Nigeria: National Policy On HIV/AIDS

H, PEACE & PRO
& FAIT G RE
ITY SS
UN
NATIONAL POLICY ON
HIV/AIDS
October 2009
Go od P eo pl e G re at N ation
National Policy on HIV/AIDS
FOREWORD
As 2015 deadline for attaining/achieving the MDGs draws closer, the challenge of our
HIV response goes beyond meeting these goals; it lies in preventing needless loss of
lives and human tragedy. Our success will be measured by the number of new
infections averted and lives saved.
Much has happened in Nigeria since the commencement of the multisectoral response
and the birth of NACA in 2002. We have seen more political commitment from
government and all stakeholders resulting in an expanded response with the launch of
the Universal Access to HIV prevention, treatment, care and support. Recently the
Nigerian response has taken more action to promote the needs and rights of vulnerable
groups including women, young people and children. In the same light, the response is
breaking the barriers of stigma and discrimination and giving PLWHAs their rightful
position as meaningful leaders in the fight against HIV. We are also seeing more
coordinated responses and stronger partnerships locally and internationally.
The first National Policy towards addressing the HIV/AIDS epidemic was developed
in 1997 by the Federal Ministry of Health and designed to limit the spread of HIV and
AIDS in the country at a time the epidemic was evolving and the information and
knowledge of the epidemic was limited. By 2001, the country enacted a new National
Policy on HIV/AIDS and adopted the multisectoral approach to her response in order
to ensure the full involvement of all sectors of the economy relevant to the control of
the HIV epidemic (in planning, implementation and evaluation of the country HIV
response). In addition all sectors were encouraged to develop plans and process
frameworks to mitigate the impact of the epidemic.
This current policy review on HIV and AIDS has been a product of extensive and
comprehensive participation of all stakeholders and a wide representation from all tiers
of society in the spirit of a multisectoral, multidisciplinary approach to prevention and
control of HIV. In addition, consultations included the mainstreaming of gender
concerns and the needs and rights of vulnerable groups. In line with the current
dynamics of the epidemic in the country, plans to actualize this policy have been
developed simultaneously and costed at the centre, in all the states and many relevant
sectors including line ministries and civil society platforms.
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This policy is an improvement on previous ones and has been the result of a detailed
evaluation of our current position and what we want to achieve in future halting and
reversing the HIV epidemic in Nigeria. This policy makes clear our commitment to
play the leadership and ownership role in reaching the goals of universal access, halting
and reversing the HIV epidemic. It makes comprehensive HIV prevention the priority
and focus, as this is the only way of curbing as well as minimizing the impact of the
epidemic.
This policy places individuals (people) at the centre of the response. HIV is an infection
that can affect any individual man, woman, or child, rich or poor. We therefore need to
empower individuals, families, communities with the knowledge and ability to protect
themselves from infection and provide support for those individuals and families
living with or affected by HIV to lead healthy and productive life.
Through this policy, the Government of Nigeria and all partners are committed to
working tirelessly to realize the common goal of halting and reversing the spread of
HIV in Nigeria and mitigating its impact on the people.
Professor John Idoko

Director General
National Agency for the Control of AIDS
October 2009.
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ACKNOWLEDGMENT
Glory and Honor be to the Almighty God for His providence and enablement in getting
this done.
NACA wishes to thank all Stakeholders who in one way or the other contributed to the
review of the National Policy on HIV/AIDS (2003) implementation in Nigeria and the
development of this revised Policy.
There is a need to mention the excellent direction and resource mobilization efforts of
the members of the Core and Advocacy group that constituted the Governance teams to
the process. Also appreciated is the immense contributions and sacrifices of all
stakeholders involved in the Policy Review consultations (Federal Ministries,
Development Partners, Civil Society Networks- CiSHAN, NEPWHAN, NiBUCAA &
NEPWHAN, State AIDS Control Agencies and the National Assembly), validation of
the review report, policy drafting meeting as well as consensus and validation meetings
of the revised National Policy.
The Lead Consultant Dr Adesegun Fatusi and the Co-Lead Consultant Dr Ifene
Enyantu deserve special appreciation for carrying out this task efficiently and
effectively in a timely manner despite their very tight schedules leading to the
production of this timeless document. Specific mention must be made also of the
Directors and Deputy Directors at NACA for chairing the review meetings and the
thematic drafting meetings.
At this juncture, I wish to appreciate all our partners within the National Response to
HIV/AIDS in Nigeria for their immeasurable support and abiding faith in the system.
Specifically, UNAIDS, UNDP, UNFPA, ENR/SFH and the United States Government
deserve to be commended for their technical, human and financial support to the
process.
This piece will be incomplete without appreciating the role played by Dr Naamara
Warren, Lord Dartey, Dr Godwin Asuquo, Chidozie Ezechukwu, Fatima Kolo, Jumai
Danuk, as well as the facilitators at the thematic drafting meeting-Dr Uwem Esiet, Dr
Kola Oyediran, Dr Kalada Green, Dr Omokhudu Idogho and Dr Hadiza Khamofu, Dr.
Comfort Agada and all others too numerous to mention.
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May I thank the Director General of NACA Professor John Idoko for his leadership and
all my colleagues especially Directors for their inputs to the process from
conceptualization to development Dr Kayode Ogungbemi, Dr Akudo Ikpeazu, Mrs.
Maimuna Yakubu Mohammed, Barrister Patrick Abah and Mr. Edward Okpaire.
Finally, to the Secretariat of the entire process, the coordination of which was led by
Mrs. Esther Ikomi with the support of Mrs. Tine Worji and Seun Oshagbami who did
wonderfully well; Nigeria and Nigerians appreciate you all.
It is only the full implementation of this National Policy on HIV/AIDS in good faith that
can lead to significant impact on the National Response to HIV/AIDS in the country and
positively impact on our people, so let the work commence now!
Alex Ogundipe mps,

Director, Policy & Strategy
National Agency for the Control of AIDS (NACA)
October 2009
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ACRONYMS AND ABBREVIATIONS
AIDS - Acquired Immune Deficiency Syndrome

ART - Antiretroviral Therapy
BCC - Behavior Change Communication
CPT - Cotrimoxazole Preventive Therapy
CSOs - Civil Society Organisations
DOTS - Directly Observed Treatment Short Course
EID - Early Infant Diagnosis
FBOs - Faith-Based Organisations
FCT - Federal Capital Territory
FMoH - Federal Ministry of Health
FSWs - Female Sex Workers
GIPA - Greater involvement of People with AIDS
HAPSAT - HIV/AIDS Program Sustainability Analysis Tool
HCT - HIV Counselling and Testing
HEAP - HIV/AIDS Emergency Action Plan
HIV - Human Immunodeficiency Virus
ICT - Information Communication Technology
IDU - Injecting Drug Users
IEC - Information, Education and Communication
IPT - Isoniazid Preventive Therapy
LACAs - Local Government Action Committee on AIDs
M&E - Monitoring and Evaluation
MAP - Multi-Country AIDS Programme
MARPs - Most-at-Risk Populations
MDAs - Ministries, Departments and Agencies
MIPA - Meaningful Involvement of People with AIDS
MSM - Men who have Sex with Men
MTCT - Mother to Child Transmission of HIV
NACA - National Agency for the Control of AIDS
NAFDAC - National Agency for Food and Drug Administration and Control
NARHS - National HIV/AIDS and Reproductive Health Survey
NASCP - National AIDS and STI Control Programme
NDHS - Nigeria Demographic and Health Survey
NEACA - National Expert Advisory Committee on AIDS
NGOs - Non-Governmental Organisations
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NNRIMS - Nigeria National Response Information Management System

NSF - National Strategic Framework
OIs - Opportunistic Infections
OVC - Orphans and Vulnerable Children
PABA - People Affected By HIV/AIDS
PHC - Primary Health Care
PHDP - Positive Health, Dignity and Prevention
PITC - Provider-Initiated Testing and Counselling
PLHIV - People Living with HIV/AIDS
PMTCT - Prevention of Mother to Child Transmission of HIV
SACAs - State Action Committees on AIDS/State Agency for the Control of
AIDS
SRH - Sexual and Reproductive Health
STIs - Sexually Transmitted Infections
TB - Tuberculosis
UNAIDS - Joint United Nations Programme on HIV/AIDS
UNGASS - United Nations General Assembly Special Session
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CONTENTS
1. Background 1
1.1. Introduction 1
1.2. Epidemiology 1
1.3. National Response 3
1.4. Impact of the HIV Epidemic 4
1.5. Rationale for Policy 5
2. Policy Framework 7
2.1. Policy Context 7
2.2. Policy Considerations 8
2.3. Guiding Principles 9
2.4. Overall Goal 10
2.5. Main Target 10
2.6. Strategic Thrusts 10
2.6.1. Prevention of new infections and behaviour change 10
2.6.2. Treatment 11
2.6.3. Care and support for infected and affected persons 11
2.6.4. Institutional architecture and resourcing 11
2.6.5. Advocacy, legal issues and human rights 11
2.6.6. Monitoring and evaluation 11
2.6.7. Research and knowledge management 11
3. Behaviour change and prevention of new infections 12
3.1. Rationale 12
3.2. Thematic Goal 12
3.3. Thematic Objectives 12
3.4. Policy Statements 13
A. Promotion of safer sex behaviour through
communication-related interventions 13
B. Promotion of appropriate use of male and female
condoms and lubricants 14
C. Prevention of biomedical transmission of HIV 15
D. HIV counselling and testing 17
E. Prevention of mother-to-child transmission of HIV 18
F. Early diagnosis and effective treatment of sexually
transmitted infections 20
G. Positive Health, Dignity and Prevention interventions 21
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4. Treatment 23
4.1. Rationale 23
A. Treatment of HIV/AIDS and related health problems 24
B. TB/HIV collaborative activities 25
5. Care and support of infected and affected persons 27
5.1. Rationale 27
A. Persons Living with HIV/AIDS 28
B. Persons Affected by HIV/AIDS 29
C. Orphans and Vulnerable Children 29
6. Institutional architecture and resourcing 31
6.1. Rationale 31
A. Coordinating Structure at National Level 32
B. National Level Resource Mobilisation
and Sustainability 33
C. State Level Coordination System and Resourcing 34
7. Human rights and legal issues 36
7.1. Rationale 36
A. Promotion and protection of rights and
empowerment of PLHIV 36
B. Protection, participation and empowerment of
vulnerable populations 37
8. Monitoring and evaluation 43
8.1. Rationale 43
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9. Research and knowledge management 45
9.1. Rationale 45
10. Policy Implementation: Roles and responsibilities 47
10.1. Public Sector 47
10.1.1. Office of the President 47
10.1.2. National and State Assemblies 47
10.1.3. Ministries, Departments and Agencies 48
10.2. Media 50
10.3. Civil Society 51
10.3.1. Non-governmental organisations 51
10.3.2. Faith-based organisations 51
10.3.3. Traditional and religious leaders 52
10.4. Private Sector Organisations and Enterprises 52
10.5. International Development Partners 52
10.6. Rights, roles and responsibilities of People
Living with HIV/AIDS 53
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1. BACKGROUND
1.1. Introduction
The first case of Acquired Immune Deficiency Syndrome (AIDS) in Nigeria was
reported in 1986. Since then, infection with Human Immunodeficiency Virus (HIV) has
spread to become a generalised epidemic affecting all population groups and sparing no
geographical area in the country. HIV/ AIDS has negatively impacted every sector of
the economy, and continues to threaten the national development gains of the past
decades. The effect of HIV and AIDS remain great as it continues to devastate
individuals, families and households, affecting their physical, social, psychological,
and economic well-being. Unarguably, HIV and AIDS constitute a leading
development challenge and a major threat to the general advancement of the nation as
well as her capacity to achieve the Millennium Development Goals (MDGs).
Despite mounting various responses over two decades, the challenge of HIV/AIDS has
continued to increase in Nigeria, particularly in terms of the number of people infected
and affected. Estimates from the Joint United Nations Programme on HIV/AIDS
(UNAIDS), for example, show a rise of 400,000 in the number of people living with
HIV/AIDS in Nigeria between 2001 and 2008. With an estimated 2.95 million people
living with HIV in Nigeria in 2008, Nigeria ranks as one of the countries with the highest
burden of HIV infection in the world, next only to India and South Africa. These
realities compel urgent review of the national response and re-strategising to achieve a
more effective control of the epidemic; the national policy constitute a cornerstone and
veritable instrument for renewed national vision and efforts to combat the HIV/AIDS
challenge.
1.2. Epidemiology
Nigeria has witnessed fluctuations in HIV prevalence level in the last 15 years, but with
an overall picture of significant increase within the period. The result of the periodic
national HIV sero-prevalence survey, which is obtained through sentinel survey of
antenatal care attendees, showed an increase from 1.9 percent in 1991 to 5.8 percent in
2001. The HIV prevalence then declined to 5.0 percent in 2003 and further to 4.4
percent in 2005. This decline, unfortunately, has been followed by a recent rise to 4.6
percent in 2008. Based on the latest result, NACA estimates that 2.95 million people in
Nigeria are currently infected, of which 278,000 are children and 1.72 million (58.3
percent) are females. Young people are also disproportionately infected, with the
prevalence in age group being 5.6 percent. In general, the most-at-risk groups include
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sex workers and their clients, injecting and other drug users, and men who have sex
with men (MSM), and mobile populations such as long-distance drivers and uniformed
services personnel. Young people, prisoners and people in other custodial settings also
constitute highly vulnerable groups. The result of mode of transmission analysis in
Nigeria, carried out by the National Agency for the Control of AIDS (NACA) in 2008,
showed that about 62 percent of new infection occur among persons perceived as
practicing “low risk sex” in the general population including married sexual partners.
The rest of the new infections (38 percent) are attributable to injecting drug users
(IDU), female sex workers (FSWs), MSM and their partners who constitute about 3.5
percent of the adult population.
The leading route of HIV transmission in Nigeria is heterosexual sex, accounting for
over 80 percent of the infections. Mother-to-child transmission and transfusion of
infected blood and blood products rank next as common routes of infection, each
accounting for almost ten percent of infections. However, other modes of transmission,
particularly intravenous drug use (IDU) and same-sex intercourse, are slowly growing
in importance. The drivers of the HIV epidemic in Nigeria include: low risk perception,
multiple concurrent partners, informal transactional and inter-generational sex, lack of
effective services for sexually transmitted infections (STIs), and poor quality of health
services. Gender inequalities, poverty and HIV/AIDS-related stigma and
discrimination also contribute to the continuing spread of the infection.
The epidemiological picture regarding HIV shows considerable diversity across

