NIGERIA: FPOTUS CARTER AND BILL GATES, SR. VISIT

UNCLAS SECTION 01 OF 04 ABUJA 001347

SIPDIS


E.O. 12958: N/A
TAGS: PREL PGOV TBIO SOCI KWMN NI HIV AIDS
SUBJECT: NIGERIA: FPOTUS CARTER AND BILL GATES, SR. VISIT
ON HIV/AIDS

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Summary:
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1. FPOTUS Jimmy Carter and Bill Gates, Sr. and staff from The
Carter Center and The Bill and Melinda Gates Foundation paid
a very successful, well-publicized March 8-10 visit to
Nigeria. The purpose of the visit was to galvanize greater
domestic support for the fight against HIV/AIDS in Nigeria,
increase the international spotlight on the HIV/AIDS crisis
in Africa, and to help destigmatize HIV/AIDS and encourage
leaders to interact with people living with HIV/AIDS (PLWHA).
Carter and Gates met with President Obasanjo, visited a
Commercial Sex Worker (CSW) community, addressed Nigeria's
first-ever National HIV/AIDS Summit, and met high-level
officials in the Ministry of Health and the National Action
Committee on Aids (NACA). President Carter also gave an
inspirational HIV/AIDS focused message at the Presidential
Villa Chapel on Sunday, March 10.





2. Throughout the visit, the delegation specifically asked
about local solutions and how to garner more support for
combating the pandemic. They commended the positive programs
instituted by the Nigerian government and encouraged it to
recognize and use proven prevention methods. The delegation
particularly emphasized Mother-to-Child transmission (MTCT)
and prevention programs, which can dramatically halve the
risk of HIV transmission to new-borns. They supported
widespread implementation of HIV/AIDS prevention efforts,
especially among groups at high-risk of contracting or
spreading HIV, such as commercial sex workers, migrant
workers, truckers, and intravenous drug-users. The
Carter/Gates team also encouraged all segments of society,
including government, faith-based groups, businesses, and
civil society organizations to engage in the fight against
HIV/AIDS. The visit fulfilled the objectives of the
delegation and more. End Summary.


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Some Facts About HIV/AIDS In Nigeria
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3. Officially, 5.8% of Nigeria's population between the ages
of 15-49 is HIV positive, which equals an estimated 3.5
million infected people. Projections are that over four
million Nigerians will be HIV positive by the year 2005. By
the end of this year, 1.3 million Nigerians will have died of
AIDS since the start of the epidemic. The toll has reached
the point where it is estimated that one person dies of AIDS
every 2 minutes (over 700 people a day). If nothing is done,
it is estimated that a further one million will die by 2005.




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Breakfast with the President
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4. The delegation met privately with President Obasanjo the
morning of March 9. Carter/Gates encouraged Obasanjo's
continued leadership on HIV/AIDS and talked about increased
funding and more effective policies, particularly focused on
high-risk groups. (Comment: President Carter and President
Obasanjo have been friends since Carter visited Nigeria in
1978 when Obasanjo was then military Head of State. This
relationship was reportedly strained after Carter refused to
certify the 1999 election as free and fair. However, the
long-standing relationship appeared to be intact during the
visit. End Comment.)



5. The Carter/Gates team described the Obasanjo meeting as
"successful". They characterized President Obasanjo as
personally engaged in the fight against HIV/AIDS and the
Embassy concurs with that conclusion. Obasanjo told
Carter/Gates that Nigeria's biggest need is funding and
stressed that everyone in his government must be involved in
the fight against HIV/AIDS. Obasanjo's goal is to hold the
infection rate at the official estimate of 5.8%, then push
for an eventual reduction. After seeing posters of President
Obasanjo with PLWHAs, President Carter praised Obasanjo for
his personal commitment, his public display of compassion,
saying Obasanjo's efforts were an important part of reducing
the social stigma associated with HIV/AIDS in Nigeria.



6. When asked about religious leadership, Obasanjo responded
that some of the new generation churches and mosques are
engaged, but in general faith-based institutions needed to be
more active. Commercial sex work is another area where more
must be done. In the area of public awareness, Obasanjo
commented the GON has published pamphlets and booklets and
erected billboards to reach the non-literate. The government
provides condoms to all military barracks. (This policy was
established after it was learned that military peacekeepers
returning from Sierra Leone had an estimated 11% HIV/AIDS
infection rate.) The GON has started the voluntary testing
of pregnant women, but found it challenging because there are
not enough counselors to reach all of those in need.
Moreover, the utility of large-scale testing is of uncertain
value at this point because there are few treatment options
and the MTCT program is still in its infancy. The federal
government is also giving money to each of the states to help
establish HIV/AIDS prevention programs. (Comment: Only three
of 36 governors have demonstrated a sustained personal
involvement in the campaign against HIV/AIDS. End Comment.)


