Reducing HIV Infections: How Nigeria Is Doing Better Than the U.S.

HIV infections are on the rise in parts of the United States, particularly among people experiencing housing insecurity, men who have sex with men, Black and Latinx communities, injection drug users, and transgender people. UNAIDS’s most recent report, In Danger, found global infection rates fell by only 3.6 percent from 2020 to 2021 — the lowest decrease since 2016 — and HIV infections actually rose in one of five countries. With COVID-19 compromising access to HIV testing and care, few countries have been able to maintain substantial reductions in infections during the pandemic.?

One exception is Nigeria.?

In December 2020, UNAIDS set a goal of “95-95-95” by 2030: at least 95 percent of people with HIV know their status; 95 percent receive sustained antiretroviral treatment; and 95 percent stay on medication and keep the virus fully suppressed. Nigeria is one of only a small handful of countries to have come close to accomplishing this. In 2021, it succeeded in ensuring 95 percent of people with HIV know their status and 90 percent attain access to treatment .?

While Nigeria’s infection rate is substantially higher than the U.S.’s, it has achieved a significant decrease in new infections, 33 percent from 2015 to 2021. In comparison, U.S. HIV infections have declined just 18 percent from 2015 to 2020. Moreover, there has been a concerning rise in cases within underserved populations, with notable outbreaks occurring among housing-insecure people in Boston , West Virginia , and Philadelphia .?

As we reflect on World AIDS Day on December 1, what can the U.S. learn from Nigeria’s progress in lowering HIV infection rates??

Nigeria’s Targeted Outreach?

In 2018, Nigeria had the third-highest burden of HIV cases in the world, and the government had stalled in its response . Recognizing the need for change, officials shifted their approach to HIV detection and care, partnering with the World Health Organization (WHO) to identify the people with the highest unmet need. Nigerian officials then adapted HIV services to meet each group’s unique challenges and integrated HIV care into general care.?

One example of this adaptive strategy is the Intensive Combination Approach to Roll Back the Epidemic (iCARE) program for high-risk young men in Nigeria ages 15 to 24. The intervention combines social media outreach with peer navigation — or support from people with experience or understanding of HIV — and provides access to rapid HIV tests and treatment in a multitude of settings, like community clinics, homes, and private testing sites in public locations. The program was able to connect 86 percent of young men who tested positive for HIV from June 2019 to June 2020 with care.?

Challenges remain: 83 percent of youth and young men, who make up 20 percent of new HIV infections in Nigeria, still don’t know their status, and infection rates for men who have sex with men are still rising (23%). But targeted programs like iCARE are making strides, navigating factors that complicate access to HIV testing and treatment, like social stigma, substance use, poverty, and the criminalization of same-sex relationships.?

Bridging Gaps in U.S. Outreach and Intervention?

While broader public health outreach should undoubtedly remain a priority in the U.S., it’s important to also recognize how viral infections and outbreaks can affect communities differently. Philadelphia took a targeted approach in the wake of an HIV outbreak in 2021. The city implemented “status-neutral” testing in the most affected communities, which involves connecting HIV-positive individuals with care and people who test negative with pre-exposure prophylaxis, or PrEP.?

Addressing rising HIV cases will require scaling up initiatives like the one in Philadelphia — as well as taking a page from Nigeria’s successful community-based approach.?