World AIDS Day 2019

Another year, another 1st of December, another World AIDS day has rolled by. In the previous years, I would normally give a run through of the phenomenon that is HIV/AIDS and how it is transmitted and prevented. However, this year, instead of going the normal route of telling you all about HIV/AIDS, I have decided to switch it up a bit and let you see how we have fared in our control of the epidemic especially in reference to the United Nations General Assembly’s goals as well as the Sustainable Development target of ending the AIDS epidemic by 2030, and how we can do better.

Here is some information on what the target is. In 2016, the United Nations General Assembly (UNGA) made a Political Declaration on Ending AIDS. This declaration was a global mandate to acccelerate efforts to end the AIDS epidemic by 2030 by fast-tracking our response. Without going into much details, these are three major goals contained in the declaration relevant to this conversation,

We really can say that there has been steady progress in the management of HIV/AIDS across board especially in the reduction of AIDS-related deaths but it is clear that we may not be on track to achieve our target by the year 2020. Again, like the goals mentioned earlier, this progress we speak of is measured in terms of new HIV infections and AIDS-related deaths occuring. Unfortunately there still happens to be a fairly large number of those.

The report records a one-third decrease in AIDS-related deaths between 2004 and 2018, leaving us with 770,000 from about 1.7million in 2004 and this is remarkable progress. In terms of new HIV infections, the decrease has been a bit more gradual. UNAIDS reports that there were 1.7 million new HIV infections in 2018 with key populations and their partners being responsible for more than half of that figure. A decline in global Incidence-Prevalence Ratio (IPR) was also recorded as 4.6% in 2018 from 11.2% in year 2000 and this is still a step away from the benchmark of 3%. This clearly shows that we need to intensify our efforts if we are to achieve the 2020 target.

Bringing the conversation home, Nigeria remains one of the three countries in the Western and Central Africa region that accounts for close to 60% of new infections and 54% of AIDS-related deaths each year and this goes to show that we need to be a lot more decisive in our efforts to improve on our national programmes. Nigeria, with an IPR of 7%, has 1.9million people living with HIV but even more alarming is the fact that only 53% of those people are on antiretroviral therapy and only 42% of that figure has achieved viral suppression, the point at which the HIV is not transmissible.

Another critical point of concern is that of Mother to Child Transmission (MTCT). 58,000 children (below the age of 15 years) acquired HIV in 2018 and 41% of that figure lives in Nigeria. To actively work towards reducing these numbers, we need a more intimate integration of our maternal and child health services with HIV services as well as Sexual and Reproductive Health (SRH) services. The risk and burden HIV puts on the children is too weighty for MTCT to be treated lightly. Also, the stigma and discrimination associated with HIV still remains at a level reasonable enough to deter those living with HIV and this can be duly managed by thoroughly and consistently educating people on the epidemic.

There also has been the rising concern about the state of funding. More than ever before, resources to combat the AIDS epidemic have been decreased. A lot of dependence is on international sources of funding like The United States Government’s President’s Emergency Plan For AIDS Relief (PEPFAR), and The Global Fund who are the major donors to Nigeria. The Nigerian Government has commendably increased its domestic public investment in HIV by more than 30% since 2010, unfortunately, we still remain at a mere 2.4% of the entire resources made available for the control of HIV as at 2018. This is a concern because as stated earlier, resources from international sources have decreased especially in recent times and domestic public funding has not been remarkably increased to cover the shortfall. The implication of this is that there is an overall deficit in the amount of resources made available to combat this epidemic within the country and thus the actual impact made on ending it is reduced.

In conclusion, while a lot of remarkable and commendable progress has been made within Nigeria and the world at large, a lot of ground still remains to be covered especially regarding the key populations, funding to combat the epidemic, particularly domestic public investment, proper integration of SRH and Maternal and Child Health services with HIV services, and finally the continuous education of people in order to overcome barriers like stigma and discrimination. The world has made a commitment to end the AIDS epidemic by 2030 and we all, governments especially, have a role to play.

*UNAIDS — Joint United Nations Programme on HIV/AIDS

*Incidence Prevalence Ratio (IPR) — The ratio of new infections to the total number of people living with HIV.

*SRH — Sexual and Reproductive Health

*MTCT — Mother To Child Transmission

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