The Human Immunodeficiency Virus (HIV) remains a leading public health and development challenge globally. With an estimated 2 million adults and children currently living with the virus, Nigeria accounted for 1,400 new HIV infections and 50,000 AIDS-related deaths weekly in 2023. This index has a far-reaching impact on the country's health, productivity, and socio-economic development.
In the midst of these challenges, progress has been made in increasing access to antiretroviral therapy (ART) for people living with HIV (PLHIV. This has improved their quality of life and reduced the risk of transmission. As of June 2024, about 1.7 million of the 1.9 million people living with HIV in Nigeria are on ART, which is 90% of those diagnosed and placed on treatment.
Nigeria has made progress in the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets, according to the Director General of the National Agency for the Control of AIDS (NACA) Dr Temitope Ilori. The target states that 95% of individuals with HIV are aware of their status, 95% of those with a diagnosis are getting antiretroviral therapy, and 95% of those on ART have reached an undetectable viral load
"With the aim of preventing any additional HIV-related fatalities or new infections, our strategy focuses on moving us closer to eradicating AIDS," Dr Ilori, revealed in an exclusive interview with Nigeria Health Watch.
Initiatives like the Prevention of Mother-to-Child Transmission (PMTCT) programme have been potent in reducing HIV transmission rates during childbirth. However, there is an urgent need for a rapid scale-up of the PMTCT services in Nigeria to reach the many women who need them. Public education campaigns have increased awareness and reduced stigma, encouraging more individuals to seek testing and treatment services.
Despite efforts to address HIV/AIDS in Nigeria, the country still faces major obstacles in achieving its 2030 HIV and AIDS-free targets due to stigma and prejudice, as well as a lack of political leadership commitment to prevention, insufficient investment at the sub-national level, and financial constraints.
With support and collaboration from important stakeholders, the private sector, civil society, and development partners, such as UNAIDS and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), seen as a critical precursor to Nigeria's HIV response successes, gaps remain in identifying undiagnosed cases and ensuring consistent treatment adherence.
Sustainability of HIV Intervention
Despite having the second-highest number of HIV-positive individuals globally, Nigeria depends on a combination of external donors, including PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) to manage its HIV epidemic. Asides from foreign donors, which is unsustainable and leaves gaps in funding that can be filled by finding other domestic funding sources from foreign donors, which is unsustainable and leaves gaps in funding that can be filled by finding other domestic funding sources.
"By prioritising increased domestic resource mobilisation and strategic partnerships, Nigeria is positioning itself to maintain its momentum in the fight against HIV/AIDS, even amidst reduced donor support," Ilori explained. She further notes that NACA is fostering public-private partnerships to enhance the domestic production of HIV-related commodities, such as antiretroviral drugs and testing kits. Sustaining these efforts is vital for the health and well-being of millions of Nigerians.
The Nigerian Business Coalition Against AIDS (NIBUCAA) and NACA established the HIV Trust Fund with the core objective of ensuring sustainable mobilisation of resources from the private sector to make significant contributions towards the funding of HIV programmes across the country, with a particular focus on the prevention of mother to child transmission of HIV (PMTCT).
The fund is devoted mainly to funding strategic inputs such as antiretroviral drugs, test kits, reagents, and logistics and to delivering these commodities to facilities in different locations all over Nigeria where they are needed.
Experts believe that partner coordination and the incorporation of HIV services into universal coverage programmes must be given top priority in pooling and budget management. Additionally, strategic purchasing needs to support cost-effectiveness, financial security, community-led initiatives, primary healthcare and private provider involvement, and outcome-driven resource distribution.
Promoting Domestic Production of HIV Commodities
The current health leadership in Nigeria clearly wants to promote the domestic production of health products by unlocking the healthcare value chain. This strategy is important because the heavy reliance on imported antiretroviral drugs and testing kits is not sustainable.
NACA is already taking steps to address this challenge by engaging with local pharmaceutical companies to build capacity for domestic production. The agency also pushes for policies encouraging investment in the local manufacturing of HIV-related commodities and advocates for regulatory reforms to ease domestic production processes.
If successful, these efforts can potentially reduce the cost of HIV programs, strengthen local capacity, create employment, enhance resilience and reduce dependence on external supply.
Multilateral organisations supporting the country should align with efforts to strengthen and sustain local supply chains. While initiatives like the sector-wide approach (SWAp) are helping to ensure alignment, creating markets for the products is also important.
In an interview with Nigeria Health Watch, a senior US Department of State Official working with the Global Health Security & Diplomacy Bureau highlighted PEPFAR's commitment to boost regional manufacturing capacities. One of these is procuring 15 million African-produced HIV tests by 2025. The commitment also involves "working with other partners to shift two million patients on first-line antiretroviral treatments to African-produced products by 2030," the official said.
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It's not a sprint
Nigeria has made commendable progress in combating HIV/AIDS, steadily advancing toward the UNAIDS 95-95-95 targets and increasing access to antiretroviral therapy for millions of people. Yet, as the country aims to end AIDS as a public health threat by 2030, the journey ahead demands sustained commitment, innovative solutions, and a focus on human rights.
The theme for this year's World AIDS Day, "Take the rights path: My health, my right!" resonates with Nigeria's efforts. It calls on all stakeholders to address inequalities that hinder progress and ensure that healthcare is a universal right, accessible to all without discrimination. This requires protecting rights, reducing stigma, and empowering communities with the tools and knowledge to prevent HIV transmission and safeguard their health.
To truly "take the rights path," Nigeria must also prioritise effective data governance, integration of HIV services into universal health coverage, and community-led initiatives. By addressing these systemic barriers, the country can ensure that no one is left behind in accessing life-saving care.
