Country progress

report - Nigeria
Global AIDS Monitoring 2020
Contents

I. Overall - Fast-track targets

II. HIV testing and treatment cascade - Ensure that 30 million people living with HIV
have access to treatment through meeting the 90-90-90 targets by 2020
III. Prevention of mother-to-child transmission - Eliminate new HIV infections among
children by 2020 while ensuring that 1.6 million children have access to HIV treatment
by 2018
IV. HIV prevention; Key populations - Ensure access to combination prevention options,
including pre-exposure prophylaxis, voluntary medical male circumcision, harm
reduction and condoms, to at least 90% of people by 2020, especially young women
and adolescent girls in high-prevalence countries and key populations—gay men and
other men who have sex with men, transgender people, sex workers and their clients,
people who inject drugs and prisoners
V. Gender; Stigma and discrimination - Eliminate gender inequalities and end all forms
of violence and discrimination against women and girls, people living with HIV and
key populations by 2020
VI. Knowledge of HIV and access to sexual reproductive health services - Ensure that
90% of young people have the skills, knowledge and capacity to protect themselves
from HIV and have access to sexual and reproductive health services by 2020, in
order to reduce the number of new HIV infections among adolescent girls and young
women to below 100 000 per year
VII. Social protection - Ensure that 75% of people living with, at risk of and affected by
HIV benefit from HIV-sensitive social protection by 2020
VIII. Community-led service delivery - Ensure that at least 30% of all service delivery is
community-led by 2020
IX. HIV expenditure - Ensure that HIV investments increase to US$ 26 billion by 2020,
including a quarter for HIV prevention and 6% for social enablers
X. Empowerment and access to justice - Empower people living with, at risk of and
affected by HIV to know their rights and to access justice and legal services to
prevent and challenge violations of human rights
XI. AIDS out of isolation - Commit to taking AIDS out of isolation through people-centred
systems to improve universal health coverage, including treatment for tuberculosis,
cervical cancer and hepatitis B and C
Overall

Fast-track targets
Progress summary
HIV is still a major public health challenge. Nigeria currently ranks fourth in the world with
regards to HIV burden. Nigeria has a generalized HIV epidemic with the highest HIV burden
in West and Central African sub-region. The country has an estimated 1.8 million people living
with HIV (PLHIV) (2019 Spectrum estimate) and an estimated 107,112 new HIV infections
which is about 38% of new infections in West and Central African region. Nigeria accounts for
about 41% of vertically transmitted HIV infections in children in the region in 2018 (UNAIDS,
2019). In 2018, a population based survey – Nigeria HIV/AIDS Indicator and Impact Survey
(NAIIS, 2018) was conducted to estimate HIV prevalence and related health indicators at
national and sub-national levels. HIV prevalence from this survey was 1.3% among 15 – 49
years which was an improvement from the last population-based survey conducted in 2012,
National HIV/AIDS Reproductive Health and Survey (NARHS) with HIV prevalence of
3.4%.While there has been a remarkable gain in rolling back the epidemic, the total number of
people affected by the epidemic remains high.

The 2014 Integrated Biological and Behavioural Surveillance Survey (IBBSS) conducted
among the key populations to estimate HIV prevalence showed men that have sex with men
(MSM) had the highest prevalence of 22.9% followed by female sex workers (FSW) 14.4%
and people who inject drugs (PWID) 3.4%.
3.1 HIV incidence rate per 1000, Nigeria (2010-2019)
Number of people newly infected with HIV in the reporting period per 1000 uninfected
population

Source: Spectrum file

1.7 AIDS mortality per 100 000, Nigeria (2010-2019)

Total number of people who have died from AIDS-related causes per 100 000
population

Source: Spectrum file

4.1 Discriminatory attitudes towards people living with
HIV, Nigeria (2019)
Percentage of respondents (aged 15-49 years) who respond "No" to: Question 1 -
"Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this
person had HIV?"; Question 2 - "Do you think that children living with HIV should be
able to attend school with children who are HIV negative?"
HIV testing and treatment
cascade

