West and Central Africa

By Winnie Byanyima, UNAIDS Executive Director

The AIDS epidemic in western and central Africa is an ongoing emergency. The early gains made against HIV in this region have not been translated into the sustained progress that has been made in other parts of sub-Saharan Africa.

Last year, there were 150 000 AIDS-related deaths in the region, and 200 000 people became newly infected with HIV. Every week more than 1000 adolescent girls and young women aged 15–24 years become infected with HIV in the region; 1.2 million people in western and central Africa are still waiting to initiate life-saving HIV treatment. Only 35% of children living with HIV in western and central Africa are on treatment.  

Now the COVID-19 crisis has obstructed services and exacerbated the inequalities that drive the AIDS epidemic. If we don’t act now, not only will many more lives be lost, but containing the AIDS pandemic will be more difficult and expensive in the coming years.

Ending AIDS is achievable: there is a tested set of approaches that are proven to work, including in challenging settings.

From Cabo Verde’s leadership on the elimination of vertical transmission of HIV, to Cameroon’s decision last year to eliminate user fees for all HIV services at public health facilities and accredited community sites, examples that light the way are already there. By aligning policy with the evidence of what has succeeded, we can end AIDS as we promised. 

Countries and communities are already leveraging the experience and expertise of the AIDS response to reduce the impact of COVID-19 across this region. From Côte d’Ivoire, to Guinea, to Senegal, public health authorities, international organizations, civil society actors and communities of people living with and affected by HIV have worked together to ensure that people living with HIV continue to receive their medication, to deliver care and prevention services in safe and innovative ways, to deliver food to people who have lost their incomes in lockdown, to convey messages about the importance of hygiene and social distancing in order to stay well and to dispel myths that feed stigma and discrimination and weaken public health messaging.

This spirit of cooperation and partnership is vital for stronger pandemic responses.

This week, hosted by the President of Senegal, Macky Sall, UNAIDS and the Civil Society Institute for HIV and Health in West and Central Africa are organizing a summit in Dakar on how to close the gaps in the region’s HIV response and strengthen pandemic preparedness.

Here are three of the bold actions we need to take.

First, embrace and enable communities to be at the centre of planning and delivery.

Communities know the situation on the ground—they must be given the resources and the space to lead. Countries need to ensure an enabling environment for communities to be involved in providing services as an integral part of the public health response, be involved as co-planners, be able to highlight experiences and concerns and be able to play their essential role ensuring accountability. 

Countries need to lift those legal, policy and programmatic barriers that hold this back, and to scale up financial support to unleash the incomparable contribution of communities.

Second, increase investment.

Countries need to increase the scale of provision in prevention, testing and treatment and eliminate all financial barriers to ensure universal access to services.

The Abuja commitment to invest 15% of government budgets in public health needs to be met. Joint commitments made by health and finance ministers at the Africa Leadership Meeting to increase domestic revenues dedicated to health must be fulfilled.

International donors too have to step up with support at the time of the worst crisis in decades. Enabling the required fiscal space will require debt cancellation to support governments in scaling up investments in health and in tackling the social drivers of HIV and pandemic risk.

International action to prevent harmful tax competition and illicit financial flows is likewise key. It is difficult to advance towards fair and progressive taxation, and grow revenues, when large corporations and high-net-worth individuals are systemically enabled internationally to evade the taxes the ordinary citizen must pay, and which are essential for health, education, social protection and economic investment.

Third, address the inequalities that drive the epidemic.

COVID-19 has once again shown the world how epidemics thrive on inequalities, both between countries and within them. The new UNAIDS strategy adopted earlier this year puts the fight to end inequalities at the centre of the mission to end AIDS.

Inequalities drive HIV. Vulnerable groups of people represent 44% of new HIV infections in western and central Africa. Their partners represent a further 27%. 

