By Vivian Ihechu, News Agency of Nigeria (NAN)

The first cases of AIDS in Nigeria were diagnosed in 1985 and reported in 1986.

They were a 13-year-old sexually active girl and a female commercial sex worker who arrived in Lagos State, from a neighbouring West African country.

The news of the first cases caused panic and disbelief in Nigeria, as AIDS was reported to be a killer disease without a cure.

The number of people infected with HIV and AIDS in Nigeria has increased rapidly since the first cases. In 1992, 367 new AIDS cases were reported, and by 1994 that number had risen to 1,490.

However, the first national response to the epidemic was the creation of the National Expert Advisory Committee on AIDS (NEACA) in 1987.

Meanwhile, the United States of America Centres for Disease Control and Prevention (CDC) had on June 5, 1981, reported a rare form of pneumonia in young gay men in California, the first AIDS alert.

CDC in September 1982, about 15 months later, used the term AIDS to describe the disease for the first time.

According to CDC, AIDS, acquired immunodeficiency syndrome, is caused by the human immunodeficiency virus (HIV).

Johns Hopkins University says the virus kills or impairs cells of the immune system and progressively destroys the body’s ability to fight infections and certain cancers.

Through the 1980s and early 1990s, the outbreak of HIV and AIDS swept across the U.S. and the rest of the world, with concerns on how to tackle the disease.

Over the years, the situation looked gloomy with sparse information on the new disease, high mortality incidents and the comorbidities that make the management of the condition more complicated.

Comorbidities is a medical condition that coexist alongside HIV/AIDS, including tuberculosis, cardiovascular disease like hypertension, respiratory diseases like pneumonia, hepatic diseases like hepatitis B and C, as well as mental health challenges.

Globally, work and researches into the disease became intensified with reports saying that HIV/AIDS is transmitted through sexual contact, blood, needles, or from mother to infant of an infected person.

With no clue to the cure for HIV/AIDS in sight, hope came in 1987, as the Food and Drug Administration (FDA) approved Zidovudine (AZT), the first antiretroviral drug used to treat HIV.

FDA also approved, and authorised the sale of male condoms as prevention for HIV.

According to the World Health Organisation (WHO’s) report, 88.4 million (71.3–112.8 million) people have been infected with the HIV virus and about 42.3 million (35.7 to 51.1 million) people are reported to have died since the beginning of the epidemic.

The report added that globally, 39.9 million (36.1–44.6 million) people lived with HIV by the year 2023.

WHO Regional Director for Africa, Dr Matshidiso Moeti, regrettably said, “HIV is a complex health challenge, inseparable from social determinants such as poverty, gender inequality and violence, and complicated by stigma and discrimination, especially among marginal populations.”

However, after years of ravaging and killing millions of people, Moeti acknowledged that a remarkable reduction in the number of new HIV infections and AIDS-related deaths was being recorded.

But she added that the number of new HIV infections was higher outside of sub-Saharan Africa for the first time in 2023.

The Joint United Nations Programme on HIV/AIDS (UNAIDS), inspiring global shared vision of zero new HIV infections, is leading the world in achieving the 95-95-95 UNAIDS HIV testing, treatment and viral suppression targets, aimed at closing gaps in treatment coverage and outcomes.

According to her, seven countries have already achieved the targets, with the overall rating for the region currently at 90-82-76, and with about 21.3 million people now on antiretroviral treatment, which raises their life expectancy.

Of interest, Botswana (silver tier status) and Namibia (bronze tier status), have both been recognised for notably curbing mother-to-child HIV transmission rates, achieving the required indicators for the “Path to elimination of HIV” criteria introduced in 2017.

In Nigeria, Dr Temitope Ilori, Director-General of the National Agency for the Control of AIDS (NACA), also gave a ray of hope to

the citizens.

According to her, the country has made notable progress in shaping “our response and strategies to address the HIV/AIDS epidemic in the country.”

At a news conference ahead of the 2024 World AIDS Day, she said about two million people were living with HIV in Nigeria, with approximately 1.6 million out of them currently receiving treatment.

The 2024 World AIDS Theme is: “Take the Rights Path: My Health, My Right!”, a rallying cry for accessible, rights-based healthcare that empowers those affected by HIV/AIDS to live vibrant and fulfilling lives.