Ensure that 30 million people living with HIV have access to

treatment through meeting the 90-90-90 targets by 2020
Progress summary
The strategies that 90% of PLHIV know their status; 90% of people diagnosed with HIV
receive ARVs, and 90% of PLHIV on ART are virally suppressed all remain valid, as there are
still many PLHIV who do not know their HIV status, the challenges facing PLHIV on treatment
remain, and the current less than optimal viral suppression rate warrant continuation of the
programmatic adjustments being proposed. This will improve performance and lead to
achieving program results and impact.

The GoN, PEPFAR and the GF agreed to align their program funding and implementation
support toward accelerated achievement of 90-90-90 HIV targets starting from 2020.

1st 90: It is estimated that there are about 1.8 million people in Nigeria living with HIV in 2019;
about one third do not know their HIIV status resulting in a gap of about 23% to reach the
target of 90% of PLHIV knowing their HIV status. Before 2018, millions of people were tested
for HIV and received the results using general population testing approach at less than 1%
HIV positivity yield. Return on investment on general population HIV testing was low. In order
to close this gap at reasonable cost, the country adopted differentiated HIV testing strategies
that include provider initiated testing & counselling, index case testing, key population (KP)
sexual network testing, HIV testing for TB patients, and targeted community testing – all of
which have been shown to have higher HIV positivity yield than general population testing.
HIV Self-Testing has since been adopted for KPs and male partners of HIV positive women.
Self-testing will be extended to adolescents and young people. Self-testing is being used to
extend reach of HIV testing to populations that are not adequately being reached by
differentiated HIV testing strategies.

2nd 90: As of December 2019, 1,147,941 people (about 63% of) people living with HIV are on
treatment consisting of 95% adults and 5% children. Differentiated ART Services Delivery is
the approach of choice and is implemented at facility and community levels according to
categorization of individual patients. Main models of DSD being implemented include case
management, multi-month dispensing (MMD) of ARVs for first line ART regiment to stable
clients and community-based refill/distribution of ARVs plus adherence support. 2nd 90 also
encompasses management of co-morbidities such as TB, STIs, fungal infection, viral
Hepatitis B & C, Human Papilloma Virus (HPV) and mental health. Management of advanced
HIV disease (AHD) has been introduced this year to address nearly 30% of clients who start
ART with CD4 count of less than 200. Also introduced is third line therapy for those who fail
second line and salvage regimens.

3rd 90: 2019 national viral load suppression rate was 74.6%. Main causes of low VLS rates
include poor adherence to and retention on treatment, drug toxicity and resistance, and co-
infections. Innovative approaches to managing adherence and retention challenges include
the use of Treatment Champions, Case Managers, and Mentor Mothers to support, motivate,
and counsel clients to adhere to and remain on treatment as well as track and return clients
lost to follow up. Adoption of VL treatment monitoring resulted in significant reduction of CD4
count coverage, including the baseline test which is used for diagnosing AHD. This trend will
have to be reversed along with introduction of TB LAM and cryptococcal antigen test for
management of AHD.
Policy questions (2019)
Is there a law, regulation or policy specifying that HIV testing:

a) Is mandatory before marriage

No

b) Is mandatory to obtain a work or residence permit

No

c) Is mandatory for certain groups

No

What is the recommended CD4 threshold for initiating antiretroviral therapy in adults
and adolescents who are asymptomatic, as per MoH guidelines or directive, and what
is the implementation status?

