Cablegate: Nigeria: Hiv/Aids

This record is a partial extract of the original cable. The full text of the original cable is not available.





E.O. 12958: N/A

REF: (A) LAGOS O1512, (B) LAGOS 01545, (C) LAGOS
01583, (D) Lagos 1678

1. SUMMARY: This cable summarizes the strategies
and activities undertaken by USAID and CDC to build
national and local capacities to alleviate the
impact of HIV/AIDS and reduce the stigma and
discrimination associated with the disease. Key to
USAID and CDC's efforts are technical assistance
to the National Action Committee on AIDS (NACA) and
its nascent state and local counterparts (i.e. SACAs
and LACAs) as well as the Federal Ministry of Health
(FMOH); capacity building for non-governmental
organizations (NGOs); care and support of people
living with AIDS (PLWA) and people affected by AIDS
(PABA) and the central involvement of PLWAs in all
activities; the training of voluntary counseling and
testing (VCT) personnel and the development of VCT
centers; the involvement of faith based
organizations and religious leaders; and the use of
mass media and advocacy. With our increase in
HIV/AIDS funding, USAID will become the largest
financial donor in FY 03, followed by the World
Bank. CDC is the major source of technical
assistance to the FMOH. End Summary.

2. Overview: The first case of AIDS in Nigeria was
reported in 1986, and the Government of the Federal
Republic of Nigeria (GON) conducted the first HIV
sentinel sero-prevalence survey in 1990. In
1990/91, the national prevalence rate was roughly
1.8%. Over the past twelve years this rate has
steadily risen to 5.8% in 2001 - an increase of more
300 percent. Currently, there are roughly over 3.5
million Nigerians living with HIV/AIDS. Nigeria has
the highest number of HIV/AIDS infected adults in
West Africa and accounts for 11% of worldwide

3. Working with the Government: Two years ago,
President Olusegun Obasanjo established the National
Action Committee on AIDS (NACA), a policy and
coordination body that reports directly to him and
pursues a multisectoral approach to HIV/AIDS. USAID
and CDC have supported NACA since its inception,
supplying technical assistance to the organization
on many occasions. For example, the USAID-funded
policy Project assisted NACA to develop the HIV/AIDS
Emergency Action Plan (HEAP) that provides the
framework for the national effort and helped NACA
draft the National HIV/AIDS policy.

4. In July, seemingly out of frustration for NACA's
inability to move as quickly as he had hoped,
President Obasanjo disbanded NACA to create a new
coordination and implementation structure under the
Federal Ministry of Health (FMOH), the National AIDS
Prevention and Control Agency (NAPCA).

5. USAID, the World Bank, and Britain's Department for
International Development (DfiD), the three major
HIV/AIDS donors in Nigeria, were concerned that creation
of NAPCA under the FMOH might hamper the
multisectoral national effort and that there was an
inherent conflict of interest in a national
structure that both coordinated and implemented
programs. The three donors endorsed an effort
leading to the re-establishment of NACA under a more
energetic leadership with greater direct access to
the President through the reactivation of the
Presidential Committee on AIDS (PCA). USAID is
attempting to help the new NACA leadership with
provision of technical assistance to: a) map donor
supported HIV/AIDS activities nationwide; b) develop
an advocacy campaign in support of the bill to make
NACA a legal entity; and c) develop a national media
campaign to combat stigma and discrimination.

6. Working to improve NACA is only part of USAID's
efforts to build institutional capacity. We realize
the relationship and division of responsibilities
between NACA and state and local government
structures are still evolving and that tensions exist.
To facilitate and expedite the development process,
both USAID and the CDC have developed projects that
provide technical assistance and support to the
SACAs and LACAs in four USAID focus states (Lagos,
Kano, Taraba and Anambra).

7. The CDC provides funding to the National
Alliance of State and Territorial AIDS Directors
(NASTAD) to work with NACA and SACA representatives
to develop models of state level organizations
appropriate to Nigeria. In a complementary fashion,
the USAID-funded IMPACT (Implementing AIDs
Prevention and Control Activities) Project works to raise
the level of political awareness and commitment of policy-
makers in support of HIV/AIDS programs at the local
level. Technical assistance to the LACA includes
training in management, advocacy and community
mobilization, and monitoring and evaluation. The
success of this project will be measured by
increased funding from the local governments to the
LACA and by increased referrals and coordination
among the groups working in HIV/AIDS. Although
neither the CDC nor IMPACT efforts are mature enough
to be evaluated at this point, preliminary observations
are encouraging. Other donors are monitoring these
projects with an eye to replication in other states
and local government areas.

8. Cooperating with Civil Society: Civil society
organizations suffered enormously during military
rule. One of the greatest challenges facing the
Mission is building the capacity of local non-
governmental organizations (NGOs) and community-
based organizations (CBOs). In the HIV/AIDS arena,
USAID supports over 60 local NGOs to build capacity.
The 60-plus local NGOs receiving this intensive
capacity building will increase access to better
quality HIV/AIDS services in their areas. Target
populations include sex workers and their clients,
transport workers, religious organizations, youth,
trade unions and the uniformed services.

