THE STATE OF HIV/AIDS IN NIGERIA AS OF JULY 2006

UNCLAS SECTION 01 OF 03 ABUJA 002504 SIPDIS SENSITIVE SIPDIS E.O. 12958: N/A TAGS: KHIV SOCI TBIO ECON PREL PGOV NI SUBJECT: THE STATE OF HIV/AIDS IN NIGERIA AS OF JULY 2006 REF: ABUJA 435 ¶1. (SBU) Summary: This cable evaluates HIV/AIDS' impact on Nigerians and their institutions. Roughly 4 million (UNAIDS, 2003) of the nation's 132 million people (PRB, 2005) are infected with HIV/AIDS, reflecting a national HIV/AIDS prevalence rate of 4.4%. (NPS, 2005) Nigeria had at least 2.4 million HIV-positive workers in 2003. (ILO, 2004) Though senior Nigerian officials are committed to combating HIV/AIDS, translating political commitment into program implementation on the ground often is unsuccessful. HIV/AIDS could further destabilize Nigeria, where about 85 million Nigerians try to survive on less than $1 per day. Most of Nigeria's economic activity occurs in the informal sector, which does not provide health and death benefits. Despite some recent improvements, Nigeria's ineffectiveness in implementing its Round 1 Global Fund grant to fight HIV/AIDS causes considerable concern, and the Fund's Nigerian partners need deeper structural changes. Because the GON recognizes the threat of HIV/AIDS and values its partnership with the U.S., our common effort to combat HIV/AIDS is strengthening our relationship. End summary. ¶2. (SBU) This is the second of Embassy Abuja's twice-yearly cables on the effects of HIV/AIDS on Nigeria. This cable seeks to evaluate broadly HIV/AIDS' impact on Nigeria's institutions and society. Statistics on HIV and AIDS in Nigeria are fragmentary and not always up to date. Nigeria's National HIV Sero-Prevalence Survey estimated the national rate of HIV/AIDS infection in 2005 to be 4.4%. (NPS, 2005) This figure is lower than the rates of 5.8% in 2001 and 5.4% in 2003. This, however, does not represent necessarily a downward trend in prevalence and for several reasons should be interpreted with a great deal of caution. First, more rural sites were included in the 2005 survey than before (74 rural sites in 2005, 37 in 2003, and 0 in 2001),and the number of samples from each rural site increased from 50 in 2003 to 150 in 2005, making the sampling frame in 2005 different from previous surveys. This survey also was a convenient sample of pregnant women attending antenatal clinics. Access to prevention-of-mother-to-child-transmission services has changed substantially since the last survey, and may result in a different HIV risk profile of the sampled women. As such, complacency must not be permitted, and intervention efforts should be intensified. Nigeria still has the world's third-highest number of HIV/AIDS cases, trailing only India and South Africa. The 4.4% infection rate means roughly 4 million adults aged 15-49 (UNAIDS, 2003) of Nigeria's approximately 132 million citizens and residents (Population Reference Bureau, 2005) have HIV or AIDS. In 2003, 310,000 Nigerian adults and children died of AIDS. (IMF, "The Macroeconomics of HIV/AIDS," Nov. 2004) Nigeria then had 7 million orphans - who comprised 10.1% of its children - and that same year, it had 1.8 million AIDS orphans. (IMF, Nov. 2004) Because of HIV and AIDS, UNICEF predicts Nigeria's orphans will increase to 8.2 million by 2010. (UNICEF, 2005) ¶3. (U) Nigeria's youth bulge - 63% of its population is under age 25 (Nigeria Demographic and Health Survey, 2003) - makes the threat of HIV/AIDS very significant. The 25 to 29 age group has the highest prevalence of HIV in Nigeria at 4.9%. Youth 20 to 24 have the second-highest rate at 4.7%. (NPS, 2005) Without sustained action to target and protect youth, a significantly larger wave of HIV/AIDS likely will result. In May 2005, Nigeria launched a drive to improve its blood-bank system and stem the spread of HIV through contaminated blood. At that time, the director of the U.S. organization Safe Blood for Africa said roughly 10% of 1 million samples of blood tested in Nigeria, taken largely from adults, were contaminated with HIV. (UN Office for the Coordination of Humanitarian Affairs, 2005) ¶4. (U) A Nigerian child born today can expect to live 49 years, according