The ECOWAS Strategy for HIV, TB, Hepatitis B & C and Sexual and Reproductive Health and Rights among Key Populations puts it so well:

“the protection of human rights for all members of each key population is crucial to success. Laws that discriminate or create barriers should be reformed, to ensure that key populations are free from stigma, discrimination and violence and their vulnerability to HIV is reduced.” 

Gender inequality likewise drives HIV: of the new HIV infections among young people in western and central Africa, almost three quarters are among adolescent girls and young women. The issue is power. 

Research shows that ensuring that girls complete secondary education reduces their risk of acquiring HIV by up to half, and that combining this with a package of services and rights for girls’ empowerment reduces their risk further still. 

The Education Plus initiative, co-convened by UNICEF, UNESCO, UNFPA, UN Women and UNAIDS, with governments, civil society and international partners, is helping to accelerate the actions and investments needed to ensure that every African girl is in school, safe and strong. 

What we need to do to end AIDS is also what we need to do to enable Africa to rise.

Governments, international organizations, scientists, researchers, community-led organizations and civil society actors cannot be successful alone, but together they can create an unbeatable partnership and an unstoppable force to end AIDS as a public health threat by 2030.

The goal of zero discrimination still eludes the Central African Republic. HIV-related stigma is pervasive in the lives of people living with HIV in the country. According to the 2018 People Living with HIV Stigma Index, discrimination affects almost all of the people living with HIV surveyed (more than 87%). And more than 45% of people living with HIV have experienced some form of stigma because of their HIV status. Stigma affects women (49%) more than men (37%).

“But the fight against HIV remains a public health priority for the government, which was the first country to join the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination, in December 2019,” said Marguerite Ramadan, the Minister of Gender Promotion, Women’s Protection, Family and Children, Central African Republic.

Since its engagement in the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination, the Central African Republic has implemented several key activities.

A memorandum of understanding was signed between the Ministry of National Defence and Reconstruction, the Ministry of Health and Population, the AIDS Control Council (CNLS) and UNAIDS to implement programmes aimed at eliminating gender-based violence and accelerating HIV prevention, treatment and care within the defence and security forces. A national charter of patients’ rights has been launched and is being disseminated progressively in health centres. A series of key human rights activities have been included in the Global Fund to Fight AIDS, Tuberculosis and Malaria’s grant for 2021–2023.

A Zero Discrimination Platform, composed of some 30 partners representing ministries, CNLS, United Nations agencies, technical and financial partners, civil society, human rights organizations and other organizations was launched in 2020 and is supporting these efforts, including through identifying synergies.

During the COVID-19 pandemic, initiatives have slowed down, so in order to relaunch the momentum of the Zero Discrimination Platform and agree on collective priorities for the end of 2021 and 2022, a validation workshop and launch of a joint workplan took place in Bangui, Central African Republic, on 28 October under the chairmanship of the Minister of Gender Promotion, Women’s Protection, Family and Children.

Priorities include the adoption of a revised law on HIV, the revision of training programmes for health professionals to include ethics and human rights, the signing of a memorandum of understanding between organizations of lawyers and networks of people living with HIV and key populations to provide free legal services and training on knowing your rights, the development of radio and television spots on discrimination issues and high-level advocacy for better integration of HIV issues in humanitarian interventions.

“The denial of health services to people living with HIV remains unfortunately common in the country, and the prevalence and effects of discrimination are often particularly severe for members of key populations, who face multiple and overlapping forms of discrimination,” said Marie Engel, Director, a.i., of the UNAIDS Country Office for the Central African Republic.

COVID-19 has underscored the crucial need for pandemic responses to include social protection measures that reach and benefit marginalized populations.

As the pandemic swept across western and central Africa in early 2020, the region was already grappling with socioeconomic distress and humanitarian crises. Social restrictions imposed to contain the pandemic exacerbated those challenges. Impoverished and vulnerable populations, including people living with HIV and key populations, were hit hard.  

Surveys conducted between June and August 2020 in 17 countries in the region on the situation and needs of people living with HIV—with support from UNAIDS, in partnership with the Network of African People Living with HIV West Africa—revealed that up to 80% of people living with HIV were experiencing livelihood losses, and more than 50% of them needed financial and/or food assistance.  

