HIV/AIDS PREVALENCE: S’South, N’Central states rank high as high-burden regions

…threaten goal of ending scourge as public health issue by 2030

BY ORIAKU IJELE & ADA DIKE

Statistics obviously show that the aim of reducing the burden of HIV in Nigeria by the targeted Year 2030 may not be met. The Daily Monitor notes that Nigeria has continued to grapple with one of the largest HIV epidemics globally, with the National Agency for the Control of AIDS (NACA) estimating over two million people living with HIV (PLHIV) nationwide.

While the national prevalence rate stands at approximately 1.4% among adults aged 15-49, the burden is heterogeneously distributed across the 36 states and the Federal Capital Territory (FCT). An examination of the most recent HIV Spectrum Estimates highlights critical disparities, showing a persistent concentration of the epidemic in specific geographic zones. These high-burden states demand targeted public health interventions to ensure Nigeria meets the UNAIDS 95-95-95 goals of diagnosis, treatment, and viral suppression by 2030.

The states with the highest absolute numbers of PLHIV—a key indicator of the epidemic’s scale—are predominantly found in the South-South and North-Central geopolitical zones. This geographical trend is tied to various socioeconomic, cultural, and behavioral factors unique to these regions. Leading the nation in terms of absolute numbers of cases is Rivers State, consistently identified as having the largest cohort of PLHIV. The high rate is often attributed to the state’s status as a major commercial and oil hub, characterized by high population density, significant mobility, and a concentration of key populations. Its neighboring states, particularly those in the South-South, share similar dynamics that drive transmission.

Closely following Rivers State is Benue State, which holds the unfortunate distinction of often having the highest actual prevalence percentage in the country, despite occasionally ranking second in absolute numbers. Benue’s epidemic is one of the most intense, deeply embedded in the local culture and challenging to control. Historically, its high prevalence has been linked to socioeconomic conditions, cultural practices, and challenges in reaching rural populations with consistent testing and treatment services. The large number of cases here underscores the critical need for community-level programs that address stigma and ensure seamless access to antiretroviral therapy (ART).

The third major epicenter of the epidemic is typically Akwa Ibom State, another key state within the South-South zone. Its substantial number of PLHIV contributes significantly to the overall national burden, solidifying the South-South as the region requiring the most intensive focus. The concentration of cases in this zone—Rivers, Akwa Ibom, and Delta, which also features high in the rankings—signals a clear regional crisis requiring a unified, cross-state approach to healthcare delivery and preventative measures.

Beyond these three leading states, other regions present alarming figures. Lagos State, as the country’s commercial and most populous center, ranks highly due to its immense population density and transient nature, which complicates public health monitoring. The Federal Capital Territory (FCT), despite being relatively small, consistently reports one of the highest case counts in the North-Central region, primarily because of rapid urbanization, high-risk behaviors associated with a transient population, and a concentration of diplomatic and governmental activity. Similarly, Anambra State in the South-East maintains a high case count, which is sometimes attributed not only to high infection rates but also to highly successful case finding, testing, and linkage-to-care campaigns.

The 2024 estimates suggest that while the infection burden remains high, significant progress has been made in getting people onto life-saving treatment. The current focus of the national response has shifted from merely identifying cases to ensuring viral suppression—which is essential for halting transmission. States like Rivers, Benue, and Akwa Ibom, despite their high burden, are also key areas of operational success for development partners and governmental agencies. The future trajectory of the HIV epidemic in Nigeria will rely heavily on the performance of these states in reaching the targets of diagnosing 95% of PLHIV, treating 95% of those diagnosed, and achieving viral suppression in 95% of those treated. Sustaining and expanding community-based interventions, reducing structural barriers to care, and tackling pervasive stigma remain the primary challenges in these high-burden regions as Nigeria moves towards the goal of ending AIDS as a public health threat by 2030.