THE BURDEN OF AIDS IN NIGERIA
Nigeria has the second largest HIV epidemic in the world. Although HIV prevalence among adults is much less (2.9%) than other sub-Saharan African countries such as South Africa (18.9%) and Zambia (12.4%), the size of Nigeria's population means 3.6 million people were living with HIV in 2016.
It is estimated that almost two thirds of HIV infections in West and Central Africa in 2016 occurred in Nigeria. Together with South Africa and Uganda, the country accounts for almost half of all new HIV infections in sub-Saharan Africa every year. This is despite achieving a 15% reduction in new infections between 2005 and 2016.
Unprotected heterosexual sex accounts for 80% of new HIV infections in Nigeria, with the majority of remaining HIV infections occurring in key affected populations such as sex workers.
Six states in Nigeria account for 41% of people living with HIV, including Kaduna, Akwa Ibom, Benue, Lagos, Oyo, and Kano. HIV prevalence is highest in Nigeria’s southern states (known as the South South Zone), and stands at 5.5%. It is lowest in the southeast (the South East Zone) where there is a prevalence of 1.8%. There are higher rates of HIV in rural areas (4%) than in urban ones (3%).
Approximately 160,000 people died from AIDS-related illnesses in Nigeria in 2016. Since 2005, the reduction in the number of annual AIDS-related deaths has been minimal, indicative of the fact that only 30% of those with a positive diagnosis in Nigeria are accessing antiretroviral treatment (ART).
Overview of HIV and AIDS in West and Central Africa
West and Central Africa is home to 6.1 million people living with HIV, of whom half a million are children. This is equivalent to 17% of the global population of people living with HIV, despite the region making up just 7% of the global population.
HIV prevalence among adults is 2.2%, which is relatively low when compared to East and Southern Africa. There is wide variation between countries, ranging from 0.5% in Niger and Senegal to 4.9% in Equatorial Guinea.
Less than half (42%) of those living with HIV were aware of their status in 2016. Of those who were aware, 83% were accessing antiretroviral treatment (ART). Of those on treatment, 73% were virally suppressed. The number of people accessing treatment rose significantly from 860,000 in 2010 to 2.1 million in 2016. However, because so many people are unaware of their status, this equates to just 35% of all people living with HIV being on treatment and just 25% of people living with HIV being virally suppressed.
As a result, 30% of all AIDS-related deaths worldwide occur in the region (310,000 AIDS-related deaths in 2016).. Although AIDS-related deaths have reduced by 30% since 2006, they are rising among adolescents (aged 15-19), with boys affected more than girls.
AIDS-related deaths are also high among children (aged 0-14), with four out of every ten children who die from AIDS-related illnesses dying in the region. Overall, it is estimated that 5 million 0-17-year-olds in West and Central Africa have been orphaned by AIDS since the epidemic began.
Good progress is being made on new infections among children, which decreased by 33% between 2010 and 2016 due to the availability of more prevention of mother-to-child transmission services. New infection rates among adults are declining more slowly, having fallen by 9% overall over the same period (370,000 new infections in 2016), and some countries are even experiencing rising infection rates.
Women are disproportionately affected by HIV in West and Central Africa, accounting for 57% of adults living with HIV in 2016. HIV prevalence stands at 2.4% among adult women, compared to 1.7% among adult men. In particular, adolescent girls and young women (aged 15-24) are disproportionately more likely to acquire HIV than their male counterparts.
West and Central Africa’s HIV epidemic is driven by heterosexual sex. Although it is generalised, meaning it affects the population as a whole, certain population groups such as sex workers, people who inject drugs and men who have sex are even worse affected. New infections among these key populations and their sexual partners accounted for 27% of all new infections in 2016, despite these groups representing a small proportion of the overall population. Yet programming for key populations remains insufficient, and stigma, discrimination and legal barriers prevent many people from these groups from accessing services.
In addition, many countries are in conflict, facing post-conflict situations or dealing with the impact of other humanitarian crises which further complicate the region’s HIV response.
GLOBAL RESPONSE TO HIV
The initial global response to HIV focused on prevention through behaviour change and research into a vaccine. However, it became clear that knowledge of transmission was not enough to stop the epidemic.
In the mid-2000s, the global response accelerated rapidly with universal access to treatment becoming a major priority. Recently, there have been calls to intensify global efforts with the UNAIDS Fast Track Strategy aiming to end the epidemic by 2030.
UNAIDS Fast Track Strategy
Launched in 2014, the UNAIDS Fast-Track strategy lined plans to step up the HIV response in low- and middle-income countries to meet the SDG 3 target to end AIDS by 2030.
The strategy acknowledges that, without rapid scale-up, the HIV epidemic will continue to outrun the response. To prevent this, it outlines the need to reduce new HIV infections and AIDS related deaths by 90% by 2030, compared to 2010 levels. To achieve this, the Fast Track strategy sets out targets for prevention and treatment, known as the 90-90-90 targets. This includes, reducing new annual HIV infections to fewer than 500,000 by 2020 and to fewer than 200,000 by 2030 – ending AIDS as a public health threat.
The 90-90-90 targets refer to the pathway by which a person is tested, linked and retained in HIV care, and initiates and adheres to antiretroviral drugs (ARVs), also known as the treatment cascade, to achieve viral suppression. At this point a person’s health is not adversely affected by HIV and HIV will not be transmitted through sex to someone else.
In support of the treatment target, WHO recommends that everyone living with HIV is eligible for treatment, regardless of CD4 count.
To achieve the 90–90–90 targets, UNAIDS emphasises the need to focus on five prevention pillars delivered through a rights-based, people-centred, combination approach.