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You're Going Where?
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7. Leaving the comfort of the President's Villa, the
delegation next visited Mabushi village to meet with peer
educators being trained by the NGO Women's Health Education
and Development (WHED). These peer educators are themselves
CSWs, trained in HIV/AIDS awareness and prevention, now
educating other CSWs. President Carter and Mr. Gates met six
women who explained how their involvement in commercial sex
work began. Carter and Gates asked specific questions and
received some very frank answers during this discussion. This
experience proved a valuable reference point to help the
delegation speak credibly about the role commercial sex work
plays in spreading HIV. Carter/Gates mentioned Mabushi in
every subsequent meeting, interview and speech, including
Carter's interview with NBC and his speech at the HIV/AIDS
Summit. U.S. media personnel also asked questions of the sex
workers during the session, and scheduled follow-up
interviews in the afternoon. Both the NBC Nightly News and
the Today Show aired significant footage of the Mabushi
visit, and highlighted the nexus between commercial sex work
and HIV/AIDS.



8. At the same time a larger group of CSWs and other members
of the Carter/Gates delegation met with the Minister of
Health and his Deputy who accompanied Carter/Gates to
Mabushi. The Minister promised to provide WHED with over two
million condoms free-of-charge by the end of the year, and
also agreed to help with re-education and relocation of the
women. The Minister of Health confided that he was unaware
of the depth of the CSW problem prior to his visit to
Mabushi. According to Sylvia Matthews of the Gates
Foundation, these promises alone validated the entire Africa
trip. WHED also received a $20,000 grant from the Aids
Prevention Initiative in Nigeria (APIN) to expand the WHED
program. Based on the results of WHED's initial efforts,
future funding is possible. (Comment: Poloff met with the
director of WHED two weeks after the visit. She has been
contacted by the Minister of Women's Affairs, and dialog on
the re-education program has begun. End Comment.)


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Nigerian National Forum on HIV/AIDS
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9. After Mabushi, the delegation attended a special HIV/AIDS
forum convened by President Obasanjo entitled "HIV/AIDS in
Nigeria: the Road Ahead". The purpose of this first ever
HIV/AIDS summit was to mobilize greater domestic political
support, particularly at the state and local levels, for the
national campaign against HIV/AIDS. Along with the
Carter/Gates delegation, Cabinet Ministers, governors,
parliamentarians, religious and traditional leaders, PLWHAs,
donors and leading HIV/AIDS experts were in attendance. Prior
to the forum many National Assembly members, state governors,
and other opinion leaders had shown little or no support for
HIV/AIDS intervention. The Saturday Forum was meant to
convince these important players to join the fight. The Forum
was well attended and well publicized by the domestic media,
and was characterized by all as a major success. Comment:
The one disappointment was the relatively small number of
governors who showed up, only about six of the total 36.
This was surprising in view of the fact that the forum was a
presidential initiative. End Comment. USAID/Nigeria will
capitalize on the momentum created by the Forum by
implementing a new program that focuses on HIV/AIDS advocacy
with National Assembly members.



10. In his opening address, President Obasanjo stated the
Saturday Forum was intended to bring national and
international experts from various sectors together. One year
after the Africa Summit on HIV/AIDS, the message was not
getting down to "every nook and cranny" in the nation, he
lamented. The President referred to his inaugural address
when he said that human resources were a nation's most
valuable resource. However, the fact that 3.6 million
Nigerians were already infected with the virus and that
number was growing undermined the notion of economic
development. Due to denial and the inaction of the past,
the HIV/AIDS epidemic now was felt at all levels of society.
Denial and government inaction also meant that past HIV/AIDS
programming was donor-driven and lacked adequate grass-roots
participation. Obasanjo thanked donors "( for keeping at
it while the Federal Government of Nigeria was in denial."
He ended his address by challenging the Forum's participants
to "reexamine our commitment and target a zero increase in
the prevalence rate and a decline in the rate from 2003 on."



11. Two of the most noteworthy Nigerian speakers were Dr.
Pat Matemilola, Chairman of the Network of People Living with
AIDS in Nigeria, and Dr. Peter Odili, Governor of Rivers
State. Governor Odili characterized the epidemic in his
state, which has the third highest HIV prevalence rate
nationally, as one fueled by the oil and gas industry. That
industry has brought an influx of highly paid expatriate and
Nigerian workers to the poverty-plagued state. This influx
of affluent oil industry personnel attracts a comparable
influx of commercial sex workers. As proof of the expansion
of the problem, he said Rivers State HIV prevalence rate
increased from 3.3% in 1999 to 7.7% in 2001. Unlike most
states, however, Rivers has responded to the epidemic. The
state has established a multi-sectoral State Action Committee
on AIDS (SACA). The state government also provides a subsidy
of 10,000 naira per month (approximately $85) towards
anti-retroviral treatments and will soon provide free
treatment for HIV/AIDS positive women. Finally, on World AIDS
Day this year, Odili's government sponsored a social
mobilization campaign called "the Million Man March". Dr.
Matemilola's speech targeted "the waste (of funding) on
research" in an environment where poor HIV- positive women
cannot access Nevriapine in order to lessen mother-to-child
transmission of the virus. He also chided NACA and the
Ministry of Health for their on-going bureaucratic struggle
for control of the national HIV/AIDS effort. Matemilola
quoted the African proverb, "When two elephants fight, the
grass suffers", indicating that the national HIV/AIDS program
in general and people living with HIV/AIDS in particular have
suffered the negative consequences of the bureaucratic
tug-of-war. This statement drew a round of applause from the
audience.



