To end the AIDS pandemic by 2030, leaders need to defend human rights and increase resources, By Leopold Zekeng

By Dr Leopold Zekeng, UNAIDS Country Director and Representative for Nigeria

The world is at a critical point in the HIV response. Decisions taken today on rights and resources will determine whether leaders meet their commitment to end AIDS as a public health threat by 2030 and save millions of lives.

The just released UNAIDS 2024 global report, The Urgency of Now: AIDS at a Crossroads shows that  the world is not on track to achieve its target of ending AIDS as a public Health threat by 2030, that the inequalities which drive the HIV pandemic are not being sufficiently addressed, that global new HIV infections are not declining anywhere near fast enough and that in three regions of the world HIV infections are rising. It shows that almost a quarter of people living with HIV are not receiving life-saving treatment, and that, consequently, a person dies from AIDS-related illness every minute.

Nigeria has made good progress in reducing new HIV infections and AIDS-related deaths, down by 46% and 53% respectively since 2010. However, the new infections are not declining fast enough. In 2023, there were an estimated 75,000 new HIV infections in Nigeria. AIDS related deaths were an estimated 45,000 in 2023. The status of the HIV testing and treatment cascade stood at 85%-85%-82% (whereby 85% of people living with HIV were diagnosed, 85% of those diagnosed were receiving Antiretroviral therapy and 82% of those all those receiving ART achieved viral suppression) as against the target of 95%-90%-86%.

In Nigeria, there are critical gaps that continue to undermine our efforts to end AIDS in children by 2030, with only 29% of the estimated number of children 0-14 years living with HIV on ART treatment (57% globally). Around 22 000 children aged 0-14 years old acquired HIV in 2023 (a third of all new infections in Nigeria in 2023), while AIDS-related deaths among children was estimated at 15,000 (a third of the estimated AIDS related deaths among all age groups in 2023).

Particular attention must be paid to addressing gender-based violence and discrimination, challenging harmful social norms and dismantling legal and structural barriers to health for adolescent girls and young women. About a third (29.5%) of ever-partnered women and girls aged 15 years and older reported being subjected to physical, sexual or psychological violence by a current or former intimate partner in the preceding 12 months. In addition, over half of women (55%) who have experienced physical or sexual violence have never sought help to stop the violence.

Although decreasing, HIV incidence among adolescent girls and young women is still high. In 2023, about 18,000 new infections occurred among young people aged 15-24 years with 72% of the infections among the females. This translates to about 250 new HIV infections every week among young women and girls aged 15—24 years old.

People living with and affected by HIV continue to suffer stigma and discrimination. In 2021, 19.4% of People Living with HIV (PLHIV) reported that they experienced stigma and discrimination in the general community while 15.4% of PLHIV reported experiencing HIV-related discrimination in health-care settings in the 12 months preceding the survey.

The prevalence of HIV among Key Populations (Female Sex Workers (FSW), Men who have Sex with Men (MSM), people who use drugs (PWID) and transgender people (TG) is disproportionately higher than the general population at 15.3%, 25%, 10.9% and 28.8% respectively. Despite the existing criminalizing laws in place, we need to ensure that HIV related services are made accessible to these Key Populations without discrimination following a Public Health approach. One Stop Shops (OSS) that provide services to Key Populations and other vulnerable groups need to be expanded as needed.

Progress against AIDS has been strongest in the countries that have invested as required in their HIV responses, and reformed their policies to enable people to access the services they need. The recently concluded National AIDS Spending Assessment in Nigeria (NASA) showed that most of the HIV funding in Nigeria was provided by international donors, primarily PEPFAR and The Global Fund (76% and19% respectively) in 2021, indicating a high dependence on external funding. Sufficient and sustainable resourcing, and a legal environment that facilitates access to effective, equitable and people-centred HIV services, are essential for ending the pandemic.

Technological advances, such as the development of long-acting treatment and prevention options, could be a game changer in the HIV response but only if these technologies are shared with all low- and middle- income countries, and are produced by multiple manufacturers across the world at scale. Right now, patent holders are not opening up access broadly enough to enable this breakthrough. In Nigeria, local production of Anti-retrovirals and other prevention commodities will in no small measure contribute to achieving the desired results in the HIV response.

All the challenges laid out by UNAIDS in this new report are surmountable. Success is not inevitable. The solutions are at hand. The HIV response is at a crossroads, in which the path to success is clearly signalled. The national leaders and authorities of the HIV response in Nigeria need to be bold and take that path.