However, UNAIDS’s Country Director, Dr Leo Zekeng, painted a gloomy picture, saying the level of progress made to eradicate HIV in the country was not encouraging.

Zekeng disclosed that the world made a commitment to reduce new HIV infection by 83 per cent; that is new infections to 370,000 by 2025, “but the data for 2022 suggests that we have 1.3 million new infections.”

According to him, about 11 countries, mostly from the east and southern Africa, have attained a 66 per cent reduction in HIV infection based on pre-2025 target assessment.

He said the progress attained by the 11 countries served as a testimony and had reinforced the hope that reducing HIV infections was achievable with determination.

Zekeng then noted that achieving the set target by Nigeria was achievable with renewed commitment, political will, increased funding and strengthened efforts at prevention by states and Federal Government.

One of the challenges in AIDS control in Nigeria, according to Ilori, is the prevention of mother-to-child transmission of HIV (PMTCT), with coverage remaining below 33 per cent.

Stigma and discrimination remain

Ilori, who also referenced the stigma barrier, urged Nigerians to join hands with NACA to break the stigma, jinx and embrace equity, to drive collective action to stop HIV, especially among children.

“We must empower every individual, especially women who are most vulnerable to contracting HIV, and other vulnerable populations, to access life-saving services and live with dignity’’.

Also, many young Nigerians lack essential knowledge about HIV prevention, the Nigeria Demographic and Health Survey (NDHS) 2023-24 report reveals.

It indicates that only 30 per cent of women and 22 per cent of men aged 15-24 understand effective ways to avoid the virus.

As a result, this knowledge gap is also contributory to the spread of HIV among youths who were particularly vulnerable due to limited access to accurate health information and misconceptions about transmission.

How do persons with HIV/AIDS feel?

The Network of People Living with HIV/AIDS in Nigeria (NEPWHAN) decried the high rate of stigmatisation faced by persons living with the virus.

NEPWHAN’s Edo chapter chairman, Mr Christopher Osayande said stigmatisation remained a significant challenge for Persons Living With HIV/AIDS (PLWHA) in society.

“Stigmatisation is still high and as a result, persons living with the virus are being denied meaningful employment.

“For those in business, once people know they have the virus they stop patronising their businesses,” he said.

He also cited inadequate support, lack of care and empathy, as well as lack of access to resources/finances to become self-sufficient as some of the inhibiting factors.

According to him, people with HIV/AIDS are a vulnerable group, with the majority being poor, hence the need for the government to make provisions for skills acquisition for PLWHA to enable them to fend for themselves.

“There are still new cases of HIV in the state and the number of people needing care is increasing due to lack of food and transportation.

“As an association, we are trying to see that the viral load reduces, but because most PLWHA do not have means of livelihood, the viral load remains high,” Osayande said.

On ways to end AIDS, Dr Patrick Dakum, Chief Executive Officer of the Institute of Human Virology Nigeria (IHVN), advocated sustainability, renewed political commitment, and collaborative action to address the challenges ahead.

Funmi Adesanya, Nigeria Country Coordinator for the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), called for the expansion of preventive efforts to end HIV/AIDS and to look beyond 2030.

Adesanya, represented by Deputy Country Coordinator, Mr Emerson Evans, at an event, stressed the need to scale up evidence-based prevention strategies, such as Pre-Exposure Prophylaxis and harm reduction services to often-overlooked populations like children.

“Invest in resilient and inclusive healthcare systems that ensure uninterrupted access to antiretroviral therapy, even in crisis situations.

“Address social determinants like stigma, discrimination, and structural inequalities that hinder access to care, particularly for marginalised groups,” she said.

Adesanya also emphasised the importance of investing in research and development, supporting innovative vaccine development, and creating long-acting treatment regimens to improve outcomes and reduce transmission.

Improved funding is also critical strategy of ending HIV/AIDS

A ray of hope in that direction is the recent proposal by the House of Representatives Committee on HIV/AIDS, Tuberculosis, and Malaria (ATM), of allocation of one per cent of the Federal Government’s Consolidated Revenue to address HIV/AIDS and other public health diseases.

Chairman of the committee, Rep. Amobi Ogah, at the end of the committee’s retreat with the National Agency for the Control of AIDS (NACA), said the decision was aimed at reducing dependency on foreign aid to sustain the fight against public health diseases.

