HIV/AIDS and Tuberculosis

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Preventive HIV/AIDS counseling and outreach activities at the Nwugo motor park, Onitsha, Nigeria.
Preventive HIV/AIDS counseling and outreach activities at the Nwugo motor park, Onitsha, Nigeria. Photography by Jide Adeniyi-Jones

In Nigeria, an estimated 3.6 percent of the population is living with HIV and AIDS.  Although HIV prevalence (3.1%) is much lower in Nigeria than in other African countries such as South Africa and Zambia, the size of Nigeria’s population (around 149 million) meant that by the end of 2009, there were almost 3 million people living with HIV.

Approximately 192,000 persons died from AIDS in 2009.  With AIDS claiming so many lives, Nigeria’s life expectancy has declined significantly.  In 1991 the average life expectancy was 54 years for women and 53 years for men.  In 2009 these figures had fallen to 48 for women and 46 for men.

In addition, Nigeria has one of the highest tuberculosis (TB) burdens in the world (311 per 100,000), resulting in the largest burden in Africa.  Despite Nigeria’s rising TB detection rates and program coverage, many TB cases are still undetected.  The high rates of TB/HIV co-infection result in a significant health challenge in the HIV/AIDS response.

Nigeria has a general HIV epidemic; however, prevalence varies widely across states and rural and urban areas.  Concentrated HIV/AIDS epidemics occur in particular geographic regions and within certain segments of the population.  Nigeria’s epidemic is largely fueled by heterosexual and mother-to-child transmission, but there are clear identifiable risk groups similar to those in many other African countries.  According to the 2007 Integrated Bio-Behavioral Surveillance Survey, this is evidenced in a significantly higher infection rate among most-at-risk populations, including commercial sex workers, injecting drug users, and men who have sex with men. Risky behaviors continue and are targets for USAID/Nigeria’s key prevention interventions. 

Nigeria has been slow to recognize the gravity of the epidemic and to mobilize the required commitment and resources for a sustainable national response.  While progress has been made in policy development and strategic planning at the Federal level, provision of care, treatment, and prevention services remains inadequate and the level of unmet need continues to increase.

HIV/AIDS and Tuberculosis Strategy:

The United States Government provides the largest amount of funding to combat HIV/AIDS in Nigeria. USAID/Nigeria implements its HIV/AIDS and TB activities under a comprehensive approach with other United States Government agencies, including the Centers for Disease Control and Prevention and the Department of Defense, which are all working as part of the President’s Emergency Plan for AIDS Relief (PEPFAR).

Prevention: In partnership with the Government of Nigeria and civil society, prevention activities include initiatives to prevent mother-to-child-transmission and the prevention of sexual transmission of the HIV virus (abstinence and be faithful programs, condoms/other prevention initiatives).  Other interventions include the prevention of medical transmission of the HIV virus (blood and injection safety). Prevention activities are integrated into all care and treatment activities, including HIV counseling and testing services. 

Care: USAID/Nigeria provides care to TB/HIV patients, adult and pediatric cases as well as support to orphans and vulnerable children.  Through these activities, assistance has been refocused from providing emergency responses to sustained efforts to ensure that clients receive ongoing care and support.  Strategies include greater focus on improved quality, sustainability, pooled procurements, cost efficiencies, and health systems strengthening.

Treatment: For AIDS treatment, USAID/Nigeria provides antiretroviral drugs and services to eligible patients, as well as laboratory support for the diagnosis and monitoring of HIV-positive patients.  The treatment program features reduced target costs, cost-leveraging, and health care worker training by all implementing partners to harmonize and standardize treatment services.
 
TB: Activities are designed to reduce TB transmission, improve diagnosis, and manage multi-drug-resistant-TB cases, especially among HIV positive patients.  Routine HIV testing is also a priority in USAID’s TB Directly Observed Treatment Short-Course.

Human Systems Strengthening: Activities are designed and implemented to strengthen Nigeria’s governance and management of its health system’s service delivery, financing, human resources, provision of supplies and medications equipment, and infrastructure. Strategies focus on supporting national ownership and leadership by Nigeria’s national institutions and organizations.

Funding: USAID assistance to the Government of Nigeria represents just over half of the PEPFAR/Nigeria budget. USAID/Nigeria spent over $1.5 billion between 2004 and 2009.

Expected Results:

  • Increased access to quality HIV/AIDS and TB care and treatment services
  • Increased access to quality HIV/AIDS and TB prevention services
  • Strengthened health care systems
  • Strengthened cross-sectoral integration of HIV/AIDS and TB programs
  • Strengthened public, private, and community enabling environment