Nigeria's geographic landscape, both in terms of the level of infection and the trend. The
2008 national survey, for example, shows the HIV sero-prevalence level as ranging
from 1.0 percent in Ekiti State (in South-West geo-political zone) to 10.6 percent in
Benue State (North-Central geo-political zone). Seventeen states and the Federal
Capital Territory (FCT) recorded sero-prevalence of at least five percent. Sero-
prevalence level was seven percent or higher in seven states: Benue (North-Central
zone) 10.6 percent, Nasarawa (North-Central zone) 10.0 percent, Kaduna (North-
West zone) 7.0 percent, Akwa Ibom (South-South zone) 9.7 percent, Bayelsa (South-
South zone) 7.2 percent, Cross River (South-South zone) 8.0 percent, and Rivers
(South-South zone) 7.4 percent. The median sero-prevalence rate for the geo-political
zones varies considerably: North-Central 5.4 percent; North-East 4.0 percent; North-
West 2.4 percent; South-East 3.7 percent; South-South 7.0 percent and, South-West
2.0 percent. The FCT, with a sero-prevalence level of 9.9 percent is one of the worst
affected geographical areas in the country.. Again, whereas urban population recorded
higher prevalence than the rural in most states, the reverse is the case in nine states and
the FCT. The geographic dissimilarities in the dynamics of the epidemics suggest that
the influence and contributions of various high-risk behaviours may vary in their
relative importance in the various communities and geographical settings within the
country.
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1.3. National Response
Nigeria's national response commenced shortly after the official declaration of the first
AIDS case in 1986 with the establishment of a National Expert Advisory Committee on
AIDS (NEACA) with mandate to report directly to the Minister of Health. The
establishment of the National AIDS and STI Control Programme (NASCP) in the
Federal Ministry of Health in 1988 marked the beginning of more coordinated
response, albeit essentially health sector response. The era of multi-sectoral response
began in 1999 with the National Action Committee on HIV/AIDS established to
coordinate the multi-sectoral response and to report to the just established Presidential
Committee on AIDS. The National Action Committee later transformed into a full
agency the National Agency for the Control of AIDS (NACA) in 2007 by an Act of the
National Assembly to further strengthen its coordinating role and the overall national
response. The State Action Committee on AIDS (SACA) and the Local Government
Action Committee on AIDS (LACA) are the coordinating bodies at the sub-national
level. Similar to the transformation of NACA, several SACAs have become self-
accounting government agencies.
The country had previously developed two national policies on HIV/AIDS (in 1997
and 2003 respectively) as part of the efforts to strengthen the national response. To
further strengthen the response in the immediate multi-sectoral era, the HIV/AIDS
Emergency Action Plan (HEAP) was developed to guide the national response between
2001 and 2003 periods. HEAP was replaced by the National Strategic Framework
(NSF) in 2005. Nigeria National Response Information Management System
(NNRIMS) for HIV/AIDS has also been developed under the multi-sectoral response.
These developments had enabled the country's national response to operate under the
framework of the “Three Ones” principle One coordinating agency (NACA), one
strategic plan (NSF), and one monitoring and evaluation framework (NNRIMS).
Nigeria has experienced a number of other positive results in her HIV/AIDS national
response since 1999. Among others, is an increase in the level of awareness of
HIV/AIDS and reduction in the level of stigma between 2003 and 2007 as the results of
the National HIV/AIDS and Reproductive Health Survey (NARHS) show. A
comparison of the 2003 and 2007 NARHS results also show that the proportion of
people who took HIV test increased from 6.6 percent to 14.4 percent for females, and
from 7.7 percent to 14.7 percent for males. The Nigeria National Response to
HIV/AIDS Update published by NACA in 2009 indicates that 675,555 pregnant
women have received HIV counseling and testing in the context of prevention of
mother-to-child transmission of HIV (PMTCT) by December 2008. While the number
of people living with HIV accessing antiretroviral therapy was about 13,500 in 2004,
the Sustainability Analysis of HIV/AIDS Services in Nigeria (HAPSAT) of 2009
reported the figure to have increased to 269,000 by March 2009.
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However, considerable challenges still remain in the HIV response. Among others, the
proportion of the population that have access to and are accessing HIV counseling and
testing (HCT), though increasing, is still low; there is inadequate and inequitable
access to antiretroviral therapy (ART); and, the number of orphan and vulnerable
children (OVC) is rising. Several population-based surveys, including Nigeria
Demographic and Health Survey (2003, 2008), NARHS (2003, 2005, 2007), and
HIV/AIDS Behavioural surveillance Survey (2005), have reported a gap between
awareness and comprehensive knowledge of HIV prevention on the one hand, and
between knowledge and behaviour on the other hand. The preliminary report of the
2008 Nigeria Demographic and Health Survey (NDHS), for example, indicates that
while awareness of HIV was almost universal (88 percent of women aged 15 to 49
years and 93 percent of men aged 15 to 59 years), only half of women and two-thirds of
men (48 and 68 percent, respectively) know that using condoms and limiting sexual
intercourse to one uninfected partner are both means of preventing the spread of HIV.
While educational level was associated with higher level of HIV knowledge, the 2008
NDHS report also shows that higher-risk sexual behaviour such as sexual intercourse
with a person who is neither a spouse nor a cohabiting partner was higher among the
more educated people. Furthermore, only a third of women aged 15 to 49 years and half
of men aged 15 to 59 years (33 and 53 percent, respectively) who had sexual
intercourse with a non-spousal or non-cohabiting partner between 2007 and 2008 used
condom during the last of such sexual encounter. The result of the Integrated
Biological and Behavioural Survey conducted in 2007 also shows a fairly high level of
risk behaviour among selected groups of most-at-risk populations for HIV and AIDS,
including transport workers, injecting drug users (IDUs), and members of the police
force. Additionally, a high level of stigma is still attached to certain risk-behaviour
groups like female sex workers (FSWs), drug users, and MSM, delimiting the volume
and quality of outreach to such groups in the country. Furthermore, there is inadequate
funding as well as capacity for HIV/AIDS programme management particularly at sub-
national levels. The diversity of players in the national response to the epidemic and
their range of activities have also generated coordination challenges between
hierarchies of institutions and among programme categories.
1.4. Impact of the HIV/AIDS Epidemic
While clear data are lacking in terms of quantification of impact in many areas of the
national life, there is absolutely no doubt that HIV and AIDS epidemic has impacted
every area of the Nigerian society negatively. The most obvious impact is in the area of
morbidity and mortality. The April 2009 update from NACA indicates that an estimated
2.99 million people, consisting of 1.38 males and 1.61 females, have so far died from
HIV-related causes in Nigeria. The Federal Ministry of Health, in the report of the 2008
HIV sero-prevalence sentinel survey, further estimates the current figure of annual
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deaths from HIV-related causes as 280,000. Thus, the prospect for the future is grim
except effective control is achieved and urgently too.
As reported by the Federal Ministry of Health in the report of the 2008 National HIV
Sero-prevalence Survey, Nigeria had witnessed a negative trend in life expectancy
lately. Citing the Human Development Report produced periodically by the United
Nations Development Programme, the report noted that whereas the life expectancy in
the country increased from 45 years in 1963 to 51 years in 1991, it has subsequently
decreased to 46.5 years by 2005. The HIV/AIDS epidemic is likely to have been one of
the major contributors to this reduction in life expectancy.
The high impact of HIV/AIDS is also evidenced in the fast rising number of children
orphaned by AIDS. The Federal Ministry of Women Affairs and Social Development, in
its Orphan and Vulnerable Children National Plan of Action (2006-2010) reported that
1.8 million children were orphaned by AIDS in Nigeria in 2003 while the Federal
Ministry of Health, in the 2008 HIV sentinel survey report, estimated the figure to be
2.23 million for 2008. Given the slow progression of HIV to AIDS, the number of
children orphaned by AIDS will continue to rise in the next decade even if the
transmission of the infection is drastically reduced within a short time.
With the high number of death, AIDS is likely to pose significant human resources
challenge to the country. With the epidemic picture, which shows urban and young
population having higher sero-prevalence, it is likely that the disease will
disproportionately affect young professionals. It will likely impact on every area of
human endeavour, including the educational, health, agricultural and defense sectors,
among others.
Already, HIV is straining the currently over-burdened health system; the human and
logistic challenge of providing ARV services, for example, is overwhelming vis-à-vis
the capacity of many facilities despite the fact that only 269,000 of the estimated
740,000 clinically eligible people for ARV are currently receiving such as reported by
the 2009 HAPSAT. As HAPSAT report further notes, approximately 4500 new patients
are being added to the treatment list monthly. With reduced number of health workers
that may be occasioned by HIV/AIDS-related death and diminished economic
resources that may result from HIV impact on the economy, the situation could be worse
in the future except effective interventions are mounted.
1.5. Rationale for the Policy
The goal of the revised National Policy on HIV/AIDS (2003) is to control the spread of
HIV/AIDS in Nigeria and mitigate its social and economic impact. To achieve this
goal, the policy focuses on five strategic components: (1) Prevention of HIV/AIDS (2)
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Law and ethics (3) Care and Support (4) Communication, and (5) Programme
Management and Development. The National Strategic Framework (NSF) provides
the broad structure for multi-sectoral implementation of the policy.
However, as the epidemic progresses, it is apparent that despite achievements of the