These findings convinced UNAIDS and the World Food Programme (WFP) to launch a pilot project on unrestricted cash transfers in July 2020 to help people living with HIV and key populations cope with the socioeconomic impact of HIV and COVID-19 in four priority countries: Burkina Faso, Cameroon, Côte d’Ivoire and Niger. The initiative was designed to capitalize on WFP’s existing arrangements with service providers and on UNAIDS’ community engagement and relationships with civil society networks in the four priority countries.

Cash transfers are increasingly recognized as an effective form of social protection, with positive social and economic effects. They provide income support and help households avoid selling off assets or removing children from school, and they have multiplier effects on local economies. They constituted approximately 40% of global social safety net expenditures in 2018, but less than 20% in western and central Africa.

As the pandemic spread across western and central Africa, only a few countries (Côte d’Ivoire and Senegal among them) allocated additional support for vulnerable households in the form of cash transfers or social grants.

The immediate objective of the pilot was to reach about 5000 households with one-off, unconditional cash transfers, which ranged from US$ 88 per beneficiary (in Côte d’Ivoire) to US$ 136 (in Cameroon).

“I am so grateful for this support. I used it to pay the fees for my sewing course and to buy a sewing machine to start my own business. I also helped my mother who lost her job due to the pandemic,” said a young woman living with HIV in Cameroon.

Civil society organizations and financial service providers were engaged during the planning of the pilot. Eligibility for the transfers was decided based on a variety of vulnerability criteria, and beneficiaries were identified with the support of community-led organizations. Additional steps involved sensitizing beneficiaries, distributing the cash transfers, troubleshooting and monitoring the process. Specific attention was made to ensure confidentiality and to mitigate any potential stigma for beneficiaries.

Across the four countries, almost 4000 beneficiaries were reached, and it is estimated that a further 19 000 household members also benefited from the cash transfers, most of which went towards food, health care, education and housing expenses, or for income-generating activities. Country experiences varied in terms of the depth of their collaboration with community partners and the extent to which government actors were involved.  

The experience of the pilot demonstrated that delivering rapid cash transfers to marginalized people living with HIV and key populations in very difficult circumstances is possible, and that it provides valuable emergency support.   

Critical lessons learned include the need for inclusive and flexible approaches, working in ways that are clear and transparent to community partners and systematically involving community partners throughout the process. Defining clear and unbiased eligibility criteria, applying them consistently and sensitizing beneficiaries and communities are also vital.

Capacity-building and other support (including funding) for community partners is another critical element. Community-level organizations, trusted counsellors and peer educators were essential for establishing trust, identifying and reaching the intended beneficiaries, minimizing stigma and assessing the impact of the cash transfers. Engaging with government structures from the beginning helps to create the potential for long-lasting improvements.  

One-off cash transfers of this kind can help households withstand short-term shocks, but they do not do away with the need to fully integrate vulnerable and marginalized populations into crisis responses and comprehensive social protection systems. It is imperative that countries across Africa expand inclusive, multipurpose social protection that is accessible and sustainable. Enhancing the people-centredness of cash transfers and slotting them in with other forms of social provisioning and support that are not necessarily cash-based—such as free or subsidized primary health care, education, water and energy—is part of this process.

Following this pilot experience on the use of cash transfers to support the most vulnerable people living with HIV and key populations, UNAIDS and the Civil Society Institute for Health have further strengthened their collaboration on advancing HIV-sensitive and inclusive social protection in western and central Africa. Recently they organized, with the support of LUXDEV funding and in collaboration with several UNAIDS Cosponsors, a capacity-building workshop to mobilize and build the capacity of civil society and communities and to promote dialogue and collaboration among civil society organizations, partners and governments to advance inclusive, HIV-sensitive social protection in the region.

Building on the recommendations of the workshop, a number of follow-up activities were agreed to enhance the role and positioning of communities in advancing HIV-sensitive social protection within their countries and the region. 

