Nigeria

Grace Amodu was 7 years old when she found out she was living with HIV. Until then she had been told to take pills daily for malaria or for headaches but she grew tired of it. Screaming and kicking she told her brother that she was going to stop taking her medicine and that she wanted answers. Her mother took her aside and explained that she was born with HIV and that the treatment would keep her healthy like other kids.

She remembers crying a lot and refusing to leave the house.

To keep her from spiraling out of control her mom encouraged her to join a support group, which she says turned her life around.

As she proudly says she has two children who are both free of HIV. Taking her medication at the same time every day throughout her pregnancy and afterwards meant she was not going to transmit HIV to her babies. "When you take medicine it suppresses the virus and even though I feared my children may have HIV they both tested negative.”

She credits International Community of Women Living with HIV (ICW) Nigeria chapter for giving her hope and confidence.

“ICW was like a backbone, they were there for me like the colleagues, everyone around was standing for me, even the boss, Assumpta Reginald, was like a mother figure to me,” Ms Amodu said. “She held me by the hand telling me that, ‘You can do this and you can become a better person.’

As a result, Ms Amodu has become an HIV advocate and a community pharmacist.

"We go to the hospital and get medicine for people and give them to patients who are maybe not able to access their drugs because they have no transport fare or they are far away or due to the stigma in the hospital they don’t want to come to have nurses and doctors shout at them so we take these drugs down to their doorstep and give it to them,” she explained.

More than 90% of people living with HIV in Nigeria are on antiretroviral medicine but stigma and discrimination are still rampant.

For Ms Amodu the solution is simple. Give people the right information about HIV to break the cycle.

“We need to make people understand that you being HIV positive is not making you less of a human, you are also a human being and you deserve equal rights,” the 28-year-old said.

Stella Ebeh knows all about stigma. She started volunteering in 2004 helping people living with HIV like herself. Then she started working in a health center and became a public health officer. Over the years Ms Ebeh said she has cared for more than 7000 patients and also became a mentor-mother (giving HIV advice to pregnant women and counselling), and an anti-stigma ambassador.

She is very proud of overcoming stigma and as she called it, “walking on it,” but despairs that she is still not a full-time staff member. People living with HIV are very capable and yet we are often overlooked she said, adding, “I work like an elephant but eat like a rat.”

Patients pour in and out of the Marabara health centre on the outskirts of Abuja all day. Ms Ebeh goes from one person to another. She lingers a while with a pregnant woman who also prepares lunch on the premises, Ngozi Blessing.

Ms Ebeh insists on pregnant women taking all the precautions they can to give birth to healthy babies. Her husband and their five children are all HIV negative. Sadly, in Nigeria this is an exception.

Vertical transmission is 25% in the country - that is when a mother passes on the virus to her child during pregnancy or breastfeeding- a record high in the region.

UNAIDS Country Director Leopold Zekeng says this is unacceptable. For him it is a demonstration of the inequalities in terms of access to services.

“Two thirds of the 8 million women who get pregnant every year in Nigeria do not have access to PMTCT (prevention between mother to child transmission of HIV) services during ante-natal care,” he said.  

This is why Nigeria and UN organizations along with other partners are spearheading an effort to end AIDS in children.

Dr Akudo Ikpeazu, Director and National Coordinator, National AIDS and STDs Control Programme (NASCP) said that in the last 2 years they have done an enormous amount of work first trying to get a mapping to understand where all the women are having babies and where they receive ante-natal care if at all.

“A lot of them are in birth homes, they go to traditional birth attendants and many deliver at home and receive services at home and so we have a got new strategy which aims to find them where they are, ensure that they are treated, ensure that we can find them first, ensure that we can  test them, link them into treatment and count every single one that has gained access to care,” she said.

In other words, find all, test all, treat all and report all which happens to be Nigeria’s slogan encapsulating their strategy.

Once that vertical transmission tap, as she called it, is closed, then there will be a smaller pool of children to look after regarding treatment. Dr Ikpeazu said Nigeria intends to put in place an acceleration plan to have more children and adolescents on treatment and push for them to stay on treatment.

