Nigeria

The United Nations system in Nigeria joined the fight against COVID-19 shortly after the first case was detected in the country in late February 2020.

UNAIDS’ lessons learned and expertise in facilitating, linking and bringing stakeholders together have been instrumental in guiding the United Nations multi-agency response, led by the Resident Coordinator, Edward Kallon. And by proactively mobilizing its political capital and goodwill in the country, UNAIDS has helped to bring resources and better lines of communication, coordination and accountability to the national COVID-19 response.

In mid-March, the Presidential Task Force was established to develop a COVID-19 response plan for how organizations should work together. Appointed as the only development member of the task force, the Representative, a.i., of the World Health Organization (WHO), Fiona Braka, provides the overall United Nations technical leadership to the government. Lessons learned from the HIV response fed into the development of the “four ones” guiding principles for the national response to the COVID-19 pandemic—one national COVID-19 multisectoral pandemic response plan, one COVID-19 national coordinating authority, one COVID-19 monitoring and evaluation system and one COVID-19 financing and investment platform.

“The “four ones” principles will simplify and clarify roles, responsibilities and relationships, including within the government,” said the Minister of Health of Nigeria, Osagie Ehanire.

Another lesson learned from the HIV response was the importance of ensuring that marginalized and vulnerable people are given consideration at every step of the development of a response to a pandemic. The potential impact of COVID-19 on people living with HIV, key populations and the poor also had to be at the centre of decision-making.

“UNAIDS regularly coordinated with the networks since the beginning of the COVID-19 outbreak, providing technical guidance and ensuring synergy with the efforts of the government,” said Abdulkadir Ibrahim, the National Coordinator of the Network of People Living with HIV/AIDS in Nigeria.

Working with the United Nations Development Programme, UNAIDS liaised with the wider United Nations system and the government and facilitated the handover of US$ 2 million worth of emergency medical commodities to the government, ensuring that the supplies and equipment were prioritized for use in public health facilities and by health-care workers.

The One UN COVID-19 Basket Fund was launched on 6 April. Part of one of the “four ones”, the one COVID-19 financing and investment platform, the Basket Fund channels the contributions of donors to the COVID-19 response. UNAIDS played a critical role in its establishment, working with the United Nations Resident Coordinator and the United Nations Development Programme to ensure that the financing platform put people and communities at the centre. UNAIDS, UN Women, WHO and the United Nations Population Fund helped to mobilize US$ 6.5 million for civil society and community engagement, social protection for vulnerable households, community-led surveillance and monitoring of COVID-19 and HIV and the documentation of community best practices.

In announcing a €50 million contribution to the Basket Fund, the Head of the European Union delegation to Nigeria, Ketil Karlsen, said, “The COVID-19 Basket Fund gives us the opportunity to cooperate and act rapidly in the deployment of assistance that can help to enhance health-care services and cushion the most vulnerable.” 

Perhaps the most important contribution by UNAIDS to the COVID-19 response in the country, however, has been advocating to harness the vast HIV infrastructure in the country for the fight against COVID-19.

“We must leverage HIV assets on the ground, including not just laboratory facilities but community health workers and volunteers. To fight COVID-19 effectively we will have no choice but to engage communities to own the response,” said Erasmus Morah, the UNAIDS Country Director for Nigeria.

In a joint effort, the United States Government, the National Agency for the Control of AIDS, the United Nations Children’s Fund, WHO, UNAIDS and the Presidential Task Force mapped and initiated the engagement of approximately 100 000 community health-care workers and volunteers to undertake risk communication, social mobilization, contact tracing and home care.

COVID-19 is far from over in the country, with cases steadily rising, and United Nations staff have not been spared. However, as Mr Kallon, said, “The United Nations must stay open for business and deliver for the people while ensuring that staff members and their dependents are provided with the necessary environment for their protection against COVID-19.” Following this, a COVID-19 isolation and treatment centre as an extension of the United Nations clinic was established for staff as frontline workers, together with their dependent family members. 

