On March 14, 2019, the National Agency for the Control of AIDS released a much-awaited report of the 2018 Nigeria National HIV/AIDS Indicator and Impact Survey (NAIIS), a large, unprecedented survey that reached 220,000 people in 100,000 households. The report revealed that Nigeria’s HIV prevalence rate had reduced to 1.5% among adults aged 15 – 49, down from previously estimated 2.8%. The obvious implication being that fewer people than previously thought live with HIV in Nigeria, a testament to the intensity of effort and resources invested in the fight against HIV in the country.
When I first encountered HIV/AIDS patients as a medical student in Port Harcourt in 2001, Nigeria’s HIV prevalence rate was put at 5.8% by NACA – the highest ever measured for the country. In 2006, while I was serving as the head of the NYSC HIV/AIDS Community Development Service Group in Ohaukwu Zone in Ebonyi State, the prevalence rate had dropped to 4.5%. By the time I had become a Program Manager on a US government-funded HIV/AIDS care and treatment program in Abuja five years later, the prevalence rate had dropped even further to 4.1%. Since then it has continued to drop.
This achievement has not been by accident: the story of the fight against HIV in the last two decades is the story of perhaps the biggest investment in a public health issue in Nigeria. A Lancet article in 2018 by the Global Burden of Disease Health Financing Collaborator Network estimated that over 1 billion dollars was invested into HIV programs in Nigeria between 1995 and 2015; with foreign donor agencies accounting for 80% of this figure. This funding no doubt galvanized a plethora of policy-makers, health administrators, health workers and their facilities, NGOs, civil society organizations, journalists, community leaders and a host of other stakeholders to implement interventions whose impact is not unrelated to the new prevalence rate. Those interventions ranged from massive publicity and awareness campaigns, through large counselling and testing drives to hospital-based care and treatment programs.
Those HIV/AIDS awareness campaigns from the 1990s were almost legendary. From radio and TV jingles, talk shows and dramas through community outreaches and faith-based engagements, it was almost impossible to live in Nigeria for a week and not come across a HIV/AIDS prevention message. HIV/AIDS campaign clubs were formed in secondary schools, higher institutions and the NYSC. Condom distribution campaigns were a regular feature in schools, clubs and even neighbourhoods. Churches and mosques were not left out, as these religious institutions also formed their own HIV/AIDS prevention organizations, carried out their own campaigns, and even set up their own treatment centres.
As at today, most of these activities and interventions have either stopped or have been scaled down considerably. Two reasons easily come to mind. The first is the reduced funding from external donors. The US government’s HIV/AIDS program, PEPFAR (The President’s Emergency Plan for AIDS Relief) drastically reduced its funding to countries like Nigeria, under the agreed framework in which the Nigerian government would increasingly take ownership of its own HIV/AIDS funding. The other major funder of HIV activities in the country, the Global Fund, has also reduced its funding to the country. The second reason for this decreased momentum in HIV/AIDS prevention activities is the one that bothers me more. It appears many stakeholders have concluded that the HIV pandemic is no longer as serious as it was ten years ago. Most of the organizations who drove the remarkable campaigns in the last two decades appear to have ‘stepped on the brakes’. While many of them might blame the funding cuts, I would attribute this to a subliminal national laisser-faire wave that has given many folks the impression that we are out of the HIV/AIDS’ danger zone and can now relent.
Nothing could be further from the truth.
And the truth here is that while the prevalence rate has reduced, UNAIDS data show that we still have 1.9 million people living with HIV in Nigeria. The onus is therefore on our Government and its agencies, to translate the President’s ‘momentum’ charge into action and step on the accelerator once again.
Dr Reward Nsirim is a physician, global health practitioner and management consultant. He studied Medicine and Surgery at the University of Port Harcourt, graduating in 2004 and subsequently working in clinical practice for five years before going to study for a master’s degree in Public Health at the University of London’s School of Hygiene and Tropical Medicine. Between 2010 and 2016 he managed various programs funded by such donors as the USAID, CDC, the Global Fund, the European Union and GAVI.