For Toyin Chukwuduzie, Director of Education as a Vaccine (EVA), HIV is one part of a larger equation.

“We see the number of unintended pregnancies, we see the burden of HIV especially among  adolescent girls, we also see the sexual and gender based violence happening in our society so these things are in existence, these things are happening, yet adolescents and young people don’t have the information they need to make decisions whether we are talking about schools, whether we are talking about health facilities or even in the homes where there are other adults so there are huge gaps,” she said.

The 35-year-old works with young people to fill those education gaps and build support. She is convinced that a main driver of these gaping holes are inequalities, one in particular.  

"I believe gender inequality is the root cause of many other inequalities so if had a magic wand gender inequality would be the one I would address the first because it’s key,” she said. “Addressing gender inequality is key to unlocking potential, potential of women and girls everywhere in this country.”

Hammering in her point, she added that despite everyone stressing the fact that young people are the force of the future Ms Chukwudize said, "If you are not providing that safe environment, if they are not healthy, if their dreams and aspirations are thrown off the path, how do they become the future that we want to see.”

Nigeria has hosted a meeting of key stakeholders in the country’s HIV and wider health response to call for a successful 7^th Global Fund Replenishment meeting. The meeting took place in Abuja and included ambassadors of key donor and recipient countries and heads of United Nations agencies, including UNAIDS.

During the event, the Minister of State for Health, Ekumankama Joseph Nkama, expressed his appreciation for Nigeria’s partnership with the Global Fund to Fight AIDS, tuberculosis and malaria. He said Nigeria included one of the Global Fund’s most important recipients of Global Fund disbursements over the last 20 years and reiterated Nigeria’s commitment to increase domestic funding for health.

‘I applaud countries who have already made their pledges to the Global Fund including the United States, Germany, Japan and Luxemburg,” said Mr Nkama.” I encourage other countries to rise up to this noble call by increasing their pledge by at least 30% to enable the Global Fund to meet its target.” he concluded.

David Green, the United States chargé d’affaires commended the partnership with the Nigeria that had he said enabled an incredible acceleration of HIV treatment coverage, registering the largest treatment growth in the history of the HIV programme, despite the COVID 19 pandemic. This was made possible through national surge and alignment efforts that saw the aligning of technical and financial resources behind a single national programme for intensified case-finding, allowing rapid expansion of access to antiretroviral treatment.

‘Sustaining this success depends upon contributions to the Global Fund and all of us standing in solidarity to fight for what counts. We are close to the finish line, but with Nigeria still accounting for one out of seven children born globally with HIV, the race is not yet over,’ said Mr Green.

For the Global Fund, Linda Mafu, highlighted the importance of Nigeria.

“Nigeria is one of our most important portfolios at the Global Fund and achievement of our ambitious targets is critical both for the health of the people of Nigeria and the ability of the Fund to raise additional funding and make an impact at the global level in saving lives,” she said.

Leo Zekeng, UNAIDS country director reiterated the importance of the Global Fund in the collective global response to end AIDS as a public health threat by 2030 and called on countries to stand in solidarity for a successful 7^th Global Fund Replenishment. ‘Investing in global health is not only the right thing to do but the smart thing to do as it guarantees a good return of investment. Every $1 invested in fighting AIDS, TB and malaria yields $31 in health and economic returns,” he added.

The Global Fund investment case of the 7^th Replenishment conference was presented to those attending the meeting, highlighting the achievements of the investments and the remaining gaps in reducing the burden of HIV, tuberculosis and malaria. The 7^th Global Fund Replenishment conference seeks to raise at least US$ 18 billion to save 20 million lives, reduce deaths associated with HIV, TB and Malaria by 65% and strengthen systems for health to build a healthier, more equitable world.

Dr Leo Zekeng, UNAIDS Country Director and Representative in Nigeria, has shared how lessons from the AIDS response apply to the Monkeypox response.

