Today is World AIDS Day, and the theme of this year’s celebration is “Communities Make the Difference.”
The World Health Organisation (WHO) is highlighting the difference
communities are making to end the Human Immuno-deficiency Virus (HIV)
epidemic, while drawing global attention to the need for their broader
engagement in strengthening primary healthcare.
Although Nigeria has made some progress in reducing the number of
AIDS-related deaths and prevalence in the general population, recent
reports suggest that the pace of decline in new adult HIV infections in
the country, and indeed some other parts of the world remains short of
ambition.
Prevalence is a statistical concept referring to the number of cases
of a disease that are present in a particular population at a given
time, whereas incidence refers to the number of new cases that develop
within a given period.
According to the 2018 National HIV/AIDS Indicator and Impact Survey
(NAIIS) released in March this year, Nigeria has recorded about 40.6 per
cent decline in the number of persons infected with HIV from 3.229
million people, with a prevalence of 3.0 per cent in 2014, to 1.9
million persons with a prevalence of 1.4 in 2019.
This decline moved Nigeria from the second position on countries with
the highest HIV prevalence to fourth behind South Africa, India and
Mozambique.
Based on the 2014 HIV Sentinel (ANC) Survey, the HIV prevalence for
Nigeria was three per cent, which made Nigeria a country with the
second-highest burden of HIV/AIDS in the world after South Africa.
The data from the NAIIS are based on a revised and enhanced
methodology. The survey provides a clearer understanding of Nigeria’s
HIV epidemic and shines a light on progress made, the remaining gaps and
challenges.
It is believed that the improved understanding of the country’s HIV
epidemic will allow for more efficient investments in the response to
HIV and more effective planning for the provision of HIV prevention,
care and treatment services, including a focus on key populations, such
as female sex workers.
It will also permit the adoption of a population–location approach to
delivering services to the people and areas where they are most needed.
The new data differentiates HIV prevalence by state, indicating an
epidemic that is having a greater impact in certain areas of the
country. The South-South zone of the country has the highest HIV
prevalence at 3.1 per cent among adults aged 15–49 years.
HIV prevalence is also high in the North Central zone (2.0 per cent)
and the South East zone (1.9 per cent). HIV prevalence is lower in the
South West zone (1.1 per cent), the North East Zone (1.1 per cent) and
the North West zone (0.6 per cent).
Nigeria has shown steady progress on increasing access to treatment
for people living with HIV, with the adoption of a test and treat policy
in 2016. This measure has further accelerated referrals to treatment
facilities for people who test positive for the virus.
From 2010 to 2017, the country almost tripled the number of people
living with HIV that have access to antiretroviral therapy, up from 360
000 people in 2010 to more than one million in 2018.
However, the new estimates released recently indicate that more than
half of people living with HIV still do not have suppressed viral loads.
The new data are more accurate as they are based on an expanded
surveillance system and a revised and enhanced methodology. In recent
years, there has been a significant expansion in the country’s response
to HIV. The number of sites providing treatment has more than tripled,
the number of sites providing services to prevent mother-to-child
transmission of HIV has increased eightfold, and the number of HIV
counselling and testing sites has increased fourfold.
A total of 11.3 million adults were counselled and tested for HIV in 2016, four times as many as in 2012.
Meanwhile, the first case of AIDS in Nigeria was reported in 1986.
Since then, the epidemic has grown steadily from 1.8 per cent in 1991 to
3.8 per cent in 1993; 4.5 per cent in 1995, and 5.4 per cent in 1999,
and peaked at 5.8 per cent in 2001.
The prevalence began a gradual reduction from 5.8 per cent to five
per cent in 2003, this decline continued to 4.4 per cent in 2005, 4.6
per cent in 2008 and 4.1 per cent in 2010. By 2014 the HIV prevalence
rate was 3.0 per cent.
According to the NAIIS, Nigeria has fewer people living with HIV than previously estimated.
How Did Nigeria Achieve 40.6 Per Cent Decline In HIV Prevalence In Four Years?
The intensive free national treatment programme with antiretroviral
(ARV) drugs has suppressed the virus in persons living with HIV (PLHIV)
and made them unable to transmit the disease. Indeed, viral load
suppression (VLS) is an important marker of transmission, as those with
undetectable virus in their bloodstream will not transmit the virus.
According to the NAIIS, VLS, defined as having less than 1,000 HIV
Ribo Nucleic Acid (RNA)/genetic material copies per ml of plasma, showed
the positive effect of ARV treatment. Achieving VLS maximises the
health benefits to PLHIV, minimises the risk of HIV transmission, and is
necessary to halt the epidemic.