Moving forwards with the COVID-19 response, in addition to the continued support for the Presidential Task Force, the United Nations Country Team, including UNAIDS, is gearing up to support Nigeria to address the major gaps in subnational preparedness. Key issues such as the loss of livelihoods, heightened vulnerabilities and food insecurity, the increased risk of gender-based violence and limited access to essential health services will also be addressed in the coming months.

Home to 5 million people living with HIV, western and central Africa is not on track to ending AIDS by 2030. Every day, more than 760 people become newly infected with HIV in the region and only 2.6 million of the 5 million people living with HIV are on treatment.

Insufficient political will, frail health systems and weak support for community organizations―as well as barriers such as HIV-related criminalization―are the most significant obstacles to progress. A regional acceleration plan aims to put the region on track to reaching the target of tripling the number of people on antiretroviral therapy by 2020 and achieving epidemic control. While progress has been made, that progress is not coming fast enough. Children are of particular concern―only 28% of under-15-year-olds living with HIV in the region have access to antiretroviral therapy.

“We need policies and programmes that focus on people not diseases, ensuring that communities are fully engaged from the outset in designing, shaping and delivering health strategies,” said Gunilla Carlsson, UNAIDS Executive Director, a.i., speaking at the Global Fund to Fight AIDS, Tuberculosis and Malaria Sixth Replenishment Conference, taking place in Lyon, France, on 9 and 10 October.

There are many examples of how investing in communities can make a difference. “The response is faster and more efficient if it is run by those who are most concerned,” said Jeanne Gapiya, who has been living with HIV for many years and runs the ANSS nongovernmental organization in Burundi.

Community-led HIV testing and prevention is effective, particularly for marginalized groups. “Most of the people tested by communities were never reached before and this shows how community organizations are unique and essential,” said Aliou Sylla, Director of Coalition Plus Afrique.

Reducing the number of new HIV infections among children and ensuring that women have access to the services they need remains one of the biggest challenges in the region. Networks of mothers living with HIV who support each other to stay healthy and help their child to be born HIV-free have been shown to be an effective way of improving the health of both mothers and children.

“Our community-based approach works. In the sites where we work we have reached the target of zero new HIV infections among children and all children who come to us are on treatment,” said Rejane Zio from Sidaction.

Financing remains a concern and although total resources for the AIDS response have increased, and HIV remains the single largest focus area for development assistance for health, domestic investments account for only 38% of total HIV resources available in western and central Africa, compared to 57% worldwide. Greater national investments reinforced by stronger support from international donors are needed to Fast-Track the regional response. Bintou Dembele, Executive Director of ARCAD-Sida, Mali, said, “We have community expertise, but we lack the funds to meet the need.”

Support is growing for community-based approaches in the region. Recognizing the importance of community-led work, Expertise France and the Civil Society Institute for Health and HIV in Western and Central Africa announced a new partnership on 9 October. “The institute brings together 81 organizations from 19 countries aiming to ensure better political influence at the global and country levels and to galvanize civil society expertise in programme delivery. This partnership is a recognition of our essential contribution,” said Daouda Diouf, Director of Enda Sante and head of the steering committee of the institute. “The situation in western and central Africa remains a priority. It is clear that community-based approaches are agile and appropriate for responding to pandemics,” said Jeremie Pellet from Expertise France.

Shifting to a people-centred approach has been at the core of reforms in the region. A growing regional resolve to accelerate the response and to strengthen community-led approaches that have been proved to work provides hope for the future of the HIV epidemic in western and central Africa.

After six months of data collection and three months of data analysis, the President of Nigeria, Muhammadu Buhari, announced the results of the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) in March 2019. Costing approximately US$ 100 million and covering more than 200 000 people, 185 survey teams collected data for the NAIIS, the largest HIV-specific survey in the history of the global response to the epidemic.

In Nigeria, three types of survey have been conducted by the Federal Ministry of Health HIV/AIDS Division to determine HIV prevalence and to monitor the trends of the HIV epidemic in the country:

• The HIV Sentinel Survey (HSS), which is conducted typically every two to three years among women attending antenatal clinics, which determines HIV prevalence among pregnant women.
• The National Reproductive Health Survey (NARHS), which is conducted every five years among the general population.
• The Integrated Biological and Behavioural Surveillance Survey (IBBSS), which is mostly used to monitor prevalence and behavioural trends among key populations.