broadened approach to HIV/AIDS and some positive results, difficult policy issues
around the strategic components are emerging. These include the differential impact of
the epidemic on women, the rising deluge of orphans, pervasive violations of human
rights of persons living with AIDS, and conflicting messages around abstinence and
condom promotion and sex education in schools. Other critical issues are the medical
and social implications of increasing access to treatment and care, the roles and
responsibility of people living with HIV (PLHIV), research ethics and the evolving
roles of stakeholders in the national response. These and other issues make the need for
a comprehensive review of national policy evident and urgent.
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2. POLICY FRAMEWORK
2.1. Policy Context
This revised policy has been developed within the context and in agreement with
selected key national and international framework that are germane to the national
response to HIV/AIDS in Nigeria:
� The 1999 Constitution of the Federal Republic of Nigeria, which affirms the
national philosophy of social justice and guarantees the fundamental right of
every citizen to life and to freedom from discrimination. The constitution
recognises a three-tier level of governance.
� Complementary Government documents provide the framework for this

policy, including the NACA Act, Medium Term Strategy, National Economic
Empowerment and Development Strategy (NEEDS) I and II, National Gender
Policy, and the Seven-Point Agenda of the Federal Government of Nigeria.
� This Policy also responds to government ratification of and commitment to

numerous international conventions including Universal Declaration of
Human Rights (1948), the Convention on Economic, Social and Cultural
Rights (1976), the Convention on the Elimination of All Forms of
Discrimination against Women (1979), Convention on the Rights of the Child
(1989), and the African Charter on Human and People's Rights (July, 2003).
� Specifically it is derived from agreed goals of international community to fight

the epidemic and mitigate its impact which Nigeria ratified. These include:
Programme of Action of the International Conference on Population and
Development ICPD (1994), The Political Declaration and further action and
initiatives to implement the Beijing Declaration and Platform for Action
(2000), Political Declaration at the World Summit for Social Development
(1995), The United Nations Millennium Declaration (September, 2000) which
target 2015 for reversal of epidemic trajectory. Others are the Greater
Involvement of People with AIDS (GIPA) and Meaningful Involvement of
People with AIDS (MIPA) Principles, The Abuja Declaration and Framework
for Action for the Fight Against HIV/AIDS, Tuberculosis and other related
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diseases in Africa (April, 2001) and The United Nations General Assembly
Special Session on HIV/AIDS (UNGASS) (June, 2001) at which countries
committed to ensure an urgent, coordinated and sustained response to
HIV/AIDS. Other relevant international document include the New York Call
to Commitment linking HIV/AIDS and sexual and reproductive health (SRH),
and the Glion call to action on family planning and HIV in women and children.
� The policy's goal and focus also derived from Nigeria's commitment to
Universal Access to comprehensive HIV prevention, treatment, care and
support as enunciated in the following: the 2005 Gleneagles G8 Universal
Access Targets, the 2006 United Nations Political Declaration on HIV/AIDS,
the African Union's Abuja Call for Accelerated Action towards Universal
Access to HIV/AIDS (2006), and the 2006 Brazzaville Commitment on scaling
up towards Universal Access to HIV and AIDS prevention, treatment, care and
support services in Africa by 2010.
2.2. Policy Considerations
The following are some of the key considerations which inform the articulation of this
Policy:
� HIV/AIDS epidemic in Nigeria threatens the well-being of many Nigerians,

burdens families, impoverishes communities, weakens institutions and
threatens the social and economic development of the country.
� As a public health issue, HIV/AIDS directly affects the health of millions of

infected persons, contributes to maternal and under-five mortality rates and
places unprecedented stress on already overburdened health care system.
� Prevention, treatment, care, support, and impact mitigation are mutually

reinforcing elements of a comprehensive response to HIV/AIDS; advancing
a public health-based response that integrates principles of these elements is
critical for success of the national response.
� Significant sections of the population are most at risk of infection due to

social, cultural and economic conditions which create and sustain
vulnerability to HIV infection. The most vulnerable are women and girls,
young people, the physically challenged people and mobile populations.
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� HIV/AIDS-related stigma remains all pervasive and that people infected or

affected by HIV/AIDS are discriminated against and denied access to
compassion, care and support and social services.
� Culture, traditions and religion have a strong influence on behaviour, attitudes
and practices of majority of Nigerians and traditional and faith based
institutions as gate keepers of attitudes and behavior and joint facilitators of
social transformation are critical assets in the fight against the disease.
� Effective response to HIV/AIDS requires respect for, protection of and

fulfillment of all human rights civil, political, economic, social, and cultural
and upholding the fundamental freedoms of all people in accordance with the
country's constitution and existing international human rights principles,
norms and standards.
2.3 Guiding Principles
This policy shall be based on, and governed by the following principles:
� Strong political leadership and commitment to transparency and prudent

management of financial and other resources at all levels for sustained response
to HIV/AIDS.
� Multi-sectoral approach that is community-based, community-driven, gender-

responsive and forges broad partnerships, dialogue, consultations and effective
coordination among stakeholders.
� Commitment to scale up prevention among the general population as well as

among high risk and other groups vulnerable to HIV infection.
� Protection and promotion of the rights and access of PLHIV to comprehensive

health care and other social services.
� Commitment to protecting rights of PLHIV, reduction of stigma and

discrimination and ensuring greater involvement of PLHIV in national
HIV/AIDS program at all levels.
� Commitment to promote and protect rights and reduce vulnerability of women,

children, young people and marginalised groups to HIV infection.
� Promotion of comprehensive approach that strongly links HIV prevention,

treatment, care and support and geared towards universal access.
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� HIV/AIDS-related stigma remains all pervasive and that people infected or

affected by HIV/AIDS are discriminated against and denied access to
compassion, care and support and social services.
� Culture, traditions and religion have a strong influence on behaviour, attitudes
and practices of majority of Nigerians and traditional and faith based
institutions as gate keepers of attitudes and behavior and joint facilitators of
social transformation are critical assets in the fight against the disease.
� Effective response to HIV/AIDS requires respect for, protection of and

fulfillment of all human rights civil, political, economic, social, and cultural
and upholding the fundamental freedoms of all people in accordance with the
country's constitution and existing international human rights principles,
norms and standards.
2.3 Guiding Principles
This policy shall be based on, and governed by the following principles:
� Strong political leadership and commitment to transparency and prudent

management of financial and other resources at all levels for sustained response
to HIV/AIDS.
� Multi-sectoral approach that is community-based, community-driven, gender-

responsive and forges broad partnerships, dialogue, consultations and effective
coordination among stakeholders.
� Commitment to scale up prevention among the general population as well as

among high risk and other groups vulnerable to HIV infection.
� Protection and promotion of the rights and access of PLHIV to comprehensive

health care and other social services.
� Commitment to protecting rights of PLHIV, reduction of stigma and

discrimination and ensuring greater involvement of PLHIV in national
HIV/AIDS program at all levels.
� Commitment to promote and protect rights and reduce vulnerability of women,

children, young people and marginalised groups to HIV infection.
� Promotion of comprehensive approach that strongly links HIV prevention,

treatment, care and support and geared towards universal access.
10
� Strengthened linkages and forged synergies between HIV/AIDS programmes

and poverty alleviation initiatives to break the vicious cycle of the disease and
its relationship with economic disempowerment.
� Determination to address social, economic and cultural factors responsible for

disproportional vulnerability of women and girls to HIV infection.
� Mainstreaming of gender into all policy-related and programming activities

and related structures to ensure that all interventions and programmes are
gender-sensitive and gender-responsive, appropriately meeting the separate as
well as related needs of females and males.
� Promotion of consistent and effective partnerships and collaboration with

development partners.
2.4 Overall Goal
The overall goal of the National Policy on HIV/AIDS is to provide a framework for
advancing the national multi-sectoral response to the HIV/AIDS epidemic in Nigeria so
as to achieve effective control by reducing the rate of new infections, providing
equitable care and support for those infected and affected, and mitigating the impact of
the infection, thereby enabling all people in Nigeria to be able to achieve socially and
economically productive lives free of the disease and its effects.
2.5 Main Target
The main target of the policy is to have halted and begun to reverse the spread of HIV,
provide quality treatment for people living with HIV, and offer care and support to
people infected and affected by HIV/AIDS by 2015 as Nigeria moves towards fulfilling
its Universal Access commitment.
2.6 Strategic Thrusts
The strategic thrusts of the policy are as follows:
2.6.1.Behaviour change and prevention of new infections: focuses on prevention

of new infections through the adoption of safer use of preventive
technologies and health promoting services, including sexual and
reproductive services, and empowering individuals and communities to
drive an inclusive and participatory social process;
11
2.6.2.Treatment: addresses issues of access to antiretroviral, tuberculosis/HIV

collaborative activities and prevention and management of opportunistic
infections;
2.6.3.Care and support for infected and affected persons: relates to provision of
holistic care and support to various groups of infected people as well as the
affected, including children orphaned by AIDS and other vulnerable
children; it also involves empowering communities to provide support
structures for PLHIV;
2.6.4.Institutional architecture and resourcing: the focus is on the design and

strengthening of the structure of the coordinating mechanism of the multi-
sectoral response within the framework of Nigeria's federal system and the
issue of sustainability through adequate resource allocation, mobilisation
and management; HIV and AIDS will be mainstreamed in the work of key
public sector ministries, departments and agencies;
2.6.5.Advocacy, legal issues and human rights: focuses on addressing legal issues,
legal rights and advancing the rights of people living with HIV and those
affected by the infection;
2.6.6.Monitoring and evaluation: aims at strengthening the quality of programme

management through effective monitoring and evaluation to generate and
appropriately disseminate and utilise data;
2.6.7.Research and knowledge management: focuses on generation and

dissemination of knowledge to provide required support for evidence-based
policy-making and programming.
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3. BEHAVIOUR CHANGE AND PREVENTION OF NEW

INFECTIONS
3.1 Rationale
Prevention remains the most important strategy as well as the most feasible approach
for reversing the HIV epidemic since there are no vaccines and no medical cure. The
majority of Nigerians are HIV-negative; keeping them uninfected is critical to the future
of the epidemic and underscores the importance of prevention as a cornerstone of the
national HIV and AIDS response. Furthermore, the national situation of persistent high
level of HIV-risky behaviour in the face of high level of HIV awareness calls for
continuous and concerted focus on effective preventive interventions that will address
the specific needs of each key population segments and stimulate the adoption of
appropriate behaviour that reduces the risk of HIV transmission.
3.2 Thematic Goal
The goal of this thematic focus is to reduce the incidence of HIV.
The focal areas under this goal are:

� Safer sexual behaviour through communication-related interventions;
� Appropriate use of male and female condoms and lubricants;
� Prevention of biomedical transmission of HIV;
� HIV counselling and testing;
� Prevention of mother-to-child transmission;
� Early diagnosis and effective treatment of sexually transmitted infections; and
� Positive health, dignity and prevention interventions by and for PLHIV.
3.3 Thematic Objectives
The objectives are to:

� Promote safer HIV/AIDS-related behavior among the general population,
including sexual abstinence, mutual sexual fidelity and condom use in higher-
risk sexual encounters, to reduce potentials for new infections;
� Promote appropriate HIV/AIDS-related behaviour change among most-at-risk

populations, including transport workers, uniformed service personnel, sex
workers, injecting drug users, men having sex with men and other sexual
minorities, prison inmates, and population of humanitarian concern such as
13
displaced people and populations affected by conflicts;

� Promote and scale up HIV counselling and testing, including both client-
initiated and provider-initiated HIV counselling and testing;
� Promote and scale up interventions for the prevention of mother-to-child

transmission of HIV;
� Prevent biomedical transmission of HIV through blood, blood products and

tissue safety, injection safety, safe healthcare waste management, adherence to
universal precautions, access to post-exposure prophylaxis and other relevant
interventions;
� Promote early treatment and strengthen the control of sexually transmitted

infections to reduce the risk of HIV transmission;
� Promote access of PLHIV to comprehensive prevention interventions;

