Time to focus on the 10-10-10

The UNAIDS 95-95-95 and 10-10-10 targets are part of the global effort to end the AIDS epidemic by 2030. They are based on the following goals:

• 95% of people living with HIV know their HIV status.
• 95% of people who know their status are on treatment.
• 95% of people on treatment have suppressed viral loads.
• 10% or less of people living with HIV experience stigma and discrimination.
• 10% or less of people living with HIV face punitive laws and policies.
• 10% or less of people living with HIV are affected by gender inequalities and violence.

Overall, these targets aim to put people living with HIV and communities at risk at the center of the HIV response, and to address the social and structural barriers that prevent them from accessing the services they need. They also emphasize the integration of HIV services with other health and non-health services, such as sexual and reproductive health, tuberculosis, mental health, and social protection.

Achieving these targets would have a significant impact on reducing new HIV infections and AIDS-related deaths, as well as improving the quality of life and well-being of people living with HIV and communities at risk.

The attention, however, has largely been on the first set of targets, the 95-95-95, and the laudable progress Nigeria has made with these have been driven by clear interventions and measures to track HIV program efforts contributing to these targets.

The 10-10-10 targets have unfortunately not received the same degree of attention and as such, have not contributed to moving the country along in the fight to end inequalities and end AIDS by 2030 as proposed in the Global AIDS Strategy 2021-2026. The lack of attention has resulted in Nigeria’s lack of progress towards achieving these targets and as there are stills laws and policies that criminalize and discriminate against people living with HIV and key populations. Here is a summary of Nigeria’s score on the 10-10-10 targets:

• Stigma and discrimination: Nigeria has a high level of stigma and discrimination against people living with HIV and key populations, such as men who have sex with men, sex workers, and people who inject drugs. According to a survey conducted in 2018, 28.3% of people living with HIV reported experiencing stigma and discrimination in the past 12 months. Nigeria also has a low coverage of stigma reduction programs, reaching only 9.4% of people living with HIV in 2019.
• Punitive laws and policies: Nigeria has laws and policies that criminalize same-sex sex, sex work, and drug use, which create barriers to accessing HIV services for these groups. For example, the Same-Sex Marriage (Prohibition) Act of 2013 imposes up to 14 years imprisonment for anyone who enters into a same-sex marriage or civil union, and up to 10 years imprisonment for anyone who supports or witnesses such unions. This law has increased the harassment, violence, and extortion faced by men who have sex with men, as well as reduced their access to health care and legal services.?
• Gender inequalities and violence: Nigeria has a high prevalence of gender-based violence, especially against women and girls. According to a survey conducted in 2019, 31% of women aged 15-49 years experienced physical or sexual violence by an intimate partner in the past 12 months. Nigeria also has laws and policies that discriminate against women and girls, such as the Penal Code that allows marital rape and the Criminal Code that allows child marriage. These laws and policies undermine the sexual and reproductive health and rights of women and girls, as well as increase their vulnerability to HIV infection.

Countries that have laws and policies that criminalize same-sex sex, sex work, and drug use have lower levels of HIV testing, treatment, and viral suppression among these groups. This means that these laws and policies increase the risk of HIV transmission and AIDS-related deaths, as well as violate human rights.

At the level of the society, it has been reported that Nigeria also has one of the highest prevalence of discriminatory attitude towards people living with HIV/AIDS (see Teshale et. al, 2022 https://doi.org/ 10.1371/journal.pone.0261978).

To make progress, countries are required to collect and report data on the following indicators:

• The percentage of people living with HIV who experienced stigma and discrimination in the past 12 months.
• The percentage of key populations who experienced stigma and discrimination in the past 12 months.
• The percentage of women and girls aged 15–49 years who experienced physical or sexual violence by an intimate partner in the past 12 months.
• The percentage of countries that have laws and policies that protect the rights of people living with HIV and key populations.
• The percentage of countries that have laws and policies that criminalize or otherwise penalize people living with HIV and key populations.

These indicators will help to assess the extent to which countries have created enabling environments that support access to HIV prevention, testing, treatment, and care services for all people, especially those who are most affected by the epidemic.

To address persisting gaps, there is a need to create space within the current HIV investment landscape for program that will help address the drivers of HIV-related stigma (largely misconceptions and misinformation) and update the knowledge of Nigeria about the progress that have been made in HIV treatment over the past 20 years.

Also, Nigeria needs to take urgent action to reform its laws and policies that violate the rights of people living with HIV and key populations, and to implement supportive ones that protect them from stigma, discrimination, and violence. This would not only help Nigeria achieve the 10-10-10 targets, but also improve the health and well-being of its people, as well as contribute to ending AIDS by 2030. Let's get to work!