9. Raising Public Awareness - PLWA/PABA: USAID is
recognized as the major donor to projects for people
living with AIDS (PLWA) and people affected by AIDS
(PABA). Some USAID-supported projects have a
national reach while others are localized. The
focus of these projects includes documenting general
human rights violations as well as the
discrimination faced by PLWA at medical facilities.
It also includes radio call-in shows run by PLWA
to local support groups run by PLWA to community-
based care and support projects for PLWA and PABA.
USAID, for example, piloted the first two community-
based projects for orphans and vulnerable children
(OVC) in Nigeria. These projects, located in areas
with the highest HIV prevalence in the country, will
not be formally evaluated until October. However, it
is obvious that these projects have galvanized
support for PLWA and PABA and have lessened the AIDS
stigma while energizing open discussion.

10. Previous to project implementation, the stigma
of HIV was so great in Benue State that there were
instances of violent demonstrations against anyone
who spoke publicly on the issue. As a result of the
OVC project, traditional and political leaders in
Benue now hold meetings and openly discuss the
gravity of the HIV/AIDS epidemic in public fora.
USAID also funded Population Services
Internationals' highly acclaimed televised anti-
discrimination campaign during the World Cup and
USAID will support NACA to develop a national media
campaign to combat stigma. In another project,
USAID is supporting the production of videos
containing testimonials of PLWA that will be used
extensively to put a human face to the epidemic.

11. The CDC is a major donor in terms of supplying
technical assistance to the FMOH and NACA to improve
prevention, care and treatment services to PLWA.
For example, the CDC recently assisted the FMOH to
complete site assessments of the three university
teaching hospitals that that will serve as training
centers for different cadres of health workers on
comprehensive patient care including home-based

12. Faith-Based Approaches: Other successful
strategies that USAID has utilized to overcome
stigma and discrimination is support to faith-based
initiatives and the recruitment of religious leaders
to advise non-faith based projects. Muslim and
Christian clergy alike have considerable influence
on the beliefs and attitudes of their followers.
USAID funded projects recognize this influence and
enlist these leaders in most undertakings. For
instance, a required component of all community-
based projects supported through the USAID-funded
IMPACT Project is a Project Advisory Committee
(PAC). A PAC is composed of local leaders who meet
monthly. They advise on project activities and how
to present a project's objectives before the
community. Religious leaders are always included as
PAC members. Thus, the project with the Kano State
branch of the National Transport Workers Union has
several Muslim and traditional leaders whose counsel
has allowed project staff to promote condom use in a
socially acceptable manner.

13. Other USAID-supported projects target the
religious leaders themselves for interventions.
The project with Church of Christ in Nigeria
(COCIN), a major social and political force in the
Middle Belt region, is an outstanding example of
this approach. Due to USAID-sponsored interventions,
COCIN's leadership has dramatically changed its
original stance that equated HIV infection with
punishment from God and forbade condom use. The
COCIN hierarchy now accepts that HIV/AIDS is a major
danger to the church and its members; they actively
support people living with HIV/AIDS (PLWHA); and
promote condom use within the confines of marriage.

14. Another critical component of USAID's effort to
alleviate stigma and discrimination is the training
of voluntary testing and counseling (VCT) personnel and
the establishment of the first two dedicated
voluntary counseling and testing (VCT) centers in
Nigeria. The USAID-funded IMPACT Project recently
opened the country's first VCT center in a densely
populated area of Lagos and will soon open the
second center in the second largest city, Kano.
These two urban VCT centers located in the country's
two most populated states serve approximately 37%
and 32% of their respective state populations.
There are no other facilities in the country where a
client can receive pre-test counseling, a rapid HIV
test and post-test counseling, including referral to
other services as necessary. VCT is a critical element
in prevention. Those who test negative need to be
counseled and motivated to maintain or adopt behaviors
to keep them safe; those who are positive need to be
counseled to adopt behaviors to protect others from
infection and themselves from reinfection. Positive persons
also need to be referred to services such as support
groups and treatment for opportunistic infections.
Some experts believe that decrease in HIV prevalence
in Uganda is attributable in part to the dramatic
increase in people receiving VCT services. The
IMPACT Project has also established 22 other
Voluntary Counseling Centers (i.e., clients receive
counseling but must go elsewhere for testing and
referral to other services) and these represent a
large proportion of the total counseling centers
nationwide. The CDC also supports the FMOH to
develop models for VCT services in public

15. CONCLUSION: The national, state, and local
structures created to lead the HIV/AIDS effort
across the country and most local NGOs are still primarily
in their developmental stages but USAID and the CDC are
major actors in building their capacity. Discrimination
against PLWA remains high and is deep seated in Nigeria
but here again USAID is at the forefront of efforts to
reduce the stigma. Another major contribution of the
CDC has been technical assistance to the National
Sero-prevalence survey, which provides critical information
for program development.

16. Much remains to be done in Nigeria to combat
the spread of HIV/AIDS and to halt the increase in
Nigeria's HIV prevalence. AIDS in Nigeria has had a
terrible personal and familial impact on PLWA and
PABA. Increasingly, it is having social and
economic and political impact that has made Nigerian
policy-makers take notice. Appropriate
programming of the $90 million World Bank loan, the
$70 million from the Global Trust Fund and the $40
million from the Government of Nigeria budget will
help but more resources, planning, and personnel as
well as the political will of all levels of government
will be needed. The USG, through USAID and CDC, is
working with the Government of Nigeria and other
donors to improve the response to HIV/AIDS and
ensure services will be in place. With half the
population of Nigeria under the age of fifteen,
another more damaging wave of the epidemic is
looming. The need to mount sufficient remedial and
prevention efforts in order to face this challenge
cannot be overstated. Jeter

© Scoop Media

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