The last HSS and IBBSS took place in 2014, while the last NARHS took place in 2012. These data sources have served as the main survey data sources for the AIDS response in the country.

Between 2012 and 2014, significant progress was made in the AIDS response in Nigeria. The number of antiretroviral therapy sites doubled, prevention of mother-to-child transmission sites increased eightfold and HIV counselling and testing sites increased fourfold. According to government data, 6.7 million adults were counselled and tested for HIV in 2014, a 65% increase from the previous year. HIV testing among pregnant women also doubled in 2014 compared to 2013. Similarly, the number of people living with HIV on antiretroviral therapy increased significantly.

However, despite this progress, there was no commensurate improvement in the statistics on the coverage of antiretroviral therapy among people living with HIV. National achievements in the AIDS response were poor compared to the targets, and programme implementers reported difficulties in identifying people living with HIV in need of services. It was therefore suggested that the HIV burden was not as high as was estimated using the available HIV prevalence data.

Former UNAIDS Country Director Dr Bilali Camara was a longstanding advocate for an expansion of the surveillance of the country’s epidemic.

“Working as UNAIDS Country Director in Nigeria, I realized early on that we did not have the full picture of the country’s AIDS epidemic,” said Dr Camara. “I was pushing for surveillance to be expanded for a long time―I am very happy that with this new survey we now have a better understanding of the AIDS epidemic in Nigeria and that it will allow us to better respond to the areas and people in most need.” 

Dr Camara’s persistence indeed paid off.

In July 2015, the National Agency for the Control of AIDS (NACA), under the leadership of its then Director-General, Professor John Idoko, decided that it was imperative to better understand Nigeria’s HIV epidemic. The NACA set up a National Stakeholder Committee, comprising the head of the National AIDS and STI Control Programme, the UNAIDS Country Director, the World Health Organization (WHO) representative, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) Coordinator, civil society and others, which decided to conduct a triangulation of data from various sources.

“The need for the survey was first initiated under my leadership, but we had overwhelming support from Dr Camara. UNAIDS headquarters was even willing to send its Strategic Information Director to Nigeria at the time,” said Professor Idoko.

Many countries have shifted to a location–population approach, which helps to ensure that HIV services reach the people and geographic areas with the greatest need. Location–population approaches require granular-level data, which were not typically available in Nigeria. In 2016, the UNAIDS Nigeria Strategic Information Team, led by Dr Gatien Ekanmian, was tasked to develop an evidence-informed methodology to estimate the HIV burden at the local level. During this process, a closer analysis of the results from the various surveys highlighted a series of issues with the HSS surveys:

• The sentinel sites were too limited in number to ensure nationally representative geographic coverage based on the demographics of the country.
• Urban sites were oversampled.
• Rural sites were usually under-sampled.
• There were often more urban sites than rural sites in many states, thus the HSS results reflect more the urban HIV epidemic than the rural epidemic among pregnant women.

The conclusion of the UNAIDS Nigeria epidemiological analysis was that the HSS and NARHS were no longer giving sufficiently precise epidemiological information. It was recommended that a comprehensive review of the HIV surveys being conducted in Nigeria be carried out in order to address the shortcomings in the existing survey approaches and methodology. 

Thereafter, the UNAIDS country office met with various stakeholders, including the Development Partners’ Group on HIV, and presented these observations and recommendations, effectively utilizing the Development Partners’ Group on HIV to galvanize support from PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) in particular.

In June 2016, the Director-General of the NACA raised an objection to the latest estimate of 3.5 million Nigerians living with HIV, believing that the figure was an overestimation. He had the opportunity to discuss his concerns with UNAIDS country directors, Dr Erasmus Morah and Dr Alti Zwandor at the International AIDS Conference in Durban, South Africa, in 2016. In July 2016, after advocacy from the UNAIDS country office, the new Minister for Health, Professor Isaac Adewole, and the new Director-General of the NACA, Dr Sani Aliyu, agreed on the need for an epidemiologically robust population-based HIV survey in Nigeria. They approved the recommendations for a population-based survey and committed to mobilize resources for it.

