“Getting to Zero”: Nigeria’s progress in the fight against HIV/AIDS

Getting to Zero-HIV-AIDS in Nigeria

The reality of HIV/AIDS in Nigeria

This article was featured in our #HIV/AIDS edition of HALA Magazine. FREE Download here!

Red Ribbon Symbol for HIV/AIDSHIV/AIDS is a major threat to development, especially in sub-Saharan Africa. The devastating effects of the AIDS epidemic are mostly seen in this region, which is home to the over 23 million of the 34 million people living with HIV worldwide, according to the UNAIDS 2012 report. HIV prevalence in Nigeria is 4.1%, which means that about one in every twenty five Nigerian is living with HIV. Nigeria currently ranks second among the countries with the highest HIV/AIDS burden in the world, next only to South Africa. There are also about 260,000 children living with HIV/AIDS and over 2 million AIDS orphans in the country. Only about a quarter (i.e. 400,000 people) of 1.6 million people that require antiretroviral drugs (ARVs) currently have access to them. HIV/AIDS has continued to take its toll on developmental indices and the health system.

The first case of AIDS in Nigeria was reported in 1986. The national HIV prevalence increased from an initial 1.8% in 1991 to 5.8% in 2001 and then declined to 5.0% in 2003 and to 4.4% in 2005. After a rise to 4.6% in 2008, there was a recent drop to 4.1% in 2010.

HIV Infection trend in Nigeria

Statistics from the National Agency for the Control of AIDS (NACA)

Public health initiatives on HIV-AIDS in Nigeria

EFFORTS BY THE NIGERIAN GOVERNMENT: The Federal Government of Nigeria has responded to the HIV/AIDS epidemic through a number of policy and programmatic approaches, including commitments to interventional conventions and goals such as the universal access to HIV/AIDS interventions. The government’s initial response to the epidemic was to develop a four year program called the HIV/AIDS Emergency Action Plan (HEAP), based on a national strategic work plan but it was designed to be jointly executed by the Government of Nigeria, bilateral donors, and a World Bank IDA credit. Upon its expiration, the Federal Government introduced the National Policy on HIV/AIDS and the National Strategic Framework (NSF) which now incorporates a wide participation from Civil Society, the Private sector, Government entities, implementing bodies and international donors. All of this is aimed at halting and reversing the spread of HIV infection, as well as mitigating the impact of HIV/AIDS, by 2015. The multi-sectorial approach adopted by the government is coordinated by the National Agency for the Control of AIDS (NACA), formerly called the National Action Committee on AIDS. NACA oversees policies, programmes and projects directed at the AIDS issue, provides leadership and monitors the progression of the epidemic.

EFFORTS BY INTERNATIONAL ORGANISATIONS: There has also been tremendous support from programmes and development partners such as the US President’s Emergency Plan for AIDS Relief (PEPFAR), Global Fund, Bill and Melinda Gates Foundation, MacAuthor Foundation, etc. However, all of these supports so far still falls short of meeting our current burden of the disease. The largest donor funders e.g. PEPFAR are time-based projects and in the event of them rolling up, may leave a detrimental gap that may very well reverse all the efforts that have been gained so far.

One of the major partners implementing the PEPFAR program is AIDS Prevention Initiative in Nigeria (APIN). It was introduced in year 2000 as a project by the Harvard School of Public Health (HSPH) to instigate HIV/AIDS prevention research, training and capacity building initiatives in Nigeria.

Only about 25% of people who require ARVs currently get the drugs. While we are still grappling with managing existing infected people we recorded about 300, 000 new infections in 2012! We can do better than this.

Current challenges that can hamper ‘Getting to Zero’ in Nigeria

In the light of the foregoing and the immense work done by the Federal Government and international agencies, there still exists a huge chasm in the fight against HIV/AIDS in Nigeria. The sustainability of efforts so far is still is at risk due to several challenges that hinder improved access to quality HIV/AIDS services in the country.

1.      Non-prioritizing of our health issues by Government: A good place to start here is a quick reminder of our Abuja declaration in 2001 where Nigeria hosted the rest of Africa and all the participating committee of Nations signed and agreed that a minimum of 15% of National annual budgetary allocations should be dedicated to the health care delivery. But only about seven countries have held up to the agreement, unfortunately Nigeria the host of the meeting is not one of the seven countries. Our 2013 budget recently approved by the National Assembly allocated a meagre 6.04% to health even though that is an improvement by 1.04% from the 2012 allocation of only 5%. Another challenge in government efforts is the non-synchronisation of efforts across the various tiers of government. In fact at the last count, the 36 states in Nigeria including Abuja contribute only 0.3 per cent budget to the national HIV/AIDS budget. This challenge of inadequate funding is coupled with the weak healthcare delivery system in Nigeria.

2.      Over-dependence on Foreign Donor Support: In reality, most of the success achieved so far in the fight against HIV in Nigeria has been driven by international donors. They are largely responsible for the distribution of ARVs to the people currently receiving treatment.  In 2003, the then President of the United States, George W. Bush set up the President’s Emergency Plan for AIDS Relief (PEPFAR) program as a five-year project in response to the high incidence of HIV in sub-Saharan Africa. By 2008, it was obvious that these countries were unable to handle the gap that would be left in the absence of PEPFAR so the program was extended by another five years to 2013. This time based approach is common to most donor projects in the fight against HIV and they are designed to build the capacity of the host country to independently take on the fight with minimal external support. However Nigeria has not put in place any concrete plan in preparation of the end of these programs. 

To be continued next week with issues on Access/Coverage, Corruption, Stigmatization… and Recommendations.

Dr. Prosper Okonkwo was our Featured Guest Contributor for our #HIV/AIDS Edition of HALA Magazine.

 

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