The first case of Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) in Nigeria was detected in 1985 and reported at an international conference in 1986. There were two cases reported by the Federal Ministry of Health (FMoH), one being a 13-year-old sexually active girl and the other, a commercial sex worker from a nearby West African Country. This news created panic, doubt and a lack of belief in the country. The country was sceptical about it and regarded it as a plan to discourage sex, tagging it as an American Idea for Discouraging Sex (AIDS). Amid misinterpretation, scepticism and reactions to the news, from the beginning of the epidemic to 2014, a total of 220,000 new cases were detected. These were mostly adults over 15 years old, with significant numbers of children less than 15 years of age perceived to be infected by their mothers.
By 2014, Nigeria had 1.6 million AIDS orphans and 3.0 million people living with HIV/AIDS (PLWHIV), with only 747,382 individuals on Antiretroviral Therapy (ART). Nigeria is the second-largest HIV disease-burdened country globally, with 3.2 million cases—second to South Africa’s 6.8 million cases. The HIV prevalence rate stabilized at 3.4% due to improved reporting and intervention systems as documented by the Federal Ministry of Health (FMoH), Nigeria National Agency for the Control of AIDS (NACA), and USAID. The prevalence of HIV is relatively stable, as documented by the Joint United Nations Programme on HIV/AIDS (UNAIDS) in 2014. This was attributed to improved reporting and intervention systems. The trend, as reported by FMoH and NACA, was 1.8% in 1991, 3.8% in 1993, 4.5% in 1996, 5.4% in 1999 and a 5.8% peak in 2001. Then, there was a declining trend, starting with 5.0% in 2003, 4.4% in 2005, 4.6% in 2008, 4.1% in 2010, and 3.4% in 2013.
As of 2019, an estimated 1.8 million people are living with HIV in Nigeria, with an estimated 107,112 new HIV infections representing about 38% of new infections in West and Central African Countries.
Geographic Distribution and Contributing Factors
States with the highest PLWHIV cases include:
- Benue
- Federal Capital Territory (FCT)
- Anambra
- Akwa Ibom
Key contributing factors include cultural practices, education levels, religious beliefs, and socioeconomic differences. Major transmission factors as identified by NACA include:
- Multiple and simultaneous sexual partners
- Unskilled birth attendants operating outside hospitals
- Female genital mutilation
- Unsterilized surgical equipment
- Traditional bloodletting practices and tattooing
Modes of Transmission and High-Risk Groups
According to NACA in 2014, heterosexual intercourse is the major route for HIV transmission in Nigeria, accounting for over 80% of the infections. However, intravenous drug use through needle sharing and same-sex intercourse have been identified as major players. From a model by NACA, the high-risk groups that represent about 1% of the general population in Nigeria, which are men having sex with men (MSM), female sex workers (FSWs) and injecting drug users (IDUs), will contribute to new infections in the coming years. The groups and their partners have been projected to represent 40% of new infections, with heterosexuals engaging in low-risk sex in the general population contributing to 42% of the infections due to low condom use and high sexual networking. NACA also identified in 2015 that poverty, child marriage, gender-based violence, masculinity and femininity norms, disabilities, harmful traditional rites, as well as human rights, legal and political factors are promoting the transmission of HIV.
As soon as the first case was identified, the FMoH set up the National Expert Advisory Committee on AIDS (NEACA), and with support from the World Health Organisation (WHO), multiple centres for HIV testing were set up. However, there was no serious effort until the restoration of democracy in 1999. Shortly after this restoration, many international organisations came on board to support. HIV has claimed many lives while millions are living with the disease, sub-Saharan Africa being mostly affected. As of 2014, 9% of global PLWHIV lives in Nigeria, according to UNAIDS. In 2012, as documented by NACA, Nigeria was prepared to take control of the disease within a few decades. The main action was to get more infected people on AART.
Mother-to-Child Transmission (MTCT)
Mother-to-child transmission is a big issue. Nigeria has more HIV-infected babies than anywhere in the world, according to Jon Cohen. Nigeria is responsible for 37,000 of the world’s 160,000 new cases of babies born with HIV in 2016. Nigeria had 3.2 million PLWHIV. However, South Africa, which is the hardest-hit country in the world with 7.1 million people living with HIV, had 12,000 newly infected babies in 2016. This shows how HIV transmissions are not controlled as they should be, knowing that control of this route looks a lot more promising. Mother-to-child transmission has a 15% to 30% chance during pregnancy and childbirth, with 15% more infection rates through breastfeeding. Mother-to-child transmission of HIV is now rare in the developed world; this can be mostly attributed to the fact that they follow the standard of care.
Strategic Framework and Progress
Under the last presidency, it was documented that fewer people are living with HIV than formerly estimated. The revised National HIV and AIDS Strategic Framework 2019-2021 was launched, which was meant to guide the response to future epidemics. It was also mentioned that Nigeria has made good progress in scaling up the treatment and prevention of HIV. “For the first time, the end of AIDS as a public health threat by 2030 is truly in sight for our country”.
Challenges and Recommendations
Monitoring and Evaluation at the State and Local government levels, as well as across public, private, and civil society, have not been great, although effort at the national level seemed to be better. Hence, there is a need to synchronise monitoring and evaluation across the board to enhance adequate data collection and reporting tools, especially at the lower levels. Also, the challenges of reaching remote areas and underserved populations, addressing disparities in healthcare access, and sustaining the ongoing efforts of stigma reduction will all improve the spread of the disease.
The Path Forward
Increasing awareness about the disease should be a priority. Some international organisations have improved their efforts in this regard and are developing initiatives to sustain them. If Nigeria can scale up its testing rate, reduce stigma and follow the standard of care for HIV judiciously, the incidence will reduce, and prevalence will stabilise with reduced mortality. Now that Nigeria has committed to working to end AIDs as a public threat by 2030, efforts toward addressing the challenges and closing the gaps should be a priority. Nigerian government, with support from international organisations such as UNAIDS, PEPFAR, and the Global Fund, have been strengthening their efforts in response to the epidemic since the early 2000s. The establishment of NACA to coordinate HIV/AIDS activities across the country has also been a great asset.
References
Awofala, A. A., & Ogundele, O. E. (2018). HIV epidemiology in Nigeria. Saudi journal of biological sciences, 25(4), 697-703.
https://naca.gov.ng/nigeria-prevalence-rate/
https://www.unicef.org/nigeria/health-hiv
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-12865-y
