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How lack of data, dwindling financial resources threaten plan to end AIDS by 2030, by NACA

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Anti retroviral (ARV) drugs has led to drop in HIV infections and AIDS-related deaths

The National Agency for the Control of AIDS (NACA) has said that despite notable achievements in reducing the number of cases and deaths due to the Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) and many more, plan to end AIDS by 2030 is inundated with challenges which threaten to erode the successes achieved.

Director-General, NACA, Dr. Gambo Gumel Aliyu, on the occasion of inaugural NACA’s Day/14th year anniversary, on Monday, February 22, 2021, said chief amongst the challenges are the need for strategic and real-time data for decision making as well as plateauing financial resources to prosecute the fight against the virus. “While looking back with nostalgia about our successes in the last 14 years, it is imperative we recognize that the time for all hands to be on deck is now!” he said.

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The NACA DG said the day provided an opportunity to reflect on the journey thus far, take stocks, review the status of the response, share the vision to end the epidemic by 2030 and celebrate all communities, partners and stakeholders for achieved milestones.

Aliyu said the agency has led the National Response to HIV through notable milestones from a rapid response towards a more controlled epidemic. “More persons are being placed on treatment in Nigeria than ever before, morbidity and mortality rates are declining thereby facilitating high population-based viral load suppression among HIV positive persons on Anti Retroviral Therapy (ART) in Nigeria. There is increased ownership of the response as the Federal Government has continued to make good her promise of placing 50,000 persons on treatment yearly,” he said.

The NACA DG said, in 2018, the Agency with support from her partners led the largest population-based HIV/AIDS survey in the world, leading to a rebasing of the HIV epidemic in Nigeria from a prevalence of 5.8 per cent to 1.4 per cent. Aliyu said the survey has armed the Agency and her partners with the requisite data to pursue the global target of ending AIDS as a public health threat by 2030, thus achieving the 95:95:95 targets.

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He said the year 2020 presented new sets of challenges to the HIV response as a result of the COVID-19 pandemic and that lessons learnt from the HIV multi-sectoral response success, leverages on the community and HIV infrastructures as well as its resources has been instrumental to the Nigerian COVID-19 response resilience.

Aliyu said the ongoing pandemic is a grim reminder that despite “our best effort, we cannot rest on our oars, as new public health and development challenges will appear and we must take lessons and best practices from the last 14 years in strategizing how we as a people will respond to them. We must ensure that we control the HIV epidemic and establish systems and structures that will sustain all our achievements going forward.”

According to Joint United Nations Programme on AIDS (UNAIDS) World AIDS Day (WAD) Report 2020, only six countries had seen treatment initiations return to the same levels as in January and February, including Nigeria, which reported large increases in July, August and September.

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Secretary to the Government of the Federation (SGF) and Chairman, Presidential Task Force (PTF) on COVID-19, Boss Gida Mustapha, in a goodwill message on the occasion of inaugural NACA’s Day, said: “The inauguration and celebration of the Day when this Agency was founded is certainly an occasion for much historic and collective reminiscence of how the HIV epidemic created a terrible burden for millions of individuals, families, and communities around us and the world.

“At the time NACA was inaugurated as an Agency on this day in 2007, the challenges that confronted the Agency were, the burden of HIV-related stigma, deficiency of the disease knowledge by most healthcare workers, lack of access to treatments, absence of vigorous prevention efforts, the dearth of effective social outreach, and support for those most vulnerable. Due to the efforts of pasts and present leadership of the Agency, most of these challenges have been surmounted.

“In the last 14 years, I make bold to say, that this Agency has achieved so much in its mission to the admiration of government and partners. Just in 2018, NACA led the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS). This was a national household-based survey that assessed the prevalence of HIV and related health indicators. The time frame for the execution/recorded successes of that survey has been rated as best to none. With the onset of COVID-19, the NACA model has worked well in demonstrating resilience and mitigating its impact on the country.

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“Through very strategic and favourable policies of the Federal Government, millions of people now have access to ARVs and global targets for prevention, testing and treatment are being met. The present government of President Muhammadu Buhari has continued to make resources available through NACA to sustain this momentum. This includes the commitment to have additional 50,000 Nigerians placed on treatment each year, feat no government in this country has achieved. Be assured that Government will continue to do more, as it has faith in the diligent commitment, accountability and transparency of the management in the Agency.”

The first two AIDS cases in Nigeria was diagnosed in 1985 and reported in 1986 in Lagos one of which was a young female sex worker aged 13 years from one of the West African countries.

The first HIV Sentinel Survey in 1991 showed a prevalence of 1.8 per cent. Subsequent sentinel surveys produced a prevalence of 3.8 per cent (1993), 4.5 per cent (1996), 5.4 per cent (1999), 5.8 per cent (2001), 5.0 per cent (2003), 4.4 per cent (2005), 4.6 per cent (2008), 4.1 per cent (2010) and 1.3 per cent (2019).

NACA, in an editorial, said the National Response stewardship day provides a platform for reflection and future projection towards ending HIV and AIDS as a public health emergency in Nigeria by 2030. It noted: “Under the guidance of eminent personalities such as Prof. Ibironke Akinsete, Prof. Babatunde Osotimehin, Prof. John Idoko, and Dr. Sani Aliyu as Chairpersons and Director Generals respectively, the Agency has ensured that the National HIV response has approached its last mile, witnessed leadership stability and cultivated a strong work ethic.

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“… Despite these successes, the HIV response in Nigeria still requires the support of all her stakeholders in winning the fight against the virus through shared responsibility, stronger partnerships, responsible implementation and shared accountability of the response. These will facilitate the institutionalizing of sustainable structures capable of responding to ending AIDS as a public health threat by 2030, as well as other development and public health emergencies. This will further leapfrog the federal government of Nigeria into greater ownership of her response, catalyze other countries in doing same thereby facilitating the achievement of some of the Sustainable Development Goals (SDGs).”

Meanwhile, the UNAIDS has alerted to gaps in antiretroviral therapy coverage among prisoners living with HIV. The UNAIDS in a statement said on any given day, approximately 11 million people worldwide are in confinement. Drug injection and sexual intercourse occur worldwide in prisons. The risk of sexual violence among prisoners—and their insufficient access to condoms, lubricants, pre-exposure prophylaxis and harm reduction services—heighten their chances of acquiring HIV, hepatitis C and sexually transmitted infections.

Among people who inject drugs, recent incarceration is associated with an 81 per cent and 62 per cent increased likelihood of HIV infection and hepatitis C infection, respectively.

Closed settings should, in theory, favour the delivery of effective testing and treatment services, although treatment interruptions and concerns about confidentiality and discrimination pose challenges.

In 2019, 78 countries reported to UNAIDS that HIV testing was available at any time during detention or imprisonment, and 104 countries reported that antiretroviral therapy was available to all prisoners living with HIV.

Coverage of antiretroviral therapy is good, although gaps remain.

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