At a press conference in Lagos on Wednesday, Dr. Agatha David, Director of Research and Consultant Paediatrician at the Nigerian Institute of Medical Research (NIMR), raised concerns over plummeting testing rates and weak treatment adherence among young people. She noted that fewer than 25 percent of adolescents aged 15–24 had tested for HIV in the past year — far below the benchmarks set by the United Nations Sustainable Development Goal (SDG 3) and UNAIDS 95-95-95 targets for 2030.
The 95-95-95 framework aims for 95 percent of people living with HIV to know their status, 95 percent of those diagnosed to be on antiretroviral therapy (ART), and 95 percent of those on treatment to achieve viral suppression. Nigeria, with an estimated 2 million people living with HIV, lags significantly, particularly among its youth population.
“If they are not tested, we don’t know who’s positive,” Dr. David stressed, pointing to a testing gap that undermines efforts to control transmission. Among those already diagnosed, viral suppression rates among adolescents remain below 80 percent — well under the 92 percent achieved at NIMR’s facilities.
Stigma, risky behaviour, and weak support systems
The shortfall is driven by stigma, poor family support, and risky sexual behaviors. A NIMR study revealed that 20 percent of adolescents reported sexual debut before age 15, while inconsistent condom use and transactional sex further heightened the risk of transmission. “If they are not virally suppressed, they can transmit the virus, continuing the chain,” Dr. David warned.
Innovations but limited scale
To tackle the crisis, NIMR has rolled out youth-focused interventions, including Nigeria’s first adolescent-friendly HIV clinic in 2009, SMS-based medication reminders, and peer navigation programs that pair virally suppressed adolescents with peers struggling on treatment. These initiatives have shown promise in improving adherence but remain difficult to scale nationally due to funding limitations.
“The government relies heavily on donor agencies for ART drugs,” David explained, adding that complementary interventions such as SMS reminders or PrEP are not covered under existing programs.
Mental health burden
Mental health challenges further complicate treatment outcomes. NIMR data shows that more than 20 percent of HIV-positive adolescents struggle with depression or suicidal ideation, often linked to stigma and family rejection. David recounted the case of a nine-year-old boy who attempted suicide after being expelled from home due to his HIV status.
To close this gap, NIMR plans to integrate mental health counseling into routine HIV care in collaboration with neuropsychiatric hospitals. “Mental health issues are real, and we are not trained to handle them at scale,” she admitted.
Funding gaps and dependency risks
While the U.S. government continues to fund ART as lifesaving treatment, other critical services — such as resistance testing, CD4 counts, hemoglobin and liver function tests — are no longer supported, leaving patients to pay out-of-pocket. Dr. David warned that this dependency on external donors is unsustainable, urging Nigeria to invest in local manufacturing of antiretrovirals, citing India as a model.
She recalled that during the Trump administration, U.S. funding cuts briefly forced Nigeria to cover ART costs domestically. “If you are depending on somebody to give you food, they could one day say they have given you enough food … that was a wake-up call,” she said.
The stakes for 2030
With barely five years left to the global deadline for ending AIDS, Nigeria faces steep challenges. Unless testing, adherence, and holistic care for young people improve rapidly, the country risks missing the 2030 target — a failure with both health and economic repercussions.
“We have the research,” Dr. David concluded. “Now we need to translate it into practice.”