NIGERIA CELEBRATES WORLD AIDS DAY WITH FOCUS ON HIV/AIDS

UNCLAS SECTION 01 OF 03 ABUJA 002218 SENSITIVE SIPDIS DEPARTMENT FOR OGAC RYAN, OES/IHA WILUSZ PASS USAID FOR GH/OHA RCLAY, CHAWKINS PASS FOR USAID FOR AFR/SD HSUKIN CDC FOR NCIRD/GID/DEEB RJSIMOND E.O. 12958: N/A TAGS: TBIO KISL PGOV SOCI ECON KOCI EAID NI SUBJECT: NIGERIA CELEBRATES WORLD AIDS DAY WITH FOCUS ON HIV/AIDS SERVICES COVERAGE SENSITIVE BUT UNCLASSIFIED - NOT FOR DISTRIBUTION OUTSIDE USG. -------------- SUMMARY -------------- ¶1. (SBU) Nigeria commemorated World AIDS Day on December 1 with a symposium on bridging the gap between the current coverage of 11 percent and its target of achieving 80 percent in the prevention of mother-to-child transmission (PMTCT). Nigeria has a 4.6 percent HIV/AIDS prevalence rate. It has an estimated 2.6 million persons infected with the virus and approximately 1.2 million HIV/AIDS orphans, making Nigeria the second highest HIV-burdened country in the world after South Africa. It has the highest percentage of pregnant women (30 percent) in need of antiretroviral treatment to prevent mother-to-child transmission among 20 highly HIV-burdened countries. The Director General of the National Agency for the Control of AIDS (NACA) promised to close the gap in PMTCT coverage through its new National HIV/AIDS Strategic Framework for 2010-2015. He thanked the USG and other donors for their support. The Chairmen of the House and Senate Committees with oversight on health matters promised more funding for HIV Testing and Counseling (HTC) and PMTCT services and hoped for the passage of an anti-stigmatization and discrimination bill by early next year. The Ambassador highlighted the need to close the gap between current and targeted PMTCT coverage. The Ambassador visited a USG-funded PMTCT clinic in Abuja on December 3 and emphasized the importance of women's leadership in the fight against HIV/AIDS. END SUMMARY. -------------- -------------- WORLD AIDS DAY AND AN OVERVIEW OF HIV/AIDS IN NIGERIA -------------- -------------- ¶2. (U) The GON commemorated World AIDS Day with a symposium on PMTCT on December 1. Invited guests, donor and civil society partners, and representatives of people living with HIV/AIDS (PLWHA) attended the symposium. The first case of HIV/AIDS in Nigeria was reported in 1986. Since then, the epidemic has steadily grown with a concomitant drop in life expectancy from 53 years in 1990 to 46.5 years in 2008, negating positive effects that might have occurred as a result of any improvements in living standards and health care. Nigeria, with an estimated 2.6 million persons infected with the virus and 800,000 people requiring anti-retroviral drugs, has the second-highest burden of HIV infection in the world, surpassed only by South Africa. The USG PEPFAR program provides roughly a third of the required retroviral drugs in the country. The epidemic has already claimed approximately three million lives and left around 1.2 million orphans to be cared for. With the epidemic many more people face physical, social, financial, and emotional problems. ¶3. (U) The national HIV-prevalence rate increased from 4.4 percent in 2005 to 4.6 percent in 2008, according to the latest GON survey conducted in 2008. (NOTE: The 2009 data of the Joint United Nations Program on HIV/AIDS indicates the prevalence rate to be 3.1 percent. END NOTE). The GON survey indicated that all states are affected, with Ekiti State registering one percent and Benue State - a major transport corridor - showing 10.8 percent. The GON states that unsafe heterosexual sex practices and blood transfusion, mother-to-child transmissions, and unsafe injections are the key Qmother-to-child transmissions, and unsafe injections are the key drivers of HIV transmission in the country. Nigerians living with HIV/AIDS suffer from stigma and discrimination and have little or no legal recourse. -------------- -------------- CLOSING THE GAP BETWEEN CURRENT AND TARGETED COVERAGE -------------- -------------- ¶4. (U) The GON's response to HIV/AIDS has been guided by the National HIV/AIDS Strategic Framework (2004-2009),which is currently under revision with assistance from the President's Emergency Plan for AIDS Relief (PEPFAR) for a new six-year period of 2010-2015. The previous plan aimed to reduce mother-to-child transmission by 50 percent in 2009; provide 50 percent of Nigerians access with quality HTC services by 2009; provide Anti-retroviral (ART) treatment to one million PLWHA by 2009; universal access to HTC service and ART drugs by 2010; 50 percent reduction in the prevalence of sexually-transmitted diseases by 2009; and zero percent HIV transmission through transfusion of blood and blood products by 2009. Achievements under the plan have fallen far short of these goals. The period corresponds with a substantial scale-up of PEPFAR resources but GON resources have been consistently lower ABUJA 00002218 002 OF 003 than