Nigerian youth are falling through the cracks of HIV prevention and treatment programs, with testing rates plummeting below 25 percent, jeopardizing the United Nations’ Sustainable Development Goal (SDG) 3 and the UNAIDS 95-95-95 targets by 2030.
Dr. Agatha David, director of Research and Consultant Paediatrician at the Nigerian Institute of Medical Research (NIMR), who disclosed this at a press conference, organised by NIMR, in Lagos, on Wednesday, said this testing gap, coupled with poor treatment adherence and low viral suppression rates below 80 percent, threatens Nigeria’s ability to meet the global goal of ending the AIDS epidemic.
Recall the UNAIDS 95-95-95 goals aim for 95 percent of people living with HIV to know their status, 95 percent of those diagnosed to receive antiretroviral therapy (ART), and 95 percent of those on treatment to achieve viral suppression by 2030.
In Nigeria, home to an estimated 2 million people living with HIV, adolescents aged 15 to 24 are a critical weak link. “If they are not tested, we don’t know who’s positive,” Dr. David said, noting that fewer than 23 percent of youth reported testing in the past year.
This testing gap is compounded by poor treatment adherence. Among adolescents and young adults living with HIV, viral suppression rates lag below 80 percent, compared to NIMR’s 92 percent success rate, which is not reflective of the national picture.
Non-adherence stems from multiple factors: stigma, lack of family support, and the exploratory nature of youth, including high-risk sexual behaviors.
David noted that 20 percent of adolescents in a NIMR study reported sexual debut before age 15, with inconsistent condom use and transactional sex further fueling transmission. “If they are not virally suppressed, they can transmit the virus, continuing the chain,” she warned.
NIMR has pioneered innovative interventions to address these challenges. In 2009, it established Nigeria’s first adolescent-friendly HIV clinic, offering tailored counseling and care. The institute also launched an outreach program for an orphanage in Ketu, where children living with HIV struggled to access follow-up care.
To boost adherence, NIMR tested bidirectional SMS reminders, where youth confirm medication intake, and peer navigation programs, pairing virally suppressed adolescents with those struggling. These strategies improved adherence and suppression rates, but scaling them nationally faces funding hurdles.
“The government relies on donor agencies for ART drugs,” Dr. David explained, noting that additional interventions like SMS programs require costly investments not covered by national programs.
Mental health is another critical barrier. NIMR studies found that over 20 percent of HIV-positive adolescents experience depression and suicidal ideation, often triggered by stigma or family rejection.
A heartbreaking case involved a nine-year-old boy who attempted suicide after being expelled from home due to his HIV status. NIMR is now planning a study to integrate mental health counseling into routine HIV care, collaborating with neuropsychiatric hospitals to address this gap. “Mental health issues are real, and we are not trained to handle them at scale,” David admitted.
Funding remains a choke point. David revealed that the U.S. government continues to fund ART as it is considered lifesaving; however she implies that other interventions, such as resistance testing, pre-exposure prophylaxis (PrEP), and additional services like SMS reminders or comprehensive testing, are not covered.
“The Trump administration is a wake-up call, not just for Nigeria, but for many African countries. Because if you are depending on somebody to give you food, and the person is not obligated to give you food, they could decide that I have given you enough food, you should have been able to cultivate some food by now. So when they first announced that they would stop it, the federal government, I think they allocated funds to procure drugs for a while. And then Trump relented and said for lifesaving, they will continue and ART is considered lifesaving. So that is why they are continuing it for now,” she explained.
While ART is funded, other critical components like resistance testing, CD4 counts, hemoglobin tests, and liver function tests are no longer supported due to funding cuts, forcing patients to pay out-of-pocket, David emphasized, calling for local manufacturing of antiretrovirals to reduce dependency, citing India as a model.
As Nigeria grapples with HIV-positive adolescents and young adults, the stakes are high. Without urgent action to boost testing, adherence, and holistic care, the country risks missing the 2030 deadline to end AIDS, with global health and economic repercussions. “We have the research. Now we need to translate it into practice,” David averred.
