Ending HIV in Nigeria: A reality in sight?

The largest ever population-based HIV survey in Nigeria conducted in 2018 indicated that Nigeria’s HIV prevalence has declined. In this report, Sade Oguntola, avers that prioritising proven measures will protect those at risk from the infection, suppress the virus and avert new infections.

 

Nigeria is one of the countries in the world with the highest number of people living with Human Immunodeficiency Virus (HIV). Over the past two decades, responses have intensively supported the scale-up of HIV prevention, treatment, care and support.

Now, the preliminary findings of the Nigeria AIDS Indicator and Impact Survey (NAIIS) indicates that an estimated 1.9 million Nigerians are living with HIV with about one million persons on treatment.

The findings of the survey presented in Abuja by President Mohammed Buhari puts Nigeria’s current national HIV prevalence at 1.4 per cent in the population aged 15 to 49 years.

The survey measured the HIV prevalence rate (defined as the proportion of persons who tested positive for HIV) stratified on the basis of age, sex and geographic location.

Prevalence among females is significantly higher at an estimated 1.9 per cent, with male prevalence estimated at 0.9 per cent. Seven states are considered to have high prevalence of 2.0 per cent and above

HIV prevalence estimates varied across Nigeria, with the highest prevalence in the South-South Zone and the lowest prevalence in the North West Zone. Seven states account for 50 per cent of the overall estimated number of persons living with HIV in Nigeria.

The distribution of HIV burden across age groups indicates 12 per cent of persons living with HIV are between the ages of zero and 14 years while 75 per cent are between 15 and 49 years. Also adolescents (10 to 19 years) account for eight per cent of people living with HIV.

Almost half of all people living with HIV in Nigeria achieved viral suppression. The prevalence of viral load suppression among people living with HIV was highest among males aged 55 to 64 years at 55.0 per cent and among females aged 45 to 54 years at 54.3 per cent Viral suppression was highest in the North Central Zone (65.6 per cent) and the lowest in the South-South Zone (33.7 per cent).

Although almost four out of five women attended at least one antenatal care visit during their most recent pregnancy, only two out of five self-reported knowing their HIV status.

Certainly, results from the NAIIS are encouraging with fewer Nigerians now affected by HIV.  But is ending AIDS in Nigeria achievable by 2030?

President Buhari speaking at the NAIIS survey sponsored by Global fund, United States government and other partners in Abuja, declared that Nigeria cannot celebrate just yet, as almost a million Nigerians living with HIV are currently not on treatment.

To achieve epidemic control and end AIDS in Nigeria, he said there is the need for a more coordinated and funded national response that will be guided by the “Revised National HIV/AIDS Strategic Framework” document.

He reiterated his commitment at the UN General Assembly in 2017 to progressively add 50,000 Nigerians on treatment every year using government resources.

Executive Director, UNAIDS, Michel Sidibe said although it is good news that Nigeria has few AIDS-related deaths, the survey indicates more work needs to be done to prevent new infection among women and adolescent girls, intensify interventions in the seven states with HIV prevalence of above 2 per cent, and ensure males are more disposed to going for testing and seeking treatment.

Sidibe stated: “So with this survey we know now that we need to put more people on treatment quickly, monitor the activity of the virus in their blood to ensure that it is suppressed and thereby be able to prolong the life.”

Ending the cycle of HIV transmission among adolescents in Nigeria, he said also requires education of the girl child; building their skills to negotiate their sexuality and to end violence against adolescent girls and women.

Health Minister, Professor Isaac Adewole, stated that the defeminisation of HIV indicates the need to re-strategise how Nigeria should face this battle.

He declared: “We need to put more emphasis on prevention of mother to child transmission so that no Nigerian child is born positive with HIV. That now becomes the major priority of this administration.

“Also, we need to market the survey to the states; working with the Nigerian Governors Forum and the National Economic Council to project the level of work to be done and in asking for targeted funding,” he declared.

Professor Adewole, however, said that Nigeria is now the fourth globally in HIV prevalence, after South Africa, India and Mozambique in terms of the burden of the disease.

“So, this survey should be seen as the new beginning to do more focused work and also to really win the fight against HIV,” he added.

He assured that initiatives like the Saving One Million Lives project (SOML) and the Basic Health Care Provision Fund (BHCPF) would be able to cushion the effect of the disease through the provision of free antenatal care(ANC), Prevention of Mother to Child Transmission of HIV(PMTCT) to pregnant women in addition to other services.

Director General, National Agency for the Control of AIDS (NACA), Dr Sani Aliyu, stated that central to ending AIDS is the strategy to suppress the virus in people living with HIV,  the 90-90-90 target.

This target is to ensure that 90 per cent of all people living with HIV know their HIV status; 90 per cent of all people with diagnosed HIV infection receive sustained antiretroviral therapy; and 90 per cent of all people receiving antiretroviral therapy have sustained viral suppression.

According to Dr Aliyu, the viral suppression level would need to increase from 43 per cent to at least 73 per cent of all people living with HIV attain viral suppressed.

However, Dr Ibrahim Dalhatu of the United States Centre for Disease Control, assured that further analysis will be done to further determine the drivers and determinants of HIV, especially in states with high prevalence to ensure location-population specific responses.

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