Key findings by the NAIIS include the fact that for every 1,000
persons aged 15-49 years, 14 will be are carrying the virus; HIV
prevalence is highest among females age 35-39 years at 3.3 per cent, and
highest prevalence among males age 50-54 years at 2.3 per cent.
It also revealed that the HIV prevalence of gender disparity between
females and males was greatest among younger adults, with females age
20-24 years having four times the prevalence of males in the same group.
Furthermore, the new prevalence gives an estimate that 1.9 million
people are living with HIV in Nigeria, even as the highest prevalence is
in the South-South Zone and the lowest prevalence in the North West
Zone.
The over $90m (N34.29t) worth survey was conducted by the Federal
Government and sponsored by the United States (U.S.) President’s
Emergency Plan for AIDS Relief (PEPFAR), with $70m, and the Global Funds
for AIDS, TB and Malaria with $20m and other development partners.
The survey reached around 220, 000 people in about 100, 000
households, and the fieldwork was conducted between July and December
2018.
The Director-General of the National Agency for the Control of AIDS
(NACA), Dr. Gambo Gumel Aliyu, in his comment said: “It is important
that all people living with HIV get into treatment and achieve viral
suppression. To halt the epidemic, we need to act now. As a government
working with our partners, we have what it takes to support HIV-positive
persons, to provide treatment, to protect their families and to help
people live long and healthy lives.”
Commenting on why more women than men are infected with the virus,
Aliyu said: “It has to do with the physiology of the woman. It also has
to do with the lower bargaining power for sex and socio-economic status
of most women. Women are also victims of violence and rape. Forced sex
increases the risk of HIV transmission among women due to lacerations.
Women dreading or experiencing violence, are less likely to negotiate
for safe sex, go for HIV testing, share their HIV status and access
treatment.”
Indeed, several studies have demonstrated why women are at a greater physiological risk of contracting HIV than men.
A study published in the AIDS Research Therapy, titled “Women and HIV in
Sub-Saharan Africa” noted: “This is in part because women have a
greater mucosal surface area exposed to pathogens and infectious fluid
for longer periods during sexual intercourse and are likely to face
increased tissue injury.
“Young women are at particularly high risk due to cervical ectopy,
which facilitates greater exposure of target cells to trauma and
pathogens in the vagina. It has been well documented that Sexually
Transmitted Infections (STIs) increase the risk of HIV acquisition. For
women, the risk is increased due to difficulty in diagnosing STIs, which
are often asymptomatic in presentation, thus making treatment
difficult.”
More than 3, 000 field staff did data collection from household
members ages zero to 64 years old, and participants were asked about
knowledge of HIV/AIDS, their behaviours, risks that may predispose them
to HIV, health-seeking behaviour, and stigma and discrimination against
people living with HIV/AIDS.
Confidential HIV counselling and testing services were provided and
blood samples tested for HIV, Hepatitis B, Hepatitis C, and other
biomarkers.
All participants that were found to be HIV positive were linked to a
health facility to help them access HIV services. HIV confirmation tests
were done, and viral load measured to determine the degree of viral
suppression among those taking HIV medications.
Pace Of Decline In New Adult HIV Infections Remains Short Of Ambition.
According to a new report, despite progress made in control of
HIV/AIDS, some coalition countries, however, experience increase in new
adult HIV infections, including Nigeria, where new adult HIV infections
increased by eight per cent, and Pakistan, which is experiencing a
rapidly growing HIV epidemic among key populations, where new adult HIV
infections rose by a staggering 56 per cent. On average, new HIV
infections in non-coalition countries remained relatively stable between
2010 and 2018.
The new report on progress made in reducing new HIV infections,
across 28 countries that have been particularly affected by HIV, was
launched by co-conveners of the Global HIV Prevention Coalition, Joint
United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations
Population Fund. The report was launched at the High-Level Meeting of
the Global HIV Prevention Coalition, held on November 12 on the
sidelines of the Nairobi Summit on ICPD25.
Together, the 28 countries account for 75 per cent of all new HIV
infections globally—1.2 million of the 1.7 million new HIV infections
among adults in 2018. The report, Implementation of the HIV prevention
2020 road map, shows that among the coalition countries new HIV
infections among adults declined on average by 17 per cent since 2010,
slightly higher than the global decline of 13 per cent, but far short of
the 60 per cent decline needed in 2018 to meet global HIV prevention
targets.
