In a small cramped room in a village in Nigeria, sits a little girl called ‘Mary’ (not her real name). Her father is dead, her mother is dead. They both died of AIDS-related illnesses, and the HIV virus was passed on to Mary. She lives with her grandfather, who is a farmer and an alcoholic. Mary runs the home, doing all the cooking and cleaning.
Mary is 12 years old and in some ways, she looks much younger, because the virus has left her painfully thin and has sapped her strength. But in her eyes and in her casual use of medical terms like ‘anti-retroviral’ she seems much older. Mary had been ill for a year before she was diagnosed of HIV. And now, orphaned, impoverished and HIV-positive, Mary has to travel 70 kilometres to collect her medicine. This is often a chore because she is weak and can’t breathe well in the cold and rainy season and when she gets to the centre, she is sometimes ignored and needs an adult to help her. “I want to go to school. I want to be a teacher. I am very sure that if I keep taking my medicine, maybe, one day, I will be strong enough to go to school and study to become a teacher.”
With 3.2 million Nigerians infected, a population the size of Enugu State, why is this disease not at the top of the health agenda in Nigeria? If the rest of the world needs a World AIDS day, every day should be World AIDS day in Nigeria, yet sadly this is not the case, as we have abdicated most of our responsibility to “foreign donors”. This has to change.
Friday 1st December was World AIDS day, a day designed for nations to individually and collectively take stock of efforts in addressing the HIV/AIDS scourge. This year’s global theme was, “Increasing Impact through Transparency, Accountability, and Partnerships”. In Nigeria however, the day was commemorated with the theme, “Right to health – Making it happen”. This is in line with the on-going advocacy for Universal Health Coverage which means that everyone, no matter their age or need, has a right to affordable, accessible and quality healthcare when they need it. This includes, access to high quality HIV Prevention Treatment and Care services, and we would like to see most of this provided by the Nigerian government. As Dr. Sani Aliyu, Director General of the National Agency for the Control of AIDS (NACA) approaches his first year in office, this message is clearly at the heart of his advocacy agenda.
“Every Nigerian has a right to good health. We have a responsibility to ensure that this basic right is available to all Nigerians. The Government is committed to enhancing ownership and sustainability of the HIV/AIDS response,” Dr. Sani Aliyu, Director General of (NACA).
Globally, the progress has been immense; more people than ever before living with HIV are accessing antiretroviral therapy; since 2010, new HIV infections among adults declined by an estimated 11%; new HIV infections among children declined by 47% since 2010; and AIDS-related deaths have fallen by 48% since the peak in 2005. In Nigeria, while some progress has been made, we are lagging behind and in many aspects, dragging the world backwards. In Nigeria, HIV prevalence declined from 5.8% in 2001 to 3.0% in 2014. In his address during the 2017 World AIDS Day, the Honourable Minister for Health observed that over 1 million Nigerians are now on life-saving antiretroviral therapy (ART). However, the sad reality is that the Nigerian government is only managing to provide ART funding for about 60,000 people living with HIV/AIDS in Abia and Taraba state. The significant funding shortfall is left to donors. The Minister did promise that the Federal Government of Nigeria is working with relevant partners to improve access to HIV treatment and especially prevention of mother-to-child transmission (PMTCT) in Nigeria. Of all the challenges with HIV care, mother-to-child transmission is probably the most tragic – there are more children infected by their mothers in Nigeria than any other country in the world. In spite of several years of intervention, access to paediatric ART services continues to hover around the 28% of need for six years running and PMTCT services are available only to 30% of the pregnant population annually. We can and must do better.
During the UNAIDS’ launch of the World AIDS Day campaign with the theme, “My Health, My Right”, Michel Sidibé, Executive Director of UNAIDS, said, “All people, regardless of their age, gender, where they live or who they love, have the right to health. No matter what their health needs are, everyone requires health solutions that are available and accessible, free from discrimination and of good quality.” This includes children. We live in a world where the health needs of children are often ranked below adults, where even when children are connected to care, stock-outs of paediatric antiretroviral formulations occur more frequently than stock-outs of adult medicines. This is unacceptable.
While we recognize and applaud the government’s renewed energy towards health issues in Nigeria, this statement by Dr. Sani Aliyu, Director General, NACA, at the commemoration of the 2017 World AIDS Day, captures what must be done. “If we must take our response to the next level, we must address the challenges related to our health system infrastructure, unmet need for commodities, data quality and human resource for health and funding. These challenges constitute key barriers to universal access to HIV/AIDS services in Nigeria.”
We cannot seriously be talking about “Universal Health Coverage” if we are not planning for a population of a middle- sized Nigerian state. While countries like South Africa have made progress in integrating HIV care into the care that is provided through the public health sector, we continue to treat HIV/AIDS in Nigeria as an exceptional disease that is largely dependent on foreign intervention.
The need is immense and in the face of growing donor fatigue, the federal government cannot bear this burden alone; state governments need to play their part. It is the government’s (federal and state) responsibility to respect, protect and fulfill the right to health of all Nigerians. This begins with ensuring that every state government takes the necessary steps towards establishing state health insurance schemes in their respective states. However, other stakeholders, such as the private sector, should join the federal and state governments as they work towards expanding HIV treatment and care services in Nigeria by providing funding for specific intervention programs, as well as offer their expertise in the initiation and implementation of these programs. It is time for all of us to take ownership of Nigeria’s HIV burden.