to DHS, 2003 data. Also using 2003 statistics, however, the UN Development Program calculates that a Nigerian's life expectancy at birth in 2003 was only 43.4 years (UN Human Development Report, 2005) - and this figure likely is falling. The IMF estimated that deaths of adults (ages 15 to 49) excluding AIDS would make up 17% of all deaths in Nigeria in 2005; the inclusion of Nigerian adults' deaths from AIDS would boost this figure to 27%. (IMF, Nov. 2004) In demonstrating how harsh daily life is in Nigeria, the International Labor Organization (ILO) estimated in 2004 that of a projected 2005 population of 130 million, fewer than 4.1 million of these persons would live to at least 65. (ILO, "HIV/AIDS and Work," 2004) ¶5. (U) By the end of 2003, Nigeria had at least 2.4 million HIV-positive people aged 15 to 64 in its labor force - with "labor force" defined as all economically active persons, including those in paid employment, gainful self-employment, or unemployed but seeking work. (ILO, 2004) The ILO estimated that Nigerians who will have died from AIDS during 1995 to 2005 would equal 3% of Nigeria's cumulative labor force during that decade. (ILO, 2004) Because most of Nigeria's economic activity occurs in the informal sector, which does not provide health and death benefits, HIV/AIDS places the severest economic impact on the poorest Nigerians. ABUJA 00002504 002 OF 003 ¶6. (SBU) HIV/AIDS has the potential to further destabilize Nigeria, where the governance and infrastructure already have broken down and where about 85 million Nigerians try to survive on less than $1 per day. In addition, HIV/AIDS poses a significant threat to Nigeria's urban elite, who because of their mobility and behavior are more likely to be infected. The urban elite are relatively young, in their economic prime, and better educated than the average Nigerian. The consequences of these shortened lives and careers include fewer leaders in Nigeria's society and economy, declining productivity, greater production costs, and decreased household income and opportunities for education. (IMF, Nov. 2004) It is difficult to quantify precisely HIV/AIDS' economic cost to Nigeria, but the disease reduces Nigeria's human and physical capital. As spending shifts toward addressing HIV/AIDS, aggregate saving is likely to fall, leaving fewer resources for investment. (IMF, Nov. 2004) ¶7. (U) Senior Government of Nigeria (GON) officials are realistic about the threat HIV/AIDS poses. President Obasanjo personally lent his support by speaking on World AIDS Day at the December 2004 launch of the (U.S.) President's Emergency Plan for AIDS Relief (PEPFAR),and he launched on World AIDS Day in December 2005 the "Operation Heart to Heart" campaign for persons suffering from HIV/AIDS. There is strong Nigerian public support for the Emergency Plan, and close coordination between the GON Ministries of Health and Defense and the U.S. Mission, including USAID, the Department of Defense (DOD),the Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH). U.S. Ambassador Campbell and Nigeria's Minister of Health co-chair a steering committee on HIV/AIDS in Nigeria, while the Nigerian Minister of State for Defense has made HIV/AIDS prevention a priority. PEPFAR has stimulated the Nigerian Ministry of Defense's (MOD) HIV program and the formation of the MOD-U.S. DOD HIV Program Steering Committee. The committee is co-chaired by Ambassador Campbell and the Nigerian Minister of State for Defense, and oversees PEPFAR's activities with the Nigerian military. ¶8. (U) The Nigerian military's HIV prevalence rate is unknown, according to a senior Nigerian military medical officer. All potential recruits are supposed to be tested for HIV before being accepted for service, but the Nigerian military maintains little data and carries out no confirmatory testing. The Nigerian military does not continue mandatory in-service HIV testing for its personnel - though the advent of free testing and treatment has strengthened the concept of testing and tempered the objections to instituting anonymous mass testing. The Nigerian Air Force has mandatory HIV testing only for air crew members on flight status. All