needed. ¶5. (U) A 2009 World Health Organization (WHO) report indicated that Nigeria accounts for the highest percentage of pregnant women (30 percent) in need of antiretroviral treatment to prevent mother-to-child transmission among 20 HIV-burdened countries. More than 90 percent of HIV infection in children occurs through mother-to-child transmission during pregnancy, childbirth or breastfeeding. The current PMTCT coverage in Nigeria is estimated to be 11 percent, but the GON wants to raise this level to 80 percent by 2015. The symposium discussed various measures that will be needed to bridge the gap, including enhancing awareness among vulnerable groups and the general public, strengthening the country's weak health system infrastructure, and scaling up and publicizing HIV/AIDS prevention and treatment services. ¶6. (U) The overall goal of the PMCT program is to reduce the transmission of HIV infection from positive mothers to their infants. The national PMTCT program began in 2002 and since then has grown from 11 delivery points at tertiary institutions to 600 sites in 2009, largely supported by the PEPFAR program. NACA Director General Dr. John Idoko blamed lack of awareness at the community level, a poor health care delivery system, gender discrimination and relatively low demand for HIV/AIDS services, and stigmatization and discrimination against PLWHA for the low PMTCT coverage and promised to enhance the coverage through the new National HIV/AIDS Strategic Framework for 2010-2015. Ambassador Sanders, in her address to the symposium, expressed USG support for Nigeria's fight against HIV/AIDS through PEPFAR and highlighted the need for the GON to scale up its funding and activities against the epidemic. -------------- -------------- NATIONAL ASSEMBLY CONSIDERS ANTI-STIGMA DRAFT LAW -------------- -------------- ¶7. (SBU) Senate Committee on Health Chairman Senator Iyabo Obasanjo-Bello and House Committee on HIV/AIDS, TB, and Malaria Chairman Honorable Oluwwole Olakunde outlined the activities of the National Assembly in strengthening the GON's response to the HIV epidemic. They pointed to an HIV Anti-Stigma Bill, currently being debated in the National Assembly, as essential to protect the rights of PLWHA and hoped that it will pass early next year. They said the bill, if passed, will repeal laws that discriminate against PLWHA and institute provisions that will protect the rights of such people. They also promised to support an increased budget for HTC and PMTCT activities. The ceremony attracted a group of persons living with HIV/AIDS that threatened to disrupt the event claiming that they have been excluded and neglected by NACA. The agency's officials countered that claim by saying they had invited representatives of PLWHA to the symposium, questioned the motives of the protest organizers, and doubted the HIV/AIDS status of the protesters. The protest nonetheless brought to light the distrust some have for NACA, due to its lack of an effective communication strategy. -------------- THE AMBASSADOR VISITS A PMTCT CLINIC -------------- ¶8. (U) The Ambassador visited the Asokoro District Hospital in Abuja to highlight USG PEPFAR support for PMTCT programs in Nigeria on Qto highlight USG PEPFAR support for PMTCT programs in Nigeria on December 3, as part of the Mission's World AIDS Day outreach. She toured the PMTCT clinic and the training laboratory housed at the hospital and engaged a mother-to-mother support group that receives services through the clinic. (NOTE: The PMTCT clinic is supported via a Health and Human Services and Centers for Disease Control and Prevention partner, the Institute for Human Virology in Nigeria. END NOTE). The visit also included the Early Infant Diagnosis (EID) program, an important piece of the country's overall PMTCT strategy. The Ambassador praised the women for providing a life free of HIV for their children and encouraged them to be leaders in promoting PMTCT services in their communities. The women expressed their appreciation for USG support and raised key issues and challenges they daily face, including lack of income generation activities, mentoring programs, community outreach, and infant feeding support. -------------- COMMENT -------------- ¶9. (SBU) The Minister of Health and the Minister of Women's Affairs ABUJA 00002218 003 OF 003 were notably absent but were represented at the director's level at the World AIDS Day event. The commemoration was not well-organized and compared poorly to similar World AIDS Day events in previous years. Lack of effective communication and coordination between the Ministry of Health and NACA and other ministries and lack of communication with the public in general and PLWHA in particular are key hurdles that need to be overcome to advance prevention and treatment efforts in Nigeria. Inadequate GON financing of HIV/AIDS activities also continues to plague the response in Nigeria. SANDERS