Achieving 40.6% decline in HIV cases

Nigeria has recorded about 40.6 percent decline in the number of persons infected with the dreaded Human Immunodeficiency Virus (HIV) from 3.229 million people with a prevalence of 3.0 per cent in 2014 to 1.9 million with a prevalence of 1.4 in 2019.

This decline has moved Nigeria from second position on countries with highest HIV prevalence to fourth behind South Africa, India and Mozambique.

Based on the 2014 HIV Sentinel (ANC) Survey, the HIV prevalence for Nigeria was three per cent, which made Nigeria country the one with the second highest burden of HIV/AIDS in the world after South Africa.

Meanwhile, the first case of AIDS in Nigeria was reported in 1986. Since then, the epidemic has grown steadily from 1.8 per cent in 1991 to 3.8 per cent in 1993, 4.5 per cent in 1995, 5.4 per cent in 1999 and peaked at 5.8 per cent in 2001.

The prevalence began a gradual reduction from 5.8 per cent to five per cent in 2003, this decline continued to 4.4 per cent in 2005, 4.6 per cent in 2008 and 4.1 per cent in 2010. By 2014 the HIV prevalence rate was 3.0 per cent.

According to the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) announced last week in Abuja by President Muhammadu Buhari, Nigeria had fewer people living with HIV than previously estimated.

How did Nigeria achieve 40.6 per cent decline in HIV prevalence in four years? The intensive free national treatment programme with antiretroviral (ARV) drugs has suppressed the virus in persons living with HIV (PLHIV) and made them unable to transmit the disease. Indeed, viral load suppression (VLS) is an important marker of transmission as those with undetectable virus in their bloodstream will not transmit the virus.

According to the NAIIS, VLS, defined as having less than 1,000 HIV Ribo Nucleic Acid (RNA)/genetic material copies per ml of plasma, showed the positive effect of ARV treatment. Achieving VLS maximizes the health benefits to PLHIV, minimizes the risk of HIV transmission, and is necessary to halt the epidemic.

Key findings by the NAIIS include:
*HIV prevalence, defined as the percentage of PLHIV in the population of Nigeria, among adults age 15-49 years was 1.4 per cent (1.9 per cent among females and 0.9 per cent among males. This means that for every 1000 persons in Nigeria aged 15-49 years, 14 will be carrying the virus.

*HIV prevalence was highest among females age 35-39 years at 3.3 per cent and highest prevalence among males age 50-54 years at 2.3 per cent.

*The HIV prevalence gender disparity between females and males was greatest among younger adults, with females age 20-24 years having four times the prevalence of males in the same group.

*The new prevalence gives an estimate that there are 1.9 million people living with HIV in Nigeria.

*HIV prevalence estimates varied across Nigeria, with the highest prevalence in the South-South Zone and the lowest prevalence in the North West Zone.
South South region has highest average prevalence with 3.1 per cent and North West region has the lowest average prevalence with 0.6 percent.

*Akwa Ibom has overtaken Benue as state with highest prevalence with 5.5 per cent against the latter’s 5.3 per cent.

*Almost half of all people living with HIV in Nigeria achieved viral suppression.

*Although almost four out of five women attended at least one ANC visit during their most recent pregnancy, only two out of five self-reported knowing their HIV status.

*The prevalence of viral load suppression among people living with HIV was highest among males age 55-64 years at 55.0 per cent and among females age 45-54 years at 54.3 per cent.

•Viral suppression was highest in the North Central Zone (65.6 per cent) and the lowest in the South-South Zone (33.7 per cent).

Buhari formally unveiled the findings of the NAIIS at a special event in the Presidential Villa and launched the Revised National HIV and AIDS Strategic Framework 2019-2021, which will form the future response to the country’s epidemic.

The over S90 million (N34.29 trillion) worth survey was conducted by the Federal Government of Nigeria and sponsored by the United States (U.S.) President’s Emergency Plan for AIDS Relief (PEPFAR) with S70 million and the Global Funds for AIDS, TB and Malaria with S20 million and other development partners.

Buhari said: “The NAIIS is therefore in line with our government’s determination of ensuring sustainable solutions to our development challenges. The survey and its results have come at the right time as we commence the full implementation of the National Health Act that will ensure that every Nigerian has access to comprehensive health services.

“The NAIIS was designed to provide the data we need to plan adequately and consolidate on the progress towards the elimination of HIV in Nigeria. We are already a step ahead in this regard, as the Federal government has ensured that the HIV treatment programme in Taraba and Abia is properly funded this year and accommodation made to resource future expansions in the coming years.

“I am pleased to report that this survey has provided Government with the crucial information needed to enable the national HIV response to move forward and plan for a more sustainable and accountable programme based on credible scientific data.”

Minister of Health, Prof. Isaac Adewole, said: “The NAIIS findings provide Nigeria with an accurate national HIV prevalence measure of 1.4 per cent. NAIIS also showed we are able to effectively provide antiretroviral treatment.

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 ANC services and are tested during every pregnancy. We know we can support HIV-positive mothers, hence ensuring the next generation is free from HIV.

“It gives me great joy to inform you that the HIV/AIDS epidemic in Nigeria has contracted. It is important to note that though there is a reduction in prevalence; the total number of people affected by the disease is still huge based on our population. We are confident that with excellent initiatives like the Saving One Million Lives project (SOML) and the Basic Health Care Provision Fund (BHCPF), we would be able to cushion the effect of the disease through the provision of free ANC, Prevention of Mother To Child Transmission (PMTCT) to pregnant women in addition to other services.

Let me specially thank His Excellency, President Muhammmadu Buhari for supporting these great initiatives that will continually provide increased access to health care in the days ahead.”

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

On why more women than men are infected with the virus, Aliyu said: “It has to do with the physiology of the woman. It also has to do with the lower bargaining power for sex and socio-economic status of most women. Women are also victims of violence and rape. Forced sex increases the risk of HIV transmission among women due to lacerations. Women dreading or experiencing violence, are less likely to negotiate for safe sex, go for HIV testing, share their HIV status and access treatment.”

Indeed, several studies have demonstrated why women are at a greater physiological risk of contracting HIV than men. A study published in AIDS Research Therapy and titled “Women and HIV in Sub-Saharan Africa” noted: “This is in part because women have a greater mucosal surface area exposed to pathogens and infectious fluid for longer periods during sexual intercourse and are likely to face increased tissue injury.

Young women are at particularly high risk due to cervical ectopy, which facilitates greater exposure of target cells to trauma and pathogens in the vagina. It has been well documented that Sexually Transmitted Infections (STIs) increase the risk of HIV acquisition. For women, the risk is increased due to difficulty in diagnosing STIs, which are often asymptomatic in presentation, thus making treatment difficult.”

Data collection was done by more than 3,000 field staff from household members ages zero-64 years old. Participants were asked about knowledge of HIV/AIDS, their behaviors, risks that may predispose them to HIV, health-seeking behaviour, and stigma and discrimination against people living with HIV/AIDS.

Confidential HIV counseling and testing services were provided and blood samples tested for HIV, Hepatitis B, Hepatitis C and other biomarkers.

All participants that were found to be HIV positive were linked to a health facility to help them access HIV services. HIV confirmation tests were done, and viral load measured to determine the degree of viral suppression among those taking HIV medications.