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Cablegate: Nigeria: Launching National Hiv/Aids Counseling and Testing

VZCZCXRO3316
PP RUEHMA RUEHPA
DE RUEHUJA #2262/01 3230658
ZNR UUUUU ZZH
P 180658Z NOV 08
FM AMEMBASSY ABUJA
TO RUEHC/SECSTATE WASHDC PRIORITY 4475
INFO RUEHOS/AMCONSUL LAGOS PRIORITY 0273
RUEHZK/ECOWAS COLLECTIVE
RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHDC

UNCLAS SECTION 01 OF 02 ABUJA 002262

SENSITIVE
SIPDIS

DEPARTMENT FOR OGAC RYAN, OES/IHA WILUSZ
PASS USAID GH/HIDN OGDEN AND GREENE
AFR/SD FOR HARVEY
CDC FOR NCIRD/GID/DEEB SUE GERBER

E.O. 12958: N/A
TAGS: TBIO KISL PGOV SOCI ECON KOCI EAID NI
SUBJECT: NIGERIA: LAUNCHING NATIONAL HIV/AIDS COUNSELING AND TESTING
PROGRAM

SENSITIVE BUT UNCLASSIFIED - NOT FOR DISTRIBUTION OUTSIDE USG.

1. (SBU) SUMMARY. From October 9 - 11 the Government of Nigeria
hosted a forum to discuss and develop a national HIV/AIDS Counseling
and Testing (HCT) initiative. The event provided a rare and useful
platform for HIV/AIDS advocacy and frank discussions. The GON
appears to view a new massive national HCT program as a principal
mechanism for expanding prevention, outreach and behavioral change,
although such a campaign seems more appropriate for a country with a
generalized HIV/AIDS epidemic (such as those in southern Africa).
Nigeria faces a complex mix of several localized and concentrated
epidemics, with significantly higher seroprevalence rates in
most-at-risk populations (MARPs), which calls for a more targeted
anti-HIV/AIDS response. Moreover, the GON showed little evidence
that it has thought through the logistical, technical, and financial
inputs that will be required to undertake such a massive nationwide
campaign (which could conceivably involve close to 59 million
Nigerians) and how it plans to treat and care for those that will be
diagnosed as seropositives. END SUMMARY

2. (U) The Nigerian National Agency for the Control of AIDS (NACA)
held a national forum to discuss and develop a national HIV/AIDS
Counseling and Testing (HCT) initiative from October 9 - 11. The
forum was officially inaugurated by the Vice President of the
Federal Government of Nigeria, Goodluck Jonathan, and brought
together a wide and influential array of federal, state, and local
government officials and representatives of civil society, people
living with HIV/AIDS, and partners from the private sector and the
international community.
.
SECOND HIGHEST GLOBAL HIV/AIDS POPULATION
-----------------------------------------
.
3. (U) According to a survey conducted in 2005, Nigeria's HIV
prevalence rate dropped from 5.2% in 2003 to 4.4% in 2005. (Note:
The Joint United Nations Program on HIV/AIDS (UNAIDS) estimates the
generalized prevalence rate to be 3.1%, the rate also used by the
U.S. President's Emergency Plan for AIDS Relief (PEPFAR). Data
stemming from the GON's 2008 HIV prevalence survey among pregnant
women is currently being analyzed, which will be used to project a
more accurate HIV prevalence rate among the general population by
early 2009. End Note). Based on the GON's data, Ekiti state has
the lowest infection rate, 1.6, while Benue state has the highest,
10%. Fifteen states including the Federal Capital Territory (FCT)
have greater infection rates than the national average of 4.4%, with
slightly higher rates in urban areas. The GON states that unsafe
heterosexual sex practices, blood transfusion, and unsafe injection
are the key drivers of HIV/AIDS transmission in the country.
Nigerians living with HIV/AIDS suffer from stigma and
discrimination.

