Nigeria: Any End To HIV/AIDS By 2030?

Since HIV/AIDS
became known, millions of people have been infected worldwide. The disease has recorded higher spread in the less developed climes like Nigeria, where such factors such as illiteracy, ignorance, tradition, poverty and the like have constituted serious challenges.
The question has been centred around the possibility of finding permanent cure to HIV/AIDS, notwithstanding the United Nation’s quest to end HIV/AIDS in 2030. In countries such as Nigeria, Ghana, Liberia and South Africa, which rely more on international donor agencies in terms of finance for HIV/AIDS-related programmes, the seeming inability of the federal and state governments to take up the responsibility of fully financing HIV programmes has further placed those countries in a precarious situation.
On July 14, 2015, the United Nations Programme on HIV/AIDS (UNAIDS), released a report, which showed that the global spread of HIV/AIDS has been reduced. At about the same time, media reports in Nigeria credited a statement to UNAIDS Nigeria Country Director, Dr. Bilali Camara, to the effect that ‘‘Nigeria is among countries which have reversed their HIV trend’’. He, however, did not state the extent to which the country has reversed the epidemic.
About a year earlier, precisely on July 16, 2014, the same UNAIDS had released a report it called the “Gap Report”, which revealed that 15 countries accounted for more than 75% of the 2.1 million new HIV infections that occurred in 2013. Among others, the report gave a damning verdict on Nigeria as a country with the highest HIV/AIDS mortality.
“Nigeria also accounts for one third of all new infections among children in the 20 worst hit countries in sub-Saharan Africa”, it stated.
Meanwhile, Nigeria’s HIV infection rate of 3.2 percent may appear considerably low when compared with South Africa’s 12.2 %, with a population of about 52.98 million, according to Human Sciences Research Council (HSRC).
A fact sheet released in 2014 on Nigeria by UNAIDS,  said 3.4 million Nigerians are living with HIV/AIDS, with only 593, 000 of them on Anti Retroviral Drugs (ARVs), which represented a paltry 21% of total number who require treatment.
New child infections in 2013 alone stood at 51, 000 while infections among all ages was put at 220, 000. According to that document, there are 190, 000 HIV positive pregnant women, with 52, 500 of the women on Anti Retroviral Drugs (ARVs). Of this number of pregnant women needing treatment, Nigeria is unable to treat about 70%. The report further stated that only 12% (47, 300) of all infected children requiring treatments are able to access them, leaving out the majority 88%.
However, what looked like a semblance of success story was noticed in the Prevention of Mother-To-Child Transmission of HIV/AIDS (PMTCT), which went up to 27% in 2013 from the 19% that it stood in 2012, according to the United Nations Children’s Fund (UNICEF). UNICEF also said some states doubled or tripled the number of clinics providing HIV services, bringing the number of PMTCT sites to 2,216. UNICEF, however, said this is still far less than the 16,400 needed to cover the 88% that the crucial services had left out.
According to UNICEF, the annual number of new child infections went down from 60,000 in 2012 to 51,000 in 2013. Meanwhile, two in every three pregnant Nigerian women are not being catered for. So, the 190, 000 figure quoted for pregnant women needing care is more likely to be an understatement.
During a visit to Nigeria from 7 to 10 February, 2016, UNAIDS Executive Director, Michel Sidibé met with the Vice-President, Yemi Osinbajo, and urged the Federal Government to increase its support for the Maternal, Neonatal and Child Health Week, with the aim that all pregnant women are tested for HIV by the end of 2016, and all women who test HIV-positive have immediate access to antiretroviral therapy.
The Vice President told Sidibé during the meeting that Nigeria was making huge budget allocations for social investment programmes, in part, to increase access to health care and help end the AIDS epidemic. How much this amounts to, and to what extent such budget will truly be executed on the purpose it is meant for can only be imagined, given alleged non-accountability of funds allocated to the fight against the HIV/AIDS epidemic.
Recall that in October 2014, the Network of People Living with HIV/AIDS in Nigeria (NEPWHAN) had mobilised its members in Abuja to protest at the National Agency for the Control of AIDS (NACA) office, shutting business at the complex, over perceived unresponsiveness of the agency to the dwindling fortunes of the HIV/AIDS treatment programme in Nigeria.
NEPWHAN’s National Secretary, Victor Omoshein,  had then remarked,‘‘We are concerned with the miserable conditions of people living with HIV/AIDS in Nigeria, as well as the high number of people dying daily from AIDS related complications due in large part to lack of access to antiretroviral medications as a result of withdrawn support by donor agencies.’’
According to Omoshein, ‘‘only 649, 000 out of about 1.8 million in need of treatment have access to drugs.’’ That figure represented about 30% of treatment needs.
The immediate past Director-General of the National Agency for the Control of AIDS (NACA), Prof John Idoko, had responded then that there were challenges, but reiterated government’s commitment to scaling up from 600, 000 to 1.4 million people on treatment. He, however, did not give a time frame for this government ambition.
There is no doubt that from inception, funding for Nigeria’s HIV/AIDS intervention has been donor dependent and donor driven, to the extent that about 90% of available funds come from donor agencies like the United States President’s Emergency Plan for AIDS Relief (PEPFAR), Global Fund, World Bank and several other international organisations.
Support ranges from training of personnel, provisions of technical know-how, supply of life-saving drugs and kits, etc. The Nigeria government’s contribution was mainly reduced to the provision of physical infrastructures such as hospital buildings and payment of salaries of medical and other allied personnel employed in the hospitals, while the core and major burden of intervention are borne by the donor agencies.
A major problem that has, however, short-changed the success story of the Nigerian intervention, is corruption. Most donor organisations have had issues with the Nigerian government over lack of accountability in the management of funds by Nigerian officials.
On several occasions, there were drugs stock-out, resulting in treatment truncation. There had also been instances where expired drugs were dispensed, fake and substandard testing kits deployed to testing centres, and when officials have had to destroy valuable supplies due to their expiration,
With the global financial crisis and changes in the priority focus of donor agencies, donor agencies now want the Nigerian government to contribute beyond just paying salaries and making available hospital spaces to actually invest in drugs purchase, equipment, training etc.
This current development clearly means that if the Vision 90:90:90 by 2030 and ending AIDS by 2030 must be achieved, the Nigerian government must go the extra mile. The first step should be allocation and release of necessary fund. This should be backed by policies that would ensure that monies meant for the execution of HIV/AIDS programmes would be used for no other purpose.
Unfortunately, the outrageous slashing of NACA’s proposed N18.9 billion for HIV/AIDS for the 2016 fiscal year to N1.5 billion by the two chambers of the National Assembly is a negative sign that may stand in the way of achieving Vision 90:90:90 by 2030.
In the words of the NEPWHAN National Coordinator, Victor Omoshehin, “If the government of change will not increase the domestic funding for HIV, then Nigeria cannot own up to the responsibility of achieving the Vision 90:90:90 by 2030 and we cannot end AIDS by 2030”.

Soibi Max-Alalibo