Why you should care
The country’s fight against AIDS starts with the basics: knowing you have it.
Two years ago, Nigeria was a battleground. Not just a literal one — though authorities were facing the mounting death tolls of Boko Haram attacks — but an immunological one. The country had just over 3 million people with HIV, second in the world only to South Africa. Roughly 8 percent of all the HIV-positive people in the world lived in Nigeria, which has less than 3 percent of the world’s overall population.
It wasn’t a hopeless fight. There were antiretroviral treatments available for the disease, after all, but many Nigerians weren’t getting them. Instead, many were refusing to get tested at all, and those who did were often kicked out of family homes or ostracized socially, and didn’t have much access to treatment or support. In 2016, only about 10 percent of Nigerians said they had ever taken an HIV test.
The battle isn’t won, but it’s less of an uphill climb now.
The HIV prevalence in Nigerian adults has dropped by 40 percent since 2017.
That’s according to this year’s Nigeria HIV/AIDS Indicator and Impact Survey of more than 200,000 people, by far Nigeria’s most comprehensive and accurate study of local origin, according to those involved in the project. In 2017, an estimated 3.1 million in Nigeria were HIV positive, and this year’s survey found that the number had dropped to 1.9 million. For one subset, adults aged 15-49, the HIV prevalence dropped even further, by 50 percent — it’s now 1.4 percent among these adults, compared to 2.8 percent in 2017. That’s still high — neighboring Niger’s rate was just .4 percent in 2016, according to the CIA World Factbook — but not as high as in Lesotho, for example, where a quarter of the population was HIV-positive as of 2016.
So how did Nigeria do it? Counseling and testing. Antiretroviral therapy sites in the country doubled between 2012 and 2014, according to the Joint United Nations Program on HIV/AIDS, or UNAIDS, while sites focused on preventing mother-to-child transmission increased eightfold. Between 2013 and 2014, the number of adults who sought counseling and testing for the virus went up 65 percent. Now those efforts are bearing fruit.
There are still wild imbalances when it comes to HIV prevalence within Nigeria. For example, sex workers’ rate of HIV infection is estimated to be eight times higher than the rest of the population. Around 80 percent of new HIV infections occur as a result of unprotected heterosexual sex, but among men who have sex with men, HIV is on the rise, accounting for 10 percent of the country’s infections. This could be linked to a 2014 ban on homosexual acts, because further stigma makes it more difficult for gay men to access prevention and treatment.
Stigma is a powerful force working against attempts to beat the virus, explains Wilfred Okiche, a Lagos-based epidemiologist and public health practitioner. “It is such a big deal because it is so broad and all-encompassing,” he says. “It shows up in many different ways.”
This most recent survey itself can serve as a powerful tool, public health experts say. Apart from the lack of funds and the cultural stigma, the lack of data on the HIV epidemic has been a major problem in Nigeria’s fight against HIV. Without it, says Ogbonna Amanze of the National Agency for the Control of AIDS, it’s hard to target the populations who most need help.
“Now we have a true picture of the Nigeria HIV situation,” says Amanze. “It can guide our interventions.”
Those interventions will be two-pronged: Prevent new infections and manage the cases that already exist. But both objectives require funding, which could be narrower going forward. The latest study has proven successful — but with most of Nigeria’s funding coming from foreign powers and organizations like the U.S. and the U.N., that funding might get scaled back, which will see local authorities struggle to make up the difference.
Amanze says Nigeria is mindful of complacency and has initiated strategies to increase domestic funding, without which the country’s progress will depend solely on foreign donor benevolence. If those donors stop giving, recent gains could be erased. But at least the new data allows them to prioritize specific populations, regions and problems.
When the funds come, it’s now easier to pinpoint the biggest priorities. Generally, young people are vulnerable, with women in their early 20s nearly four times more likely to be infected than men the same age. And reducing the stigma of HIV will be a key factor. “Young people are fragile, naive and vulnerable to unprotected sex,” says Judge Abel, a college student based in Nigeria’s southeastern city of Enugu. “People have lost friends and families for merely identifying their status. Robust support is missing.”
Nigeria has tried to combat the stigma of HIV already. In 2015, it enacted a law prohibiting discrimination or attacks against those with HIV and AIDS, with penalties of imprisonment or stiff fines. Still, the perception among many is that the law is widely ignored when it comes to things like job discrimination — which means there’s still a resistance to getting tested or seeking treatment among populations who are already vulnerable and worry about being further marginalized.
The next phase of work, says Okiche, is to intensify prevention, testing and treatment measures in the key populations. “With more education, advocacy, campaigns and reduced discrimination,” he says, “People will find it easier living their best lives irrespective of status.”