Victor Omoshehin has witnessed dramatic improvements in Nigeria’s HIV response.

“Patients used to wait over four hours to see a doctor, leaving endless queues at treatment sites across the country,” said Mr Omoshehin. “Some people living with HIV were crossing over two local government areas, and in some cases, traveling to other states to pick up their drugs because of stigma.”

Mr Omoshehin is HIV-positive and an advocate for People Living with HIV (PLHIV) in Nigeria. He has spent much of his life turning his personal experience into powerful advocacy for the 3.1 million HIV-positive people in Nigeria. The country has the second highest HIV burden in the world.

In the past, Mr Omoshehin says health care providers were overwhelmed, providing HIV services to more than 80 patients a day and treatment centers gave little consideration to tailoring services to the specific needs of the many different people seeking help. Adolescents, seniors, men who have sex with men, sex workers and pregnant women were all receiving the same care.

“It was a survival of the fittest, a scenario where the weak and the sick were always suppressed in the race for access to medical care,” said Mr Omoshehin.

Since its 2016 consolidated guidelines for preventing and treating HIV infection were published, the World Health Organization has recommended differentiated service delivery (DSD) of HIV care as a way to increase service efficiencies and impact. DSD is a people-centered approach that simplifies and adapts HIV services to reflect the preferences and expectations of different communities living with HIV.

The introduction of DSD has led to some profound changes in the way Nigeria offers services to people living with HIV.

Rather than making people travel long distances and endure lengthy waits at specialized facilities, HIV services are now available in many more facilities across the country, integrated as a part of overall health care. This allows each center to adapt its approach to the needs of its local population and provides people living with HIV with an array of options on how to receive treatment.

Temisan Iweja is a woman living with HIV in Nigeria’s southern city of Port Harcourt. She is happy there are now centers everywhere and more consideration is given to different people’s needs.

But she is hopeful that the coverage can become wider: “Many people still don’t know about this. In the rural areas, people travel as far as from Anambra to Port Harcourt to access drugs. They go through dangerous roads, and long distances to come and get their drugs.”

In Abuja, the capital, Abayomi, a local NGO, runs a center which caters to the needs of adolescents and those involved in same-sex relationships, using a peer-to-peer model to build trust and draw people into treatment. For those who are already virally suppressed, an appointment with the doctor is no longer needed; instead, people pick up their medications at regular intervals (to avoid treatment interruptions) but at a time that best suits their needs. Differentiated care protocols based on individual needs like this has led to a sharp decrease in waiting times, giving those who do visit the center the time to talk to their health care professional about their personal and social, as well as medical, issues.

Mr Omoshehin calls Abayomi a safe community which is like a family. He says there has been a huge improvement in access to HIV treatment, “Our consultancy time has reduced drastically. Those virally suppressed are receiving their drugs at the pharmacies. Patients pick up their ARVs at their own schedule. Pharmacies always open their shops from Monday to Friday.”