Dr Zekeng said:

“Monkeypox is endemic in Nigeria, and in recent weeks there has been a significant increase in suspected and confirmed cases. The Nigeria Center for Disease Control (NCDC)’s most recently published sitrep (7^th August 2022) indicates that in 2022 there have been over 473 suspected Monkeypox cases (407 of which are since 30^th May), of which have been 172 confirmed (151 of which are since 30^th May).  In the most recent weekly data published (1^st to 7^th August), 60 suspected cases were recorded in one week, out of which 15 were confirmed.

The Nigerian government, civil society organisations, development partners and the UN are working together to respond to the increase of suspected and confirmed Monkeypox cases in Nigeria. On 26th May 2022, the Nigeria Centre for Disease Control and Prevention (NCDC) activated a national multisectoral Emergency Operations Centre for Monkeypox to strengthen and coordinate ongoing response activities in-country while contributing to the global response.

Lessons we have learnt in the AIDS response apply to the Monkeypox response too. The Monkeypox response in Nigeria is being impacted by both social stigma and by global inequality in access to essential medicines, including vaccines.

Local staff in the most affected states have reported that stigma, connected with commentary from across the world blaming gay people for Monkeypox, is discouraging some people from seeking care. Local staff report that there have been situations of people being too afraid to access medical care because of stigma. State Health officials are working to ensure that staff at health clinics are sensitized to break down such stigma, and not to reinforce it. State Ministry of Health officials are also embarking on community sensitization on Monkeypox, emphasizing identification of symptoms, prevention, and the need to get tested.

The scarcity of key medicines is also holding back Nigeria's Monkeypox response. There is a need to support expansion of the supply of medicines, equipment, and sample collection materials. Unlike the US and EU, Nigeria does not have any supply of vaccines for Monkeypox. This brings amongst people in affected areas a sense of frustration that they have been left behind by the world. This inequality in access to vaccines and other key medicines must be urgently put right by sharing doses, sharing production rights and sharing know-how.

Support in efforts to challenge stigma, and in enabling access to essential medicines, are key to ensuring that everyone impacted by Monkeypox in Nigeria gets the care they need. Support for the response in Nigeria is essential for the success of the global response."

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

In the lead up to the West and Central Africa Summit on HIV/AIDS taking place in Dakar from 31 October to 2 November 2021, UNAIDS asked its country directors across the region five questions about the AIDS response in their country. Here are the replies of Dr. Erasmus Morah, UNAIDS country director in Nigeria

The National response in Nigeria is growing more ambitious and efficient—better information and high-level political commitment have led to increased antiretroviral therapy coverage. Communities, networks of people living with HIV and key populations are given more space to be actors in the response. The private sector is stepping up to play its part in funding the response.

Despite such effort, Nigeria is failing children living with HIV and vertical transmission is on the rise. Violent arrests are still routinely carried out against key populations. And user fees continue to impede access to HIV care and hinder adherence to treatment. Resilience in times of the COVID-19 epidemics gives hope that more effort will be invested to address these systemic barriers to truly turn the tide on HIV and end AIDS.

1.  What are the main areas of progress in your country’s response to the HIV epidemic in the last five years?

First, the availability of data has expanded to enable the country to truly know its epidemic and its response. Several surveys took place since 2017 which provided precious support to national decision-makers to prioritize, track program performance and mobilize resources to end the epidemic.

In 2017, the Nigerian President committed to treating 50,000 Nigerians annually and has since honored his commitment. HIV treatment coverage has leapt from 55% in 2016 to over 85% in 2020. Currently, we estimated that 90% of people living with HIV (PLHIV) know their status, 86% of them receive antiretroviral therapy (ART), and among those, 72% have a suppressed viral load—meaning they have no risk of transmitting it.

To put communities at the centre of the response, the network of persons living with HIV and key populations are engaged in community-led monitoring to assess the quality of services they are receiving and to use data to influence policy and lead to programmatic changes.

To reduce Nigeria’s over reliance on international resources, the Nigeria Business Coalition Against AIDS has worked with the National Agency for the Control of AIDS (NACA) and UNAIDS to set up a trust fund of 150 million US dollars for HIV to be launched on World AIDS Day 2021. A sustainability plan is also being developed for HIV, tuberculosis and malaria.