“When I resumed as Director-General of the National Agency for the Control of AIDS, a recurring issue that came up at every introductory meeting with partners was the difficulty in finding new cases. It was obvious that there was a problem with case-finding. Was this because we were looking in the wrong places? I had doubts on the quality data we had … and we can’t achieve epidemic control if we don’t even know where we are. Hence, the number one priority of my administration was born―establishing the true prevalence of HIV in Nigeria by employing the best scientific and technical survey tools available in the shortest possible time,” said Dr Aliyu.

In November 2016, a review and triangulation of HIV data in Nigeria was commissioned by the NACA, in collaboration with UNAIDS, the findings of which gave further support for a national survey to develop more precise estimates of HIV prevalence. Firm support for the survey came from the Government of the United States of America (the Centers for Disease Control and Prevention, PEPFAR, USAID and the Department of Defense) and the Global Fund, which committed funding to the NAISS.

“It was easy to see that getting the data situation in Nigeria right was not only the right thing to do but also the dream of so many people. Fortunately, Nigeria had great partners to help turn this dream into reality. Programming and accounting for HIV results in the country will never be the same,” said Dr Morah, the current UNAIDS Country Director for Nigeria.

The United Nations system’s contributions in the NAIIS Technical Committee were anchored by UNAIDS, WHO and the United Nations Children’s Fund. Before the results of the survey were announced, Peter Ghys, UNAIDS Director of the Strategic Information Department, led a multi-group technical mission to Nigeria. The team gave advice on the use of the survey results, on the trends and the geographic locations of the epidemic, at the national and subnational levels. They also gave technical guidance to national partners on data management and governance, including on a strategy for country ownership and leadership of the survey results and support on how to communicate the changes in the epidemiological profile of HIV in the country.

“The road to NAIIS is a wonderful and brilliant story to tell, because it actually tells the story of the HIV response in Nigeria,” said Professor Adewole.

This feature is adapted from an article written by Erasmus U. Morah, Gatien K. Ekanmian and Doris, A.Ogbang

Nigeria has adopted its Revised National HIV and AIDS Strategic Framework 2019–2021 to guide the country’s future response to HIV. It follows the results of a new survey that shows that HIV prevalence in the country stands at 1.4%. Previous estimates had indicated Nigeria’s HIV prevalence at 2.8%.

The results of the Nigeria National HIV/AIDS Indicator and Impact Survey (NAISS) were unveiled at a special event held in Abuja, Nigeria, on 14 March that was attended by the President of Nigeria, Muhammadu Buhari, and the Executive Director of UNAIDS, Michel Sidibé. During his speech, Mr Sidibé commended the president’s leadership in guiding the country’s response to the HIV epidemic. Nigeria has tripled the number of people on HIV treatment since 2010 and adopted a test and treat policy in 2016.

The improved understanding of the country’s epidemic based on the survey results will allow for more efficient investments in the response to HIV and a more effective planning for the provision of HIV prevention, care and treatment services. It will permit the adoption of a population–location approach to deliver services to the people in the areas where they are needed the most.

During his three-day visit to Nigeria, Mr Sidibé met the Minister of Health, Isaac F. Adewole, to discuss progress, gaps and challenges in the AIDS response and pledged UNAIDS’ support to Nigeria in the implementation of the new framework. This was further underscored when Nigeria’s Minister of Foreign Affairs, Geoffrey Onyeama, and Mr Sidibé signed a new cooperation agreement to strengthen the relationship between UNAIDS and Nigeria.

Mr Sidibé also paid a courtesy call on the wife of the country’s president, Aisha Buhari, to formalize and extend her appointment as the UNAIDS Special Ambassador for the Elimination of Mother-to-Child Transmission of HIV and the Promotion of Treatment for Children Living with HIV in Nigeria.

Ms Buhari thanked UNAIDS for extending her mandate and reiterated her commitment to achieving an AIDS-free generation of children.