“The cash transfer initiative in Niger came at the right time. The cash transfers were used by the beneficiaries to stockpile food and pay rent, but most importantly to allow the children to continue their schooling. This initiative demonstrated the value and importance of working together with the communities and our Cosponsors to achieve a common goal,” said El Hadj Fah, the UNAIDS Country Director for Niger.

Underinvestment in the HIV responses of low- and middle-income countries was a major reason why the global targets for 2020 were missed. Financial resource availability during the past five years was consistently below the resources needed, and in 2020 it was 29% less than the US$ 26 billion target for that year (in constant 2016 US dollars).

In western and central Africa, large resource shortfalls and continued reliance on out-of-pocket expenditures (such as user fees for health services) are associated with more modest declines in the incidence of HIV infection and the rate of AIDS-related mortality compared to eastern and southern Africa, where a combination of domestic and international investments has fuelled the rapid expansion of HIV prevention, testing and treatment in areas with a high burden of HIV, resulting in strong and steady reductions in the rate of HIV infections and AIDS-related mortality.

Participants from four countries—Côte d’Ivoire, Guinea, Guinea-Bissau and Senegal—recently met in Saly, Senegal, to capitalize on the know-how developed during the implementation of the Capacity Building and Capitalization of Experiences for Improved HIV Care among Key Populations in West Africa (ReCCAP) project, implemented by ENDA Santé and funded by L’Initiative through Expertise France.

The project aims to strengthen local people so that they are able to map sites and estimate the size of key populations on a continuous basis at the local level, conduct detailed analyses of HIV services and needs, and use the results to adapt the services offered and increase their effectiveness.

“The lack of data on key populations hinders the development of interventions that address their specific needs. Programmatic mapping and size estimates are usually conducted by international consultants and are not always adapted to the needs of field actors, and data may exist but are often quickly outdated because targets are dynamic and mobile,” said Sidy Mokhtar Ndiaye, Research Manager at ENDA Santé.

Guinea-Bissau, for example, was able to share its experience in estimating the size and/or needs of four key population groups, including a needs analysis of prisoners in three prisons in the country. “This is the first time that a study on HIV has been done in prisons in the country. The data will be used for the development of the new national HIV strategic plan,” said Miriam Pereira, Monitoring and Evaluation Officer at ENDA Santé Guinea-Bissau. The country has completed the deployment of two national trainings, including on community-based surveillance, which has been useful for monitoring the COVID-19 pandemic, and on the implementation of key population mapping in four regions—Bissau, Bafatà, Bubaque and Mansôa—in sites including bars, restaurants, hotels and public spaces.

The meeting, which welcomed members of partner entities and people who had benefited from two regional trainings in 2019 and 2021, was an opportunity to share South–South operational experiences and to develop recommendations for scaling up lessons learned and extending the project, particularly in terms of geographic coverage, with the support of UNAIDS.

“Key populations and their sexual partners account for 69% of new HIV infections in western and central Africa.  And yet in the region the funding received for programmes for key populations represents only 2.4% of funding between 2016 and 2018. Projects like ReCCAP are essential for advocating for greater investment in key populations and evidence-informed programming,” said Marie Engel, UNAIDS Regional Adviser.

Gabon is one of the partnering countries involved in the Partnerships to Accelerate COVID-19 Testing (PACT) initiative in Africa. The project, developed under a partnership between UNAIDS and the Africa Centres for Disease Control and Prevention, aims at fostering collective action to respond to the colliding HIV and COVID-19 pandemics through strengthened community engagement, including the deployment of community health workers.

The UNAIDS Country Office for Gabon, in collaboration with other stakeholders, has chosen, as a starting point, to involve community actors to support the most vulnerable populations, in particular people living with HIV and the lesbian, gay, bisexual, transgender and intersex (LGBTI) community, in the context of COVID-19.

