For around $5 on Konga.com, one of Nigeria’s major e-commerce platforms, Nigerians can buy an oral HIV self-test kit. After ordering the product, Devex found that the kit was easy to use, but the package contained no information about where to get treatment, counseling, confirmation, or any other post-testing services following a positive result.

Starting in January 2021, Nigeria will centralize and harmonize its HIV/AIDS program, and a key component of this approach is to prioritize self-testing.

“Nigeria’s gay community is a very secret one. If we don’t know who is testing positive, we will not be able to get them on treatment.”

— Michael Amalumilo, co-chair, Nigeria’s key population secretariat

This is more cost-effective than community testing. But rights groups representing gay men — one of the communities worst affected by HIV in Nigeria — fear it could erode the fragile gains made in HIV control among the group. Self-testing does not ensure that follow-up services and treatments are offered, and discriminatory laws and attitudes mean that gay men face particular challenges in accessing these services.

Some health experts also fear that employers and others could enforce self-testing among their employees or communities, enabling discrimination.

Why self-testing?

Until now, HIV testing in Nigeria has been provided at hospitals and via population screening efforts such as free HIV testing campaigns and medical outreach programs. But as the disease prevalence dropped, screening large numbers of people increasingly looked like a waste of resources. The Nigeria HIV/AIDS Indicator and Impact Survey conducted in 2019 found the national HIV prevalence to be 1.4% among adults ages 15-49 — far lower than previously thought. As a result, policymakers and donor organizations began to focus testing efforts on key populations experiencing higher rates of infection, such as gay men and sex workers. Read more via Devex