World AIDS Day: Nigeria’s HIV response still donor funded

Nigeria’s response to tackling HIV/AIDS is mostly driven by donors, Daily Trust reports as countries mark World AIDS Day today. Experts have said that Nigeria needs to do more to fund its HIV response amid increasing global uncertainty. The coronavirus pandemic which grounded the world in 2020 also affected global response and collaboration towards stemming […]

Nigeria’s response to tackling HIV/AIDS is mostly driven by donors, Daily Trust reports as countries mark World AIDS Day today.

Experts have said that Nigeria needs to do more to fund its HIV response amid increasing global uncertainty.

The coronavirus pandemic which grounded the world in 2020 also affected global response and collaboration towards stemming the spread of HIV/AIDS.

The theme of World AIDS Day 2021 is ‘End Inequalities. End AIDS’.

It is estimated that about 75 per cent of HIV/AIDS response is funded by international donors. About 25 per cent is funded by the federal government mostly followed by state governments; which is a little improvement from the 95 per cent donor funding in 2019.

Between 2005 and 2018, about $6.2bn (the equivalent of N2.54 trillion) was spent to identify close to one million people living with HIV in Nigeria and place them on treatment.

 “However, 80 per cent of this money came from international donors and development partners; only 18 per cent was contributed by the federal and state governments and 1 per cent came from the private sector,” Dr. Gambo Aliyu the Director-General of the National Agency for the Control of AIDS (NACA), said during the launch of the national domestic resource mobilisation and sustainability strategy in Abuja.

He urged national stakeholders and state governments to increase efforts towards owning and financing the country’s HIV response.

The key donors for the country’s HIV response are the United States through its President‘s Emergency Plan for AIDS Relief (PEPFAR), and the Global Fund to Fight AIDS, Tuberculosis and Malaria and some UN agencies. The exact amount contributed by each of the donors and the federal government could not be ascertained at press time.

An estimated 1.8 million people are living with HIV/AIDS in Nigeria, out of which 1.6 million have been placed on treatment.

As of June 2021, 150,000 children are HIV positive. About 13,000 out of about 150,000 children living with HIV/AIDS in Nigeria die annually. A total of 21,000 children were infected with HIV in 2020, the Director General of the National Agency for the Control of AIDS (NACA), Dr Aliyu Gumel Gambo, said.

He said as at 2020, only 36 per cent of the 150,000 children living in Nigeria had access to life-saving antiretroviral therapy.

The United States, through its President‘s Emergency Plan for AIDS Relief (PEPFAR) has been supporting Nigeria’s HIV/AIDS response since 2004.  

PEPFAR said in Nigeria alone, it has invested $6 billion in the national HIV/AIDS response, both at national and state levels to identify and treat people living with HIV.

In September, the US Chargé d’Affaires, Kathleen FitzGibbon, said they have supported the treatment of over 1.5 million persons, representing more than 83 per cent of the estimated 1.8 million Nigerians living with HIV.

She also said PEPFAR has supported comprehensive services to over one million vulnerable children impacted by HIV.

FitzGibbon said, “It has been a great source of pride for me to witness the success of the US government’s partnership with Nigeria to get HIV epidemic control within our reach. 

“The US PEPFAR team has worked closely with government stakeholders to urgently reorient the national response to address areas with the highest HIV burden.

However, the National Coordinator of the Network of People living with HIV/AIDS in Nigeria (NEPHWAN), Abdulkadir Ibrahim, has decried Nigeria’s dependence on donor funding for its HIV response.

He said, “Last year during the World AIDS Day, the Secretary to the Government of the Federation on behalf of President Buhari made a pledge that Nigeria would establish local manufacturing of antiretroviral drugs in the country. But one year after we have not received any update on that.

 “So, we want the government to come out with that commitment, so that we will see the blueprint and know that it is not theory but practical, and that we are moving forward to ensure that we have these drugs locally produced in the country. 

“That way we don’t need to wait, because during COVID it was proven that we had to go outside the country and purchase these drugs and because of the restriction of the lockdown, a lot of people didn’t have access to drugs.