Executive Director of UNAIDS, Winnie Byanyima, said: “We are nearly
40 years into the HIV epidemic and it is unacceptable that governments
and leadership are still shying away from sensitive issues.
“Investments in HIV prevention do not match the needs of our people;
in some countries, even the basic commodities like condoms are not
available, accessible or affordable in rural areas, for young people or
key populations.”
The report shows that some countries have made significant progress,
with 12 countries reducing new adult HIV infections by 26 per cent or
more since 2010. They include countries with major epidemics, such as
South Africa, with a 39 per cent decline, the Democratic Republic of the
Congo, with a 37 per cent decline, Uganda, with a 36 per cent decline,
and Zimbabwe, with a 28 per cent decline.
The report shows that while there has been some progress in
developing programmes for adolescent girls and young women, the Global
HIV Prevention Coalition estimates that in 2018 only 34 per cent of the
areas with high HIV prevalence had dedicated comprehensive HIV
prevention programmes for women and girls—far short of the global target
of reaching 90 per cent of adolescent girls and women with these
services by 2020. During the meeting, Nyasha Sithole, from the Athena
Network, made a strong call for investment and engagement of adolescent
girls and young women in HIV prevention and sexual and reproductive
health programming.
The Global HIV Prevention Coalition was established in 2017 to
galvanize greater commitment and investment in HIV prevention to achieve
the 2020 prevention target of reducing new HIV infections among adults
by 75 per cent by 2020 (against the 2010 baseline). Its added value is
visible in several focus countries and beyond. Countries confirm that it
has promoted a more systematic and structured approach to HIV
prevention programming and built momentum in most of the 28 countries;
however, much more needs to be done to meet global commitments.
To accelerate progress in stopping new HIV infections, momentum
urgently needs to be stepped up by increasing investment, addressing
HIV-related stigma and discrimination, addressing the legal, policy and
structural barriers to HIV prevention, especially for adolescent girls
and young women, key populations and their sexual partners, and taking
measures to expand community-based responses.
By taking these critical steps and increasing efforts to address
persistent gaps in programme coverage and ensuring that services and
community programmes are available to everyone in need, significant
progress can be made towards ending AIDS.
Govt Scaling Up Interventions To End Scourge
The Minister of Health, Dr. Osagie Emmanuel Ehanire, told The
Guardian that, “there is something to cheer about in the just-released
“National Aids Indicator and Impact Survey (NAIIS) of 2018, which is the
largest such survey conducted, which now shows that Nigeria has
HIV/AIDS prevalence of 1.4 per cent, down from three a few years ago.
“It gives us an idea of our problem, so we can target and scale up
interventions to the 90-90-90 target, which is to detect 90 per cent of
all HIV cases, treat 90 per cent and ensure 90 per cent are suppressed
virally. We can build on that achievement.”
Osagie said about 1.9 million Nigerians are infected with HIV, and
about one million get treatment free. Many of the rest do not even know
their status. “Know your status,” “test and treat,” are part of the
strategy of the Federal Ministry of Health (FMoH).
On the country’s poor paediatric HIV treatment statistics, Ehanire
said: “Paediatric HIV derives largely from mother to child transmission
during delivery. Prevention of Mother To Child Transmission (PMTCT) is
an important item in our HIV elimination strategy. Detecting the
mother’s HIV status during antenatal care visits, putting positive ones
on treatment at once to defeat most transmissions does it. To scale this
and such intervention up to rural and underserved areas, we advocate
the need for functional Primary Healthcare Centres (PHCs) in every ward
in Nigeria.”
On what the government was doing to improve a situation where over 70
per cent of HIV activities in the country are funded by the United
States, he described the U.S. government as a great partner, not just in
fighting HIV/AIDS, but in other challenges. “We also get support from
the Global Fund and other partners, without whom it would not be easy.
The government of Nigeria does its best within the circumstances that it
finds itself. But all must work together to eliminate diseases of
global concern by 2030,” he said.
While enumerating challenges facing HIV control in the country, the
surgeon said funding challenges are the topmost. “I hope it improves as
public revenue increases and pressure on the budget from security, food,
and energy agencies are satisfied. Behaviour risk communication needs
to be stepped up, with high priority to youths in age-appropriate and
culture-sensitive HIV education. Key groups need to be addressed too,”
he said.
Commenting on the alleged neglect of persons living with HIV in
prisons, Ehanire said Nigerian prisons have medical units to take care
of persons in custody, adding that the Ministry of Health was not
directly in charge of these units, but is ready to support correctional
institutions to meet their medical needs, including HIV treatment.
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