Results from the largest HIV Survey ever conducted in Nigeria were made public by the President of the Federal Republic of Nigeria, Muhammadu Buhari, on 14th March 2019. He formally unveiled the findings from the survey and launched the Revised National HIV and AIDS Strategic Framework 2019-2021 which will guide HIV program interventions in the country. The Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) assessed the prevalence of human immunodeficiency virus (HIV)-related health indicators in Nigeria. Key findings from the NAIIS fact sheet are HIV prevalence, Viral Load Suppression (VLS) and the PMTCT (Prevention of Mother-to-Child Transmission) cascade in Nigeria. Compared to previous surveys, NAIIS findings are more credible because analysis is based on a revised and enhanced methodology.
NAIIS-2018 revealed a national HIV prevalence of 1.5% for people between 15-64 years and VLS of 44.5%. Women aged 15–49 years are more affected by HIV than men (1.9% versus 0.9%). The estimated population of people living with HIV (PLHIV) aged 0 – 64 years is 1.9 million, the estimated treatment gap comprises 800,000 PLHIV. VLS among PLHIV aged 15-49 years with access to treatment is 42.3%. Among adults aged 15-64 years, HIV prevalence varies by geopolitical zones, with the highest prevalence in the South South Zone (3.1%) and the lowest prevalence in the North West Zone (0.6%). Disaggregation of the HIV burden by age shows that an estimated 75% of PLHIV are 15-49 years old and 8% adolescents (10-19 years). Prior to the NAIIS, national HIV prevalence was estimated at 3.4% (NARHS, 2012), while the estimated population of PLHIV in Nigeria was 3.4 million.
The “drop” in key HIV indicators in the country is a confirmation, first of all, that previous national HIV estimates were wrong. As mentioned above, the NAIIS used a better methodology to assess HIV-related indicators compared to previous surveys in Nigeria. In addition, the huge investment from stakeholders (Government of Nigeria, U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria, and other development partners) was worth it, and no doubt explains part of the decrease.
The drop in HIV prevalence has implications for HIV programming in Nigeria, however. The big question is, to what extent will the outcome of this survey influence HIV programs in Nigeria? Will the country sustain funding for the current strategies to HIV prevention, care and treatment or redirect funds? What happens to donor-funded HIV programs? Will donors invest less or shift focus to other diseases of public health importance or redirect funding to countries with higher HIV prevalence in sub-Saharan Africa?
It is clear from NAIIS results that the picture of the HIV epidemic in Nigeria is mixed and is probably fueled by socio-cultural practices, stigma and discrimination, poverty, key populations and poor commitment from both national and state governments. Other contributing factors include inappropriate technology, inadequate human resources for health and stock outs of essential drugs.
Key populations (KP) comprising of female sex workers, men who have sex with men and persons who inject drugs, accounted for 32% of new infections in 2014. Therefore, this population must be prioritized if we want to win the war against HIV/AIDS in Nigeria. All stakeholders in the health sector should advocate for government policies that support an enabling environment for KP to access HIV services in the country. Funders and implementing partners should also ensure a gender and KP sensitive approach to program implementation. Also, there is a need to scale up community-based Anti-Retroviral Therapy (ART) services for KP by setting up specialized clinics where KP can access HIV treatment without fear of stigma or discrimination.
Currently in Nigeria, Pre-Exposure Prophylaxis (PrEP) is not readily accessible. The Federal Ministry of Health and the National Agency for the Control of AIDS should shoulder this responsibility in order to increase access of eligible patients who are at substantial risk of HIV, to PrEP. As a priority, Nigeria should scale up PrEP beyond the ongoing demonstration studies and PrEP interventions in select clinics for key populations and sero-discordant couples..
To further improve on HIV indicators in the country, community involvement and involvement of PLHIV in programming is crucial. This can be promoted through community based programs and individualized care. Evidence from studies on Differentiated Service Delivery (DSD) models revealed that a significant percentage of PLHIV receiving treatment through this/these model(s) achieved optimal virological suppression and retention to care.
Nigerian researchers and implementers should invest more in HIV research and conduct studies to bridge gaps in HIV implementation with a focus on HIV testing services, linkage to treatment, ART uptake, virological suppression and retention in care.
Sustainability is key and it is high time Nigerians invested more in the health sector. The NAIIS survey was conducted by the Government of Nigeria with support from international donors but in the future, the Government should conduct its own survey. This gesture will showcase sustainability and real ownership of the HIV/AIDS response in Nigeria. The time has come for more commitment from the political class and all stakeholders in the health sector to take ownership in order to sustain whatever gains we have achieved since the emergence of the HIV infection in Nigeria.