“There is also the issue around resource mobilization. It is through that resource mobilization that we look forward to having more equitable ways to establish manufacturing industry in Nigeria for HIV drugs to be produced.”

He added that the proposed HIV Trust Fund would go a long way in ensuring sustainable financing for HIV in the country.

The Country Director, UNAIDS Nigeria, Dr Erasmus Morah, said the government of Nigeria has commenced incrementally paying for the treatment of Nigerians living with HIV using domestic resources at 17 per cent Vs 83 per cent HIV programme resource contribution between the government and donors respectively 

He said, “there are still some funding gaps the country needs to address as it moves towards epidemic control.”

Morah said there is an urgent need for states to redeem their commitments to release 0.5 to 1.0 per cent of their federal monthly allocations to the HIV response in their states.

“For example, states should invest more in the procurement of HIV test kits as part of their counterpart contribution. This will go a long way towards halting the decline of HV positive pregnant women accessing PMTCT services.

“Nigerian government needs to stop viewing healthcare as a consumption good. Health is a sensible investment, a nation’s source of wealth.”

While commending partners that have been supporting the county’s HIV response, he said Nigeria should build on the momentum and ensure sustainable financing of HIV through the initiatives that are currently in place inclusive of the HIV Trust Fund.

He called for support for the HIV Trust Fund and strong country ownership, adding that it would help stamp out inequalities while putting communities at the centre.

About $2.4bn needed for treatment in the next 3 years

Findings reveal that about $2.4 billion is needed to control the spread of the Human Immunodeficiency Virus (HIV) in Nigeria for the next three years

Asked about what the government is doing to own its HIV response, Dr. Gambo Aliyu, the D-G of NACA said the federal government has tremendously increased funding for HIV.

He said it has moved “From supporting the treatment of 50,000 individuals two years back to now supporting treatment of about 100,000 people living with HIV/AIDS.”

And it is determined to add 50,000 in the next two years to make it 150,000. 

On the other hand, the private sector is also coming together to form the HIV Trust Fund of Nigeria.

This is similar to the role the private sector played during the COVID-19 pandemic with the creation of CA-COVID.

 “We are looking at similar structures. This time around addressing HIV; addressing HIV squarely; addressing the issue of sustainability because we have realized the control is within our reach. 

“Controlling HIV transmission, controlling spread among people and also controlling deaths from HIV is rapidly within our reach. The question is after achieving that control, how do we make sure we sustain it and don’t drop the ball along the line.

“This is where the HIV Trust Fund support by the private sector is going to have a critical role to play in terms of supporting the provision of drugs, test kits and logistics to distribute drugs and test kits across the country.”

COVID-19 and HIV response  

On the impact of the COVID-19 pandemic, Dr. Gambo Aliyu said “Despite the negative impact of the lockdown instituted as a public health measure to curb the spread of COVID-19 across the world, the HIV programme in Nigeria proved resilient with an increase in the number of people placed on treatment,” he said.

Also speaking yesterday during the flag off of the world AIDS Day, the Secretary to the Government of the Federation, Boss Mustapha, said during the lockdown, Nigeria strengthened its community response through leveraging existing systems and placed on treatment an additional 350,000 new persons.

Tackling inequalities

The National Coordinator of the Network of People living with HIV/AIDS in Nigeria (NEPHWAN), Abdulkadir Ibrahim, said the issue of inequality is all about empowering people and identifying everybody.

He said, “Poverty is everywhere and putting most of our young people and women at risk of contracting HIV, and people living with HIV are finding it difficult to access the services because some of the services are not at their doorsteps, especially those in the rural communities.

“So we want government to procure HIV test kits and ensure that our pregnant women are tested. It is unacceptable for pregnant women to be charged bills, we want it to stop in order to ensure that no one is left behind. 

The Country Director, UNAIDS Nigeria, Dr Erasmus Morah, said there are still some funding gaps the country needs to address as it moves towards epidemic control.

He said tackling inequities would advance the human rights of key populations and people who are living with HIV, make societies better prepared to beat COVID-19 and any other pandemic and also support economic recovery and stability.