UNCLAS SECTION 01 OF 03 ABUJA 000436

SIPDIS

SIPDIS

E.O. 12958: N/A
TAGS: KHIV SOCI TBIO ECON PREL PGOV NI
SUBJECT: THE STATE OF HIV/AIDS IN NIGERIA AS OF DEC. 2005

REF: ABUJA 209


1. Summary: This cable evaluates broadly HIV/AIDS' impact
on Nigerians and their institutions. Roughly 4 million
(UNAIDS, 2003) of the nation's 130 million people (PRB,
2002) are infected with HIV/AIDS, reflecting a national
HIV/AIDS infection rate of 5% (NPS, 2003). Nigeria had at
least 2.4 million HIV-positive workers in 2003. (ILO, 2004)
Although senior Nigerian officials are committed to
combating HIV/AIDS, the sense of urgency to do something
about it diminishes increasingly down the Nigerian
bureaucratic ladder. HIV/AIDS has the potential to further
destabilize Nigeria, where about 85 million Nigerians try to
survive on less than USD 1 per day. Most of Nigeria's
economic activity occurs in the informal sector, which does
not provide health and death benefits, so HIV/AIDS harms the
poorest Nigerians disproportionately. Despite some recent
improvements in performance, Nigeria's ineffectiveness in
using Global Fund money to fight HIV/AIDS causes the U.S.
Mission Nigeria considerable concern, and deeper structural
changes to the fund's Nigerian partners are needed. Because
the GON nonetheless recognizes the threat and values its
partnership with the United States, our common effort to
combat HIV/AIDS is strengthening our bilateral relationship.
End summary.


2. This is the second of Embassy Abuja's twice-yearly cables
on the effects of HIV/AIDS on Nigerians and the Nigerian
economy. 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 2003 to
be 5%. (NPS, 2003) This 5% infection rate means roughly 4
million adults aged 15-49 (UNAIDS, 2003) of Nigeria's
approximately 130 million citizens and residents (Population
Reference Bureau, 2002) have HIV or AIDS. In 2003, 310,000
Nigerian adults and children died of AIDS. (IMF, "The
Macroeconom

ics 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 rapidly to 8.2 million by 2010.
(UNICEF, 2005)


3. 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 country's
highest prevalence of HIV, 5.6%, is found among its 20 to 24
age group. (NPS, 2003) Unless there is sustained action to
target and protect this age group, a significantly larger
wave of HIV/AIDS likely will result. In May 2005, Nigeria
launched a new 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. charity 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. 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 will make up 17% of all
deaths in Nigeria in 2005; the inclusion of Nigerian adults'
deaths from AIDS will 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, that
fewer than 4.1 million of these persons would live to at
least age 65. (ILO, "HIV/AIDS and Work," 2004) (Note: This
ILO population projection is about 10 million shy of our
current estimate, which is based on data compiled by the
Population Reference Bureau.)


5. 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 persons who are economically
active, including all persons of working age who are in paid
employment, gainful self-employment, or unemployed but
available for and seeking work. (ILO, 2004) The ILO
estimated that Nigerians who will have died from AIDS during
1995 to 2005 will equal 3% of Nigeria's cumulative total
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
harms the poorest Nigerians disproportionately in economic
terms.


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6. HIV/AIDS has the potential to further destabilize
Nigeria, where government and services infrastructures
already have broken down and where about 85 million
Nigerians try to survive on less than USD 1 per day.
HIV/AIDS poses a significant threat particularly 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 costs of production, and decreased household income
and opportunities for education. (IMF, Nov. 2004) While it
is difficult to quantify precisely HIV/AIDS' economic cost
to Nigeria, the disease's effects reduce Nigeria's human and
physical capital. As spending shifts toward HIV/AIDS-
related activities, aggregate saving is likely to fall,
leaving fewer resources for investment. (IMF, Nov. 2004)


7. 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, as well as close coordination between the
GON Ministries of Health and Defense and the U.S. Mission,
including officials at USAID, the Department of Defense
(DOD), and the Centers for Disease Control. U.S. Ambassador
Campbell and Nigeria's minister of health co-chair a
biweekly steering committee on the issue of 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 policy and implementation in
the Nigerian military. Nigeria's military HIV program has
begun operating at four locations and has enrolled more than
300 persons for treatment. This program is open to the
civilian community surrounding these hospitals, but this
could place great strain on the system's staffing, which is
generally understrength.


8. The Nigerian military's HIV prevalence rate is unknown
but is estimated at between 5 and 10%, according to several
small studies conducted in recent years. All potential
recruits are supposed to be tested for HIV before being
accepted for service, but the Nigerian military maintains
little data on this subject and carries out no confirmatory
testing. Unlike the U.S. armed forces, 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 Nigerian military's 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.


9. Despite the commitment at the senior level of the GON to
combating HIV/AIDS in Nigeria, government personnel's
awareness of the extent of this disease diminishes
increasingly down the Nigerian bureaucratic ladder.
Nigerian officials occasionally express complacency over
Nigeria's success in capping the nation's infection rate at
"only" 5% - especially compared to other African countries'
significantly higher rates. Moreover, AIDS' serious threat
to Nigeria is relatively abstract to the typical Nigerian.
Many Nigerian institutions and a large percentage of
Nigerian society still engage in denial of the damage
wreaked by the disease, in large part because of HIV/AIDS'
stigma in Nigerian society. Unlike in Uganda, where AIDS
has been widespread, only 25% of Nigerians report knowing
someone who has AIDS or who died from it. (Nigeria National
HIV/AIDS and Reproductive Health Survey, 2003) Nigerians
facing death from AIDS generally leave the city and return
to their village. The weakened AIDS sufferers usually die
from malaria or tuberculosis (TB), which is attributed as
the cause of death rather than AIDS.


10. In fiscal year (FY) 2006, U.S. Government (USG) funding
in Nigeria for PEPFAR is about USD 163 million. Under the
Office of the U.S. Global AIDS Coordinator and Ambassador
Campbell, five USG agencies work collaboratively, including

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with Nigerian and international entities, to implement the
Emergency Plan through sustainable prevention, care, and
treatment programs. As of the end of September 2005, the
USG directly supported 18,885 individuals on antiretroviral
therapy (ART) in the nine focus states of Anambra, Borno,
Cross-River, Edo, Kano, Lagos, Oyo, Plateau, and the Federal
Capital Territory. Also as of September 2005, the USG was
rapidly increasing the ART services its partners offer to
meet its target of having 36,222 individuals on ART by March

2006. Currently, 447 USG-supported HIV-prevention programs
target at-risk individuals. In FY2005, about 67,925
patients received basic health care and support at 128 USG-
sponsored service outlets. More than 98,000 clients have
received counseling and testing in facilities supported by
the Emergency Plan.


11. Nigeria's ineffectiveness in using Global Fund money to
fight HIV/AIDS has caused considerable concern in the U.S.
Mission Nigeria. 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
(NACA), 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. A lack of
results, coupled with the lack of reform and proper
oversight by the CCM, in December 2005 nearly cost Nigeria
HIV/AIDS grants totaling almost USD 43 million. While this
funding ultimately was not canceled, the U.S. Mission
Nigeria remains concerned that despite some progress made
from July to December, NACA and the CCM need deeper
structural changes to ensure that Global Fund money is well
managed and that desired results are achieved in Nigeria.


12. 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. This cable was reviewed by Embassy Abuja's Economic
Section, its Office of Defense Cooperation, and by USAID
Abuja.

CAMPBELL