To increase coordination, ensure successful implementation and minimize the risks, all the stakeholders were involved from the design phase of the project. From the government, the Ministry of Health and the national steering committee of the pandemic response plan were involved at the highest level and appointed representatives to follow the development process and launch the project. In addition to a cabinet minister, representatives of Ministry of Health specialized national programmes joined the project, along with representatives of civil society and development partners.

The project will support the deployment of more than 70 people to accelerate the response to COVID-19 among vulnerable populations and to mitigate the impact of COVID-19 on the HIV response and services for other diseases, sexual and reproductive health and gender-based violence. In particular, it will contribute to supporting the continuity of services through increased community engagement. The project will cover four regions of Gabon, Libreville, Lambaréné, Port-Gentil and Franceville, that are severely impacted by COVID-19 and that have the highest HIV prevalence in the country.

Before the official launch of the project, UNAIDS signed an agreement with the Gabonese Red Cross, which in turn signed agreements with the selected community health workers, members of six associations and networks involved in the response to HIV and gender-based violence and that work with the LGBTI community and on sexual and reproductive health.

“The partnership with the Africa Centres for Disease Control and Prevention and support through UNAIDS has given a glimmer of hope to communities in Gabon that are often left to fend for themselves. It has shown that with even a little support, communities can innovate and make a difference. The involvement of communities should always be at the heart of the response to pandemics. We hope that this support can be sustained over time as the needs are still tremendous,” said the UNAIDS Country Director for Gabon, Françoise Ndayishimiye.

The project also has an innovative component in the monitoring of community actors. A mobile digital app was developed to support the community health workers with real-time data collection for monitoring and reporting on their activities. The app will ease reporting by allowing them to provide regular weekly reports on awareness and to support activities for people living with HIV and people living with tuberculosis, including on sexual and reproductive health, prevention of early pregnancies, HIV, gender-based violence, COVID-19 and discrimination.

Since the West Africa Commission on Drugs launched a groundbreaking model drug law in 2018, civil society across the region and beyond has been engaging stakeholders on the need to use the model law as a blueprint for national reform.

The model drug law promotes, among other things, the availability of harm reduction services as well as the decriminalization of possession of drugs for personal use, which have long been called for by UNAIDS. 

As the model drug law is, by design, a long and technical document, UNAIDS supported the West Africa Drug Policy Network and the International Drug Policy Consortium to develop and disseminate two important new tools for civil society: a shorter and more accessible resource that summarizes the key points of the model drug law and a short guide for local nongovernmental organizations to explore how to use the model drug law in their work. In other words, the first advocacy explainer is about the key “ingredients” of the model drug law and the second contains a list of methods and strategies on how to use these ingredients to better integrate the law in their advocacy and to advance drug policy reform, based on experiences from the region.

The documents were launched on 27 September during a virtual webinar live on Facebook and can be found in English, French and Portuguese at https://www.wadpn.org/resources.

“These new tools will directly support and empower civil society advocacy for more health- and rights-based drug policies in western Africa and, in turn, strengthen the response to HIV among people who use drugs,” said Patrick Brenny, the Director of the UNAIDS Regional Support Team for West and Central Africa.

Adeolu Ogunrombi, a West Africa Commission on Drugs Commissioner, underlined that the needs and demands for drug dependence treatment and harm reduction are high, but service provision is low in the region, and specified that the law provides guidance on this. He also noted that criminalizing the possession of equipment and materials, such as needles, syringes and other paraphernalia, has been demon­strated to undermine harm reduction service provision and uptake and to have a damaging impact on public health.

A case study was presented by Chinwike Okereke, a civil society organization representative and focal point for the West Africa Commission on Drugs in Nigeria, on the use of the model drug law. In 2020, a coalition of civil society organizations made presentations on the model drug law to key policymakers, including the Federal Ministry of Justice, the Drug Law Reform Commission and the National Drug Law Enforcement Agency. “The model drug law presented an opportunity to have face-to-face discussions and drive a buzz on the reform that led to a drug law reform round table where all key federal, criminal justice and state actors and civil society made a case for the adoption of the law as a template for reform,” he said. Further engagement with the Drug Law Reform Commission then led to the setting-up of a working group that is actively working on reshaping drug laws in the country. He also encouraged civil society to use the new explainers and urged technical and funding partners to invest more funding for this effort across western Africa, as law reform takes some time to achieve.

