By Joyce Ekeh
Despite the availability of effective HIV medicines, thousands of Nigerians living with the virus remain at risk of treatment interruption because “free treatment” does not necessarily translate to free access to care, a leading infectious disease expert has warned.
Professor Prosper Ifeanacho Okonkwo of Bingham University said transport costs, food insecurity, fear of disclosure, stigma, confidentiality concerns and other social pressures continue to undermine Nigeria’s HIV response, threatening gains made over more than two decades.
Okonkwo, Professor of Infectious Diseases and Epidemiology, spoke during Bingham University’s 14th inaugural lecture, titled “Beyond Molecules: From Science to Sustainable Impact in Nigeria’s HIV Response.”
He said Nigeria had already acquired the scientific knowledge and medical tools needed to control HIV, but the country must now confront the social, financial and health-system barriers preventing people from starting and remaining on treatment.
“Free treatment” does not necessarily mean cost-free access, he said, stressing that patients may still have to bear the cost of transportation, food and other expenses associated with maintaining regular care.
According to him, fear of disclosure, breaches of confidentiality and stigma could also discourage patients from accessing or continuing treatment.
Okonkwo said Nigeria’s HIV treatment programme had expanded from about 15,000 people receiving treatment in its early years to more than 1.78 million by 2023, describing the growth as a major public health achievement.
But he cautioned against interpreting the progress as victory over the epidemic.
“The question before us is no longer whether we know what works, but whether we are prepared to govern success with the same seriousness that once drove emergency action,” he said.
The professor identified Nigeria’s continued dependence on international donors as another major threat to the sustainability of the HIV response.
He said external partners financed between 93 and 96 per cent of HIV spending between 2019 and 2021, warning that declining donor support could expose gaps in treatment and prevention unless domestic financing increases.
He acknowledged recent government efforts, including the National Health Compact signed in November 2025 and the N22.68 billion HIV, tuberculosis and malaria co-financing provision in the 2026 budget.
But he cautioned that commitments must translate into actual releases and sustained funding.
“A signed compact is not money released,” he said.
Okonkwo also raised concern over the continued burden of HIV among Nigerian children despite the availability of interventions capable of preventing mother-to-child transmission.
He disclosed that about 160,000 Nigerian children aged 0–14 were living with HIV, while an estimated 22,000 children acquired the virus and 15,000 died from AIDS-related causes in 2023.
He said timely HIV treatment for pregnant women could reduce the risk of transmission from about 45 per cent to below five per cent.
However, Nigeria’s prevention of mother-to-child transmission programme reached only about 66 per cent of those requiring the service in 2024.
Okonkwo attributed the gap to poverty, distance from health facilities, transport costs, stigma, fear of violence or abandonment, confidentiality concerns and dependence on traditional birth attendants in some communities.
“Preventing HIV in babies is fundamentally a women’s health intervention, not simply a paediatric one,” he said.
He, however, noted that the country had demonstrated its capacity to close treatment gaps rapidly when political and institutional attention was sustained.
According to him, treatment coverage among children already diagnosed with HIV rose from about 29 per cent in 2023 to 74 per cent in 2025.
He urged government to sustain the momentum until every child living with HIV who requires treatment is reached.
The expert also called for stronger interventions targeting adolescents, young women and populations experiencing stigma, discrimination and criminalisation.
He noted that girls and young women aged 15 to 24 have higher HIV infection rates than young men of the same age, with economic dependence, relationships with older partners and limited ability to negotiate safer sex contributing to their vulnerability.
Okonkwo said misinformation and stigma must also be tackled because modern HIV treatment had fundamentally changed the outlook for people living with the virus.
He explained that a person diagnosed early and maintained on effective treatment could now expect a near-normal lifespan.
He highlighted the Undetectable equals Untransmittable, U=U, principle, explaining that people on effective treatment who maintain an undetectable viral load do not transmit HIV sexually.
But he warned that U=U depends on uninterrupted access to medication, adherence and regular viral-load testing backed by functioning laboratories.
He therefore urged government to treat the national HIV laboratory network as a health security asset, noting that laboratories strengthened during the HIV response later became critical to Nigeria’s COVID-19 testing capacity.
The professor also advocated integrating HIV treatment into the National Health Insurance system to reduce the programme’s vulnerability to fluctuations in discretionary government funding.
He called for completion of the planned integration of HIV services into primary healthcare and greater attention to paediatric treatment, while urging health authorities to design services around trust, confidentiality and patients’ realities.
Earlier, Vice-Chancellor of Bingham University, Prof. Haruna Kuje Ayuba, said scientific advances alone could not eliminate the social and economic factors driving HIV transmission and treatment interruption.
Ayuba said sustainable progress required the integration of science with policy, education, community engagement and stronger health systems.
He described Okonkwo’s lecture as “insightful and transformative.”
Okonkwo, who has worked in Nigeria’s HIV response for more than 22 years, including over two decades heading APIN Public Health Initiatives, has authored or co-authored more than 130 peer-reviewed publications.
He also contributed to the development of Nigeria’s first national antiretroviral treatment guidelines and guidelines for preventing mother-to-child transmission of HIV.