No threshold; treat all regardless of CD4 count; Implemented countrywide (>95% of treatment
sites)

Does your country have a current national policy on routine viral load testing for
monitoring antiretroviral therapy and to what extent is it implemented?

a) For adults and adolescents

Yes; Implemented countrywide (>95% of treatment sites)

b) For children

Yes; Implemented countrywide (>95% of treatment sites)

HIV testing and treatment cascade, Nigeria (2019)

Source: Spectrum file

Progress towards 90-90-90 target, Nigeria (2019)

Source: Spectrum file

1.1 People living with HIV who know their HIV status, Nigeria
(2010-2019)
Number of people living with HIV who know their HIV status

Source: Spectrum file

1.2 People living with HIV on antiretroviral therapy,

Nigeria (2010-2019)
Number of people on antiretroviral therapy

Source: Spectrum file

1.3 People living with HIV on antiretroviral treatment who have
suppressed viral load, Nigeria (2010-2019)
Number of people living with HIV with suppressed viral loads

Source: Spectrum file

1.4 Late HIV diagnosis, Nigeria (2019)

Percentage of people living with HIV with the initial CD4 cell count <200 cells/mm3
during the reporting period
1.4 Late HIV diagnosis, Nigeria (2019)
Percentage of people living with HIV with the initial CD4 cell count <350 cells/mm3
during the reporting period

1.6 AIDS mortality rate per 100 000, Nigeria (2010-2019)

Total number of people who have died from AIDS-related causes per 100 000
population

Source: Spectrum file

1.6 AIDS mortality rate per 100 000 among adults, Nigeria
(2010-2019)
Total number of adults who have died from AIDS-related causes per 100 000 population

Source: Spectrum file

1.7 HIV testing volume and positivity, Nigeria

Percentage of HIV -positive results returned to people (positivity) in the calendar year
Prevention of mother-to-
child transmission

Eliminate new HIV infections among children by 2020 while

ensuring that 1.6 million children have access to HIV
treatment by 2018
Progress summary
All HIV pregnant women accessing antenatal care services are provided with HIV testing and
extending the testing points to other service delivery points like pediatric and immunization
clinics. In high burden states, community mobilization for HIV testing for pregnant women was
priorities. Case managers and mentor mothers (peers) are used to support all HIV positive
pregnant women and to ensure that HIV all exposed babies were proactively linked to early
Infant diagnosis services. The resilient health system strengthening by Government of Nigeria
through Federal Ministry of Health is another way to ensure elimination of new HIV infections
among children.
Policy questions (2019)
Does your country have a national plan for the elimination of mother-to-child
transmission of HIV?

Yes

Target(s) for the mother-to-child transmission rate and year: -

Elimination target(s) (such as the number of cases/population) and year: -

Do the national guidelines recommend treating all infants and children living with HIV
irrespective of symptoms and if so, what is the implementation status of the cut-off?

Treat all, regardless of age

Implemented countrywide (>95% of treatment sites)

2.1 Early infant diagnosis, Nigeria (2011-2019)
Number of infants who received an HIV test within two months of birth

2.1 Early infant diagnosis, Nigeria (2018-2019)

Percentage of infants born to women living with HIV receiving a virological test for HIV
within two months of birth

Source: Spectrum file

2.2 Mother-to-child transmission of HIV, Nigeria (2010-2019)
Estimated percentage of children newly infected with HIV from mother-to-child
transmission among women living with HIV delivering in the past 12 months

Source: Spectrum file

2.3 Preventing mother-to-child transmission of

HIV, Nigeria (2010-2019)

Source: Spectrum file

2.3 Preventing mother-to-child transmission of
HIV, Nigeria (2018-2019)
Percentage of pregnant women living with HIV who received antiretroviral medicine to
reduce the risk of mother-to-child transmission of HIV

Source: Spectrum file

2.4 Syphilis among pregnant women, Nigeria (2019)

Percentage of pregnant women tested for syphilis
2.4 Syphilis among pregnant women, Nigeria (2019)
Percentage of pregnant women tested positive for syphilis

2.4 Syphilis among pregnant women, Nigeria (2019)

Percentage of pregnant women on treatment among those who tested positive
2.6 HIV testing in pregnant women, Nigeria (2018-2019)
Percentage of pregnant women with known HIV status
HIV prevention; Key
populations