“This will enable me to contribute more towards ensuring that no child is born with HIV in Nigeria,” said Ms Buhari.

Representatives of the Network of People Living with HIV/AIDS in Nigeria also met with Mr Sidibé to voice their concerns about the gaps and challenges in the country’s AIDS response.

The network’s national coordinator, Abdulkadir Ibrahim, said services were too often not reaching the people in the greatest need. He asked for UNAIDS’ help in strengthening community responses to the HIV epidemic and to ensure that people living with HIV, particularly young people, were involved in creating policies and programmes that affected their health and well-being.

Expanded data collection and analysis provides better understanding of HIV epidemic in Nigeria

ABUJA/GENEVA, 14 March 2019—Results released today by the Government of Nigeria indicate a national HIV prevalence in Nigeria of 1.4% among adults aged 15–49 years. Previous estimates had indicated a national HIV prevalence of 2.8%. UNAIDS and the National Agency for the Control of AIDS estimate that there are 1.9 million people living with HIV in Nigeria.

Speaking in Abuja, Nigeria, the President of Nigeria, Muhammadu Buhari, welcomed the news that there are fewer people living with HIV in the country than previously estimated and launched the Revised National HIV and AIDS Strategic Framework 2019–2021, which will guide the country’s future response to the epidemic. Nigeria has made good progress in scaling up HIV treatment and prevention services in recent years.

"For the first time, the end of AIDS as a public health threat by 2030 is truly in sight for our country,” said H.E. Muhammadu Buhari, President of Nigeria. “I urge all of us not to relent but to increase the momentum. Let us work collectively and push for the last mile.”

The data from the Nigeria National HIV/AIDS Indicator and Impact Survey (NAIIS) are based a revised and enhanced methodology. The survey provides a clearer understanding of Nigeria’s HIV epidemic and shines a light on progress and the remaining gaps and challenges.

The Executive Director of UNAIDS, Michel Sidibé, welcomed the new estimates and said the improved understanding of the country’s HIV epidemic would allow Nigeria to better reach people living with HIV and people at higher risk of acquiring HIV.  

“I commend the Government of Nigeria and its partners for conducting this ambitious survey, which provides us with a much better understanding of the country’s HIV epidemic,” said Mr Sidibé. “While it is fantastic news that there are fewer people living with HIV in Nigeria than previously thought, we must not let down our guard. Let us use the results of this survey to better focus our delivery of HIV prevention, treatment and care services to the people in the greatest need and ensure that Nigeria gets on track to end the AIDS epidemic by 2030.”

While Nigeria’s national HIV prevalence is 1.4% among adults aged 15–49 years, women aged 15–49 years are more than twice as likely to be living with HIV than men (1.9% versus 0.9%.) The difference in HIV prevalence between women and men is greatest among younger adults, with young women aged 20–24 years more than three times as likely to be living with HIV as young men in the same age group. Among children aged 0–14 years, HIV prevalence according to the new data is 0.2%. Significant efforts have been made in recent years to stop new HIV infections among children.

At the national level, viral suppression among people living with HIV aged 15–49 years stands at 42.3% (45.3% among women and 34.5% among men). When people living with HIV are virally suppressed they remain healthy and transmission of the virus is prevented.  

The improved understanding of the country’s HIV epidemic will allow for more efficient investments in the response to HIV and more effective planning for the provision of HIV prevention, care and treatment services, including a focus on key populations, such as female sex workers. It will permit the adoption of a population–location approach to deliver services to the people and areas where they are most needed.

The new data differentiate HIV prevalence by state, indicating an epidemic that is having a greater impact in certain areas of the country. The South-South zone of the country has the highest HIV prevalence, at 3.1% among adults aged 15–49 years. HIV prevalence is also high in the North Central zone (2.0%) and in the South East zone (1.9%). HIV prevalence is lower in the South West zone (1.1%), the North East zone (1.1%) and the North West zone (0.6%).  