2. What are the main challenges that still need to be addressed?

Unfortunately, children are still being left behind, and their treatment coverage remains much lower compared with adults. Only 45% of children living with HIV know their status, 45% of them receive antiretroviral therapy (ART), and among those, 31% have a suppressed viral load.  It is sad to note that prevention of mother-to-child-transmission has been less effective over the past five years. 

We continue to deplore the frequent arrest of key populations. Criminalization of the behaviour of key populations, violence and widespread stigma and discrimination continues to feed their avoidance of health care centers.

Finally, some health facilities are still demanding user fees from patient—despite evidence from western and central Africa showing that user charges undermine uptake of antiretroviral therapy, hinders the retention of people in care and reduce the quality of care. Studies specifically carried out in Nigeria have also shown that user fees undermine adherence to HIV treatment (Global AIDS report, 2020).

3. How has COVID-19 affected the HIV response in your country?

Despite the initial negative impact of lockdowns, the contingency measures put in place has ensured that Nigeria was able to successfully put about 300,000 people on treatment by the end of 2020. Through the one UN Basket Fund, about 10,000 households of PLHIV in needs were provided with cash transfers, personal protective equipment, and hygiene products to help prevent and mitigate the impact of COVID-19.

To ensure service continuity, the National AIDS and STI Control Program (NASCP) issued a policy directive from the Minister of Health for multi-month dispensing of ART, meaning that all clinically stable patients were provided with 3 months of treatment at once. NASCP set up a situation room to track HIV commodity stocks. Furthermore, NASCP regularly updated the UNAIDS HIV service disruption portal with programmatic data to monitor HIV service delivery during the COVID-19 pandemic. PLHIV networks provided home delivery ART services for their peers who could not access health services.

4.  Who are the unsung leaders of the AIDS response in your country?

First, we need to recognize the outstanding work delivered by communities of key populations and networks of Persons Living with HIV in Nigeria. They truly are unsung heroes of the AIDS response. We also need to laud the support and commitment of international partners such as PEPFAR and the Global Fund.

5. If you could ask your Head of State to change one thing to strengthen the HIV response, what would it be?

I would call on Nigeria to take forward its commitments by investing its fair share in the AIDS response and by increasing domestic financing.

New HIV infections among children declined by more than half (53%) globally from 2010 to 2020, but the momentum has slowed considerably. There are particularly large gaps in services to prevent vertical (mother-to-child) transmission of HIV in western and central Africa, home to more than half of pregnant women living with HIV who are not on treatment. 

Nigeria accounts for 24% of pregnant women living with HIV worldwide who are not on antiretroviral therapy and is the largest contributor among the seven countries that account for half of all new HIV infections among children globally. One in every seven babies born with HIV in the world is a Nigerian baby. Because of this, there is an urgent need to scale up sustainable programmes for the elimination of vertical transmission of HIV in the country, and the government has committed to end vertical transmission by the end of 2022.

The Nigerian Minister of Health, Osagie Ehanire, chaired a national consultation on vertical transmission of HIV in May 2021 and pledged the government’s full support and commitment to work with all partners in order to ensure that no baby is born with HIV, directing the National AIDS, Sexually Transmitted Infections Control and Hepatitis Programme (NASCP) to provide technical support to all Nigerian states to develop actionable operational plans to meet the objective. In addition, the Federal Ministry of Health has delivered 1.7 million of the 4 million HIV and syphilis test kits ordered as a step towards ensuring that all pregnant women are screened, regardless of where they live in the country.

“The procurement of the HIV test kits is a powerful demonstration of political leadership and country ownership by the Government of Nigeria for an AIDS-free generation. As a priority, the United Nations Joint Team on AIDS remains committed to fully support the government in its efforts to eliminate vertical transmission of HIV in the country,” said Erasmus Morah, the UNAIDS Country Director for Nigeria.

NASCP, supported by the National Agency for the Control of AIDS (NACA), is providing technical support to all Nigerian states, but with a priority given to five states—Abia, Anambra, Ebonyi, Kaduna and Taraba. The Joint Team has provided financial and technical support, including support for data analysis for each state. Each state is driving its own planning process and choice of strategy and key activities.

