Nigeria’s COVID-19 response: Critical lessons from the HIV/AIDS epidemic

While many nations, especially in the developing world, were still reeling from the social and economic effects of HIV/AIDS and Ebola, the world was hit hard with the COVID-19 pandemic. As Nigeria battles its increasing number of coronavirus cases and the disruptions on economic and social life, what lessons can be applied from previous or ongoing (depending on countries situational contexts) global epidemics such as HIV/AIDS that can be applied to the nation’s current COVID-19 policy and public health response? To identify these lessons and their potential application, we can illuminate current intersections between COVID-19 and the HIV/AIDS epidemic, not only to formulate an effective COVID-19 response, but to avoid past pitfalls.

Why HIV/AIDS? COVID-19 shares striking similarities with HIV/AIDS, but a crucial intersection is the severity and impact of both global epidemics. In a short time, since the start of the COVID-19 pandemic, the world has experienced a high number of deaths, and the death toll continues to increase. Less than 8 months since the first case of COVID-19 was discovered in Wuhan, China, on November 17, 2019, over 500,000 deaths have been recorded from this pandemic, globally. This is in addition to disruptions in the social and economic life of nations and people across the globe. COVID-19’s severity and impact necessitate an urgent and effective policy response at the global, national, and subnational levels. But with so many unknowns about the disease, and with the pandemic still unravelling, how might countries like Nigeria that are at the early to middle phase of the pandemic, act to formulate an effective policy blueprint to mitigate COVID-19’s spread and impact? Nigeria’s COVID-19 Presidential Task Force must look back to similar global epidemics such as HIV/AIDS, and the lessons learned so far, to develop an effective public health response to the coronavirus insurgence in the country. The COVID-19 policy action plan must be designed to mainstream and apply lessons learned from the country’s response to HIV/AIDS (and Ebola) to avoid pitfalls that may undermine its effectiveness.

Although Nigeria’s response to the HIV/AIDS epidemic is far from over, the country has made substantial progress in the fight against this epidemic. Nevertheless, Nigeria’s HIV/AIDS response has been marred with several policy lapses that include lack of political will and poor political coordination, lack of consideration to socioeconomic inequalities, and lack of effective public health enlightenment campaigns, which delayed progress and exacerbated the adverse impact of the epidemic on socioeconomic life, as well as population health and wellbeing. These factors, again, are set to delay and undermine the country’s current response to the COVID-19 pandemic, if not immediately redressed.

Lack of political will and poor political coordination
The HIV/AIDS epidemic hit hard in Nigeria because of the disbelief that greeted the discovery of its first case in 1985. It was not until 1999, through the establishment of the Presidential Commission on AIDS (PCA) and the National Action Committee on AIDS, that any coordinated or active policy response was established to curb the epidemic in Nigeria. Subsequently, in 2000, the National Agency for the Control of HIV/AIDS (NACA) was established to coordinate the country’s HIV/AIDS response but decentralized at the state and local levels for a more comprehensive and coordinated response. However, the delayed response, which was from a lack of political will, increased transmission rates and debilitated the country’s economy and population health.

At present, Nigeria has put together a COVID-19 task force at the national level, but the country is still lacking a coordinated and comprehensive COVID-19 response due to the fact that public health measures have been sporadic and uncoordinated; for example, the decisions on social and economic lockdown and reopening have lacked a systematic approach, and largely uncoordinated at the state and local government levels. While the presidential task force on COVID-19 may serve to coordinate the country’s response at the national level, this body must be decentralized at the state and local government levels for a more comprehensive and effective response. A more decentralized or localized COVID-19 public health approach will help to mainstream the unique context and needs of each state and local government, and to forge a more effective response that is in line with national public health measures as laid out by the presidential task force.

Nigeria must apply the lessons learned from its HIV/AIDS public health response to the current COVID-19 response, where the delay in formulating a comprehensive and coordinated policy response at the beginning of the HIV/AIDS epidemic, due to a lack of political will, catapulted HIV/AIDS into a public health crisis of unprecedented magnitude.

Lack of an effective public health enlightenment
At the early stage of the HIV/AIDS pandemic, there were no vaccines or treatment. Globally, prevention became a treatment strategy through aggressive public health enlightenment campaigns targeted at individual behavioral change to reduce transmission rates. In Nigeria, HIV/AIDS public enlightenment campaigns were also designed at the start of the epidemic to prevent or reduce transmission, but these were implemented in ways that stigmatized particular subsets of the population; for example, women and, in particular, sex workers, who were socially constructed as vectors of transmission. Furthermore, the dominant narrative that HIV/AIDS was primarily contracted through sexual relations created moral and social prejudices around infection. The failure of public health enlightenment campaigns to effectively communicate the nature of HIV/AIDS and its varied transmission routes, created gaps in the uptake of counselling and testing services because of the fear of stigmatization.

In Nigeria, there is an emerging pattern of stigma and discrimination on COVID-19 from the ways that contact tracing is being implemented and from the ways that presumed COVID-19 individuals are evacuated from their homes to isolation centers for quarantine. Nevertheless, an effective public enlightenment campaign on COVID-19 can demystify the virus and disease, and facilitate testing and the desire to socially isolate or quarantine when individuals test positive for the virus. A more aggressive public health enlightenment campaign is needed to educate citizens on COVID-19 risk factors and transmission routes, as well as the need for individuals to take preventive measures to reduce spread, and to opt for testing when it is necessary. But preventive efforts cannot be solely individualized; rather, these must also be systemic to provide the enabling structure that engenders personal responsibility in fighting the coronavirus.

Lack of consideration to social and economic inequalities
COVID-19 has exposed structural inequalities at national and subnational levels, by race, ethnicity, socioeconomic class, and gender. Likewise, HIV/AIDS not only exposed structural inequalities but reproduced and exacerbated these inequalities across the globe, and also within national and subnational systems. Countries in sub-Saharan Africa and other low-income countries in the developing world suffered the most impact from HIV/AIDS. Within national systems, poor and marginalized groups suffered the most impact from the HIV/AIDS epidemic, whether in terms of risk, morbidity, and mortality. In addition to epidemiological factors, socioeconomic inequalities became key drivers of the HIV/AIDS epidemic in Nigeria.

Globally and at the national level, there is evidence of greater COVID-19 risk, transmission, and impact on poor, marginalized, and minority groups. To this end, Nigeria’s effort to fight the COVID-19 pandemic within its shores must include a multisectoral approach that addresses socioeconomic inequality, and other forms of inequality that drive the risk, transmission, and impact of the disease across diverse groups or subsets of its population. In addition to current biomedical strategies, such as the search for vaccines and treatment, the country must adopt a multipronged intersectional approach that mainstreams the social and economic dimensions of this pandemic to reduce its transmission and impact especially among the most vulnerable.

Nigeria’s COVID-19 Presidential Task Force must take into consideration, the aforementioned elements to win the fight against the coronavirus. The elements identified here are by no means definitive and holistic in the formulation of a comprehensive and effective COVID-19 response. Rather, they are a springboard from which Nigeria can establish its COVID-19 response. These elements also represent critical lessons from Nigeria’s HIV/AIDS response that when applied to the country’s current COVID-19 response, may help to avoid repeating the failures of past public health response. If these pitfalls are reproduced in the current COVID-19 response, they would undermine its effectiveness and may lead to a public health crisis of unprecedented proportion, especially, in the absence of a vaccine or treatment.
Basikoro is a research, academic and international development consultant.