Alida Nguimale is a survivor. She has been living with HIV for 21 years in the Central African Republic. Some 10 years ago, she lost two of her children to AIDS-related illnesses. At the time, she was unaware that she was living with HIV, and life-saving antiretroviral therapy and medicine to prevent mother-to-child transmission of HIV were rare in the Central African Republic.

Speaking at the opening ceremony of a national workshop on HIV and gender, co-organized by the Ministry of Gender, the Ministry of Health, the National AIDS Council and UNAIDS, in Bangui, Central African Republic, on 30 and 31 August, Ms Nguimale explained how she was expelled from her home by her abusive partner, who accused her of bringing HIV into the household. She also recounted her helplessness in the face of denial and violence by her partner, who had refused to accept his own HIV-positive diagnosis.

Ms Nguimale’s story illustrates the vulnerability to HIV of women in the Central African Republic and the barriers that they face in accessing health services. More than 56% of all new HIV infections in the country in 2019 were among women and girls, and 60% of all people living with HIV in the country are women. According to data from the MICS-6 survey published in 2021 by the government, with the support of the United Nations, 23.6% of women and girls between the ages of 15 and 49 years were married or entered into a marital union before the age of 15 years. More than 21% of central African women had undergone female genital mutilation. In January 2021 alone, 340 cases of gender-based violence, including 72 rapes, were collected by the gender-based violence information management system in the Central African Republic.

“The vulnerability of women and girls to HIV in the Central African Republic is the consequence of protracted insecurity, violence and humanitarian crises compounded with toxic masculinities and negative social norms. There can be no end of the AIDS pandemic without renewed action and accountability to end this plague of gender-based violence and the social marginalization of women,” said Denise Brown, the Deputy Special Representative of the United Nations Secretary-General in the Central African Republic, Humanitarian Coordinator and United Nations Resident Coordinator.

For the first time, the Government of the Central African Republic, with the support of UNAIDS, conducted a thorough assessment of the gender dimensions of the HIV epidemic and response in the country. The assessment report, which was discussed and adopted during the national workshop on gender and HIV, warned that women, girls and key populations are being left behind in the recent progress made against HIV in the country. HIV prevalence is highest among sex workers, at 15%, and among gay men and other men who have sex with men, at 6.4%, compared to 3.6% among the general population. Access to prevention of mother-to-child transmission of HIV services also remains worryingly low, with less than 25% of women accessing such services in three of the country’s seven health regions.

“The gender assessment report alerts us on a blind spot in our response. We must refocus our efforts on transformative interventions that work for women, girls and key populations,” said Pierre Somse, the Minister of Health of the Central African Republic.

Building on the recommendations of the gender assessment, the participants of the meeting developed and adopted an action plan to implement key interventions in 2021–2023. The action plan includes a combination of structural, biomedical and behavioural interventions to promote gender-transformative education and sensitization, to address the legal, social and cultural barriers to access to HIV services by women, girls and key populations, to implement differentiated models of care that promote access to health, social and psychosocial services for women, including for prevention of mother-to-child transmission of HIV, and to ensure accountability for progress on gender, HIV and tuberculosis. The Minister of Gender, Marguerite Ramadan, noted that the assessment report and the action-oriented operational plan that ensued are essential to implement the vision of equality in the 2021 United Nations Political Declaration on AIDS.

Expressing satisfaction after the adoption of the operational plan, Patrick Eba, the UNAIDS Country Director for the Central African Republic, said, “UNAIDS is at its best when it brings together government, civil society, development partners and other stakeholders to critically assess the national response to HIV and articulate a collective agenda for action. There is no better way to vindicate the rights of those millions of women like Ms Nguimale who demand dignity, justice and health.”

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.”