Lack of sincerity, poor funds administration, NACAunclear motives and lax attitude of government officials, as well as key NGO personnel have left little to cheer about, two decades after HIV/AIDS was first reported in Nigeria.
Nigeria is the most populous nation in Africa with an estimated population of over 140 million people. Government reports claim that over 300,000 Nigerians die yearly of complications arising from AIDS. Over 1.5 million children are said to be orphaned annually and an estimated 8 million are expected to be infected by 2012. Official figures put the steady rise in HIV prevalence rate from 1.8% in 1988 to 5.8% in 2001, 5.0% in 2003 and 4.4% in 2005.
The 2005 survey released in 2006 estimated that there were 4,000,000 adults living with HIV/AIDS in Nigeria, and 57% of these are women. From the figures, there is significant variation in prevalence between states and between population groups. The epidemic is said to be fuelled in the country largely by poverty, lack of awareness, dense commercial sex networks, early age of sexual debut, poor gender empowerment, with religion and culture obstructing open debate about sexuality. The biggest challenge however, impeding progress of Nigeria’s intervention effort, is corruption.
If these figures weren’t alarming enough for any country to raise the red flag, one would have wondered what else would.
It is alarming, but HIV/AIDS has become a localized epidemic in many states of Nigeria. For instance, if we look at the HIV prevalence rate even with the 2005 figure (serious doubts exist about the credibility of official figures), Benue State has a 10% prevalence rate, with Akwa Ibom following in line with 8% and Nasarawa, Enugu, Rivers, and Taraba all in the 6% range. A 3.3% prevalence rate was ascribed to Lagos, but in some part of Lagos, on Lagos Island specifically, the rate is 9%. We had asked officials what the peculiar situation is on Lagos Island that is not present in other parts of Lagos. The most credible explanation is that Lagos Island has the highest concentration of Voluntary Counseling and Testing Centers (VCT), so, more people test here than other parts of the city!
Several people hold the opinion that a reduced prevalence figure released last year is actually meant to justify the huge funding that the HIV/AIDS project has gulped till date. With nothing tangible to show for it, it was designed to speak to the obvious under-performance in intervention efforts.
At the moment, it is now very difficult, more than ever, to make reference to any credible statistics for Nigeria given the unreliability of figures being churned out on a daily basis. This fact was again recently corroborated by the nation’s Ministry officials who announced weeks ago that Nigeria will yet spend another N247 million to conduct a new sero-prevalence survey between November and December 2007. The report suggested that the National AIDS and Sexually Transmitted Infections Control Programme (NASCAP) of the Federal Ministry of Health (FMOH), plans to adopt a new but costlier model in the survey in order to better reflect the number of People Living With HIV/AIDS (PLWHA) in the country. According to Araoye Segilola, the Assistant Director, project programme of NASCAP in justifying the Ministry’s decision, “if you conduct a study among the high risk groups and at the hot spots, you will realise that the five or even 10 percent prevalence is not reflective of the HIV/AIDS situation in the country. Conduct a study in any university and you will find that nothing less than 37 to 40 per cent of the populations are HIV positive. The problem we are seeing on paper as 4.4 per cent prevalence is a tip of the iceberg. When you carry out studies with the high risk groups, you will know we have a problem at hand.” I agree totally with Segilola, like others will wont, that the 4.4% figure is not a true reflection of our HIV/AIDS burden. It might be interesting to request for a tangible reason why it took Nigeria this long to realize that it was wrong to have ignored the high risk groups in the first place?
To be certain, the treatment situation is such that more than halve a million people from those who are HIV positive in the country needs to be on treatment. What we have as the reality is that less than 30,000 people are on treatment as of this moment. From this figure, almost half access their treatment from sources other than that of government, yet, every year, HIV/AIDS gulps so much from the federal budgets and commands heavy grants from donor agencies.According to the Global Fund, Nigeria has won an approximate $200m over five years to fight HIV/AIDS. The principal Recipient of most funding for HIV/AIDS remains the National Agency for the Control of AIDS (NACA). This figure is aside the yearly budgetary allocations to the agency from Government and grants from other donor agencies. In 2006, the Global Fund had no choice but to cancel a grant to Nigeria for reasons that border on non performance. This grant could have gotten thousands of PLWHA who needs treatment on the anti retroviral therapy. Inadequate capacity for efficient program management of large scale financial interventions for public health was one important reason the body cited for the cancellation. Just as it disclosed that questionable data were provided to it by the Nigerian agency. It also said that NACA favoured manual accounting system. To the Global Fund, “funds should not just be spent simply for its own sake, just as a process, or disappear into deep private pockets, but to achieve concrete outcomes in prevention, treatment and lives saved by the interventions funded”.
Between 2005 and 2006 alone, a total of N14.7 billion was budgeted to fight HIV/AIDS from the federal allocation. A quick glance at NACA’s budget reveals stupefying overhead cost come first before matters that can have direct and immediate impact with corresponding benefits in terms of quality of services to PLWHAs. In other words, nothing in the documents suggests that the 6 million PLWHAs in Nigeria will fare better as it is.