military personnel seeking to serve outside Nigeria on peacekeeping operations are supposed to be tested for HIV, both before and after their deployment - but these test results generally are unavailable even to the Nigerian military's medical commands and to its Armed Forces Program on AIDS Control. Nigeria's PEPFAR-funded military HIV program now is operating at five locations and has enrolled more than 1,000 persons for treatment. The program is open to the civilian community near these hospitals, but this could place great strain on the system's staff, which is generally under strength. ¶9. (SBU) Despite the commitment at the GON's senior level to combating HIV/AIDS in Nigeria, the ability to translate political commitment into program implementation on the ground often is limited. Nigerian officials occasionally express complacency over Nigeria's success in capping the nation's infection rate at "only" about 5% - especially compared to other African countries' much higher rates. AIDS' serious threat to Nigeria is relatively abstract to the typical Nigerian. Many Nigerian institutions and a large percentage of Nigerians are in denial about the damage wreaked by the disease, in large part because of HIV/AIDS' stigma. Unlike in Uganda, where AIDS has been widespread, only 21% of Nigerians report knowing someone who has AIDS or who died from it. (Nigeria National HIV/AIDS and Reproductive Health Survey, 2005) Nigerians facing death from AIDS generally leave the city and return to their village. The weakened AIDS sufferers usually die from malaria or tuberculosis, which is attributed as the cause of death rather than AIDS. ¶10. (U) In fiscal year (FY) 2006, U.S. Government (USG) funding in Nigeria for PEPFAR is approximately $163 million. Under the Office of the U.S. Global AIDS Coordinator and Ambassador Campbell, five USG agencies work together with Nigerian and international entities to implement sustainable prevention, care, and treatment programs. As of March 31, 2006, the USG was supporting 30,061 individuals on antiretroviral therapy (ART). More than 106,000 individuals have received care and support services in USG-sponsored clinical- and community-based facilities. Among the more than 44,400 pregnant women who received antenatal care at PEPFAR sites, 2,873 HIV-positive women received ARV prophylaxis to reduce the risk of mother-to-child transmission. Nearly 150,000 clients have received HIV test results at counseling and testing sites. These prevention, care, and treatment services are provided in 15 Nigerian states: Anambra, Bauchi, Benue, Borno, Cross River, Edo, Enugu, Kaduna, Kano, Lagos, Nasarawa, Oyo, Plateau, Rivers, and the Federal Capital Territory. ABUJA 00002504 003 OF 003 ¶11. (SBU) Nigeria's ineffectiveness in using Global Fund money to fight HIV/AIDS causes the U.S. Mission Nigeria considerable concern. The Global Fund for AIDS, Tuberculosis, and Malaria grant program in Nigeria is plagued by slow implementation and weak management by one of its principal recipients, Nigeria's National Action Committee on AIDS, as well as by the country coordination mechanism (CCM). The Global Fund in Nigeria works through the CCM, which develops and submits grant proposals to the Global Fund, then oversees program implementation. Earlier this year, the Global Fund terminated two HIV grants to Nigeria totaling $81 million due to weak management and improper oversight of expenditures, failure to meet performance measures, and failure to implement promised CCM reforms. Nigeria needs to demonstrate improved competency in managing its financial resources and in implementing programs - for the Global Fund's canceled grants demonstrate that Nigeria's challenge in its war against AIDS is not simply a lack of funding. ¶12. (U) The GON fully recognizes the threat of HIV/AIDS. It values its partnership with the United States and U.S. cooperation on the HIV/AIDS issue. Our partnership in combating HIV/AIDS is strengthening our bilateral relationship. ¶13. (U) This cable was reviewed by Embassy Abuja's Economic Section, the HHS/CDC-Global AIDS Program Nigeria, the Centers for Disease Control and Prevention Abuja, and USAID Abuja.