“The Nigeria National HIV/AIDS Indicator and Impact Survey (NAISS) findings provide Nigeria with an accurate national HIV prevalence measure of 1.4%. NAIIS also showed we are able to effectively provide antiretroviral treatment,” said Isaac F. Adewole, Nigeria’s Minister of Health. “Everyone infected with HIV needs to get treatment so they can achieve viral suppression, especially pregnant women. We must ensure pregnant women have access to antenatal services and are tested during every pregnancy. We know we can support HIV-positive mothers, hence ensuring the next generation is free from HIV.”

Nigeria has shown steady progress on increasing access to treatment for people living with HIV, with the adoption of a test and treat policy in 2016. This measure has further accelerated referrals to treatment facilities for people who test positive for the virus. From 2010 to 2017, the country almost tripled the number of people living with HIV having access to antiretroviral therapy, up from 360 000 people in 2010 to more than 1 million people in 2018. However, the new estimates released today indicate that more than half of people living with HIV still do not have suppressed viral loads.

The new data are more accurate as they are based on an expanded surveillance system and a revised and enhanced methodology. In recent years, there has been a significant expansion in the country’s response to HIV. The number of sites providing treatment has more than tripled, the number of sites providing services to prevent mother-to-child transmission of HIV has increased eightfold and the number of HIV counselling and testing sites has increased fourfold. A total of 11.3 million adults were counselled and tested for HIV in 2016, four times as many as in 2012.  

“It is important that all people living with HIV get treatment and achieve viral suppression. To halt the epidemic, we need to act now,” said Sani Aliyu, Director-General of the National Agency for the Control of AIDS. “As a government working with our partners, we have what it takes to support people who are HIV-positive, to provide treatment, to protect their families and to help people live long and healthy lives.”

The NAIIS was led by the Government of Nigeria through the Federal Ministry of Health and the National Agency for the Control of AIDS. UNAIDS, the United States President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria provided support for the work on the survey, which was overseen by the United States Centers for Disease Control and Prevention and implemented by the University of Maryland, Baltimore, with a scope that included all 36 states and the Federal Capital Territory of Nigeria. The survey reached around 220 000 people in about 100 000 households. Fieldwork was conducted between July and December 2018.

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.

Federal Ministry of Health (FMOH)

Federal Ministry of Health is one of the Ministries in the Federal Republic of Nigeria. It is concerned with the formulation and implementation of policies related to health. The Ministry has several departments focusing on different aspects of health care. The Department of Public Health’s National HIV and STI Control Program (NASCP) participated in the conduct of NAIIS and guided its implementation. More information can be found at http://www.health.gov.ng/

National Agency for the Control of AIDS (NACA)

The National Agency for the Control of AIDS was established to coordinate the various activities of HIV/AIDS in the country. The Agency among several functions coordinate and sustain advocacy by all sectors and at all levels for HIV/AIDS/STDs Expanded Responses in Nigeria. The Agency in collaboration with the FMoH guided the implementation of NAIIS. More information can be found at https://naca.gov.ng/ for more information about NACA.

The wife of the President of Nigeria, Aisha Muhammadu Buhari—the new UNAIDS Special Ambassador for the Elimination of Mother-to-Child Transmission of HIV and the Promotion of Treatment for Children Living with HIV in Nigeria—has vowed to end mother-to-child transmission of HIV in the country.

“It is with a great sense of responsibility and humility that I accept the honour to serve as a UNAIDS Special Ambassador. I am looking forward to using my voice to help ensure that no child is born with HIV in Nigeria by 2020,” said Ms Buhari, upon commencement of her new role.

Nigeria has one of the highest rates of new HIV infections among children in the world. In 2016, an estimated 37 000 [22 000–56 000] children were newly infected with HIV and 24 000 [14 000–37 000) children died of AIDS-related illnesses. Around 270 000 children [180 000–380 000] children were living with HIV in 2016, and just 32% of pregnant women living with HIV had access to antiretroviral medicines to prevent transmitting the virus to their child.

“I am privileged to announce Aisha Muhammadu Buhari’s acceptance of the appointment as UNAIDS Special Ambassador for Nigeria. The trust and respect that she commands in the country will help us to quicken the pace of stopping new HIV infections among children as well as ensuring treatment for all children living with HIV,” said Michel Sidibé, the Executive Director of UNAIDS.