Ensure access to combination prevention options, including

pre-exposure prophylaxis, voluntary medical male
circumcision, harm reduction and condoms, to at least 90% of
people by 2020, especially young women and adolescent girls
in high-prevalence countries and key populations—gay men
and other men who have sex with men, transgender people,
sex workers and their clients, people who inject drugs and
prisoners
Progress summary
PrEP is provided in-country for the Key Population (Provided by partners) and discordant
couples (Provided by GON).In partnership with USAID and with support from PEPFAR There
are on-going plans for a PrEP collaborative study in Nigeria. The Collaboration for HIV
Prevention Options to Control the Epidemic (CHOICE) will conduct a series of learning and
planning sessions to support oral PrEP roll out and scale-up.

With a score of 98%, voluntary medical male circumcision is not one of the Global HIV
prevention pillars that Nigeria reports on. However, there are plans to ensure that the
remaining 2% are reached with interventions.

Nigeria is in the process of piloting harm reduction interventions in three states (Oyo, Abia
and Gombe states). The pilot program will cover Needle Syringe program(NSP) and provision
of Naloxone for treatment of drug overdose.

A National Condom Strategy (NCS) 2017-2021 is in place. This strategy outlines the strategic
priorities and key interventions needed to ensure the availability of and access to male and
female condoms in Nigeria.

Combination prevention package has been updated for Adolescent Girls and Young women
(AGYW) in high prevalence settings. Resource mobilization ongoing to expand focused
programming for AGYW in priority locations
Policy questions: Key populations (2019)
Criminalization and/or prosecution of key populations

Transgender people

• Neither criminalized nor prosecuted

Sex workers

• Other punitive and/or administrative regulation of sex work

Men who have sex with men

• Yes, imprisonment (up to 14 years)

Is drug use or possession for personal use an offence in your country?

•-

Legal protections for key populations

Transgender people

• Neither criminalized nor prosecuted

Sex workers

• No

Men who have sex with men

•-

People who inject drugs

• No

Has the WHO recommendation on oral PrEP been adopted in your country's national
guidelines?

No, guidelines have not been developed

3.1 HIV incidence rate per 1000, Nigeria (2010-2019)
New HIV-infections in the reporting period per 1000 uninfected population (Adults,
ages 15-49)

Source: Spectrum file

3.2 Estimates of the size of key populations, Nigeria

3.3 HIV prevalence among key populations, Nigeria (2011-
2019)
Percentage of specific key populations living with HIV

3.4 HIV testing among key populations, Nigeria (2016-2019)

Percentage of people of a key population who tested for HIV in the past 12 months, or
who know their current HIV status
3.5 Antiretroviral therapy coverage among people living with
HIV in key populations, Nigeria (2016-2019)
Percentage of the people living with HIV in a key population receiving antiretroviral
therapy in the past 12 months

3.6 Condom use among key populations, Nigeria (2011-2019)

Percentage of people in a key population reporting using a condom the last time they
had sexual intercourse
3.15 People who received pre-exposure prophylaxis,
Nigeria (2017-2019)
Total number of people who received oral PrEP at least once during the reporting
period

3.18 Condom use at last high-risk sex, Nigeria (2018)

Percent of respondents who say they used a condom the last time they had sex with a
non-marital, non-cohabiting partner, of those who have had sex with such a partner in
the last 12 months
3.19 Annual number of condoms distributed, Nigeria (2019)
Number of condoms distributed during the past 12 months
Gender; Stigma and
discrimination

Eliminate gender inequalities and end all forms of violence

and discrimination against women and girls, people living
with HIV and key populations by 2020
Progress summary
A multi-sectoral national plan of action was developed in 2015 to conduct interventions to
eliminate gender inequalities and end all forms of violence and discrimination against women,
girls, and PLHIV and key populations. The 3-year plan aimed at reducing the incidence of HIV
by addressing GBV using a multi-sectorial approach at the national, states and local levels.
The main achievements of the plan include strengthened human and institutional capacity;
reviewed laws and policies; increased knowledge and awareness on GBV/HIV prevention and
management; and improved information management and use. Plans under way to expand
interventions to improve outcomes of HIV prevention and impact mitigation program towards
ending AIDS by 2030.
Policy questions (2018)
Does your country have a national plan or strategy to address gender-based violence
and violence against women that includes HIV

Yes

Does your country have legislation on domestic violence*?