According to the government, Anambra state has an HIV prevalence of 2.2%. In 2020, less than 30% of pregnant women were tested for HIV and less than a quarter of pregnant women living with HIV accessed antiretroviral therapy, even though more than 90% of pregnant women attended a health facility for antenatal care in Anambra. There was a 73% increase in the estimated number of new HIV infections among children in the state from 2015 to 2020. Given its HIV prevalence, and the increase in new HIV infections among children, Anambra was recently supported to develop an operational plan for the elimination of vertical transmission of HIV.

The state’s leadership, including the Secretary of the State Government, Solo Chukwulobelu, and Anambra’s Commissioner for Health, Vincent Okpala, met together with representatives of NASCP, NACA and the United Nations Joint Team. The resulting Framework for Anambra State Action to Eliminate Mother-to-Child Transmission of HIV provides a summary of the current provision of services to prevent vertical transmission of HIV in the state and outlines strategies to reach every pregnant woman in the state, the state government’s commitments and key activities, along with timelines. The framework provides specific action by service providers from both the private and public sectors to reach every pregnant woman in the state with HIV testing services and provide antiretroviral therapy and viral load testing to every pregnant women who tests HIV-positive. The framework also commits to ensuring antiretroviral therapy prophylaxis at birth and early infant diagnosis of HIV for every infant, along with continuity of care for both mothers and their babies. The federal and state governments and existing donors will fund the initiative.

Akudo Ikpeazu, the National Coordinator of NASCP, said, “It’s important to work extensively with the First Lady of the State as a Champion for Eliminating Mother-to-Child Transmission of HIV to ensure every pregnant woman is reached in Nigeria.”

ABUJA/GENEVA, 10 March 2021—The UNAIDS Executive Director, Winnie Byanyima, has met the President of Nigeria, Muhammadu Buhari, to discuss the country’s response to the colliding pandemics of HIV and COVID-19. The meeting was part of Ms Byanyima’s three-day visit to the country, which also included visits to communities on the frontline of the response and events to mark International Women’s Day on 8 March.

During their meeting, Ms Byanyima thanked Mr Buhari for being an early champion of the People’s Vaccine campaign, which is calling for a fair and equitable distribution of vaccines against the coronavirus to ensure that poorer countries are not left behind in the response. Nigeria began to vaccinate frontline health workers last weekend after taking delivery of 4 million doses of vaccine, facilitated through COVAX, the international mechanism set up to bulk buy vaccines and distribute them equitably worldwide. Of 300 million vaccine doses administered worldwide so far, most have been administered in just 10 countries.

Ms Byanyima also applauded the country’s progress against the HIV pandemic and said UNAIDS stood ready to strengthen its partnership with Nigeria to further reduce the impact of the HIV pandemic and end AIDS as a public health threat as part of the 2030 Agenda for Sustainable Development.

“Nigeria has made good progress on expanding the delivery of HIV testing, treatment and care services over recent years, contributing to a steep decline in AIDS-related deaths,” said Ms Byanyima. “I look forward to reinforcing UNAIDS’ partnership with government, communities and all other stakeholders to drive new HIV infections down and kick-start a decade of action to end AIDS as a public health threat for everyone.”

There were 1.8 million people living with HIV in Nigeria in 2019 and 1.3 million people know their HIV status. Around 1.1 million people are now on HIV treatment to keep them alive and well. AIDS-related deaths have fallen by more than a third over the past decade, although HIV infections have declined at a more modest rate.

During her visit, Ms Byanyima also met community activists, who have been instrumental in minimizing the disruption to HIV testing, treatment and care services despite the challenges caused by the COVID-19 pandemic and the measures taken to contain it.

On Monday, Ms Byanyima took part in events to commemorate International Women’s Day hosted by the Federal Minister of Women’s Affairs, Pauline Tallen. Ms Byanyima stressed the importance of women’s leadership and participation at all levels of decision-making to ensure that issues of importance to women, such as ending gender-based violence and expanding access to essential services, including health and education, were addressed.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Nigeria has demonstrated that putting people at the centre of the AIDS response works in advancing HIV service delivery. The 2018 Nigeria HIV/AIDS Indicator and Impact Survey identified 10 states with HIV prevalence above 2%, nine of which had a significant unmet need for HIV treatment and were at risk of being left behind if no action was taken. These states were prioritized by the national AIDS response for concerted action with the help of the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).