12. In his speech, President Carter challenged the forum
participants to face their responsibility for combating
HIV/AIDS. He criticized African leaders who were in denial
and ignore the epidemic, while praising President Obasanjo
for leading the fight against HIV/AIDS in Nigeria and in
Africa. He also stated that the battle against AIDS could not
be won if every government official were not actively engaged
in the fight. Carter challenged the forum to overcome the
social stigma of talking about HIV/AIDS and stressed the need
for information and education. The former President ended
his speech by saying: "My prayer is that everyone assembled
here, and everyone with whom you come in contact, will be
inspired to be active and enthusiastic and dedicated to the
control of this terrible disease."



13. The Aids Prevention Initiative in Nigeria (APIN),a $25
million, three-year grantee of the Bill and Melinda Gates
Foundation, which had previously been criticized by the GON,
was showcased during the Forum. Seven of the program's
twenty speakers were associated with either the Gates
Foundation or with APIN, including Bill Gates, Sr., Dr.
Helene Gayle, Professor Jeffrey Sachs, and Phyllis Kanki.
APIN was applauded by the Minister of Health for helping
prepare Nigeria's proposals to the Global Fund. Jeffrey
Sachs received the greatest applause of the Forum following
his suggestion to "write postcards" to the international
lending institutions saying that Nigeria would no longer pay
its debts. According to Sachs, "The debt is unpayable and
should no longer be paid". Sachs estimated that Nigeria
needs $1 billion annually to fight HIV/AIDS, contrary to the
estimate of $226 million given by the NACA chairperson. He
also suggested that most of the $1.5 billion Nigeria pays
every year in debt servicing could be used to meet this gap
once the "postcards were sent". In addition, Sachs called
for greater involvement by the oil industry saying "no world
class business can be in this country without joining the
fight as their own economic survival is at stake." Dr. Pia
Malaney, also from Harvard, posited that Nigeria's GNP is
already 5% lower because of the HIV/AIDS epidemic and, if not
contained, the toll will reach 25% by 2025.


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Goin' to the Chapel
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14. The final event of the visit was the Sunday Church
service at Aso Villa Chapel. Reverend Y.A. Obaje, the Villa
Chaplain, said, "We consider President Carter to be a
brother. He cares about the poor. He cares about the sick. He
cares about the downtrodden. We consider him one of us."
Accordingly, the congregation was pleased to have President
Carter in their midst and to hear his sermon: "A Faith Based
Approach to HIV/AIDS." President Carter spoke directly to
issues of stigma and prevention, and emphasized that it was
imperative for religious leaders to discuss HIV/AIDS from the
pulpit. Carter's inspirational sermon reached an audience
beyond the immediate congregation. His message was broadcast
live on Nigerian TV and radio, and was replayed several times
during that day. Initial estimates indicate the radio
broadcast reached approximately 26 million people and the TV
broadcast reached an estimated 13 million. The Gates
Foundation is pursuing other avenues for wide dissemination
of Carter's message within the Christian media. (Note: After
consultation with some Islamic leaders, the delegation
decided that a different message was needed to reach the
Muslim population. End Note.)


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Comment
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15. There were numerous highlights of the Carter/Gates
visit. First, it helped educate the delegation on the
HIV/AIDS situation in Nigeria, emphasising the areas of
greatest needs. Secondly, the delegation was able to
generate unprecedented local attention while also focusing
the international spotlight on the problem of HIV/AIDS in
Nigeria. Accompanying the Carter/Gates team were Karen
DeYoung of the Washington Post and Lynelle Gradwell, Robert
Grant, Howard Smith and Keith Miller from NBC News. HIV/AIDS
received broad media coverage and attention from national,
state and local officials and policy-makers that otherwise
would have never occurred. Finally the delegation was able
to show the GON facets of the HIV/AIDS problem about which it
had previously been unaware, particularly the enormity of the
CSW issue. President Obasanjo has embraced the challenge that
HIV/AIDS presents, and appears ready not only to continue,
but to redouble his own efforts and efforts the of his
government to confront seriously the growing menace of
HIV/AIDS in Nigeria. From our perspective the Carter/Gates
Visit was well worth the effort. End Comment.


JETER