Yes

• Physical violence

• Sexual violence

• Emotional violence

• Economic violence

• Explicit criminalization of marital rape

• Protection of former spouses

What protections, if any, does your country have for key populations and people living
with HIV from violence?

• General criminal laws prohibiting violence

• Specific legal provisions prohibiting violence against people based on their HIV status or
belonging to a key population

• Programmes to address intimate partner violence*

• Programmes to address workplace violence

• Interventions to address police abuse

• Interventions to address torture and ill-treatment in prisons

Does your country have policies in place requiring healthcare settings to provide
timely and quality health care regardless of gender, nationality, age, disability, ethnic
origin, sexual orientation, religion, language, socio-economic status, HIV or other
health status, or because of selling sex, using drugs, living in prison or any other
grounds?

Yes, policies exists and are consistently implemented

Does your country have laws criminalizing the transmission of, non-disclosure of or
exposure to HIV transmission?

No, but prosecutions exist based on general criminal laws

4.1 Discriminatory attitudes towards people living with
HIV, Nigeria (2019)
Percentage of respondents (aged 15-49 years) who respond "No" to: Question 1 -
"Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this
person had HIV?"; Question 2 - "Do you think that children living with HIV should be
able to attend school with children who are HIV negative?"

4.3 Prevalence of recent intimate partner

violence, Nigeria (2018)
Proportion of ever-married or partnered women aged 15-49 who experienced physical
or sexual violence from a male intimate partner in the past 12 months
Percentage of Global AIDS Monitoring indicators with data
disaggregated by gender
Knowledge of HIV and
access to sexual
reproductive health
services

Ensure that 90% of young people have the skills, knowledge

and capacity to protect themselves from HIV and have access
to sexual and reproductive health services by 2020, in order
to reduce the number of new HIV infections among adolescent
girls and young women to below 100 000 per year
Policy questions (2018)
Does your country have education policies that guide the delivery of life skills-based
HIV and sexuality education, according to international standards, in:

a) Primary school

Yes

b) Secondary school

Yes

c) Teacher training

Yes
5.1 Young people: Knowledge about HIV
prevention, Nigeria (2018)
Percentage of women and men 15-24 years old who correctly identify both ways of
preventing the sexual transmission of HIV and reject major misconceptions about HIV
transmission

5.2 Demand for family planning satisfied by modern

methods, Nigeria (2018)
Percentage of women of reproductive age (15-49 years old) who have their demand for
family planning satisfied with modern methods
Social protection

Ensure that 75% of people living with, at risk of and affected

by HIV benefit from HIV-sensitive social protection by 2020
Progress summary
Interventions and engagement with the National Social Safety Net Coordinating Office
(NASSCO) to facilitate the linkage of vulnerable populations with the social investment
program in Nigeria. Ongoing linkages of poor and vulnerable People Living with HIV and key
population to economic empowerment initiatives within the community.
Community-led service
delivery

Ensure that at least 30% of all service delivery is community-

led by 2020
Progress summary
Concerted efforts to strengthen the community end of the service delivery include the review
of the National HIV/AIDS Community Care and Support Guidelines scheduled to be rolled out
in 2020.
Policy questions (2019)
Does your country have a national policy promoting community delivery of
antiretroviral therapy?

No

Are there any of the following safeguards in laws, regulations and policies that provide
for the operation of CSOs/CBOs in your country?

