We already have HIV medicines: Why are people still dying? — by Melody Okereke
Four decades ago, an HIV diagnosis often carried fear, uncertainty, and the possibility of an early death. Today, the story has changed. Antiretroviral therapy can suppress the virus, prevent HIV-related illnesses, and allow people living with HIV to live long and productive lives.
This progress is one of the biggest achievements in modern medicine. But an uncomfortable question remains: if we already have medicines that work, why are people still dying from HIV? The answer is not because science has failed. It is because access to medicines is only one part of the HIV response.
A person can have effective treatment available and still not benefit from it. Someone may test positive but never start treatment. Another person may begin treatment but stop returning to the clinic because of stigma, financial difficulties, poor mental health, or challenges within their community. Someone else may only discover their HIV status when they are already very sick. The medicine may exist, but the pathway to that medicine is often where the problem begins.
For many years, the HIV response has focused on increasing the number of people tested, initiating more people on treatment, and achieving viral suppression. These targets remain important. They show progress and help health systems measure performance. However, behind every number is a person navigating a real-life situation.
A patient living with HIV is not only managing a virus. They may also be dealing with transport costs, family responsibilities, fear of disclosure, unemployment, stigma, mental health challenges, or previous negative experiences with healthcare providers. These realities can determine whether someone receives care, continues care, or disappears from the healthcare system.
This is where implementation science becomes important.
Implementation science helps us understand how proven health interventions can work effectively in real-world settings. It focuses on the gap between what we know works and what actually happens when those solutions reach communities. In HIV care, we already know that antiretroviral therapy works. The challenge is ensuring that people can access it, trust the systems providing it, and remain connected to care long enough to experience its benefits.
A clinic may have medicines available, but what happens when a patient cannot afford transportation to return for refills? A testing programme may exist, but what happens when people avoid it because they fear being recognised? A treatment guideline may be available, but what happens when healthcare workers lack the resources needed to implement it effectively?
These are not failures of medicine. They are failures of systems that must be improved. Nigeria has made significant progress in its HIV response. Through the efforts of government agencies, healthcare workers, communities, researchers, and partners, millions of people have gained access to HIV services. However, gaps remain.
Some people are still diagnosed late. Some people still avoid testing because of fear and stigma. Some people start treatment but struggle to remain in care. Some communities continue to experience barriers that make healthcare feel distant or unsafe. The people being missed are not always difficult to reach. Sometimes, our health systems are difficult to access.
This is why the future of HIV care must focus on more than providing medicines. It must involve designing services around the realities of the people who use them. Community-based approaches, peer support, differentiated care models, digital health solutions, and stronger referral systems can help bring services closer to people. Healthcare workers must also be supported to provide care that is respectful, confidential, and responsive to patients’ needs.
The first interaction a person has with the healthcare system can determine whether they return or walk away. A person who fears judgement may avoid testing. Someone who does not trust confidentiality may avoid treatment. A community that feels excluded may not engage with health programmes. Trust is not a small part of healthcare. It is part of the intervention.
As Nigeria continues its efforts to end HIV as a public health challenge, we must ask difficult questions. Who are we still missing? Why are they being missed? What changes will make services easier and safer to access? The HIV response has already proven that science can save lives. The next challenge is ensuring that those lifesaving tools reach everyone who needs them.
Because the biggest HIV challenge today is no longer only about finding medicines. It is about building systems that ensure people can reach them, use them, and live long enough to benefit from them.
Pharm. Melody Okereke is a clinical pharmacist and HIV/AIDS implementation science researcher working on harm reduction, health systems innovation, and community-driven approaches to improving healthcare access and outcomes.