The political commitment actually started In 2002 when the Nigerian government with a $3.5 order commenced what some then referred to as an ambitious antiretroviral (ARV) treatment programme to get 10,000 adults and 5,000 children onto ARVs within 1 year. In 2004, several PLWHA who commenced the ARV treatment eventually lost their lives when they skipped treatment for up to three months when the programme was hit by a shortage of drugs. In 2005, Government again announced that PLWHAs will henceforth access ARV free of charge, and also came up with a presidential mandate to place at least 250, 000 from the more than half a million people on treatment before the end of 2006. With the presidential mandate came increased funding, and a political commitment by former president Obasanjo which is yet to be rivaled. Meanwhile, at several treatment sites across the country, the few PLWHAs on the program still pay through their noses to access treatment.
To our officials, HIV/AIDS represent another conduit pipe to siphon money. Last year, a controversial contract to the tune of N2.5 billion was awarded for the supply of ARV by the Ministry of Health (link). When the whistle blew, the president ordered a review of the contract, with compelling evidence of a less than sunshine bid process. One of the companies that won the controversial bid has its office in a ram shackled building without power supply at a downtown suburb of Lagos; and has as directors persons suspected to have kinship affinity with the then Minister in charge. The contract has now been executed, and not just that, yet another, to the tune of N1.9b with accompanying dirty details was again awarded to an ireland based company to supply testing kits against the recommendation of an algorithm set up by the same Ministry of Health.
Also last year, the food and drugs control agency in the country, NAFDAC, arrested a former deputy Governor of Akwa Ibom State, Eastern Nigeria, who specializes in repackaging inferior HIV/AIDS testing kits for the market. It is instructive that a neighboring West Africa Country, Ghana, recently banned a brand of condom from circulation in their market. The brand of condom was banned for obvious defects ascertained by experts, and as a result of confirmed complaints from consumers. Ironically, that same brand of condom from the same manufacturer remained the most popular and most accessible brand in the Nigerian market at over 150 million condoms annually, representing over 74% of the Nigeria condom market, but to us, it is business as usual.
Questions to put forward to gauge the impact of our intervention on the life of an average person who is HIV positive and on the community include: How many of our healthcare facilities have the required equipments necessary for HIV/AIDS management? Do our people have enough information necessary to take informed decisions? Do people now see the need for voluntary counseling and testing? Are our women now more empowered to negotiate safer sex and have a decisive say on issues that affects their sexuality? Do we still stigmatize and discriminate based on HIV status? How easy has it become for someone who is positive to hold on to his/her job, and how easy is it to secure paid employment with ones positive status?
If these questions will be honestly answered, it could represent the state of our response as a community of people in the face of the level of resources at our disposal. In another breathe, we could consider a few isolated cases, but which represents a deep trend of occurrence of reactions to the AIDS pandemic by the people.
On July 8, 2003, Chinasa Nwapu-Okereke, a nursing sister at Owerri, Southern Nigeria, committed suicide two weeks after she was told she is HIV positive. Last year, Abigail Atirene who also lost her daughter to AIDS was left with no option but to pack out of her family house because her siblings said they could no longer stay with someone who is HIV positive (link). Abigail before now lost her young marriage and was stopped from worshipping in her church. Theresa is a young woman living with HIV in Benin City. She has since lost her job, her aunt with whom she stays asked her to pack out and her parent in the village said it is better they don’t set their eyes on her again. Not long ago Frederick Adegboye, a student at the Nigerian Institute of journalism (NIJ), and now a reporter with the Nation Newspaper based in Lagos was relieved of his admission at NIJ based on his HIV status, it took so much outcry before he was reinstated (link). Few weeks ago, the media was awash with reports about Covenant University, Sango Otta, Western Nigeria, and the insistence of the Institution on its students to conduct HIV/AIDS test as a preclude to graduation.
Just like when it was first discovered, real knowledge about HIV/AIDS among Nigerians is at its lowest ebb. The media have created appreciable awareness about HIV/AIDS but failed to match that with AIDS education. In Nigeria, HIV/AIDS is often portrayed as punishment for immoral behavior, as a crime in relation to innocent and guilty victims, as war against a virus that must be fought, as horror with which infected people are demonized, thus fuelling the widespread belief that HIV/AIDS is shameful. Following examples often set by the West, the media here use images of death, depravity and despair to depict people living with HIV/AIDS. At the same time, rarely are the voices of PLWHAs included in reports, just as depictions of healthy individual engaging in productive lives are equally absent (http://www.nigeriahivinfo.com/media_monitoring.php).
The immediate impact is the perpetuation of negative perceptions already entrenched in the minds of the people who continue to see People Living with HIV/AIDS (PLWHA) as hopeless people, and the effect is that we have millions of our people who will never determine their status, and several thousands who test but don’t show up for treatment and a legion who are positive but will never receive care. The situation will remain the same until we make our leaders and those in charge of intervention efforts accountable. The media remain the one institution that can face the challenge.