigeria has succeeded in getting 94 per cent of its population to know their HIV status; 90 per cent of the people who are living with HIV put on lifesaving ART; while 96 per cent of them have successfully gained viral suppression (meaning they can’t transmit the virus to someone else).
Stakeholders speak
UNAIDS Nigeria Country Director, Dr. Leopold Zekeng, said this year’s theme reflects the country’s recognition of the importance and the significant role of communities’ leadership in driving the much-needed goals and targets for ending HIV/AIDS by 2030.
National Coordinator, NASCP, Dr. Adebobola Bashorun, said that Nigeria is doing well in HIV response as reflected in the data, and expressed optimism that the newly launched PMTCT Standard Operational Procedure (SOP) document for health facilities will further assist in bringing down the figure of PMTCT cases.
Director General, NACA, Dr. Gambo Aliyu, said that Nigeria has demonstrated tremendous capacity for HIV case identification at community level as was witnessed during the COVID-19 epidemic.
He promised that Nigeria will continue to make commendable progress towards achieving epidemic control necessary to end AIDS by 2030. “We are also mindful of the fact that ending AIDS comes with huge challenge of sustainability of the control.
Chairman, House of Representatives Committee on AIDS Malaria and Tuberculosis (ATM), Amobi Ogah, advocated a new approach in funding of HIV/AIDS cases in Nigeria.
He said: “There’s urgent need for us to reduce foreign financial dependence for HIV related interventions by, at least, 50 per cent. In addition to that, we should also make effort to expand the number of HIV testing and treatment centre to accommodate more interests.
“This will enable us have a backup and sustainability plan in case of any unexpected withdrawal of financial support by international partners.”
He appealed to communities to take up the HIV response cases, so they can help the government meet the 2030 global target of achieving epidemic control and ending HIV/AIDS by 2030.
Sustainability pathway (Adults)
NACA launched two strategic documents that would, expectedly, guide HIV/AIDS response in Nigeria, thus culminating in global target of achieving epidemic control and ending HIV/AIDS by 2030.
The documents, National HIV and AIDS Strategic Plan (2023-2027) and the Sustainability Pathway for National HIV Response (2023-2030), in Nigeria, were developed by NACA with inputs from different local and international partners involved in global HIV response.
Meanwhile, some of international partners warned against complacency, and the need to sustain the momentum in order the meet the UNAIDS target but government officials said that many innovative approaches have been adopted to ensure that PLHIVs are identified, linked to care, initiated and retained on ART to achieve viral suppression, in addition to tracking clients with interruption in treatment.
They also advocated that there should also be enhanced adherence counseling sessions for unsuppressed clients, as well as expansion of viral load testing coverage with point of care machines, and the use of remote sample logging to reduce documentation time and turnaround time for viral load testing.
Sustainability pathway (Children)
Currently, there’s a country pediatric action plan for Nigeria that was developed using the bottom top approach. The 36+1 states developed specific plans for children/adolescents based on identified gaps in state data.
The National Plan was developed in accordance with the three pillars of the alliance. First, early testing and optimized comprehensive, high quality treatment and care for infants, children, and adolescents living with HIV and children exposed to HIV.
The second one was closing the treatment gap for pregnant and breastfeeding women living with HIV, and optimizing continuity of treatment towards eliminating vertical transmission.
The third was preventing and detecting new HIV infections among pregnant and breastfeeding adolescents and women; and the last one was addressing social/structural barriers that hinder access to services.