HIV/AIDS at 20
By Nick Uweru

There is not much to cheer two decades after HIV/AIDS was reported in Nigeria, no thanks to lack of sincerity, poor funds administration, unclear motives and laid back attitude of government and local NGO who are more interested in what goes to their kitty.

In 1986, the Military Hospital, Yaba, Lagos, confirmed the diagnosis of Human Immune Deficiency Virus, HIV, in the blood samples of a 13-year-old girl brought from Lagos State University Teaching Hospital, LUTH. It should have jarred the country into a deep concern. Five years earlier in 1981, the Center for Disease Control and Prevention in the United States of America, first identified the strange virus and named it Gray-related immune deficiency, GRID, later known as HIV. HIV, they said, destroys the human immune system and renders the entire body vulnerable to any kind of disease. Apart from the health implication, its debilitating health condition — the Acquired Immune Deficiency Syndrome, AIDS — was predicted to be major threat to development particularly in poor countries of Africa.

No heed was paid. Its mode of transmission, via seminal fluid and blood exchange, left more of scepticism and scorn, while government feigned ignorance. Two decades on however, the unfolding realities about HIV/AIDS has unravelled the fog of cynicism in the country. Walking on all fours, the virus has manifested in every nook and cranny of the country with varying degree of devastation. “We can only pray that the entire country does not pay too heavily for our past ignorance of the virus,” said George Akume, governor, Benue State, a place believed to have the highest density of people living with the virus. From a little over a million people confirmed to be living with HIV/AIDS, its population increased by as much as five per cent every three years. So did deaths believe to be related to the debilitating effect of the virus increase. From a population of 3.5 million people by a 2001 survey, people living with HIV/AIDS increased to 6.1 million as at the beginning of this year. Clearly, the figure places the country third in the rank of countries with the highest HIV/AIDS population after China and India. As a result, more than 200,000 people die from HIV/AIDS related death every year. It has now become a major concern. “It is more like nothing has been done in the last two decades despite all the frightening statistics,” said Steve Aborishade, AIDS information expert with Project Hope, an NGO in the vanguard of creating awareness about the virus.

For the better part of the first 13 years after the virus was reported successive military government did little in putting measures in place to containing the spread of the virus. But in the last six years, the administration under President Olusegun Obasanjo seems to have thrown everything at it without making any meaningful impact, if the figures are anything to go by. So what went wrong? Opinion defers on this.
There are; however suggestions that between government, health experts and international organizations, there was much of lack of sincerity on the matter. With the huge money that came with funding the campaign against the spread of the virus, there was corruption. Poor policy implementation on the part of government, unclear motive of international organizations and perhaps, the hand of nemesis (for the 13 years the country played ostrich on the matter) all add up to explain why HIV/AIDS in the country is in pandemic proportion.

The notion of an ailment whose cause has no cure left so much doubt in the minds of players in the country’s health sector. Not only do some claim that a cure exists, others like Paul Ojei, a natural medicine practitioner, as far back as 1986 insisted that such virus does not exist. For him, AIDS as a health condition may well happen as a result of endemic illnesses in Africa, but the notion of HIV is a fairy tale, he says. His views were no less attractive, and it got so many disciples to boot. Jeremiah Abalaka, a medical doctor, though not exactly claiming that there is no HIV, said he has a regimen that could take out the virus. He as well as other people made similar claims. With government feigning indifference to the controversy that nearly split the health sector into warring factions, international health organisations looked on with consternation. Government finally acted in 2000. It banned the activities of the cure claimants. But many saw government action as being forced by the impending visit of Bill Clinton, former US President, and the financial support expected from America to fight HIV/AIDS in the country. US will certainly not give funds to countries claiming to have a cure for HIV/AIDS. Surprisingly, the ban was lifted immediately Clinton left. The perceived prevarication by government on the matter is believed to have left doubts in the minds of many over the various claims about the virus.