� Promote the adoption of appropriate HIV/AIDS related behavior, including
health seeking-practices, and holistically address prevention-related needs
among vulnerable populations, particularly females of all ages and status, and
young people, as well as other special population groups such as children with
special needs (physically and/or mentally-challenged), healthcare workers,
out-of-school youths, young people in institutions of higher learning,
discordant couples, and people in specific work environments
� Strengthen collaboration between HIV-related prevention interventions to

improve synergy and increase impact; these include drug demand reduction
programmes, blood transfusion services, family planning) and other
reproductive health services, population and family life education and other
adolescent and youth-focused interventions;
� Ensure appropriate constellation of preventive services at facility and

community levels and strong linkage with treatment, care and support; and
� Improve acceptance of individual and collective responsibility for prevention

of HIV transmission and the provision of care and support.
3.4 Policy statements
A. Promotion of safer sexual behaviour through communication-related

interventions
� Safer sexual behaviour shall be promoted at all levels and targeted at all people
14
and population sub-groups through relevant HIV communication

interventions, including information, education and communication (IEC) and
behaviour change communication (BCC).
� Abstinence and mutual sexual fidelity will be promoted as the best protection
against HIV and AIDS.
� Safer sexual behaviour interventions shall be gender-sensitive and specifically

designed and implemented to appropriately respond to the needs of various
population sub-groups including vulnerable populations, most-at-risk
populations, and other special populations including PLHIV.
� Creative and innovative youth-friendly approaches, including information and

communication technology (ICT), shall be used to reach young people with
HIV-related communication interventions using existing youth-related
structures and networks, such as schools, National Youth Service Corp
Scheme, adolescent-friendly health services, youth centres, holiday camps,
skills development centre, sporting events, youth organisations, and faith-
based youth programmes.
� Government and partners, including networks of employers of labour and

professional bodies, shall ensure that all private and public workplaces develop
and implement workplace policies with strong communication-related
components, which is well linked to other preventive services as well as to
treatment, care and support.
� Communicating programmes on safer sexual behaviour shall also take

advantage of appropriate institutional settings, including workplaces and
schools, and community structures to ensure their cost-effectiveness, and
integration with existing programmes, where necessary, to support their
institutionalisation.
� Government shall effectively address poverty as well as other factors that

increase vulnerability to unsafe sexual behaviour.
B. Promotion of appropriate use of male and female condoms and lubricants
� Correct and consistent use of both male and female condoms as methods of
preventing HIV, STIs and unwanted pregnancy shall be promoted through
multi-media communication approaches.
15
� All mass media marketing of condoms for the prevention of HIV and AIDS
shall promote abstinence and mutual fidelity through inclusion of a message
that expresses the view that abstinence and mutual fidelity remain the best
protection against HIV/AIDS a message that is in consonance with scientific
evidence and respond to the cultural sensitivity of the country.
� The elimination of all legal, regulatory, financial and socio-cultural barriers to

the universal access to condoms shall be facilitated by the government.
� Condom outlets shall be established in locations which are easily accessible to

all population groups, including vulnerable and high risk groups.
� The government shall formulate, enforce relevant legislation, and monitor

condom quality.
� All condoms shall be distributed with instructions on their proper use and
disposal; additionally, efforts will be made to train users on the proper use of
condoms.
� In view of the low awareness of female condom, communication activities shall

be undertaken to promote knowledge of female condom among health workers,
males and females of reproductive age group, and MARPs and to increase its
adoption by all sexually active people. Advocacy efforts shall also be targeted
at government and other development partners to ensure its availability at little
or no cost and increase the accessibility to it.
� Availability of water-based lubricants shall be promoted to improve the

effectiveness of condom use particularly among high-risk groups such as men
having sex with men and others engaged in similar sexual practices.
C. Prevention of Biomedical Transmission of HIV

� The government shall promote universal access to safe blood transfusion
services throughout the nation, and transfusion of blood and blood products
shall be carried out only when medically indicated.
� The government will develop/strengthen and enforce legislations at all levels to

forbid transfusion of blood that has not been screened for HIV and other
transfusion transmissible infections as well as establish relevant standards,
including minimum standard of practice for blood banking institution.
16
� Blood banking services shall only be provided in public and private health
institutions accredited by relevant government agencies for such purposes and
the quality of services shall be continually monitored by relevant agencies and
professional groups with such mandate.
� The government, her agencies, as well as other relevant development partners,

including civil society organisations, shall vigorously promote the voluntary
non-remunerated donation of blood and concomitantly strongly discourage the
donation of blood on remunerative basis.
� All donors of blood, blood products, and organs for transplant including sperm
for assisted reproductive technology shall be screened for HIV and other blood
borne pathogens; all healthcare institutions providing such services must
comply with government prescribed minimum standard and apply the relevant
national protocol with regards to the transfusion or transplantation services as
well as the HIV screening.
� Government shall make and enforce relevant legislation to address other

relevant issues relating to biomedical transmission of HIV, such as injection
safety, injecting and non-injecting drug use and male circumcision.
.
� All health workers both orthodox and non-orthodox shall be educated on
methods of preventing biomedical transmission of HIV, including universal
precautions, safe healthcare waste disposal, injection safety, blood and tissue
safety, and sterilization/disinfection procedures.
� All health care institutions shall provide equipment, materials and drugs for the
proper observation of universal safety precautions and the implementation of
other relevant activities to prevent biomedical transmission of HIV.
� All healthcare workers shall observe universal safety precautions and

procedures in the management of their patients, handling of corpses, disposal
of body fluids and other potentially infectious materials.
� All traditional health care providers using skin-piercing instruments shall be

educated on sterilization techniques before being licensed to practice, and will
be subsequently monitored by relevant government agencies to ensure
compliance with accepted standard of practice.
� All surgical procedures will be carried out with only appropriately sterilized or
otherwise disinfected equipment in accordance with standard medical
17
practices, and shall also conform with other standard infection prevention
procedures.
� Infectious control units (or points) shall be established in all private and public
health institutions and shall be charged, among others, with monitoring,
reporting and addressing issues regarding the adequacy of prevention practices
with respect to biomedical transmission of HIV.
� All public and private health institutions shall have provisions for post-
exposure HIV prophylaxis, and shall offer same to their health workers needing
such services in the line of their work as well as clients/patients that need such.
� Activities of all diagnostic and medically-related laboratories as well as other

healthcare institutions and practitioners in the country shall be monitored and
regulated by appropriate government-approved agencies to ensure conformity
with the guidelines relating to their professional practice.
D. HIV Counselling and Testing (HCT)

� Nigeria, recognising the central place of HIV counseling and testing (HCT) in
the national response, commits herself to the establishment and support of a
network of HCT services that will provide universal access to quality,
affordable and accessible quality HCT services.
� The promotion of HCT shall be intensified among the general population as

well as groups that have high vulnerability to HIV.
� All HIV services shall strictly observe confidentiality, include pre- and post-
test counselling, and be carried out with the informed consent of the client.
� All centres providing HCT services shall be certified by the Government

following guidelines as detailed in the protocols of the Federal Ministry of
Health (FMoH), and all screening facilities shall apply the prescribed national
protocol and process for HIV testing.
� Both client-initiated and provider-initiated HIV testing and counseling shall be

vigorously promoted.
� HIV counselling and testing shall be routinely offered to all men and women of
reproductive age, including couples applying for marriage licenses; however,
refusal shall not be a reason for denial of granting such marriage licenses.
18
� HIV counseling and testing shall be part of the routine services for all pregnant
women attending ante-natal clinics and patients with STIs, and patients with or
suspected to have tuberculosis.
� Voluntary confidential testing with pre and post-test counselling shall be an

integral part of primary health care services, and shall be universally available
in secondary and tertiary facilities.
� Post-test counselling in the event of a positive HIV test shall include provision
of information on the risk of HIV transmission to future children, nutritional
counselling, counselling on ARV, counselling on safer sexual practices, family
planning counselling and referrals to family planning services when necessary.
Post-test counselling shall also be provided to those with HIV-negative results
to encourage them to maintain their status.
� HCT will be made accessible to most-at-risk people, including FSWs, drug

users, and MSM.
� All new HIV screening reagents for use in the country shall be certified and
licensed by National Agency for Food and Drug Administration and Control
(NAFDAC) in collaboration with the Federal Ministry of Health and the
National Agency for the Control of AIDS (NACA),and continual monitoring of
the products shall be maintained afterwards.
E. Prevention of Mother to Child Transmission (PMTCT)

� Nigeria is committed to the promotion and provision of comprehensive
PMTCT services, consisting of a four-pronged approach of: (i) primary
prevention of HIV infection among women of childbearing age; (ii) prevention
of unintended pregnancies among women living with HIV; (iii) prevention of
HIV transmission from women living with HIV to their infants, and (iv)
provision of appropriate treatment, care and support to mothers living with HIV
and their children and families.
� All maternal health care services shall offer HCT for all women of childbearing
age, including pregnant women as part of existing integrated reproductive
health care services and shall include referrals for family planning counselling
and services when necessary. Testing will not be mandatory.
� Provider-initiated testing and counseling (PITC) shall be greatly encouraged in

PMTCT services without compromising the ethical standards of informed
consent and confidentiality. PITC shall be targeted not only at women
19
presenting in antenatal care period, but also those presenting for delivery and
postnatal care whose HIV status is unknown in order to reduce missed
opportunities.
� Recognising the current low level of utilisation of formal health services and
skilled attendants for antenatal care and delivery, innovative partnerships shall
be encouraged between formal health care services and non-formal maternal
health service providers such as traditional birth attendants to promote the
access of all pregnant women to PMTCT.
� As part of primary prevention of HIV in the context of PMTCT services, HCT

will be offered to all women of reproductive age using multi-pronged
approaches and multiple outlets, including family planning services, well-
woman clinics, and community-based outreach settings.
� All maternity services shall provide counselling on the potentials for mother to
child transmission of HIV (MTCT) during pregnancy, delivery and breast
feeding; in this regard, HIV-positive mothers shall be thoroughly counseled on
ways to reduce the potential of transmitting the virus to her child as well as
other relevant services for herself, including referrals for family planning,
STIs and cervical screening services;
� In recognition of the effectiveness of antiretroviral medications to prevent

mother-to-child transmission of HIV, Nigeria commits herself to ensuring
universal access of all HIV-positive pregnant women and their children to
antiretroviral medication and other relevant medical interventions to prevent
vertical transmission of HIV and enhance the health and quality of life of the
woman.
� Appropriate mechanisms shall be put in place to ensure the appropriate training

of health care providers at all levels to provide quality PMTCT services.
� All HIV-positive pregnant women shall be offered quality counselling on

nutritional care for themselves and their children according to the best
nationally and internationally applicable evidences and protocols, taking due
cognizance of the woman's specific physical, mental and social circumstances.
� Early Infant Diagnosis (EID) service shall be offered to all babies delivered by
HIV positive women and appropriate comprehensive HIV-related services,
including medication, offered freely afterwards in public sector facilities to
prevent vertical transmission to those who are HIV-negative or ensure survival
and quality of life for those found to be HIV-positive. EID will also be carried
20
out for babies of mothers with unknown HIV status who die at childbirth or
during postpartum period.
� All PMTCT services shall have strong linkage with or integrated focus on
malaria prevention and treatment services for HIV-positive women, including
promotion of insecticide-treated nets and intermittent presumptive treatment,
in view of the scientific knowledge on the interactions between malaria and
HIV in pregnancy.
� Male involvement and active participation shall be strongly encouraged as part

of PMTCT programmes; PMTCT services shall explore creative mechanisms
and innovative ways to invite men's participation, address men's concern and
HIV-related treatment issues, and leverage their support as partners with
strong stake in PMTCT in the context of overall family health and well-being.
These will include men-targeted communication activities, couple
counselling, couple-focused HCT, referrals to HIV treatment and SRH
services, and linkage to support services as relevant to the health needs and
HIV status of the man.
F. Early Diagnosis and Effective Treatment of Sexually Transmitted Infections

