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By Iyke Obi Durumba

Issues in the fight against the HIV/AIDS scourge came into focus again recently when civil society groups involved in the fight against the epidemic in Nigeria met to deliberate on the progress made so far, reflect on challenges and exchange ideas on the best strategies to achieve the goals of eradication of HIV/AIDS from Nigeria by 2030.

The 3-day conference themed ‘Domestic Resource Mobilization: Increasing public private sector investment’ was held in Abuja in November, is a precursor to the International Conference on AIDS and STIs in Africa ICASA scheduled for Kigali, Rwanda in 2019. It also featured a scientific symposium titled “Task shifting and Viral Load Testing – the role of community actors as partners”.

Welcoming over a hundred delegates from 10 African countries and the US, co-Chair of this year’s Civil Society Accountability Forum and Chair of the Peer Review Forum, Ize Adava highlighted the objective of harnessing local capacity to respond to funding challenges. She said the 2018 edition of the forum was designed to bring stakeholders together to deliberate on how to address the growing gap in domestic resourcing for AIDS control in Nigeria.

According to the organizers, Society for AIDS in Africa (SAA) and Peer Review Forum, the conference was convened to fast-track stakeholders’ commitment and action towards achieving the 2020 ‘90-90-90’ global goal and the 2030 goal of eliminating new HIV infection in Nigeria. The annual platform, the third of such, provided opportunities for critical stakeholders engaged with the HIV response in Nigeria to discuss and respond to several areas of concern about the status of HIV/AIDS treatment and health priorities in Nigeria.

Dr. Walter Ugwuocha, Executive Secretary Civil Society for AIDS and focal person for the conference explained civil society’s role further, “We’re doing a holistic engagement with the Federal Ministry of Health and the National Agency for the Control of AIDS. We’re asking them to step up and increase the number of people that are in treatment on government support.”

Presently, government funds just 5% of the HIV/AIDS program in Nigeria while partners provide the balance of 95%. However, with the threatened withdrawal of international donors from the program, the fate of tens of thousands hang in the balance. Explaining the importance of mobilizing local resources, Dr. Nnamdi Ugwuocha said civil society is asking the government to take over fully. He also added that demands are being made on the private sector to contribute their own resources.

“Government has no choice but to do it,” Ugwuocha said. “If they slack, people will die. No responsible government will want to see people dying.”
Nigeria has slightly over 3m people living with HIV with about 2.2m in need of treatment. So far, just slightly more than 1m are receiving Anti-Retroviral Treatment.

Emphasizing the need for increased funding, the immediate past DG NACA and current Chair Society for AIDS in Africa (SAA), Prof. John Idoko said Nigeria could not keep depending on grants and must look inwards. Speaking at the opening ceremony, he said, “If we do not have more resources, we will lose the gains we have made.”

Taking cue from the domestic resource mobilization theme of this year’s engagement, Ugwuocha explained civil society’s expectation from private sector involvement. “What we’re asking the private sector to do is to just buy the commodities and distribute to the facilities. We will get the government to employ the workers to go to those facilities as well as get the people living with HIV/AIDS to attend those facilities,” Ugwuocha said.

This best extrapolates the linchpin role CSOs play in the fight against HIV/AIDS. Their entirely issue-based, citizen participation structure are best suited best to produce real results using private sector resources backed by government policies and support.

Sharing experiences was also one of the objectives of the conference and Yvonne Kahimbura from the Eastern Africa National Networks of AIDS Service Organisations (EANNASO) presented a paper titled ‘Anglophone Africa GF CRG Platform efforts towards strengthening community engagement in the Global Fund and national processes’. Her presentation provided useful suggestions to help CSOs ensure that community needs are represented in the Global Fund country grant processes.

The three-day conference was structured into six plenaries (two per day) and nine sessions with at least two to three speakers per session. There were also two satellite sessions every day. As expected for such a gathering, the speakers were distinguished as evinced by the question lively question and answer bits.
One of the highlights of the scientific symposium was the highly expository presentation in the first plenary by Akanmu Sulaimon, Professor of Haematology and Transfusion Medicine on ‘reaching the third 90’ in the 90-90-90 plan.

The 90-90-90 is a plan announced in January 2017 by UNAIDS to ensure that by 2020, 90 per cent of all people living with HIV will know their HIV status; 90 per cent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy (ART); and 90 per cent of all people receiving ART will have viral suppression.

Prof Akanmu Sulaimon reaffirmed the UNAIDS position that the suppression of viral load achieved by sustained anti-retroviral use is the next strategy in the battle against the scourge. He listed some of the advantages of low viral load in people living with HIV/AIDS as the surest way of confirming efficacy of the anti-retrovirals and it also means less fear of ongoing transmission in the community. He affirmed the fact that suppression of viral load is the brightest chance of achieving a HIV/AIDS free country by 2030 and urged stakeholders to pursue the objective vigorously even in the face of challenges.

Statistics from UNAIDS show that about 24% of people living with HIV/AIDS in Nigeria have suppressed viral loads indicating more work to be done in bringing more people on the treatment program by deploying more resources. As Ugwuocha said, “the government agrees that every year there will be 50,000 people added to the govt-owned treatment. It is a milestone for us and we’re going to ensure that those 50,000 are not just promises but actual numbers.”

However, the DG NACA, Dr, Sani Aliyu had hinted at a shift in focus from treatment to prevention next year. Commenting on the ongoing new national survey for HIV/AIDS in Nigeria at the opening ceremony, the DG said 10 states had been concluded and while not giving anything away, he remarked on the need for increased deployment of resources towards prevention to accord with present realities. He also said the challenge of funding are being met by a HIV/AIDS Trust Fund which will be driven by the private sector and assured that Nigeria is prepared to own the fight against the epidemic.

As Civil Society Organizations continue to improve on their participatory roles using conferences such as this, it is envisaged that the resources of the private sector will boost local capacity towards meeting targets in the years up to 2030. An increased synergy between CSOs, private sector and government has become imperative to mobilize and optimize local resources in the fight against the epidemic.

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