In 2020, while many countries experienced HIV service disruptions, the PEPFAR-supported HIV programme in Nigeria experienced significant growth and exceeded some targets.  

“The achievements of Nigeria with PEPFAR and the Global Fund in 2020 have significantly moved the needle towards treatment saturation and advanced the hope of epidemic control and the end of AIDS in these states and the entire country,” said Osagie Ehanire, the Minister of Health of Nigeria.

PEPFAR’s leadership and implementing partners took quick action and fast-tracked their community engagement plans, utilizing existing community network machinery to ensure there were no disruptions in the delivery of HIV services.

“Thanks to PEPFAR and its implementing partners, Nigeria was able to ensure not just continuity of HIV services, but was able to expand the reach, despite the country being locked down due to COVID-19,” said Gambo Aliyu, Director-General of the National AIDS Coordination Agency. “A record 279 000 people living with HIV additionally were put on treatment during this period.”

PEPFAR, together with its implementing partners, developed a people-centred package of services that was informed by data, best practices and community intelligence. The package recognized that one size does not fit all and catered for the unique needs of the various populations served.

Existing community networks, including key population networks and social groups, were consulted to determine the best way to make sure that the services that people need were available to them in their homes, at social gatherings or through support groups—thus minimizing contact with facilities.

Community antiretroviral therapy teams (CART teams) went to hard-to-reach areas around the country as well as to areas effected by COVID-19 lockdowns. Programmes such as a minimum three-month provision of antiretroviral therapy and viral load services were provided at treatment pick-up areas, which not only helped community-led providers to ensure that people stayed on treatment but saw a record number of people living with HIV start on treatment. By the end of 2020, the majority of people on treatment were included in the multimonth dispensing programme, which had a large impact on HIV treatment retention and adherence.

Viral load samples were collected in the communities, sent to laboratories for analysis and the results were then sent to health-care facilities, from where people were notified—this had a positive impact on viral load coverage. Index testing was expanded through community networks, ensuring continuity and safety as well as improvements in testing and case finding.

Results were seen across the entire 90–90–90 cascade as follows:

• An increase in people on HIV treatment of more than 279 000 people living with HIV in 2020, with more than 131 000 people being initiated and retained in care during the fourth quarter alone. PEPFAR Nigeria showed excellent success, accelerating efforts to identify people living with HIV and link them to care, with quarter-on-quarter growth. The growth in people on HIV treatment saw an additional seven states moving towards treatment saturation since the initiation of the “surge” programme approach, where intervention efforts are dramatically scaled up. Key populations represented approximately 25% of this overall growth, as the number of people on treatment among most key populations tripled. Key populations also had a testing yield of more than 10%.
• Improvements in pre-exposure prophylaxis (PrEP) uptake, especially among key populations. The number of people newly initiated on PrEP rose from nearly 2000 in the third quarter of 2020 to nearly 23 000 in the fourth quarter.
• Scale-up of multimonth dispensing from 55% in the first quarter to 94% in the fourth quarter 2020 was a key factor in improved continuity of treatment.
• Improvement in viral load coverage (88%) and suppression (93%) by the third quarter, building on previous successes and maintaining those gains to approach the third 90 target in a little over six quarters.
• PEPFAR’s orphans and vulnerable children programme achieved and exceeded all targets set for the year, including more than a million orphans and vulnerable children served by PEPFAR Nigeria by the end of 2020. Additionally, 98% of those under the age of 18 years in the orphans and vulnerable children programme have a documented HIV status, and approximately 100% of those who tested HIV-positive started treatment.