� The government and her agencies, including the Federal Ministry of Health,
shall prioritise the implementation of the control programme for STIs, paying
particular attention to the early diagnosis and prompt effective treatment of
STIs with, post-diagnosis counselling and contact tracing.
� Treatment of STI shall be promoted by Government as a priority social service,

and syndromic management of STI will be the priority approach for treatment
in public and private primary health services.
� All health workers shall receive relevant and appropriate training in the
epidemiology and management of STI.
� Programme will be developed to provide treatment of STI for such high risk
groups as most-at-risk populations (MARPs) and priority attention will be
accorded such initiatives.
� Prevention and treatment for STIs shall be strongly linked as part of

comprehensive STI control services.
� Provider-initiated HIV counselling and testing services are recommended for

all STI patients with informed consent and confidentiality observed.
21
G. Positive Health, Dignity and Prevention Interventions (PHDP)
� The government and partners recognise that prevention services for people
living with HIV is an important element in the national response, not only to
reduce HIV transmission but also to ensure the health, quality of life, and
dignity of PLHIV; It centers on the efforts of PLHIV to learn and practice ways
to promote their own health and prevent disease and shall be vigorously
promoted and supported by government and other stakeholders.
� Services targeted to PLHIV shall inculcate a human rights approach,

combating stigma and discrimination, and they shall be offered in gender-
sensitive and gender-responsive ways, and address social vulnerabilities such
as poverty and gender-based violence.
� Prevention services for PLHIV shall be offered in the context of continuum of

care, with a strong link to treatment, care and support.
� Provide pre- and post-test risk reduction counselling and access to affordable
and confidential treatment, care and support for all people living with HIV,
including quality STI treatment.
� Ensure the access of all PLHIV to comprehensive sexual and reproductive

health services, including family planning services with special emphasis on
male and female condoms to prevent unintended pregnancies among HIV-
positive women.
� Promote the consistent and proper use of male and female condoms (and water-
based lubricants) among PLHIV and ensure their availability, affordability and
consistent supply.
� Ensure the access of pregnant PLHIV to maternal health care, including

antenatal, delivery and postnatal approaches that will reduce the risk of
transmission of HIV from the mother to the child.
� Promote the access of all PLHIV to general health promotion services as an

integral part of PHDP, including nutrition education, self care, environmental
health issues and physical exercises.
� Access of PLHIV to HCT and diagnostic testing procedures to monitor HIV

and immune system shall be promoted.
22
� Regular screening and related diagnostic and treatment services for

tuberculosis and STIs shall be provided to all PLHIV.
� Prevention of opportunistic infections through drug prophylaxis and treatment

services when infection occur shall be offered to PLHIV.
� Psychological services, counselling and other relevant mental health services,

including those targeted at building self confidence and self-esteem,
relationship counselling shall be offered to all PLHIV using both institutional
and community structures and facilities.
� Risk-reduction counselling shall be promoted, including both individual

counselling and skills-building sessions on dating, disclosure, and
communication with partners.
� Provide support for couples and family based counselling, testing and referral;
special attention shall be given to the concerns and challenges of sero-
discordant couples.
� Harm reduction services shall be offered to HIV-positive drug users.
� Adherence training shall be provided to PLHIV, members of their social

support system, health workers and other service providers.
� Facilitate the formation of support networks and self-help groups, recognising

the diversity in populations and needs of people living with HIV, and provide
support for self-help groups and networks of people living with HIV.
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4. TREATMENT OF HIV/AIDS AND RELATED HEALTH

CONDITIONS.
4.1 Rationale
Increased access to anti-retroviral drugs has had significant and positive impact on the
HIV epidemic in Nigeria, particularly in terms of improved quality of life of people
living with HIV/AIDS, better public perception of HIV and AIDS, as well as decreased
infectivity of PLHIV and potential for transmission of HIV. Yet, considerable
geographical, gender and age inequity exist in terms of access to these drugs; overall, a
high proportion of those needing treatment still has no access to the drugs. Additional
challenges exist in terms of variations in the quality of treatment services, poor referral
practices, and emerging drug resistance problems. Although the effects of
opportunistic infections (OIs) account for most of the ill health associated with HIV
infection, a minimum package for diagnosis, prophylaxis and treatment is yet to be
defined to ensure standardisation and equitable access to these services. Also, the
increasing incidence of tuberculosis (TB) among PLHIV and associated increased
morbidity and mortality necessitates the scale up of TB/HIV collaborative activities.
The challenge of access is further compounded in the case of PLHIV that belong to
MARP groups such as FSW, MSM and drug users; their access to treatment is further
constrained by issues like stigma and discrimination. Thus, more needs to be done not
only to equitably reach eligible adults and children with ART, OIs, and TB/HIV co-
infection services but also to ensure quality of these services.
4.2 Thematic Goal
The goal of this thematic focus is to ensure that all eligible PLHIV have access to quality
treatment services for HIV/AIDS and opportunistic infections as well as TB treatment
services for PLWHIV co-infected with TB.
The objectives of the thematic focus of treatment are to:

� Increase access of men and women living with HIV and AIDS to quality
treatment;
� Strengthen quality assurance system for all treatment and care options;
� Strengthen logistics management system to facilitate sustainable supply of

drugs, laboratory materials and other commodities; and
24
� Expand access to comprehensive treatment and care by strengthening

collaboration between HIV services and other health interventions such as TB,
malaria and reproductive health.
4.4 Policy Statements
A. Treatment of HIV/AIDS and Related Health Problems

� Government shall ensure that affordable HIV care and treatment is made
available to people living with HIV and AIDS equitably without bias to risk
behaviour or sexual orientation and on nation-wide basis.
� To ensure quality in HIV treatment services, government shall ensure the

availability of adequate infrastructure, skilled health workers, and effective
logistic system to support care and treatment services and ensure uninterrupted
supply of drugs and commodities including appropriate formulations for young
children at all levels.
� HIV and AIDS management, including treatment of HIV/AIDS-related

conditions, shall be appropriately integrated into pre-service and in-service
training for health workers at all levels.
� Government shall ensure the availability of up-to-date national protocols and

guidelines for management of HIV/AIDS and related conditions for all levels
of care and in all health facilities.
� Government shall ensure the availability of an enabling environment for the

local manufacture of HIV diagnostic kit and ARVs as part of the effort to ensure
sustainability in drug supply.
� ARVs and other drugs for the management of HIV/AIDS and related conditions
shall be appropriately included in the essential drug list at every level.
� Government and her agencies shall ensure that hospital policies are PLHIV-
friendly and in no way constitute barriers to the uptake of drugs and related
services by all groups of individuals, including women, youth and children.
� Treatment literacy shall be vigorously promoted as an essential part of

HIV/AIDS treatment programmes at all levels and will be targeted to PLHIV,
people affected by AIDS, population sub-groups with high vulnerability to HIV
and AIDS, health workers and the general community.
25
� Government shall establish a national framework for quality assessment and

continuous quality improvement for HIV diagnostic and treatment services.
� Integrated care shall be ensured as much as possible to meet the multiple health
needs of PLHIV in a timely fashion and ensure quality of services through
collaborative activities between HIV and other health interventions, especially
tuberculosis, malaria, and reproductive health care.
� Government shall spearhead and support the development/review of

appropriate guidelines, standard of practice and other relevant tools for the
management of HIV and related disorders effective care and treatment of
PLHIV.
� Referral network pertaining to HIV/AIDS treatment services shall be

appropriately strengthened to ensure continuum of care, and all development
partners are required to follow the health system structure and national
guidelines in referring patients and clients.
� Professional practice and activities of alternate care practitioners, including

advertisements and products, shall be carefully monitored by government
agencies and professional bodies with relevant mandates to ensure that they are
scientifically and ethically sound in every respect to ensure that they truly add
value to the HIV control efforts and to protect PLHIV, people affected by AIDS
(PABA) and the general community from being endangered health-wise,
misled or exploited by false claims.
B. TB/HIV Collaborative Activities
� TB/HIV advisory committees shall be established and strengthened at the

national, states and local government levels, and state and facilitators
designated at state and facility level.
� Expand access to HCT, DOTS, isoniazide preventive therapy (IPT) and co-
trimoxazole preventive therapy (CPT) through provision of these services at all
levels of care
� Build the capacity of health workers in the public and private sector on TB/HIV
collaborative activities
26
� Ensure continuous rapid testing for HIV in TB patients and screening for active
TB in PLHIV
� Ensure the screening for TB in the general outpatient department in all clinics
including ART and PMTCT.
� Ensure that all contacts for TB patients are traced at outpatient level and are
screened for HIV.
� Ensure the screening for active TB in children.
� Develop and/or review the national guidelines and protocols regarding TB

infection including the HCT algorithm to include all TB suspects
� Ensure the expansion and decentralisation of TB microscopic sites especially in

ART sites.
� Integrate CPT and IPT required fields in the ART electronic data and promote
the development of joint M/E plan to monitor the scale up of activities.
27
5. CARE AND SUPPORT OF INFECTED AND AFFECTED

PERSONS
5.1 Rationale
As the number of people infected and affected by HIV and AIDS (PABA) rises, the
burden of the epidemic on individuals, families, and communities is increasingly
evident, and is exacerbated by widespread poverty. Some of the critical indicators of
the social consequences of the epidemic are the increasing numbers of orphans and
vulnerable children (OVC) and a general stigmatisation of PLHIV. At household and
community levels, the challenge of providing care and support for infected and affected
persons falls disproportionately on females, and may negatively affect their schooling,
productivity and quality of life. Also, access to ART means that more PLHIV are having
longer and improved lives. Thus, there is a big challenge to the nation to provide the
increasing care and support including palliative care for infected and affected persons.
This challenge will continue for a very long time even when the epidemic is brought
under control in terms of significantly reduced incidence of HIV.
Government recognises that provision of high quality care and support to infected and
affected people is not a drain on the economy; rather, such care and support is a matter of
human rights, and an investment in the sustenance of the quality of life of PLHIV and
PABA and continued productivity which have significant added value to the social and
economic status of the country.
5.2 Thematic Goal

The goal of this thematic focus is to promote the survival and improve the quality of life
of PLHIV and people affected by HIV/AIDS especially OVC.

