In a small cramped room in a village in Nigeria, sits a little girl called ‘Mary’ (not her real name). Her father is dead, her mother is dead. They both died of AIDS-related illnesses, and the HIV virus was passed on to Mary. She lives with her grandfather, who is a farmer and an alcoholic. Mary runs the home, doing all the cooking and cleaning.
Mary is 12 years old and in some ways, she looks much younger, because the virus has left her painfully thin and has sapped her strength. But in her eyes and in her casual use of medical terms like ‘anti-retroviral’ she seems much older. Mary had been ill for a year before she was diagnosed of HIV. And now, orphaned, impoverished and HIV-positive, Mary has to travel 70 kilometres to collect her medicine. This is often a chore because she is weak and can’t breathe well in the cold and rainy season and when she gets to the centre, she is sometimes ignored and needs an adult to help her. “I want to go to school. I want to be a teacher. I am very sure that if I keep taking my medicine, maybe, one day, I will be strong enough to go to school and study to become a teacher.”
With 3.2 million Nigerians infected, a population the size of Enugu State, why is this disease not at the top of the health agenda in Nigeria? If the rest of the world needs a World AIDS day, every day should be World AIDS day in Nigeria, yet sadly this is not the case, as we have abdicated most of our responsibility to “foreign donors”. This has to change.
Friday 1st December was World AIDS day, a day designed for nations to individually and collectively take stock of efforts in addressing the HIV/AIDS scourge. This year’s global theme was, “Increasing Impact through Transparency, Accountability, and Partnerships”. In Nigeria however, the day was commemorated with the theme, “Right to health – Making it happen”. This is in line with the on-going advocacy for Universal Health Coverage which means that everyone, no matter their age or need, has a right to affordable, accessible and quality healthcare when they need it. This includes, access to high quality HIV Prevention Treatment and Care services, and we would like to see most of this provided by the Nigerian government. As Dr. Sani Aliyu, Director General of the National Agency for the Control of AIDS (NACA) approaches his first year in office, this message is clearly at the heart of his advocacy agenda.
Globally, the progress has been immense; more people than ever before living with HIV are accessing antiretroviral therapy; since 2010, new HIV infections among adults declined by an estimated 11%; new HIV infections among children declined by 47% since 2010; and AIDS-related deaths have fallen by 48% since the peak in 2005. In Nigeria, while some progress has been made, we are lagging behind and in many aspects, dragging the world backwards. In Nigeria, HIV prevalence declined from 5.8% in 2001 to 3.0% in 2014. In his address during the 2017 World AIDS Day, the Honourable Minister for Health observed that over 1 million Nigerians are now on life-saving antiretroviral therapy (ART). However, the sad reality is that the Nigerian government is only managing to provide ART funding for about 60,000 people living with HIV/AIDS in Abia and Taraba state. The significant funding shortfall is left to donors. The Minister did promise that the Federal Government of Nigeria is working with relevant partners to improve access to HIV treatment and especially prevention of mother-to-child transmission (PMTCT) in Nigeria. Of all the challenges with HIV care, mother-to-child transmission is probably the most tragic – there are more children infected by their mothers in Nigeria than any other country in the world. In spite of several years of intervention, access to paediatric ART services continues to hover around the 28% of need for six years running and PMTCT services are available only to 30% of the pregnant population annually. We can and must do better.