• Registration of HIV CSOs is possible

• HIV services can be provided by CSOs/CBOs

• Services to key populations can be provided by CSOs/CBOs

• Reporting requirements for CSOs/CBOs delivering HIV services are streamlined

HIV expenditure

Ensure that HIV investments increase to US$ 26 billion by

2020, including a quarter for HIV prevention and 6% for social
enablers

8.2 The average unit prices of antiretroviral regimens (in

US$), Nigeria (2018-2019)
8.3 HIV expenditure by programme category, Nigeria (2013-
2019)
Empowerment and
access to justice

Empower people living with, at risk of and affected by HIV to

know their rights and to access justice and legal services to
prevent and challenge violations of human rights
Progress summary
In 2014, the national HIV and AIDS Anti-Discrimination Act of the Federal Republic of Nigeria
was passed into law. This Act makes provisions for the prevention of HIV and AIDS-based
discrimination and protects the fundamental human rights and dignity of people living with and
affected by HIV and AIDS in Nigeria. The law has been domesticated in 17 States. It has also
been translated into four Nigerian languages (Hausa, Igbo, Pidgin English and Yoruba) for
popularization. Mediation and litigation of cases are carried out to challenge violations while a
compendium of HIV/AIDS related stigma and discrimination cases has been developed to
document cases.
Policy questions (2018)
In the past two years have there been training and/or capacity building programmes for
people living with HIV and key populations to educate them and raise their awareness
concerning their rights (in the context of HIV) in your country?

Yes, at scale at the sub-national level

Are there mechanisms in place to record and address cases of HIV-related

discrimination (based on perceived HIV status and/or belonging to any key
population)?

Yes

What accountability mechanisms in relation to discrimination and violations of human

rights in healthcare settings does your country have, if any?

• Complaints procedure

• Mechanisms of redress

• Procedures or systems to protect and respect patient privacy or confidentiality

What barriers in accessing accountability mechanisms does your country have, if any?

•-
AIDS out of isolation

Commit to taking AIDS out of isolation through people-

centred systems to improve universal health coverage,
including treatment for tuberculosis, cervical cancer and
hepatitis B and C
Progress summary
There is a national policy in place on cervical cancer screening and treatment for all women
including women living with HIV.

The National Guidelines on HIV Prevention and Treatment for adult, adolescent and children
and TB/HIV contains co-infection policies on Isoniazid preventive therapy (IPT) or latent TB
infection (LTBI) prophylaxis for people living with HIV, Intensified TB case finding among
people living with HIV, TB infection control in HIV health-care settings, Co-trimoxazole
prophylaxis, Hepatitis B and C screening and management in anti-retroviral therapy clinics
Policy questions (2019)
Is cervical cancer screening and treatment for women living with HIV recommended in:

a) The national strategy, policy, plan or guidelines for cancer, cervical cancer or the
broader response to non-communicable diseases (NCDs)

b) The national strategic plan governing the AIDS response

c) National HIV-treatment guidelines

What coinfection policies are in place in the country for adults, adolescents and
children?

• Isoniazid preventive therapy (IPT) or latent TB infection (LTBI) prophylaxis for people living
with HIV

• Intensified TB case finding among people living with HIV

• TB infection control in HIV health-care settings

• Co-trimoxazole prophylaxis

• Hepatitis B screening and management in antiretroviral therapy clinics

• Hepatitis C screening and management in antiretroviral therapy clinics

10.1 Co-managing TB and HIV treatment, Nigeria (2011-2019)
Number of HIV-positive new and relapse TB patients started on TB treatment during
the reporting period who were already on antiretroviral therapy or started on
antiretroviral therapy during TB treatment within the reporting year

10.2 Proportion of people living with HIV newly enrolled in HIV

care with active TB disease, Nigeria (2015-2019)
Total number of people living with HIV with active TB expressed as a percentage of
those who are newly enrolled in HIV care (pre-antiretroviral therapy or antiretroviral
therapy) during the reporting period
10.3 Proportion of people living with HIV newly enrolled in HIV
care started on TB preventive therapy, Nigeria (2015-2019)
Number of patients started on treatment for latent TB infection, expressed as a
percentage of the total number newly enrolled in HIV care during the reporting period