� Promote access to gender sensitive continuum of integrated comprehensive
care, treatment, counselling, clinical and home-based care and community
support;
� Improve access to gender sensitive information, social and economic

opportunities for PLHIV and PABA
28
� Establish and strengthen gender-sensitive referral and coordination systems

that link hospital services for PLHIV to community-based care in the context of
an integrated, complementary and sustainable approach.
� Ensure the protection, care and empowerment of orphans and vulnerable

children.
A. Persons Living with HIV/AIDS

Government shall:
� Ensure universal and sustained access to a continuum of gender-sensitive
information and care including palliative care, ART and nutritional support.
� Ensure that PLHIV, including MARPS living with HIV and AIDS, access
appropriate and adequate information about location and availability of health
services.
� Ensure that HIV-positive women access information that enables decision-

making regarding pregnancy, child birth, and infant feeding.
� Link care and support programmes to poverty alleviation and other

development initiatives to promote self-help among PLHIV.
� Adopt special measures that ensure equitable access to HIV/AIDS prevention,

treatment, and care by marginalised persons, including women, young persons
and physically challenged persons who are infected.
� Establish, strengthen and sustain wide network of gender sensitive referral

systems linking community based services to health facilities.
� Ensure the accessibility of PLHIV, including MARPS living with HIV and
AIDS, to appropriate and adequate information on available economic and
development opportunities, and the location of related services.
� Deliberate target PLHIV, including MARPs living with HIV and AIDS, with
poverty reduction, social protection and other development initiatives; ensure
29
economic empowerment and equitable participation of PLHIV, including

MARPs living with HIV and AIDS, in national development by linking
HIV/AIDS activities to development initiatives including poverty alleviation
programmes.
� Adopt affirmative approaches to ensure that HIV-positive women and other

MARPs living with HIV, young people and physically challenged persons have
access to economic empowerment initiatives.
� Facilitate greater involvement of PLHIV in HIV/AIDS prevention, care and

support efforts.
� Promote support groups and encourage positive living among PLHWA to

protect them from re-infection, avoid risk to others and curb wilful spread of the
virus.
� Ensure that PLHIV, including MARPs living with HIV and AIDS, are protected
from all forms of violence.
� Ensure meaningful participation of PLHIV in community discussion, decision-

taking, action and evaluation.
� Ensure the availability of relevant support services, including psychosocial and

spiritual services, to PLHIV.
� Ensure that relevant legal protection is available to people living with HIV.
B. Persons Affected by HIV/AIDS

Government commits to:
� Ensure that PABA have equitable access to appropriate and adequate

information on available economic and development opportunities and
services.
� Ensure participation and economic empowerment of PABA by linking

HIV/AIDS activities to development initiatives including poverty alleviation
programmes.
30
� Enact, disseminate and enforce legislations to protect PABA, particularly

vulnerable groups such as widows, against human rights abuse including
exploitation, discrimination, and loss of inheritance.
� Facilitate greater involvement of PABA in HIV/AIDS treatment, care and

support efforts.
� Promote the active participation of PABA in support groups.

spiritual services, to PABA.
C. Orphans and Vulnerable Children
Children and young persons, particularly orphans and vulnerable children, are
especially susceptible to HIV/AIDS infection and its impact. In response to these
challenges, government undertakes to;
� Enact, disseminate and enforce legislations to protect orphans and vulnerable

children against abuse including sexual abuse, violence, exploitation,
discrimination, trafficking and loss of inheritance.
� Ensure gender sensitive access to food, shelter, healthcare, clothing and

education, and psycho-social support for OVC.
� Strengthen economic capacity of households and care givers and support

community-based initiatives by various categories of development partners,
including non-governmental organisations, community- and faith-based
organisations, women-led associations and the private sector, to mitigate
impact on OVC.
� Establish gender-responsive coordinating mechanisms and build capacity of

states, local governments and other stakeholders to leverage resources to
support gender-sensitive community initiatives.

spiritual services, to PLHIV.
31
6. INSTITUTIONAL ARCHITECTURE AND RESOURCING

6.1 Rationale
Despite achievements towards control of HIV/AIDS the epidemic continues to pose a

significant challenge to national development. While the response has experienced
increased inflow of resources from government and development partners significant
funding and resource gaps still exists. Also, the national response is largely donor
dependent and for most part, donor driven. At the state level, political commitment is
generally weak as, any states have recently provided no financial allocation to
HIV/AIDS activities, outside of the counterpart funding to access the World Bank MAP
funds. Many several federal agencies are also solely dependent on World Bank funds for
their HIV/AIDS programs. With the international financial meltdown signaling
potential reduction in financial contributions by development partners, governments
and citizens at all levels need to own and assume responsibility for scaling up and
sustaining HIV/AIDS response. These realities compel urgent review and realignment
of the institutional framework, coordination mechanisms and resources issues for the
national response.
Besides financial resources and physical infrastructure, availability and capability of

human resources are pivotal to sustainability of HIV/AIDS response. Although it is
generally agreed that Nigeria has a good supply of health professionals, compared with
other countries in the sub-region, there are wide regional disparities and the vast
majority are based in urban areas. It is also true that the HIV/AIDS epidemic has
significantly increased pressures on health care delivery systems that are already
overstretched. While, in general, the numerous strands of human resource needs of the
national HIV/AIDS are appropriately addressed within thematic areas response some
themes of the human resource required to ensure a sustainable response are generic as
well as cross-cutting.
6. Thematic Goal
The goal of the thematic focus is to strengthen structures and systems for the
coordination of a sustainable and gender-sensitive multi-sectoral HIV/AIDS response
in Nigeria.
32

� Support improved resource mobilisation, management and accountability at all
levels within the national response;
� Clarify the roles and responsibilities of key players to optimise comparative
advantages of stakeholders and forge synergies to strengthen the national
response;
� Facilitate strengthened coordination at all levels and components of the multi-
sectoral national response.
A. Coordinating Structure at National Level
The National Agency for the Control of AIDS (NACA) is mandated to provide
leadership and coordinate the national response. Its functions include but are not limited
to the following:
� Facilitate and coordinate activities of various sectors in the National Response

Strategic Framework;
� Facilitate engagement of all tiers of government and all sectors on all

HIV/AIDS-related issues;
� Advocate mainstreaming of HIV/AIDS interventions into all sectors of

society;
� Support HIV/AIDS research;
� Mobilise resources and coordinate equitable application for HIV/AIDS

activities;
� Provide and coordinate linkages and collaboration with the global community
on HIV/AIDS;
� Monitor and evaluate all HIV/AIDS activities in the country;
33
� Facilitate the development and implementation of the policies and strategies of

all sectors to leverage human, financial and organisational resources to support
successful execution of national HIV/AIDS response;
� Develop and strengthen human capacity for effective management of national

response;
� Perform such functions as may, from time to time be assigned to it by the

Government; and
� Ensure that membership of advisory bodies of the national, state and local
coordinating entities shall reflect multi-sector and broad representations of
stakeholders such that at least 30% are women.
Government through NACA undertakes to ensure the following:

� Strengthen management capacity of NACA to provide effective leadership of
the national response;
� Establish and sustain relationships with public sector institutions including

SACAs, LACAs, civil society organisations including NGO, FBO and
community organisations, private sector and development partners;
� Strengthen and sustain coordination arrangements among implementing

institutions at all levels;
� Establish and support appropriate interaction and coordinating platforms

between NACA and SACA and between NACA and stakeholder groups; and
� Align, harmonise and strengthen collaboration and reporting relationships

between National Planning Commission, development partners, SACA and
NACA.
B. National Level Resource Mobilisation and Sustainability
Government, through NACA, undertakes to do the following:

� Expand and diversify resource mobilisation options for the national response;
34
� Develop and sustain robust private-public partnership to leverage local and

international resources for programme sustainability;
� Strengthen state institutions and non-state stakeholders' capacity to forge and

sustain partnerships to leverage local and international resources;
� Provide direct funding of programme and reduce administrative bottlenecks in

resource allocation;
� Develop options for leveraging greater resources and responsibility by federal,

states and local governments including the establishment of HIV/AIDS Tax or
Derivation Fund;
� Mobilise extra resources for the national response from external resources and
through partnership with multilateral and bilateral agencies;
� Strengthen human resource capacity at all levels to leverage and effectively

manage resources for service delivery;
� Establish and maintain transparent and accountable financial and programme

management systems that is able to effectively track resources allocation and
utilisation at all levels and covering all stakeholders in the national response;
and
� Support development of local capacity to manufacture ARV and other

consumables for HIV/AIDS services.
C. State Level Coordination System and Resourcing
State Governments at their levels shall:

� Provide leadership and strong ownership of the HIV/AIDS prevention and
control programme;
� Establish, support and sustain states agencies and local council coordinating
entities through provision of relevant legislative and legal framework, and
adequate human, material and financial resources, among others;
35
9
� Devise their own strategies and develop programmes to effectively address the
HIV challenge keeping the national objectives in view;
� Provide direct funding of programme and reduce administrative bottlenecks in

resource allocation;
� Mobilise extra resources for state programmes through partnership with other
development partners, including private enterprises and international
development organisations;
� Establish and maintain transparent and accountable financial and programme

management systems that is able to effectively track resource allocation and
utilisation within their area of jurisdiction; and
� Support local government councils through LACA to develop and implement

strategic plans for control of HIV/AIDS.
36
7. HUMAN RIGHTS AND LEGAL ISSUES

7.1 Rationale
Despite compelling evidence that reducing stigma, protecting human rights and
promoting greater involvement of PLHIV advance HIV/AIDS control, Nigeria's
achievements in this regard remain slow and hesitant. More than two decades after the
identification of the first case of HIV in Nigeria, violations of human rights of persons
infected and affected is still rampant and stigma remains pernicious and pervasive. This
situation is compounded by attitudes and practices discriminate against widows and
Children orphaned by AIDS and other MARPs. Furthermore, current approach of the
national response appears to accentuate the differential access to information, services
and participation by marginalised sections of the population. The epidemic trends and
trajectory compels policy shifts to address the disproportional incidence and impact of
HIV/AIDS on Nigerian women, girls, young people, physically challenged persons,
drug users, prisoners and persons engaged in transactional sex or same sex
relationships.
7.2 Thematic Goal

The goal of this thematic focus is to protect the rights of PLHIV and PABA and
empower them as well as other HIV vulnerable or marginalised groups so as to reduce
their social, cultural, legal and socio-economic vulnerability and ensure their full
participation in the national HIV/AIDS response and development initiatives.

� Protect the rights, empower and facilitate greater participation of persons living
with HIV and AIDS; and
� Protect women, children and other socially vulnerable and marginalised groups
from HIV infection.
A. Promotion and Protection of the Rights and Empowerment of PLHIV

In fulfillment of its constitutional obligations and in response to its commitments under
numerous international declarations and conventions, government shall protect the
rights and dignity of persons living with HIV/AIDS by creating a conducive legal,
political, economic, social and cultural environment for full expression of such rights.
37
Therefore, under this Policy government shall:

� Enact and enforce laws against discrimination and promote measures to reduce
stigma against PLHIV;
� Ensure that HIV status, suspected or actual is not grounds for denial of
employment and access to social services including housing, health, and
education;
� Ensure that mandatory HIV testing is not a prerequisite for employment or

school enrolment;
� Health workers and other persons working with PLHIV must conform to
highest ethical standards of patient/client-service provider relationship and
ensure confidentiality regarding the HIV status of their clients or patients;
� Support gender-sensitive participation of PLHIV in all decision-making on the

design, implementation of HIV programmes at all levels;
� Ensure that sector policy-makers, in both public and private sectors establish
gender-responsive workplace policies and programmes to address stigma and
discrimination;
� Support PLHIV whose rights are infringed to access independent and speedy
administrative or legal redress; and
� Support intensive community based advocacy, gender-sensitive support

systems and services at family, community and national levels to promote
disclosure of HIV sero-status.
B. Protection, Participation and Empowerment of Vulnerable Populations
Women, Girls and HIV/AIDS
Nigerian women and girls are disempowered by social, cultural, economic and legal
factors which deny them the right to autonomous decision-making in sexual and
reproductive matters. As a result, they are vulnerable to physical and sexual abuse. Also
a high proportion being illiterate and poor, many women are often unaware of or
powerless to exercise their rights. These factors and the gender-insensitive manner in
which many HIV/AIDS programmes are currently implemented combine to create
differentials in three critical areas: access to information, access to services and denial
of participation in decision making and programme activities.
38
In response governments at all levels through this Policy shall:

� Ensure that women and girls, regardless of marital or HIV status, have equal
access to culturally appropriate, gender-sensitive youth-friendly HIV/AIDS
and reproductive health information and services;
� Reinforce and enforce legal measures to deter rape, violence against women
and sexual harassment of girls;
� Enact and enforce laws, domesticate international conventions that advance the
social, cultural and economic rights of women and girls;
� Support traditional and religious institutions to eliminate harmful traditional

practices against women;
� Support gender-sensitive integrated prevention, care, and support programmes

linked with girl education, employment and poverty alleviation programmes;
and
� Promote gender sensitive family life education for in-school and out-of-school
young persons to empower girls as well as boys to protect themselves from HIV
infection or live positively with HIV/AIDS if infected.
Protecting Children and Young People against HIV/AIDS
Young persons aged 19-25 years; particularly females have the highest incidence of new
HIV/AIDS infections. Besides, children, particularly orphans, vulnerable children and
girls are at grave risk of HIV infection from sexual abuse. Children below the age of 15
years present opportunities for the national response because health seeking behaviour
imbibed early in life makes them effective promoters of HIV/AIDS prevention. Overall,
it is evident that current epidemiological trends compel intensive scale up of prevention
interventions targeting young people.
In response to these challenges, the various Governments of Nigeria will ensure the
availability of youth friendly information and health services that are accessible and
socially acceptable, providing services that will reduce the vulnerability of youths to
HIV/AIDS.
In furtherance of this Policy, governments at federal, state and local councils shall:
� Review and modify national policies and programmes with the view to
39
reducing the vulnerability of young people to HIV/AIDS;
� Expand access to gender-sensitive, age and culturally appropriate youth-

friendly HIV/AIDS, STI and reproductive health information and services;
� Expand prevention programmes targeting children aged 414 years (Window of