Ogah also called for the amendment of the NACA Establishment Act of 2007 to restructure NACA into a multi-sector agency, enabling it to effectively coordinate responses to HIV/AIDS, viral hepatitis, tuberculosis, buruli ulcer, leprosy, and malaria.

According to him, the committee is committed to reviewing the Anti-Discrimination Act of 2014 to address stigmatisation.

“Other key decisions reached at the retreat that will help toward the goal of ending AIDS include, promoting local production of HIV drugs, ensuring accountability of NGOs, and enhancing NACA’s oversight capabilities,” he said.

Another solution as identified by some clerics is upholding cultural values, including frowning at LBGTQ activities, rape and drugs and substance abuse.

The Chief Imam, Lagos State University (LASU), Prof. Amidu Sanni, said the whole phenomenon of LBGTQ was a form of violence against established norms.

The General Superintendent, Holy Spirit Mission, Ikeja, Lagos, Bishop Charles Ighale, holds the same view.

“The act, much as it is “abominable’’, also promotes the spread of HIV/AIDS, according to experts, hence, it should not be tolerated,” he said.

“The need to prioritise comprehensive sex education, alongside continuous community and schools sensitisation, is important,” says Dr Ehey Ijezie, Country Programme Director, AIDS Healthcare Foundation (AHF).

Prof. Oliver Ezechi, the Director of Research at Nigerian Institute of Medical Research (NIMR), advocates youth’s involvement in proffering solutions to some health challenges including HIV/AIDS.

He said that the initiatives such as the 21-day boot camp, would serve as a unique research project to raise awareness among youths on HIV self-testing.

“It also serves as a platform to harness the power of young people and local knowledge to tackle some of the country’s biggest health challenges like Hepatitis B, HIV, hypertension and other diseases that are common in Nigeria.”

For Prof. Juliet Ezekwe, a Professor of Medicine from Washington DC, U.S., “Empowering communities will also aid in the fight to manage and stop HIV/AIDS.

“Communities have the first-hand experience, the knowledge, and the resilience to combat health challenges.

“Experts and doctors can provide guidance, but true progress hinges on empowering communities through the youths,” she said.

What is the Government doing?

Illori said NACA had implemented various strategies including combination prevention therapy, HIV self-testing, harm reduction initiatives, treatment as prevention, and the re-evaluation of Nigeria’s HIV epidemic through the NAIIS in 2018, among others.

“Among other initiatives, is the advancement of PMTCT programme in Nigeria, which is key to eliminating new HIV infections among children.

“The federal government has adopted a comprehensive approach for the implementation of PMTCT and this includes: Primary prevention of HIV infection among women of childbearing age.

“NACA has developed the Global Alliance Action Plan to End AIDS in children and established a national-level acceleration committee to track implementation.

“The agency has also engaged stakeholders to co-create a sustainability roadmap, ensuring that gains in the HIV response are sustained and government-mandated structures are in place.

“Also, a new initiative to expand Health Insurance Project access for vulnerable Nigerians including Persons Living with HIV (PLHIV) and TB patients, is on ground, to run from 2024 to 2026, across five Nigerian states, namely, Kwara, Gombe, Ebonyi, Anambra, and Lagos,” said Illori.

The Way Forward

Though the fight against HIV/AIDS is not over, Amb. John Nkengasong, said it required sustained global response against the disease.

Nkengasong is the Global Aids Coordinator and Senior Bureau Official for Global Health Security and Diplomacy, the United States President’s Emergency Plan for AIDS Relief (PEPFAR).

Nkengasong acknowledged that efforts to control HIV/AIDS had recorded tremendous success with lifesaving impacts across communities.

He, however, cautioned that HIV/AIDS should not be seen or termed a disease of the past.

According to Nkengasong, a Virologist, HIV is a hidden pandemic that doesn’t disrupt, warning that it spreads silently in communities.

Nkengasong urged governments to commit their own resources to the fight, advising that programmes should be shaped in a way that they could respond to the needs of today and fill the inequity gap that existed in young children, adolescent girls, young women, and key populations.

All in all, the need for improved multi-sectoral coordination, accountability, and adoption of global best practices in HIV response, is vital to ending HIV/AIDS and prevention of its resurgence. (NANFeatures)

***If used, credit the writer and News Agency of Nigeria (NAN)