4. (U) NACA officials estimate 2.9 million Nigerians are living with
HIV/AIDS, the second largest number in the world after South Africa.
Of these, 540,000 need Anti-retroviral (ARV) treatment. Nearly
200,000 individuals are receiving ARV treatment funded through USG
PEPFAR programs. NACA calculates that there are 58.4 million
Nigerians who need to be reached with prevention messages through an
HCT program. This figure is composed of people who are in the
active reproductive age range and vulnerable groups such as female
sex workers, transportation workers, and populations living in
junction towns. (Note: There are important risk differences
between all Nigerian adults of reproductive age and those belonging
to vulnerable groups such as the aforementioned. End Note). So
far, only 10.8% of the target 58.4 million have undergone HIV tests
because of shortage of testing services, the stigma associated with
the disease, or poor awareness of testing benefits and counseling.


THE GOAL OF A NATIONAL HCT PROGRAM
----------------------------------
.
5. (U) At the HCT forum, Vice President Jonathan noted Nigeria's
comparatively low infection rate (compared to other African
countries) and acknowledged the significantly higher number of
Nigerians living with HIV/AIDs. He said given Nigeria's sizable HIV
burden and population, more needs to be done to arrest the expansion
of the disease. He underscored the GON's commitment to combating
HIV/AIDS and identified HCT as a key link in an effective
anti-HIV/AIDS strategy. The Vice President reaffirmed the federal
government's "non-revocable commitment" to protect and develop its
human resources and said "we are all commanders and generals and
cannot afford to lose the war against HIV/AIDS." He also
specifically acknowledged and thanked the USG for its "significant

ABUJA 00002262 002 OF 002


assistance in curbing the ravages of HIV/AIDS through PEPFAR and the
Global Fund."

6. (U) NACA Director General Professor Babatunde Osotimehin
described the HCT program as "a clear entry point to a successful
prevention, treatment, care, and support regime" and announced the
GON's plan to launch such an initiative shortly. He said in
recognition of HCT's importance and in collaboration with partners,
the GON plans to expand access to HCT services by integrating them
into existing public and private health facilities and by
establishing standalone HCT sites. The plan will scale-up HCT
services by establishing at least five HCT delivery points in all
774 Local Government Areas (LGAs) by 2010 and support targeted
public outreach efforts. According to the NACA Director General,
those that test positive will receive treatment, counseling and care
and those that test negative will receive prevention counseling.

7. (U) To implement the program NACA will request greater commitment
from the GON and mobilize support (financial and technical) from the
private sector, civil society, and multilateral and bilateral
donors. The HCT forum established a committee composed of various
players to develop an action plan to launch a national HCT program.
Speaking on behalf of the Development Partners Group against
HIV/AIDS (DPG), a donor committee that includes both USAID and CDC,
the World Bank representative applauded the GON for its
anti-HIV/AIDS efforts, stated the significant assistance by the
international community, and urged the GON to show its commitment by
providing the funds necessary to undertake the proposed HCT program.

.
IMPLEMENTATION IS KEY
---------------------
.
8. (SBU) COMMENT: To reach close to 59 million Nigerians with HCT
service, the GON must come up with sufficient funds to mainstream
HCT services into existing health facilities, establish additional
HCT sites and train the personnel that will staff them while
overcoming very low level of public awareness and negative
perception against those infected with the virus. It also needs to
formulate a strategy on how it is going to care for and treat those
that will be diagnosed with the disease.

9. (SBU) The GON's proposal to use HCT as a principal measure for
boosting prevention and behavioral change is challenged by the DPG's
consensus that a nationwide HCT campaign may be more appropriate for
countries with a generalized epidemic, such as those in southern
Africa. Nigeria essentially suffers from a more localized threat
among MARPs and therefore a nationwide campaign for HCT is unlikely
to receive much donor and development partners' support. It will
fall upon the GON to appropriate funds, and create the technical and
logistical framework that will be needed to launch and sustain such
a massive campaign.

10. (SBU) Apart from funding the HCT initiative, the issue of
treatment and care for those that will test positive needs to be far
more clearly outlined. In a separate follow-on meeting with AIDOff,
the NACA Director General said a more realistic target for HCT over
a 3-5 year period might be testing 15 million people, as per the
recent Global Fund Round 8 application. The U.S. Mission will
continue to engage the GON with the goal of shaping a more
appropriate HCT program. END COMMENT.

11. (U) This cable has been coordinated with Consulate Lagos.

SANDERS

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