Hope Period) to reduce future risky sexual behaviour;
� Integrate HIV and AIDS education into the curricula of formal schools
beginning at the primary level and support school-based and support out-of-
school family life education programmes;
� Improve access of out-of-school youths in both urban and rural areas to

prevention and other relevant HIV/AIDS-related services through
organisations, youth clubs, tertiary educational institutions, faith based groups,
work place programmes and customised programmes for most-atrisk- young
people;
� Expand access of young people to youth-friendly facilities that provide

prevention, HCT and care, treatment and support services;
� Establish and sustain functional linkages between HIV/AIDS programmes and

employment and poverty reduction initiatives;
� Intensify prevention programmes targeting tertiary institutions and out- of-

school youths; and
� Support traditional and faith based institutions to invigorate family and moral
values and inculcate fidelity, abstinence and delay sexual debut among young
people.
Physically Challenged Persons and HIV/AIDS Vulnerability

Physically challenged people are vulnerable to HIV infection because they rarely have
access to formal education and are often denied participation. Yet lacking education,
employment and economic opportunities, many engage in risky sexual behavior and are
subjected to sexual abuse.
Government, through this Policy, undertakes to do the following:

� Ensure that physically challenged persons have access to appropriate and
customised gender-sensitive HIV/AIDS and reproductive health information
and services; and
40
� Protect and enforce human rights of physically challenged people and ensure
their participation in all decision-making processes and structures.
Vulnerability of Poor People to HIV/AIDS
Poverty is a critical determinant of vulnerability to HIV/AIDS. The vast majority of

poor Nigerians who lack employment and support are at risk from risky sexual behavior.
Furthermore, they lack financial and physical access to HIV/AIDS prevention
information, care and treatment services.
Government, through this Policy undertakes to:

� Ensure equitable access to HIV/AIDS prevention information and services by
poor people in urban, rural and hard-to-reach areas;
� Provide sustainable prevention, care, treatment and support that are financially
and physically accessible to poor people who are infected by HIV, including
PMCTC services;
� Promote public-private partnerships including collaboration with CSOs to

expand prevention, care, ART and OI treatment services to the poor and expand
service coverage to rural and hard-to-reach migrant, refugee and nomadic
populations; and
� Mainstream HIV/AIDS prevention strategies into poverty reduction

interventions in all sectors.
.
People Engaged in Transactional Sex
Although Nigeria's epidemic is generalised, persons engaged in transactional sex, in

particular females, still constitute a critical most-atrisk group which requires intensified
HIV/AIDS prevention interventions.
Government, through this Policy commits to:

� Support access to confidential and considerate reproductive health,
HIV/AIDS/STIs prevention information and services by persons engaged in
transactional sex;
� Support widespread availability and accessibility of female and male condoms;
� Ensure that sex workers living with HIV/AIDS have access to care, support and
treatment including anti-retroviral and opportunistic infections medications;
and
41
� Support skills acquisition and economic empowerment of people engaged in

transactional sex to enable them assume responsibility for protecting
themselves and their clients.
Men who have Sex with Men
There are strong cultural taboos against same-sex sexual relations which drive the
practice underground. Thus due to prevailing attitudes, the national response remains
silent about this most-at-risk group, particularly, men who have sex with men. Yet
failure to address their sexual behaviour through appropriate reproductive health and
HIV/AIDS interventions endanger the public since in the Nigeria environment many
MSM also engage in opposite sex relationships.
Government shall:
� Ensure that MSM have access to full range of integrated HIV and STI
prevention, HCT, treatment, care and support.
Injecting Drug Users
The use of contaminated needles among injecting drug users is one of the most efficient
ways of transmitting HIV; thus, HIV spread through injecting drug users is among the
most explosive. Many drug users often have multiple risks, including higher-risk
sexual behaviours including sex work and multiple sexual partners. Unmet
challenges/issues related to illegality of drug use and of harm reduction programmes
can drive drug users away from services and/or into prisons and fuel the spread of HIV.
Government, through this Policy commits to:

� Increase access of drug users to full range of harm reduction measures and to
service providers offering treatment for drug dependence, sexually transmitted
infections, AIDS and tuberculosis;
� Train relevant health and other service providers to increase familiarity with
and effective work with injecting drug users;
� Expand the access of sexual partners of injecting drug users to HIV prevention,
antiretroviral treatment and care services, including post-exposure
prophylaxis;
� Provide targeted reproductive health and prevention of mother-to-child

transmission services to respond to the needs of women injecting drug users
and women partners of injecting drug users and;
42
� Create safe virtual or physical spaces (for example telephone hotlines, or drop-
in centres, respectively) for injecting drug users to seek information and
referrals for care and support.
Prisoners
Prisoners need to be empowered to make informed sexual health decisions because they
are at high risk of HIV infection arising from abusive sex within their prison
environment.
Government, through this Policy, commits to:

� Ensure that prisoners and prison staff have access to HIV/AIDS prevention
information, education, HCT, treatment, care and support;
� Provide capacity and resources to all correction institutions to protect inmates

from rape, sexual violence and coercive sex and provide timely access to post-
exposure prophylaxis to victims of rape and sexual violence;
� Ensure separation of juvenile offenders from adult prisoners to protect them

from abuse
43
8. MONITORING AND EVALUATION
8.1 Rationale
Monitoring and Evaluation (M & E) constitute a cornerstone of evidence-based

planning and decision-making for all components of HIV/AIDS programmes; they are
essential for guiding future strategies and interventions as well as informing new
policies, strategies and plans. Data generated through M & E activities are critical for
tracking the progression of the epidemics, assessing the status of response efforts, and
documenting gaps, needs and results of interventions. To achieve maximal benefit from
the national M & E plan, which is an element of the “Three Ones” principle, and to build
on past gains such as the development of Nigeria National Response Information
Management System (NNRIMS), it is critical to further strengthen M & E
infrastructure, framework and related activities at every level, including dissemination
and use of information in HIV/AIDS programming.
8.2 Thematic Goal

The goal of the thematic focus is to strengthen and embed a sustainable systems-based
approach to delivering a cost-effective, multi-dimensional monitoring and evaluation
system which supports the continuous improvement of the national response.

� Harmonise and strengthen the use of the national monitoring and evaluation
framework for the national response;
� Strengthen institutional and human capacity for monitoring and evaluation;
� Promote timely dissemination of monitoring and evaluation results and their
use in programme management; and
� Promote and support evidence-based approach in HIV/AIDS interventions.
� In line with her commitments to the “Three Ones” principle, the government
shall continuously promote the use of one national monitoring and evaluation
plan in the national response.
� The government is committed to the implementation of a comprehensive and

responsive national HIV monitoring and evaluation framework to assess the
success of the HIV response and shall commit and mobilise adequate resources
44
to support relevant activities, including public health surveillance, surveys, and

HIV expenditure tracking on a regular basis
� Human and material resources to effectively manage and coordinate the

national M&E system and its activities shall continuously be strengthened
� The government is committed to establish and maintain a network of

organisations/partners and all stakeholders involved in HIV and AIDS response
at national, sub-national and service delivery levels.
� Data generated from national M & E activities and related national studies shall
be widely disseminated to all tiers of government, all sectors, development
partners and the general public to promote their use for policy-making and
programming
� Mechanisms for quality assurance and continuous data quality improvement

shall be established by the government
� The Federal Government, through NACA, shall actively advocate that a

minimum of eight percent (8%) of the HIV/AIDS programme budget of all
institutions engaged in the implementation of HIV/AIDS activities be
committed to monitoring and evaluation activities in line with the
recommendation of the international M & E Reference Group
� The Federal Government, through NACA, is committed to regular updating

and dissemination of strategic information, and the implementation of the
national HIV M & E plan, supporting states to develop and monitor the
implementation of state-specific HIV M & E plans, and strengthening HIV
databases at national and state levels
� The Federal Government, through the collaboration of NACA and other

relevant agencies, shall develop a core set of Indicators/data that all
stakeholders in the national response must submit to NACA on a regular basis,
irrespective of whatever agencies and institutions they are also required to
submit data to.
� Advocacy and communication will be used to develop the culture of

monitoring and evaluation and data use by all stakeholders at all levels to ensure
transparency and accountability.
45
9. RESEARCH AND KNOWLEDGE MANAGEMENT
9.1 Rationale
The evolution of the HIV/AIDS epidemic has been intriguing and complex in both its
biological and social dimensions. Gaps exist till date not only in the knowledge of the
disease but also in terms of intervention; research provides the best tool to address them.
Yet, research constitutes perhaps the weakest link in the HIV response in Nigeria as it is
accorded low priority by many stakeholders. Existing challenges relating to HIV/AIDS
research include gaps in defining national research priorities, funding priority research,
coordinating research efforts, and ensuring compliance with ethical standards. Results
generated from the largely individually-driven research endeavours, even when such
are of national relevance, are often poorly disseminated and hardly used to inform
policies, programmes and practices. Overall, to make the national response more
effective, it is important that research be conducted locally and the results used to
inform policies, practices and other interventions.
9.2 Thematic Goal

The goal of this thematic area is to promote continuous generation and use of nationally-
driven, high-quality, scientifically-credible, and ethically-sound evidence to improve
the understanding of HIV/AIDS epidemic and to guide HIV/AIDS-related policy,
practice and interventions.

� ��Promote the establishment of sustainable framework for defining, funding and
implementing national research priorities in HIV/AIDS in the context of multi-
sectoral programming;
� Promote the conduct of operations research, basic biomedical research and

social sciences and economic impact research as relevant to the country's
HIV/AIDS response;
� Promote the conduct of population-based surveys and special surveys to track

the HIV epidemic and behavior trend;
� Strengthen the framework for collating and disseminating relevant research

findings; and
46
� Promote the use of research findings to strengthen HIV/AIDS-related policy

and programmatic interventions.

