Nigeria’s shameful health indices have been reinforced in the 2020 Quarterly HIV fact sheet issued by the National Agency for the Control of AIDS. The report states that 103,404 Nigerians contract HIV annually, while 44,830 die from the AIDS based on the 2019 estimates. UNAIDS estimates that about two-thirds of new HIV infections in West and Central Africa in 2019 occur in Nigeria.
It is frightening that these statistics may be exacerbated by the interruptions in the HIV response caused by the COVID-19 pandemic with the NACA admitting to have lost contact with 51,000 persons living with HIV during the lockdown and recorded over 20,000 deaths within the same period. Some persons living with HIV were denied access to treatment centres because some of the facilities had been converted to isolation centres, while there was also a restriction of movement. Consequently, the use of antiretroviral drugs declined by 45 percent.
This is not surprising since the World Health Organisation and UNAIDS had warned in May that a six-month disruption of antiretroviral therapy due to the COVID-19 pandemic could lead to more than 500,000 extra deaths in sub-Saharan Africa between 2020 and 2021. The Bill and Melinda Gates Foundation in its Goal Keepers’ report in September said that the COVID-19 pandemic, which began late in 2019, had reversed the gains recorded in the health sector by 25 years in several parts of the world. But Nigeria’s inability to effectively control the spread of HIV predates the pandemic. The poor funding of the HIV response paints the picture of a country that has failed to take the lives of its citizens seriously.
Since the start of the epidemic in 1981, an estimated 74.9 million people worldwide have been reportedly infected with HIV, while 32 million have died of AIDS-related illnesses. In 2018, 770,000 people died of AIDS-related illnesses, a 55 percent reduction from the peak of 1.7 million deaths in 2004 and 1.4 million in 2010. Between 2005 and 2018, about $6.2 billion was spent on identifying and treating 60 percent of the estimated number of persons living with HIV. Over $5 billion of the funding came from international donors, especially the United States through its President’s Emergency Plan for AIDS Relief; and the Global Fund to Fight AIDS, Tuberculosis and Malaria.
This implies that over 80 percent of Nigeria’s HIV treatment comes from international donors. This is worrisome when compared to South Africa, which accounts for 80 percent of its own funding, while foreign donors provide the remaining 20 percent.
The President, Major-General Muhammadu Buhari (retd.), had at the 72nd United Nations General Assembly in 2017, pledged to use domestic funds to provide antiretroviral drugs for additional 50,000 HIV patients annually, but so far, only two states out of 36 have benefited from Federal Government’s treatment since 2018. This is abysmal given that 1.8 million Nigerians are HIV-positive, according to the 2018 Nigeria HIV/AIDS Indicator and Impact Survey. But there is enough blame to go around. Most states have also failed to own the HIV response even though health is on the Concurrent Legislative list.
Lagos State, which has 120,000 persons living with HIV, only bears about 22.8 percent of HIV treatment cost as of 2017 despite boasting of one the largest economies in Africa. NACA recommends investing $2.4 billion in identifying and treating additional 540,000 persons living with HIV to reach the UNAIDS target for epidemic control.
But the HIV quagmire goes beyond the funding deficit. Experience has shown that some of the challenges Nigeria is facing with the epidemic are self-inflicted. The then Minister of Health, Isaac Adewole, revealed in 2016 that upon his inauguration, he discovered that HIV drugs worth $3.2 million expired in storage, thereby depriving thousands of persons living with HIV from using the much-needed drugs.
Not long after, the Global Fund to fight AIDS, TB and Malaria alleged that $3.8 million was stolen by health workers and consultants. The government promised to refund the funds and prosecute the culprits.
NACA’s decision to cut off intermediaries and buy antiretroviral drugs directly from the international market is expected to reduce the cost and time of procuring the drugs. The development is therefore welcome in the interim. However, Nigeria cannot continue to rely on imported goods, which take about four to five months to arrive in the country. According to the National Agency for Food and Drug Administration and Control, Nigeria imports about 70 percent of its drugs and only makes 30 percent locally, while 100 percent of ingredients are imported. Thus, there is a need to enhance local production. The Federal Government should give incentives to local manufacturers, while interest rates should be lowered to stimulate investments.
Studies and experience have shown that HIV is no longer a death sentence if managed properly, but stigmatisation easily discourages many from confirming and accepting their status. The HIV AND AIDS (Anti-discrimination) Act, which holds that no individual or institution shall discriminate, directly or indirectly, against any person in the society based on the person’s HIV status, is hardly enforced, though Section 24 of the Act compels the Attorney-General of the Federation to do so. States must also domesticate the Act to ensure total compliance.
Experts argue that the inability of Nigeria to integrate HIV treatment fully into the general health care system is one of the reasons the epidemic has refused to abate. According to statistics, out of nine million pregnant women in Nigeria, only about 4.5 million get antenatal care and of this, only 2.8 million are tested for HIV. With millions of Nigerian women giving birth outside formal health facilities or without knowing their status, Nigeria now has the world’s highest number of babies living with HIV, recording an average 60,000 HIV positive babies yearly.
Nigeria’s fight against HIV cannot be won by doing the same thing repeatedly but by taking bold steps and innovative decisions. There is therefore a need for all parties to play their part effectively if UNAIDS 2030 deadline is to be met.
