On 1st December 2021, Nigerians joined the global community to commemorate the World AIDS Day .This is a Day that people around the world unite to show support for people living with HIV and to remember those who have died from AIDS-related illnesses.
Salutary as it was, the day once again, reminds us of the plight of those living with the disease as well as the plight of those that were untimely widowed, orphaned or killed by the disease. It brings to discourse the commitment of state and non-state actors to bringing to an end, this deadly disease which has claimed over 50 million lives globally.
Nigeria has the second largest HIV epidemic in the world and one of the highest rates of new infection in sub-Saharan Africa. Casualties from this disease exclude those from COVID-19, tuberculosis and other deadly diseases in the country.
Nigeria also has the fourth largest tuberculosis epidemic in the world, with HIV and TB co-infection now becoming an increasing concern for people living with HIV.
With COVID-19 pandemic, Nigeria like many others shifted attention to the new epidemic while allowing AIDS to silently but steadily kill thousands of people, especially Nigerian youths. It remains unknown the number of people lost to AIDS in the last one year to HIV/AIDS.
Despite huge resources dissipated on the prevention and awareness, Nigeria is still a long way off in meeting the global target of enrolling 90% of people diagnosed with HIV on antiretroviral treatment (ART). Poor treatment coverage and adherence means that the number of AIDS-related deaths in the country has remained high with 150,000 deaths allegedly recorded in one year.
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The National Strategic Framework initiated by the National Agency for the Control of AIDS (NACA), outlined key targets for the years 2017-2021 with the objective to provide 90% of the general population with HIV prevention interventions by 2021 and for 90% of key populations to be adopting HIV risk reduction behaviours by same year. With few weeks left in the year, it is doubtful if the country met half of the set target.
According to UNAIDS about two-thirds of new HIV infections in West and Central Africa occur in Nigeria. Together with South Africa and Uganda, the country accounts for around half of all new HIV infections in sub-Saharan Africa every year with six states, namely, Kaduna, Akwa Ibom, Benue, Lagos, Oyo, and Kano accounting for 41% of the population.
It is estimated that 4.8 million children have been orphaned by AIDS, with a huge impact on their health, safety and wellbeing. About 20% of these orphans and vulnerable children do not attend school regularly and around 18% are sexually abused. Major carriers of the disease are sex workers, men who have sex with men and people who inject drugs make up only 3.4% of the population, yet account for around 32% of new HIV infections.
Although Nigeria adopted a ‘test and treat’ policy in 2015, which means that anyone with a positive diagnosis is eligible for treatment, this is far from a reality. Weaknesses in the health system exist and create a barrier to many people accessing or staying on treatment. Even when ART can be accessed, drug supplies are known to run out and cause stock-outs.
Although accessing the antiretroviral drugs themselves is free, often patients will be asked to pay for other services, for example running other tests. Studies have shown that these fees and high costs of travel to clinics are barriers to people accessing care.
Aside fees charged, certain cultural practices increase HIV vulnerability among the people. These include female genital mutilation (FGM), denial of women’s access to inheritance, widowhood rites, encouragement of multiple sexual partners for males, and marriage of young girls to much older men.
With COVID-19 pandemic, Nigeria like many others shifted attention to the new epidemic while allowing AIDS to silently but steadily kill thousands of people
And while many people living with HIV in Nigeria are unaware of their status, Nigeria continues to fall short of providing the recommended number of HIV testing and counseling sites. Low levels of access to antiretroviral treatment remains an issue for people living with HIV, meaning that there are still many AIDS-related deaths in Nigeria.
Several other factors have contributed to the HIV/AIDS prevalence in Nigeria. First, the overall magnitude of the response has been inadequate, and expectations about what could be achieved quickly have been unrealistic. Secondly, a lack of indigenous management capacity and chronic weaknesses in the public health system has hindered the development and implementation of AIDS control programs.
In addition, individuals and organisations working against the spread of AIDs have had to face discrimination, complacency, and even persistent denial in the community. Many AIDS workers have become exhausted after struggling for so long against impossible odds; many others have died. Furthermore, myths surrounding modes of transmission hinder the dissemination of correct knowledge and sustained behaviour change.
To increase the likelihood of success, interventions need to be culturally appropriate and locally relevant, reflecting cognizance of the social context within which they are embedded. They should be designed with a clear idea of the target population and the types of behaviours to be changed. In turn, impediments in the social environment to behaviour change should be removed or weakened.
In this regard, behaviour-change interventions should include promotion of lower[1]risk behaviour, assistance in risk-reduction skills development, and promotion of changes in societal norms.
As it is done in other countries, HIV-prevention messages should include-the promotion of partner reduction, postponing of sexual debut, alternatives to risky sex, mutually faithful monogamy, consistent and proper use of condoms, better recognition of STD symptoms, and more effective health-seeking behaviour.