The appointment of Ms Buhari will reinforce recent efforts to scale up the response to HIV in Nigeria. In December 2016, the President of Nigeria, Muhammadu Buhari, launched a Fast-Track plan that includes using domestic resources to maintain 60 000 people living with HIV on treatment and to ensure that an additional 50 000 people can access treatment each year.  

“We are delighted that her excellency has accepted this important role of UNAIDS Special Ambassador. The goal of eliminating mother-to-child transmission of HIV in Nigeria is a laudable one. It must be achieved,” said Pauline Tallen, the Board Chairperson of the National Agency for the Control of AIDS, Nigeria.

Ms Buhari is a passionate advocate for the rights of vulnerable women and girls. During her one-year tenure, she will advocate for increased access to antenatal care services and HIV testing for all pregnant women and their linkage to adequate treatment and care. She will also advocate for an increase in domestic resources for the HIV response at the federal and state levels.

“My three lovely children are all HIV-free because I benefited from prevention of mother-to-child transmission of HIV services. All pregnant women living with HIV in Nigeria deserve children who are born free from the virus, and the new UNAIDS Special Ambassador’s voice can help us make a huge difference. She is now in a strong position to advocate for free prevention of mother-to-child transmission of HIV services in the country,” said Lucy Attah Enyia, a beneficiary of prevention of mother-to-child transmission of HIV services.

A formal ceremony to commemorate Ms Buhari’s acceptance of her appointment will take place during the visit of Mr Sidibé to Abuja, Nigeria, in April 2018.

There is a consensus among political leaders, civil society and development partners that ending AIDS as a public health threat in Nigeria will require increased domestic funding.

In the past 10 years, Nigeria has made progress in its AIDS response. The number of people living with HIV on life-saving antiretroviral therapy in the country grew to more than one million by mid-2017. AIDS-related deaths have been reduced from 210 000 in 2006 to fewer than 160 000 in 2016. Although only 30% of people living with HIV in Nigeria are now on treatment, 81% of people on treatment are virally suppressed.

According to the Society for Family Health, Nigeria, spending on the AIDS response in Nigeria increased from US$ 300 million in 2007 to US$ 730 million in 2013. But the AIDS response has been largely sustained through external funding, especially from the United States President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

In order to increase domestic funding for the AIDS response, efforts are under way for each of Nigeria’s 36 states to contribute up to 1% of their monthly allocations from the federal government to the response to HIV. The Government of Nigeria, with technical support from UNAIDS and the World Health Organization, is also establishing an HIV trust fund aimed at increasing private sector contributions from 2.1% in 2014 to 10% by the end of 2018.

Increases in domestic funding will boost efforts to diagnose the estimated two million people living with HIV in Nigeria who do not know their HIV status and are not yet on treatment. In December 2016, the President of Nigeria, Muhammadu Buhari, launched a Fast-Track plan using domestic resources to maintain 60 000 people living with HIV on HIV treatment and to ensure that an additional 50 000 people access treatment each year. 

Stepping up the role of faith-based organizations in the response to HIV can present new opportunities to save the lives of children living with HIV in western and central Africa, agreed the participants at a meeting held in Abuja, Nigeria, on 14–16 June.

The Regional Consultation on Early Diagnosis and Treatment for HIV-Positive Children: Strengthening the Engagement of Faith-Based Organizations saw more than 100 representatives of faith-based organizations, governments and organizations of people living with HIV come together to discuss the role of faith-based organizations in the response to HIV. The participants, who were mainly from the Democratic Republic of the Congo, Nigeria and Zimbabwe, agreed that churches, mosques, religious leaders and the health facilities they support are critical to ensuring that HIV among children is diagnosed and treated.

The participants developed plans to create demand for testing and treatment, as well as to support people living with HIV to stay in care. The participants also planned to build the capacity of faith-based service providers to deliver quality HIV services for children and discussed the strengthening of age-appropriate HIV and sexual health education in faith schools.

The event was organized by Caritas Internationalis, UNAIDS and the United States President’s Emergency Plan for AIDS Relief, with the support of Caritas Nigeria.