Is health minister celebrating death of HIV patients?
•67% of people living with HIV knew their status.
•53% of people living with HIV were on treatment.
•42% of people living with HIV were virally suppressed. Although Nigeria has done well to increase the number of people who know their HIV status, the percentage of people who know is still much below the target 90% and 2020 is upon us. Also, the percentage of people initiated on treatment among those who tested positive is low. On the World’s AIDS Day, these are the statistics that should be conveyed, along with messaging to improve HIV testing.
Rather than celebrate the decline in HIV prevalence, which probably reflects the natural history of the epidemic, the country’s control programme should place more emphasis on the annual number of new infections. Incidence is a more immediate reflection of the programme’s efforts. Are the number of new infections decreasing in Nigeria?
The global campaign is to combat the scourge to the level of zero new infections by 2030. The government should be telling Nigerians where we are on the way to zero infections. Unfortunately, it seems our journey is yet to start. Recent estimates show that there has been an increase in the number of new HIV infections in Nigeria from 120,000 infections in 2010 to 130,000 new infections currently. Also, about two thirds of new HIV infections in West and Central Africa occur in Nigeria. If the number of new infections has in fact increased in the past decade, why should the decline in HIV prevalence be highlighted and lauded?
The UN targets that mother-to-child transmission should be eliminated by 2020, but Nigeria is quite far from achieving that. The success of the government’s prevention of mother-to-child transmission (PMTCT) is tied to the success of antenatal care uptake. Unfortunately, both antenatal uptake and PMTCT are below optimum in Nigeria.
Only 44% of pregnant women living with HIV in Nigeria received antiretroviral medicine to prevent transmission of the virus to their baby. Furthermore, early infant diagnosis at eight weeks of age to determine if infants born to HIV positive mothers were infected was only 18%. Current UNAIDS estimates show that over 20% of hiv-positive pregnant women in Nigeria transmit the virus to their children because of the country’s weak PMTCT programme. In contrast, in South Africa in 2018, 95% of pregnant women living with HIV received antiretroviral medicine to prevent transmission of the virus to their baby and early infant diagnosis using PCR testing stood at 94%. Mother-to-child transmission of HIV is now rare in South Africa, at less than one per cent.
The government should cease celebrating the decline in HIV prevalence in Nigeria and attributing it to the efforts of the country’s response programme. This decline is either due to improved surveillance or high HIV deaths. Rather, attention should be drawn to indicators that are more valid and meaningful, reflecting the progress made by the country towards targets set by the UN. Such indicators include, number of new HIV infections, percentage of people who know their HIV status, the percentage of PLHIV who are on treatment and the percentage of hiv-positive pregnant women who received treatment to prevent transmission of infection to their unborn children.
Concluded. •Bello, an epidemiologist, university lecturer and the research technical lead at the Centre for Statistical Analysis and Research based in Johannesburg and Abuja, wrote in via [email protected]sar-africa.com