The claims and counter-claims, not withstanding, what is not in contention is that AIDS exists. And it has started killing Nigerians. More than ever, treatment for those believed to be living with the virus is needed. Of the estimated two per cent of the country’s population living with the virus, more than 540,000 of them are certified to be in need of antiretroviral, ARV, the drugs needed for treating HIV. With the poor financial state of most of the people living with the virus, the cost of getting the drugs is almost unaffordable at N1,000 currently being changed at government-designated centres. With the huge funds dedicated to the campaign, the aim is not only to make the drugs free, but also to make it accessible to those who need it. This is because a person infected with the virus and deemed in need of ARV must strictly observe the daily drug regimen. Lack of adherence could lead to the virus developing resistance, a situation said to be deadlier and costlier.
In the last four years, no less than N23 billion ($153 million) has been donated to the country by World Bank, Global Fund (a financial initiative by eight of the world’s richest economies to help combat the spread of the virus especially in Africa) and the President’s Emergency Plan for AIDS Relief, PEPFAR (US President George Bush’s initiative to help in the campaign). There is also a N5.5 billion budgetary allocations made by federal government on HIV/AIDS.  Despite these huge funds, government has only succeeded in placing 12,000 out of the over half a million people needing ARV on free treatment.

Lots of reasons have been adduced for this lapse. The drugs are said to come with prohibitive cost in the countries where they are produced.  And the strict patenting convention, to which most of these countries are signatories, does not help matters for Nigeria. Though a country could produce the generic versions of these drugs, why the country has not commissioned its indigenous pharmaceuticals to start producing them, to health experts, is also worrisome. Though government often counters that the foreign funds come with conditions on where to buy ARV, the question often asked is why government spends its own funds buying this drugs from foreign companies as well. “It is not out of place for foreign donors to give a choice on where to buy ARV, but why should our government spend its own money outside the shores of the country when the drugs could be produced locally,” wondered a perplexed Ijimakin Ola Ebo, pharmacist and chief marketing officer for an indigenous pharmaceutical company. Apart from the cost implication involved in buying ARV from abroad, it reduces larger access to ARV. In the world, Brazil is ranked as first in terms of HIV/AIDS treatment. This is because the drugs are free and accessible in the country. But the strength of the country’s program lies in the fact that ARVs are locally produced in Brazil.

Also, donor organisations are also flayed on account of their attaching conditions to the funds given. Aside the mercantile strings attached, other donors give conditions believed to be unreasonable in the face of the pandemic situation of HIV/AIDS in Africa. For instance with PEPFAR, President Bush believes that traditional methods of combating the spread of the virus should not be encouraged. “Giving condoms free should not be encouraged because premarital sex is wrong”, says Bush. He also believes that his money is not meant for men who sleep with men, homosexuals, and drug addicts. But activist counters that the situation in Africa goes beyond moralising.

With huge money  earmarked for  HIV/AIDS, the campaign has attracted no less odium as a result of corruption. Non-governmental organisations, NGOs, have been mushrooming with a view to accessing funds even they have nothing to offer. “It is saddening because the NGOs get this money but hardly do anything to help people living with the virus,” says Omololu Falobi, coordinator, Journalist Against AIDS, JAAIDS. Even more, government agencies have not proved above board in this matter. For instance, Global Funds withdrew its second tranche of $80 million meant for HIV/AIDS campaign from National Action Committee on AIDS, NACA, on account of the agency’s inability to place 10,000 people living with HIV/AIDS on free treatment every year the first tranche lasted. It was alleged that NACA spent the money on other matters not related to the mandate for which it was meant. 

More tragic, no response seems to be coming from government in the face of these allegations. In the words of Aborishade, “the country does not seem to realise the dire implication of these charges in the face of increasing number of people living with HIV/AIDS.” At 6.1 million HIV/AIDS population, several implication arises for the country. Apart from indicating a disturbing geometric increase, it has overshot the five million-population mark projection for 2010 by United Nations Program on AIDS, UNAIDS. Even more, the spectre of the grave implication for development in the country now seem real. With more than 80 per cent of people living with HIV/AIDS within the productive sector of the economy (ages 15-49 years), workplace population may well be in danger of annihilation. For business and corporate concerns, more staffers would be lost to death, payment of health care and insurance cost will increase, and more recruitment and training cost will be incurred in addition to decreasing productivity because staff would be more susceptible to illness. Since the infection cuts across every divide, it can only mean that anybody, including highly skilled hands difficult to replace, may be affected. By UN estimation, a country could lose as much two per cent of its gross domestic product, GDP, to the problem.