These results could not have been achieved without the support of community-led organizations. “The Network of People Living with HIV/AIDS in Nigeria (NEPWHAN) wishes to thank PEPFAR for the continuous engagement of our members across the country in the provision of HIV services to people living with HIV,” said Ibrahim Abdulkadir, NEPWHAN National Coordinator. “This has increased retention in care and improved quality of life for people living with HIV, as well as viral suppression among people living with HIV on antiretroviral therapy.”

PEPFAR Nigeria has designed its approach so that it can be owned by the Nigerian people. The National Data Repository and the National Alignment Strategy are key building blocks of a long-term and sustainable public health and health services approach to ending the AIDS epidemic in the country.  

“I am profoundly impressed by the progress that PEPFAR Nigeria has made, in collaboration with the Government of Nigeria, partners and allies, to identify, enrol and sustain so many Nigerian people living with HIV on life-saving treatment,” said Bill Paul, the Deputy Coordinator for Program Quality, Office of the United States Global AIDS Coordinator. “Their success in sustaining the effort despite the impact of COVID-19 would not have been possible without a supportive policy environment both in the government and in the United States embassy.”  

Based on these accomplishments, Nigeria is well-positioned to accomplish the 95–95–95 targets well in advance of 2030.

At the end of 2020, progress on the 90–90–90 treatment targets was 73–89–78—that is, 73% of people living with HIV had been diagnosed, 89% of those diagnosed were accessing treatment and 78% of those accessing treatment were virally supressed.

The proposed new global AIDS strategy calls for putting people at the centre of the HIV response, empowering communities and closing the gap on inequalities. “Nigeria is poised to be the next HIV turnaround country, after South Africa. We have all the ingredients to make this happen and I commend PEPFAR for working with the government, communities and partners to show the world that this is the only way to end this pandemic, by working with the affected communities,” said Erasmus Morah, the UNAIDS Country Director for Nigeria.

GENEVA, 16 October 2020—The President of Nigeria, Muhammadu Buhari, has announced that Nigeria will be joining the urgent global call for a People’s Vaccine for COVID-19. The President endorsed the initiative and released an official public statement in favour of the campaign.

“Learning from the painful lessons from a history of unequal access in dealing with diseases such as HIV we must heed the warning that “those who do not remember the past are doomed to repeat it”,” said Mr Buhari. “Only a People’s Vaccine with equality and solidarity at its core can protect all of humanity and get our societies safely running again. A bold international agreement cannot wait.”

Nigeria is the most populous country in Africa, home to more than 200 million people, and has the third highest number of COVID-19 cases in Africa after South Africa and Ethiopia. In March 2020, Mr Buhari set up a multisectoral Presidential Task Force to combat the COVID-19 pandemic, which produced a mid-term report in July 2020 outlining a significant body of work undertaken to stop the spread of COVID-19.

However, the report also shows that the health infrastructure and equipment levels in Nigeria are not strong enough to support a sustained national response to COVID-19 and that if the pandemic were to spread exponentially Nigeria would struggle to mount an effective response. This demonstrates the urgent need for access to a vaccine for COVID-19 in Nigeria as soon as it becomes available.

“UNAIDS and other members of the People’s Vaccine Alliance are calling for a new approach that puts public health first by sharing knowledge and maximizing supply to make sure that no one is left behind,” said Winnie Byanyima, Executive Director of UNAIDS. “Anything short of that will lead to more deaths and economic chaos, forcing millions into destitution.”

The People’s Vaccine Alliance is a coalition of organizations and activists united under a common aim of campaigning for a People’s Vaccine for COVID-19. In support of actions taken by the World Health Organization (WHO), including the COVID-19 Technology Access Pool, the People’s Vaccine Alliance demands that all vaccines, treatments and tests be monopoly-free, mass produced, distributed fairly and made available to all people, in all countries, free of charge.

“The People’s Vaccine will go far in levelling the power dynamics that perpetuate inequality and fuel injustice and it will ensure that no one is left behind,” said Edward Kallon, United Nations Resident Coordinator and Humanitarian Coordinator in Nigeria. “Nobody should be denied a COVID-19 vaccine because of where they live or how much money they have—it has to be a global public good, available to all who need it, regardless of their situation.”

