Improving Nigeria’s HIV Fight; The Transformative Power Of State Ownership

By Marcus Fatunmole

Nearly four decades since Nigeria recorded its first cases of HIV/AIDS, foreign donors have sustained the country’s fight against the virus.

Currently, Nigeria provides less than 20 per cent of its HIV/AIDS funds despite having nearly two million of its population living with the condition.

According to the Joint United Nations Programme on HIV and AIDS, Nigeria ranks fourth globally in HIV burden. The country also has a generalized HIV epidemic with the highest HIV burden in the West and Central African sub-region. As of March 2023, about 100,000 people with the virus in Nigeria were yet to be on antiretroviral treatment. Through the National Agency for the Control of AIDS (NACA), Nigeria closed the gap in the population of people on treatment for the virus in the last eight years with several initiatives led by the Federal Government.
From 2010 to 2017, the country almost tripled the number of people living with HIV having access to antiretroviral therapy, up from 360,000 people in 2010 to more than one million people in 2018. However, the National HIV/AIDS Indicator and Impact Survey (NAIIS) indicates that more than half of people living with the virus still do not have suppressed viral loads.
HIV remains a major public health concern in Nigeria. Nigeria, Africa most populous nation has an estimated 1.9 million people living with HIV (PLHIV), according to NAIIS. The survey indicates that Nigeria’s HIV prevalence rate is 1.4%. The prevalence rate is slightly lower among adults aged 15–49 years at 1.3%.
It also differentiates HIV prevalence by state, showing the South-South of the country having the highest HIV prevalence, at 3.1% among adults aged 15–49 years.
HIV prevalence is also high in the North Central (2.0%) and in the South East (1.9%). In the South West, the virus’ prevalence is lower at 1.1%, while it is 1.1% in the North East and 0.6% in the North West.
At the national level, viral suppression among people living with HIV aged 15–49 years stands at 42.3% (45.3% among women and 34.5% among men).
The NAIIS further shows that Akwa Ibom has the highest prevalence rate of HIV in Nigeria, with 5.5%, followed by Benue State, which has about 5.3% prevalence rate. Donor funding is not sustainable to drive Nigeria’s HIV/AIDS management.

The Director General of NACA, Dr. Gambo Aliyu, said as of June 2021, international donations accounted for more than 80% of about $6.2 billion spent to identify and treat 60% of PLWHIV in Nigeria between 2005 and 2018. Dr. Aliyu said “Between 2005 and 2018, about $6.2 billion dollars was spent to identify close to one million people living with HIV in this country and place them on treatment.

“However, 80 per cent of this money came from international donors and development partners, only 18 percent was contributed by the federal and state governments, and one per cent came from the private sector.”

As Nigeria joins the rest of the world to diagnose 95% of all HIV-positive individuals, provide antiretroviral therapy (ART) for 95% of those diagnosed and achieve viral suppression for 95% of those treated by 2030, it has become imperative for it to look inward and harness resources for the goal.

Halting mother-to-child transmission of HIV, containing new infections, providing essential kits for HIV prevention, procuring drugs for people on treatment, and recruiting more human resources foresting , counselling and managing the virus, among others, require sources for funding locally.

However, the Federal Government cannot sustain current gains made without the support of State Government. What the State Government can do. The states have the potential to join hands with the Federal Government to end the HIV menace in the country.

States support can come in the form of direct funding of the HIV/AIDS programme through a joint funding basket. This funding can be deducted directly from the monthly allocations by the Revenue Mobilization, Allocation and Fiscal Commission (RMAFC) if mutually agreed upon.

State governments should make their AIDS control agencies very functional by recruiting more competent hands and equipping them with all the resources they need to enable them to reach all communities.

State governments can do more to sensitize their people on testing and treatment and end all forms of stigmatization related to HIV/AIDS.

With increased states’ participation in resource mobilization for HIV/AIDS control, NACA can save funds it spends on administrative purposes, such as mobilizing staff across states, among others, for other purposes. For instance, NACA will focus more on coordination at the centre while the states deploy resources to engage communities for sensitisation, testing and treatment. State resources such as health workers, health facilities and other fixed assets will help the campaign against the virus.

As states prepare another budget cycle, HIV funding should be an integral part of the document.

With states’ support, the Nigerian Government can review the nation’s educational curriculum to accommodate key topics on HIV/AIDS. This will make knowledge of the virus begin from elementary classes. States’ contributions to the national HIV/AIDS campaign and fight will support more awareness creation at the state level. This is because the more the states engage in the campaign, the more sensitization they make at the grassroots level.

States greater participation in HIV/AIDS management will increase overall investments in human resources and health sector funding.

Some of the states in Nigeria that have demonstrated commitment to the HIV response in Nigeria are Lagos, Akwa-Ibom, Osun, and the FCT. Every state is endowed with resources and capacity to support the campaign.


Some of the challenges the states face include dwindling revenues amid acute poverty, high rates of unemployment, insecurity, and others which compete for the states’ insufficient funds. However, corruption has seen much of the available funds squirrelled by leaders while the citizens and basic infrastructures suffer.

Another major blow to Nigeria’s fight against the virus is brain drain. Trained medical professionals are leaving Nigeria in droves for greener pastures.

Many health facilities that should offer care to the public, especially people with HIV, are dilapidated.

Most states in Nigeria rely on the monthly allocation they receive from the Federal Government and have been unable to tap the 43 vast natural resources in their domains. It’s been so bad that only a few states, such as Lagos, Rivers and the Federal Capital Territory (FCT), generated over 49% of Nigeria’s internally generated revenue in 2022.

Because of over-reliance on the government at the centre, many states have failed to provide basic services such as security, education and health. Consequently, poverty, exclusion, unemployment and preventable diseases are rising.

The worst of all is that local governments, which are the closest arm of Government to the people, are controlled by the states. Most of them are starved of funds duly allocated to them from the federation’s accounts by state governors who determine who runs them and how they are managed.

This often makes the local governments far from development, incapable of tackling common challenges, including insecurity, unemployment, poor health and education and providing other basic amenities.


Some of the solutions to these problems are blocking conduit pipes for corruption, making the government more accountable to the people, creating more initiatives for revenue generation, hiring and paying competitive wages to doctors, nurses and other health workers, making the health facilities very conductive to work, and guaranteeing inclusiveness in governance.

States should engage more community and religious leaders to sensitize their people to test for HIV since testing is fundamental to the HIV/AIDS fight.

States can amend their health insurance laws to accommodate free treatment for all persons with HIV. The law could also specify the deduction of a percentage of the state’ s revenues to fund the HIV fight. Another way to address the HIV crisis is to initiate HIV/AIDS clubs in schools. The clubs can be nurtured to become ambassadors and game changers in the country’s fight against the menace. Besides, since the people with the virus reside in the states, the State Governments should engage them to lead sensitization against the virus.


The state government can collaborate with the private sector to mobilize funds for fighting HIV

At the onset of COVID-19, the Federal Government engaged the private sector to raise funds to combat the epidemic in 2020

The partnership birthed the Nigeria Private Sector Coalition Against COVID-19 (CACOVID) Relief Fund, which raised about N40 billion to procure critical infrastructures for the nation’s public hospitals to bolster the country’s preparedness to confront the epidemic.

Though COVID-19 is no longer a threat today, the resources provided by the CACOVID fund are in the hospitals and supporting services for all.

It is hoped that if State Governments can take this path, HIV will become history someday, and the investments made will produce an enduring impact on the Nigerian health system.