A new HIV prevention and accountability report developed by Frontline AIDSand community partners, reveals that while the Nigerian government has made important progress in HIV prevention approaches, a lot more progress needs to be made in order to meet its targets.
Nigeria has recently developed and launched a new National Prevention Plan for HIV, including high level prevention targets. The government also actively engages with a Civil Society Accountability Forum – a space for advocates to actively hold government accountable and to highlight community priorities.
But while progress is moving in the right direction, there are significant – and growing – challenges in the area of HIV prevention which the country faces, preventing Nigeria from progressing further.
The new HIV prevention and accountability report developed by Frontline AIDS and its community partners has highlighted several of the most pressing barriers – which are slowing progress and reducing the likeliness achieving its target to reduce the number of new HIV infections to under 21,000 annually by 2025.
Discrimination towards sexual identity, drug use and sex work
Populations in Nigeria continue to face criminalisation, with same-sex relations, sex work, drug use/possession, and HIV transmission/exposure still classified as punishable crimes. This fuels stigma, marginalisation, and barriers to prevention services.
Advocates support efforts like the Patient Empowerment and Education Programme which aims to combat stigma by educating patients on their rights. However, the report states that substantial scale-up of anti-stigma and discrimination programmes is still needed, targeting both healthcare settings and law enforcement.
Funding constraints
The health budget in Nigeria accounted for just 5.75% of the country's total budget in 2023, falling significantly short of the 15% Abuja Declaration target.
NACA Nigeria (National Agency for the Control of AIDS) is advocating for both HIV prevention and treatment to be included in the country's Basic Health Care Provision Fund and is seeking ways to increase revenue for this fund. This includes expanding private sector partnerships.
As such, the report recommends an increase in domestic funding for health to reach the 15% Abuja Declaration target, as well as intensifying advocacy to increase the amount of funding available from other sources.
Impact of anti-rights groups
Research has highlighted an organized and well-funded anti-rights and anti-LGBTQ+ movement which is rapidly gaining influence across Africa, posing a major threat to HIV prevention progress.
In Nigeria specifically, there has been growing pressure from anti-rights groups within the legislature and the wider policy environment. This has led to amendments to Nigeria's National Drug Law Enforcement Agency Act, which seeks to limit judges' discretion and impose longer prison terms for drug-related offences, and are currently awaiting Presidential approval.
Opposition groups are also opposing the rollout of Human Papilloma Virus (HPV) vaccines for girls in Nigeria, with false but vocal claims that it will promote promiscuity among adolescents.
Further to this, certain high-profile politicians are advancing a more regressive agenda, including the former Minister of Education who is opposing comprehensive sexuality education (CSE), with backing from transnational anti-SRHR groups. There's also been push back against lowering the age of consent for HIV testing and other sexual and reproductive health services.
In response, the report states that more must be done to scale up anti-stigma programmes and recommends taking proactive steps to protect and champion the delivery of CSE in schools, in order to counter the false claims made by activists.
Slow prevention technology adoption
There are effective tools and approaches available to prevent HIV. This includes the Dapivirine vaginal ring (DVR), which provides women and girls with vital protection from HIV. And an injectable, long-acting form of PrEP, known as Cabotegravir Long-Acting Injectable PrEP (CAB-LA), has been shown to significantly reduce a person's risk of acquiring HIV.
Nigeria has plans to introduce both CAB-LA and the DVR. However, funding constraints threaten its rollout. There are also widespread and unfounded concerns about new prevention technologies replacing condoms. Publicity materials for communities need to be urgently developed to educate them on the purpose and correct use of these promising new technologies, alongside other prevention technologies, such as condoms.
In 2011 the Nigerian government also introduced a new National Condom Strategy Operational Plan. But condom use and coverage in Nigeria is still relatively low, especially among women. Ongoing challenges, such as declining donor funding and difficulties in data collection from some commercial sector actors, are impacting this.
The report therefore concludes that Nigeria needs to scale up provision and usage of existing prevention technologies, by exploring alternative funding sources.
Oluwatoyin Chukwudozie, Executive Director, Education as a Vaccine, said: "Frontline AIDS' new HIV Prevention & Accountability report provides valuable insights into where Nigeria stands when it comes to delivering on HIV prevention goals.
On the one hand, we are encouraged to see attention being paid to adolescents and youth in the National Prevention Plan and its targets. This indicates growing awareness of the heavy toll HIV takes on the young generation.
However, the reports also expose major gaps when it comes to translating policy into impactful prevention programming for adolescents and youth. Comprehensive sexuality education (CSE), for example, remains unavailable to many young people still.
As an organization dedicated to improving the health and development needs of young people in Nigeria, we believe the measures set out in the report are vital in order to see a drastic impact on the country's annual HIV infection figures and much needed change."
Prof Nana Poku, Chair of Frontline AIDS, said:"Today's landmark report shows that while governments across Africa and in India have made important steps towards reducing the number of people newly acquiring HIV, much more can and needs to be done in the fight against HIV.
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"Our reports highlight that all nine of the African countries analysed are presently failing to meet the target of spending 15% of their national budgets on health, as outlined in the 2001 Abuja Declaration. With effective tools and approaches to prevent HIV, including exciting new prevention technologies, it is vital that governments take the requisite steps to stop more people newly acquiring HIV around the world.
Lois Chingandu, Director of External Relations, Frontline AIDS said: "It is important that countries do more when it comes to investing in HIV prevention methods but also show stronger leadership in countering anti-rights narratives within their countries. Well-funded and highly organized movements are promoting anti-gender and anti-LGBTQ+ narratives which have resulted in 7 out of the 10 countries analysed criminalizing people who engage in same-sex sexual acts.
"While progress has been made, barriers to HIV prevention remain. Today's reports highlight the need for further investment to prevent HIV but also the need for much stronger leadership when it comes to countering anti-rights narratives if the global community is to strengthen and progress the HIV response across these nations.
Looking at the Nigeria report specifically, structural elements need to become an urgent priority, particularly in the face of the growing anti-rights movement, which has the potential to dismantle significant progress made on sexual and reproductive health and rights, comprehensive sexuality education and rights for LGBTQ+ communities."
