About 180,000 people die from AIDS annually in Nigeria. The country also has the second highest number of people living with HIV (PLWHIV) in the world. Of the estimated 3.2 million people living with HIV/AIDS in the country, only approximately 900,000 are currently accessing antiretroviral therapy (ART) with children constituting a mere 5%.
While some modest achievements have been made in the fight against the disease, a lot still needs to be done for the country to fully own or fund its HIV/AIDS response, especially in the face of dwindling donor funding.
There is a need for a paradigm shift in the delivery of HIV services in the country and this requires innovative strategies to fast track HIV treatment and prevention of mother-to-child transmission (PMTCT) services.
According to the Minister of Health, Professor Isaac Adewole, while the country may celebrate some of its modest achievements, “We are mindful that we are still a long way from achieving our goals. We recognise that the 860,000 patients who are on ART represent only 23.5% of the estimated 3.4 million Nigerians, who require treatment and suggested that more, can be done to expand service delivery.”
The minister said it remains a concern that despite several years of interventions, access to paediatric ART services continues to hover around the 28% mark for six years consecutively now adding, “It is equally worrying that PMTCT services are available only to 30% of the pregnant population annually. These poor indicators are unacceptable and require a re-think around our coordination strategies for the containment.”
Suffice to say there is need for strategic thinking in order to bring up innovations on HIV prevention programmes and services that will reach the target audience, especially the key population.
These nagging issues and the need for Nigeria to take charge of its national HIV/AIDS response formed the crux of the recent 3rd National Council on AIDS with the theme “Nigeria’s HIV/AIDS Response: Taking Charge of our Destiny” held on January 30 to 31st in Abuja.
The council is the highest technical decision-making body on HIV/AIDS response in Nigeria. It was created by the same act that established the National Agency for the Control of AIDS (NACA) with the purpose of providing technical direction on all HIV/AIDS issues in the country.
The Director General of NACA serves as the Chairman of the Council. The National Council on AIDS comprise of delegates from all states, the Federal Capital Territory (FCT) and representatives of other stakeholders on HIV/AIDS matters.
The 3rd National Council on AIDS was organised by the Director General of the agency, Dr. Sani Aliyu. He had earlier organised the National HIV Prevention Conference, the first of its kind in Nigeria, which was held in Abuja from November 29 to December 1, 2016.
A one-day technical meeting was held before the council meeting and a total of 78 memos that were received from stakeholders were discussed.
One of the major participants at the council meeting was the Network of People Living with HIV/AIDS in Nigeria (NEPWHAN). The group proposed that Nigeria can take charge of its National HIV/AIDS response through the establishment of an AIDS Trust Fund, and improved funding by government at all levels.
National coordinator of the group, Victor Omosehin, said: “We need not wait for statutory allocation every year or wait for donors to help us all the time. This country is blessed and rich with abundant resources. The National AIDS Trust Fund has worked in so many countries. It can work in our country because it has worked in so many countries.”
He commended NACA saying that more people now access treatment than in 2007, and that there was now less discrimination.
Director General of NACA, Dr. Sani Aliyu said Nigeria cannot afford to be left behind as the rest of the world fast tracks towards ending the HIV epidemic by 2030 particularly with the challenges of inadequate domestic funding, shrinking donor support, a weak health care support system, and a poorly coordinated national response. He said it was important for government at all levels to increase funding on HIV/AIDS programme.
According to him, between 2009 and 2014, the amount committed to HIV and AIDS funding was mostly by the donor/international community to the tune of about 70% with government contributing about 27% and the private sector about 2.1%.
He said: “With the dwindling donor funding, especially by our biggest contributors, which is PEPFAR, from $488,614,277(76%) in 2012 to 358,614,280 (70.8%) in 2016, shows that more than ever before, we have to take charge of our destiny if we have to achieve the test and treat strategy of ensuring that 90% of the populace know their status, 90% of those tested are placed on ART and 90% of persons on treatment will have viral suppression to prevent zero AIDS related deaths.”
Aliyu said it was important for states to take ownership of their HIV/AIDs response now, adding that those that have included HIV/AIDS in their health insurance schemes should not just leave it at testing or screening alone but also treatment.
He said that his goal as the DG of NACA is to ensure that in the next 18-24 months, the issues of actual prevalence rate of HIV in Nigeria through a collective and all-inclusive population survey is resolved, improve uptake of prevention of mother to child transmission (PMTCT) services among pregnant women, address concerns with data integrity and commence sustainability plans for the states’ HIV response.
UNAIDS Country Director for Nigeria, Dr Bilali Camara, said these objectives are not beyond the reach of Nigeria when “we chose the right strategies; states own and lead their AIDS response, and we coordinate our efforts at all levels; we integrate our HIV interventions into existing health services and we embrace the primary health care approach to AIDS response by bringing integrated health services closer to the people who need them the most at the LGA level.”
The Chairman, House Committee on AIDS, Tuberculosis and Malaria, Rep. David Mbugadu, who was represented by a member of the committee, Dr Henry Archibong, said there should be increased awareness creation on stigma of people living with HIV/AIDS and prevention of the disease.
The stakeholders who attended the 3rd National Council on AIDS unanimously made some resolutions on the way forward. In a communiqué issued after the meeting, the council approved the setting up of a specific Trust Fund on HIV/AIDS response in the country outside the normal budgetary provision, and that states should step-up budgetary releases for HIV/AIDS response. The council also approved the strengthening of human resources accountability, sustainability and efficiency at the states/ (FCT) agencies for the control of AIDS (SACAs) in the federation, and also recommended that NACA supports the coordination of HIV/AIDS control in states affected by insurgency.
Other resolutions approved by the council include: formulation of policies by the council on HIV in Nigeria that would focus on persons with disabilities, prison inmates, wardens and other uniformed personnel among others, that funding mechanism be put in place to support patients for their chemistry and haematology investigations in all sites, women groups should be involved in PMTCT programmes, and implementation of comprehensive sexuality education that addresses the specific needs of adolescents living with HIV, among others.
A new dawn is clearly emerging in the delivery of HIV programmes in Nigeria and all hands need to be on deck to support a more transparent and cost effective solution to the HIV epidemic in the country. The long term sustainability of the programme is in jeopardy unless the country takes up ownership now and ensures adequate funding through innovative funding solutions.
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