In the lead up to December 1, 2023, World AIDS Day, with the global theme “Let Communities Lead” and domesticated in Nigeria as “Communities Leadership to end AIDS by 2030” reflects the country’s recognition of the importance and the significant role of communities’ leadership in driving the much-needed goals and targets for ending HIV/AIDS by 2030.
Communities are people living with, at risk of, or affected by HIV, leading the frontline of progress in the HIV response, working alongside donor partners, government, public health systems and other societal institutions, for the success and sustainability of the global response to HIV. Communities have been making a difference, together with the broader civil societies, communities play a significant role, particularly in hard-to-reach areas where access to modern healthcare services are limited and where the barriers of inequalities and the experiences of stigma and discrimination constrained access and uptake of HIV/TB and related health services.
In Nigeria, community-led interventions are often led by the Network of People Living with HIV/AIDS in Nigeria, NEPWHAN, Association of Women Living with HIV/AIDS in Nigeria, ASWHAN, Association of Positive Youths, APYIN, International Community of Women Living with HIV, West Africa (ICW-WA) and others to support the implementation of global and national strategies in HIV response.
The Global Fund’s statistics show that community organizations in Nigeria reached more than 1 million people with HIV testing and counseling services in 2020 and these organizations also distributed over 5.5 million condoms and provided support to thousands of people living with HIV.
During the lockdown due to COVID-19, Nigeria demonstrated that putting people at the centre of the AIDS response works in advancing HIV service delivery.
While many countries experienced HIV service disruptions, the PEPFAR-supported HIV programme in Nigeria experienced significant growth and exceeded some targets because of community engagement. A people-centred package of services was designed and deployed, utilizing existing community network machinery to ensure there were no disruptions in the delivery of HIV services.
Several examples also exist where communities have either catalysed innovative delivery of services for people living with HIV or are in the lead of implementing services.
Within the regional south-east context of Anambra and Ebonyi States, Nigeria, where NEPWHAN implements the community component of the Global Fund’s NAHI (National Aligned HIV/AIDS Initiative) grant, successes have been made in its pursuit of ending Mother-to-Child Transmission (MTCT) in these two states with high burden of vertical transmission.
NEPWHAN instituted rigorous Testing Protocols, ensuring that HIV testing is a standard component of antenatal care and an integral part of the prenatal care journey for pregnant women. The outcome is the achievement of an impressive PMTCT 1 coverage rate of over 80% in 2022 in Anambra state.
Achievement of this remarkable coverage rate could be attributed to several factors like, Comprehensive Testing Protocols, Free Maternal Health Initiative in partnership with the State Government, Community Outreach Program by Mentor Mothers and Women Empowerment programs.
In Ebonyi State as well, the outreach activities of Mentor-Mothers drastically reduced the vertical transmission of HIV in the last 3 years. Through their efforts, 12 clients who initially refused to accept their HIV status at Iboko General Hospital and Elunwovu General Hospital eventually embraced treatment and achieved viral suppression. All were led by the Community of People living with HIV (PLWH).
It is also good to mention the initiative of the Community “iMonitor +” app for HIV /AIDS communities, a novel digital approach towards improving community engagement and empowerment of PLWH in Nigeria. The app provides a platform for the community to report abuses and rights violations, information on service centres and surveys to track activities within the community.
The community of PLHIV in the country have demonstrated evidently that they are not only beneficiaries of services but are contributing and driving the lead in the HIV/AIDS response in Nigeria.
However, barriers to communities’ leadership roles exist and need to be removed. The leadership gaps in the communities which inhibit the performance of their roles have been recognized, dwindling resources, capacity constraints, and intermittent infringement on their human rights, as well as structural barriers in a heterogeneous society like Nigeria are some of the spotlighted barriers.
Communities will lead but need our support to overcome these challenges. Engaging and empowering diverse communities in a big country like Nigeria requires deliberate efforts in building strong relationships, continuous learning, adapting to changing circumstances, and celebrating incremental achievements.
Equally, as Nigeria makes an effort towards attaining the 95-95-95 target, community-led initiatives, supported by global donors like PEPFAR, Global Funds, UNAIDS, government and other partners, are an indispensable component of Nigeria’s HIV response in reducing new infections and improving the lives of those living and affected by the virus.
The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals.
Dr Leopold Zekeng, is the Nigeria Country Director of UNAIDS, he writes from Abuja
Dr Leopold Zekeng: Leveraging communities’ leadership to end Aids in Nigeria