Nigeria presently has an estimated 3.2 million people living with HIV, the second largest in the world after South Africa, but only an estimated 1.1 million of these know their status (just over 30%). Though 88% of those who know their status are on treatment and 81% of those have achieved viral suppression, the statistics look worse when put in the perspective of the total number of people living with HIV, revealing that only 30% of people living with HIV in Nigeria are on treatment. This means that we still have a long way to go in ending AIDS in Nigeria despite the 90-90-90 target.
Between 2010 and 2016, new infections in Nigeria reduced by just 5% and the total number of people living with AIDS increased slightly. Most new infections are among the heterosexual population but key populations like men who have sex with men, sex workers and people who inject drugs are estimated to contribute about 40% of the total HIV burden in Nigeria.
Achieving 90-90-90 and ultimately zero AIDS involve community effort. We must all work together to push for behavioural change for men to reject harmful versions of masculinity, prioritizing and protecting key populations, empowering women and girls. It is also key that stigma and discrimination are addressed. More work also needs to be done on educating and informing Nigerians on safe sexual practices especially condom usage and other strategies.
We must address harmful masculine gender norms, which contribute to greater risk-taking and poorer uptake of health services among men as well as criminalization and high levels of stigma and discrimination of members of key populations. Consent laws and insufficient access to comprehensive sexuality education deny young people the services and knowledge they need.
We must aggressively work towards ensuring that 90% of HIV persons know their status, and improve on linkage of newly detected positives to sites where they can access treatment. This must also be coupled with increased capacity for offering treatment especially in underserved locations. The prospect of achieving this goal has increased with new deals on more effective and cheaper dolutegravir used for HIV treatment, which will be made available next year in African countries, as well as the ongoing test and start strategy. Importantly, we must hold our government accountable to increase its funding to tackle AIDS and quit relying only on external donor funding.
Yes, 90-90-90 is possible in Nigeria. Together we can end AIDS.
Dr. Owoyemi Ayomide,
Lagos