The People’s Vaccine Alliance is calling on pharmaceutical corporations and governments to:

• Prevent monopoly on vaccine production by making public funding for research and development conditional on research institutions and pharmaceutical companies sharing all information, data, biological material, know-how and intellectual property. The WHO COVID-19 Technology Access Pool provides the mechanism for such sharing.
• Prevent monopoly on vaccine supply by enabling as many manufacturers as possible, including in developing countries, to produce the vaccines.
• Implement fair allocation of the vaccine that prioritizes health workers and other at-risk groups in all countries. Vaccination programmes should include marginalized groups, including refugees, prisoners and people living in slums and other crowded housing conditions. Allocation between and within countries should be based on need and not ability to pay.
• Provide the vaccine free of charge at the point of use.
• Ensure the full participation of the governments of developing countries as well as global civil society in decision-making forums about the vaccines (and other COVID-19 technologies) and ensure transparency and accountability of all decisions.

To date, the People’s Vaccine has been endorsed by more than 140 leaders and advocates globally, including the President of South Africa and the Chairperson of the African Union Commission, the Presidents of Ghana and Senegal, the Prime Minister of Pakistan, the Director of the Africa Centres for Disease Control and Prevention and the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

The People’s Vaccine Alliance

The People’s Vaccine Alliance is a coalition of organisations and activists united under a common aim of campaigning for a People’s Vaccine’ for COVID-19 that is based on shared knowledge and is freely available for all. A global common good. It is coordinated by Oxfam and UNAIDS and its other members include: Free the Vaccine, Frontline AIDS, Global Justice Now, International Treatment Preparedness Coalition, Just Treatment, Nizami Ganjavi International Center, Open Society Foundations, STOPAIDS, SumOfUs, Wemos and Yunus Centre.

UNAIDS

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The restrictions on movement and lockdowns currently being enforced to curb the spread of the new coronavirus in both Côte d’Ivoire and Nigeria are having an impact on many people living with HIV. To help mitigate those effects, the International Community of Women Living with HIV (ICW) West Africa is partnering with health-care facilities to facilitate the home delivery of HIV and other treatments.

Key to being able to provide this service is the recruitment of community pharmacists, who collect and deliver antiretroviral therapy and other medicines to people, especially adolescent girls and young women, who can’t access their treatment themselves. An initiative of ICW and its partner, Positive Action for Treatment Access (PATA), 59 women living with HIV are now serving as community pharmacists, visiting hard to reach semi-urban and rural areas and helping to ensure that no one is left behind because of the COVID-19 crisis.

Under the arrangement, the medicines are provided by the Institute of Human Virology Nigeria, while PATA provides the logistics with support from the Open Society Initiative for West Africa (OSIWA) and ICW West Africa is responsible to the final home delivery.

“I willingly accepted to do this work because as a woman living with HIV, I know what it really means staying without antiretroviral therapy and the likeliness that people may develop drug-resistant strains, whose long-term effects could be worse than COVID-19,” said Queen Kennedy, a community pharmacist in Nigeria.

In Nigeria, community pharmacists are providing services in three COVID-19 high-burden states, Lagos, Federal Capital Territory and Oyo, covering 26 health-care facilities, while in Côte d’Ivoire community pharmacists are working in three provinces covering nine health-care facilities. In addition to their work delivering medicines, the community pharmacists are also sensitizing adolescent girls and women living with HIV on COVID-19 prevention measures, such as physical distancing, wearing face masks and regular hand washing.

“Ensuring access to quality health-care services for adolescent girls and young women and key populations living with HIV is one of our mandates. The only difference here is that we are providing these services in an emergency situation, putting at risk also our own health,” said Reginald Assumpta Ngozika, the Regional Director for ICW West Africa.

Through this partnership, ICW West Africa is also facilitating access to antiretroviral medicines for two foreign women living with HIV who are stranded in Nigeria because of border closures. Since the two women ran out of their medicines, they are being assisted by ICW community pharmacists, who collect and deliver their treatment in Lagos and Rivers State.

“Thank you ICW West Africa for keeping me on my medicines during this COVID-19 lockdown in Nigeria,” said one of the beneficiaries.