� The Federal Government, through NACA and other relevant research
institutions, shall encourage and promote biomedical, basic, social and
operational research in current and emerging areas of HIV/AIDS and related
interventions.
� The government shall ensure the availability of adequate resources for funding
the coordination and implementation of HIV/AIDS research activities as well as
the documentation, archiving of past and ongoing HIV/AIDS related research
and dissemination of findings.
� The government, through NACA, shall annually identify and publish, based on
the best available evidences, a list of national HIV/AIDS research priorities, and
widely disseminate such to all stakeholders.
� Government agencies, academic and research institutions, and health facilities

shall promote the teaching of research ethics in HIV/AIDS training curricula
and ensure that all HIV/AIDS related research involving human participants
complies with standard ethical and human rights requirements as embodied in
national and international guidelines as well as respect national norms and
cultural sensitivities.
� The government shall promote the accessibility of national survey dataset in an

ethical manner to researchers such that further analyses could be undertaken
and at the same time ensure the confidentiality with regards to the individual
research participant.
47
10. P O L I C Y I M P L E M E N TAT I O N : R O L E S A N D
RESPONSIBILITIES
With the adoption of a multi-sector, multi-tiered approach, management of the national

response to HIV/AIDS has become increasingly complex. It is evident that the roles
and responsibilities of key actors and other stakeholders at multiple levels should be
defined, clarified, aligned to strengthen the national response. This Policy undertakes
to define and streamline the roles, responsibilities of and relationships among key state
and non-state actors in the national response to reduce duplication, minimise conflict
and strengthen coordination for effective service delivery.
10.1 Public Sector
10.1.1 The Office of the President

The Office of the President, through the NACA shall:
� Provide political leadership and adequate funding for the national response to
HIV/AIDS epidemic.
� Ensure strong and sustained political and resource commitment, leadership and
accountability by state and local governments.
� Support the involvement of all sectors and leverage commitment of local

stakeholders and development partners.
10.1.2 National and State Assemblies
Given its powers to enact laws, make appropriations and provide oversight for
execution, the Legislatures at national, state and local councils shall:
� Provide overall legislative and political support for legal and institutional
reforms and enact appropriate laws to facilitate the implementation of this
Policy.
� Review laws related to population and reproductive health and ensure that
required resources are appropriated and released by all tiers of government for
HIV/AIDS programmes.
� Ratify and domesticate all international instruments for empowerment of

marginalised persons including women, children and physically challenged
persons.
48
� Provide leadership and mobilise support for HIV/AIDS activities within

legislatures and their constituencies at all levels and support CSO in their
communities.
� Promote policy dialogue and lead advocacy to reduce stigma and eradicate
discrimination against PLHIV.
10.1.3 Ministries, Departments and Agencies.
This Policy undertakes to ensure that all Ministries, Departments and Agencies are
supported to design, implement, and monitor and evaluate sector specific HIV/AIDS
prevention, care and support programmes including workplace policies for their
employees. Beyond this, some ministries have specific contributions to the multi-
sector non- health response.
In this regard:
A. The Ministry of Finance shall:
� Ensure release of budgeted funds as well as accountable and transparent
utilisation of funds released to line ministries and other government agencies
for HIV/AIDS interventions.
� Ensure that government meets its financial obligations towards execution of

bilateral and multilateral support for HIV/AIDS.
B. The National Planning Commission shall:

� Collaborate with NACA, recipient line ministries and states to coordinate
development partners' activities at all levels of the national HIV/AIDS
response.
� Ensure effective and transparent reporting relationship between development

partners and NACA on the one hand and benefiting states and other community
stakeholders.
C. The Ministry of Health shall:

� Pursue the implementation of health-sector based interventions to prevent the
sexual, blood-borne and MTCT of HIV in particular and of sexually transmitted
infections in general.
� Provide appropriate health facility-based care for persons with HIV-related

conditions and AIDS, including counseling and home-based care and support.
49
� Build capacity of health care delivery personnel and strengthen health care
delivery systems.
� Ensure adequate availability and equitable distribution of healthcare workers,

infrastructure, equipment, drugs and other commodities as well as technical
materials that will facilitate effective health sector response to HIV and AIDS.
� Coordinate the health sector HIV and AIDS response.
D. The Ministry of Education shall:

� Involve parents, through Parent-Teacher Associations and other appropriate
mechanisms to promote school-based reproductive and HIV/AIDS education.
� Strengthen educational curricula at various levels to support HIV prevention

and other control approaches
� Provide accessible and free youth friendly reproductive health services

including HCT related to HIV and STIs control and care to students at all levels
of educational system.
� Collaborate with all relevant ministries, departments and agencies (MDAs) to

develop and strengthen HIV/AIDS/STIs programmes for young people.
� Coordinate the educational sector HIV and AIDS response.
E. The Ministry of Justice shall:

� Provide assistance for the review and reform of legislation relating to
HIV/AIDS and public health.
� Generate public interest litigation to protect rights of PLHIV.
� Prepare legislation on reproductive health, HIV/AIDS and related matters as

approved by Cabinet.
F. The Ministry for Women Affairs and Social Development shall:

� Establish criteria and standards of care for support to families and care givers of
orphans and vulnerable children access needed support.
� Develop programmes and mechanisms for the provision of welfare support to

address the basic needs of OVC.
50
� Develop and implement AIDS prevention programmes for relevant groups

within the Ministry's purview, for example, women, girls, in-school and out-of-
school youth, and orphans.
� Develop, and sustain a comprehensive multi sector coordination and

collaboration platform to address factors responsible for women's differential
vulnerability to HIV infection.
G. The Ministry for Youth Development shall:
� Mainstream HIV/AIDS control activities into all areas of youth-related

programmes under the purview of the Ministry.
� Develop and implement AIDS prevention programmes for youths using

facilities established by the Ministries such as youth centres as well as through
the mechanism of her parastatals such as the National Youth Service Corp.
� Develop capacities of youths to develop and implement HIV/AIDS-related

programme.
� Develop programmes that address factors that contribute to the vulnerability of

young people to HIV using multi-dimensional approaches, including
communication approaches, development of life and livelihood skills, and
provision of gender-sensitive recreational and counselling services through
youth centres.
� Collaborate with all relevant MDAs to develop and strengthen HIV/AIDS/STIs

programmes for young people.
10.2. Media
The media shall:
� Provide sustained accurate and culturally appropriate information,

enlightenment and education to general public on HIV/AIDS.
� Report and project challenges and responses by sectors and stakeholders in

control of HIV/AIDS.
� Disseminate scientific publications epidemiological, research and surveillance

publications in user-friendly formats to promote safe practices by public
51
� Investigate, accurately document and widely disseminate information on the

performance of governments, MDAs, CSOs, international development
organisations and other development partners vis-à-vis HIV activities and
regularly report on the trend in the national response and the implementation of
this policy, highlighting both successes and challenges.
10.3. Civil Society
10.3.1 Non-Governmental Organisations

With respect to the involvement of Non-governmental organisations in the national
response, the government shall:
� Enhance collaboration between governments and NGOs and ensure their

representation in advisory bodies of national state and local HIV/AIDS
agencies and structures.
� Expand and strengthen CSO participation in prevention, care and support of

PLHIV and OVC interventions.
� Strengthen capacity of women and youth focused organisations to engage in

community level programmes.
� Encourage networking and facilitate coordination arrangements among NGOs

to avoid duplication and increase national coverage of programmes/ NGO.
10.3.2 Faith-Based Organisations

Faith-Based Organisations shall:
� Integrate messages and information about abstinence, prevention, care and

support into activities and promote family and moral values.
� Advocate for care and support of PLHIV, OVC and vulnerable groups
including children and widows and promote stigma and discrimination
reduction.
� Advocate the rights of women and eliminate harmful practices against women.
� Partner with government and other development partners in developing and

implementing HIV programmes.
52
� Encourage members of faith communities to actively participate in government

initiatives on HIV control and to seek care from orthodox health services in
timely manner as relevant to their health status.
10.3.3 Traditional and Religious Leaders

As custodians of culture and gatekeepers of behavior in communities, traditions and
religion shall:
� Provide leadership to eliminate negative cultural practices which increases the

vulnerability of women and girls STIs and HIV/AIDS and STIs.
� Support HIV/AIDS programmes in their community and advocate reduction of

stigma and discrimination against HIV infected and affected persons.
� Uphold, promote and mobilise communities to disseminate cherished

traditional values such as fidelity, delay of sexual debut and abstinence and
support families to inculcate same in children and young people.
� Facilitate inclusion and participation in community dialogues and action.
10.4 Private Sector Organisations and Enterprises

Private Sector Organisations and Enterprises shall:
� Develop workplace policies and implement prevention, care and support

HIV/AIDS programmes for workforce.
� Support related communities and constituents to develop and implement

programmes as corporate social responsibility.
� Support and leverage local and international private sector competencies,

financial and other resources to strengthen the national response.
10.5 International Development Partners

Development Partners shall:
� Support NACA as the focal agency for the national response and strengthen
capacity of governments at all levels to effectively implement the national
response.
� Strengthen local and international resource mobilisation and build technical

and institutional capacity to sustain effective and efficient national response.
53
� Ensure that their contributions are within and aligned with the national
response.
� Collaborate with NACA to ensure equitable coverage of services and establish

partnership platforms , systems, and instruments to strengthen the integrity,
credibility, transparency and accountability of national response
10.6 Rights, Roles and Responsibilities of People Living with HIV and AIDS
10.6.1 Rights of PLHIV:

The rights of all PLHIV include:
� Access to prevention, treatment, care and support interventions;
� Freedom from discrimination and stigma;
� Equitable access to economic and development opportunities, including

education and employment, and rights to participate in national development
initiatives; and
� Rights to participate in the design and implementation of HIV/AIDS-related

policies and programmes
10.6.2 Roles of PLHIV in national response:
� Development and implementation of innovative HIV/AIDS prevention, care

and support projects and activities, in line with the priorities articulated in this
national policy and national strategic plan.
� Mobilise communities for HIV/AIDS prevention and care activities.
� Advocate for appropriate legislation and services to protect and promote their
rights.
� Advocate for the involvement of various sectors of government, leaders at

national, state and community levels in HIV/AIDS prevention and care.
� Establish support groups to facilitate easy and equitable access of their

members to care and support.
54

Nigeria: National Policy On HIV/AIDS

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Nigeria: National Policy On HIV/AIDS

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What are the goals of the National Policy on HIV/AIDS?

What are the goals of the National Policy on HIV/AIDS?

What are the roles and responsibilities of different stakeholders in the national HIV/AIDS response?

What are the roles and responsibilities of different stakeholders in the national HIV/AIDS response?

H, PEACE & PRO

Professor John Idoko

Alex Ogundipe mps,

ACRONYMS AND ABBREVIATIONS

AIDS - Acquired Immune Deficiency Syndrome

NNRIMS - Nigeria National Response Information Management System

8.4. Policy Statements 43

The epidemiological picture regarding HIV shows considerable diversity across

1.3. National Response

1.4. Impact of the HIV/AIDS Epidemic

1.5. Rationale for the Policy

However, as the epidemic progresses, it is apparent that despite achievements of the

2.1. Policy Context

� Complementary Government documents provide the framework for this

� This Policy also responds to government ratification of and commitment to

� Specifically it is derived from agreed goals of international community to fight

2.2. Policy Considerations

� HIV/AIDS epidemic in Nigeria threatens the well-being of many Nigerians,

� As a public health issue, HIV/AIDS directly affects the health of millions of

� Prevention, treatment, care, support, and impact mitigation are mutually

� Significant sections of the population are most at risk of infection due to

� HIV/AIDS-related stigma remains all pervasive and that people infected or

� Effective response to HIV/AIDS requires respect for, protection of and

2.3 Guiding Principles

� Strong political leadership and commitment to transparency and prudent

� Multi-sectoral approach that is community-based, community-driven, gender-

� Commitment to scale up prevention among the general population as well as

� Protection and promotion of the rights and access of PLHIV to comprehensive

� Commitment to protecting rights of PLHIV, reduction of stigma and

� Commitment to promote and protect rights and reduce vulnerability of women,

� Promotion of comprehensive approach that strongly links HIV prevention,

� HIV/AIDS-related stigma remains all pervasive and that people infected or

� Effective response to HIV/AIDS requires respect for, protection of and

2.3 Guiding Principles

� Strong political leadership and commitment to transparency and prudent

� Multi-sectoral approach that is community-based, community-driven, gender-

� Commitment to scale up prevention among the general population as well as

� Protection and promotion of the rights and access of PLHIV to comprehensive

� Commitment to protecting rights of PLHIV, reduction of stigma and

� Commitment to promote and protect rights and reduce vulnerability of women,

� Promotion of comprehensive approach that strongly links HIV prevention,

� Strengthened linkages and forged synergies between HIV/AIDS programmes

� Determination to address social, economic and cultural factors responsible for

� Mainstreaming of gender into all policy-related and programming activities

� Promotion of consistent and effective partnerships and collaboration with

2.4 Overall Goal

2.5 Main Target

2.6 Strategic Thrusts

The strategic thrusts of the policy are as follows:

2.6.1.Behaviour change and prevention of new infections: focuses on prevention

2.6.2.Treatment: addresses issues of access to antiretroviral, tuberculosis/HIV

2.6.4.Institutional architecture and resourcing: the focus is on the design and

2.6.6.Monitoring and evaluation: aims at strengthening the quality of programme

2.6.7.Research and knowledge management: focuses on generation and