Nigeria's National HIV Response - 14 Years Later

23 February 2021

Nigeria made history through NACA with the addition of about 400,000 people living with HIV on treatment.

The human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) has existed in Nigeria for over 30 years. The two index cases were discovered in 1985, one of which was a young female sex worker aged 13 years from one of the West African countries and by 1998, 4.5 per cent of the country's population had been affected by the disease.

In response to the devastating effect on both Nigeria's health and socioeconomic status, the Federal Government set up the National Expert Advisory Committee on AIDS (NEACA) and with the assistance of the world health organization (WHO) established several HIV testing centres across the country.

The National Agency for the Control of AIDS (NACA) was later established under an act of parliament on February 22, 2007, to coordinate the various HIV/AIDS interventions in the country.

Since its establishment, the agency has had exceptional personalities with impeccable track records as its Director-General (DG), pioneered by Professor Babatunde Osotimehin, followed by Professor John Idoko, Dr. Sani Aliyu and presently, Dr Aliyu Gumel Gambo - who before his appointment, led the implementation of the largest HIV population-based survey in the world as the then Country Director of the University of Maryland, Nigeria.

The contributions of these Director-Generals, with the support of notable figures who served as NACA Board Chairperson at various points in time, such as Professor Ibironke Akinsete (pioneer), Emeritus Professor Umaru Shehu and Dame Paulin Tallen and Senator Oladipo Odujinrin (current), have ensured that the National HIV response approached its last mile.

Celebrating 14 years as an agency, the National Response stewardship day provides a platform for stocktaking and future projection for ending HIV and AIDS as a public health emergency in Nigeria by 2030.

14 years after, where are we?

Nigeria, Africa most populous country currently has HIV prevalence rate of 1.4 per cent, indicating a 40 per cent reduction from the country's official national HIV prevalence estimates for 2017.

The first HIV Sentinel Survey in 1991 showed a prevalence of 1.8 per cent. Subsequent sentinel surveys produced prevalence of 3.8 per cent in 1993, 4.5 per cent in 1996, 5.4 per cent in 1999, 5.8 per cent in 2001, 5.0 per cent 2003, 4.4 per cent in 2005, 4.6 per cent in 2008, 4.1 per cent in 2010 and 1.4 per cent in 2019.

The Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) conducted in March 2018, released in 2019 highlighted the country's response to the HIV epidemics at the time. As described by United Nations Agency for International Development (UNAID), it is the largest population-based, cross-sectional survey ever, which costed about $100 million and involved 185 survey teams, covering about 225,000 people.

Findings from the NAIIS has shaped NACA's response to the epidemic moving forward, as it shows that people practicing low-risk sex are the driving force of HIV epidemic in Nigeria while the high-risk groups involving female sex workers, men who have sex with men and injecting drug users contribute substantially to new infections.

The National Response has recorded many successes, some of which includes

· The provision of a National Strategic Framework to fast track the response towards ending AIDS in Nigeria by 2030

· The HIV/AIDS Anti-Discrimination Act in 2014 which makes it illegal to discriminate (in any form) against people based on their HIV status.

· The formation of strategic partnerships with key stakeholders which has led to the placement of over 1,000,000 persons on Anti Retrovirals (ART).

Establishment of six regional offices to track and monitor the progress of HIV control programmes across the country

Development of a pathway for the sustainability of the National HIV response through a pilot in Abia and Taraba states now supporting 49,629 people living with HIV

The development of the Nigeria National Response Management Information System (NNRIMS), which is the fulcrum upon which the Monitoring and Evaluation of the HIV National response sits.

Increased awareness of HIV prevention strategies among Key Population groups as a result of tailored and strategic HIV programming for these population

Economic empowerment of vulnerable and indigent persons living with HIV including women, girls, key populations, young people at different locations.

Astronomical growth in key population treatment centres, 10 in 2017 with a coverage of 16,147 to 60 in 2020 with coverage of 149,23

Nigeria made history through NACA with the addition of about 400,000 people on treatment, a feat no other country in the 17 years of the United States President's Emergency Plan for AIDS (PEPFA) have reached

Among all PEPFA supported countries, Nigeria's HIV response is the most resilient globally

The efforts of NACA and her partners has continued to reduce the HIV incidence, mobilize resources for placing more persons on ART, and development of needed human capital for responding to the virus.

Despite successes recorded, a lot more needs to be done by way of shared responsibility and accountability, responsible implementation and stronger partnerships but the National Agency for the Control of AIDS is not sitting on its oars with an even stronger resolve to fight HIV/AIDS to finish by 2030.

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