Cablegate: Measurable Success in Nigerian Hiv/Aids

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

091559Z Jun 04




E.O. 12958: N/A

1. (SBU) SUMMARY: Ambassadors Tobias and Campbell and
USAID Country Director Liberi met with Nigerian
Minister of Health Lambo on June 4 to discuss
coordination between the GON national HIV/AIDS strategy
and USG objectives under the President's Emergency Plan
for AIDS Relief (PEPFAR). Reflecting GON efforts to
meet increasing demand for treatment in existing
centers, Lambo announced local production of
antiretroviral (ARV) drugs to begin in November 2004.
He also said that while there had been a registered
decline in HIV/AIDS prevalence rates, there is no cause
for complacency. Tobias applauded the GON's efforts
and said he hopes Nigeria will serve as an example for
the region. END SUMMARY.

2. (SBU) On Friday, June 4 in Lagos, Ambassador
Randall Tobias, Ambassador John Campbell, and USAID
Director Dawn Liberi met with the Nigerian Minister of
Health, Professor Eyitayo Lambo. Lambo said that,
while Nigeria confronts public relations challenges
pertaining to its polio vaccine program, HIV/AIDS
initiatives are becoming more effective. Lambo added
that Nigeria's national prevalence rate of HIV/AIDS has
declined from 5.8 percent to 5.0 percent, according to
national sero-prevalence surveys conducted in 2001 and
2003. He cautioned that Nigeria could only begin to
claim success if the prevalence rate continues to
decline in the next surveillance survey planned for
2005. Even with a lower prevalence rate, Lambo
acknowledged that Nigeria's population of "140" million
presents difficult challenges in reducing the number of
people infected.

3. (SBU) Lambo also said the GON has worked largely
with the secondary and tertiary institutions in
implementing HIV/AIDS education and prevention
programs, adding that work in the primary institutions
must be revitalized. Lambo outlined achievements
Nigeria has made since launching the 2002 pilot program
to provide affordable antiretroviral (ARV) treatment.
He said the GON has established 25 treatment centers,
and over-enrollment in these centers indicates that the
demand for ARV drugs and resources for treatment far
exceeds the supply. (GON initiatives provide for an
initial 10,000 adults and 5,000 children to benefit
from a monthly administration of ARV drugs.
Beneficiaries pay 1000N for this service, approximately
$7 USD per month instead of the $25-$72 USD commercial
cost for ARV treatment. The GON is spending 1.5
billion naira (approximately 11.5 million USD) on this
subsidized service).

4. (SBU) Lambo outlined five principles that guide all
GON-supported HIV/AIDS initiatives: 1) country
involvement, 2) accountability, 3) transparency, 4)
value-for-money or showing results, and 5)
sustainability. These reflect Nigeria's commitment to
the President's Emergency Plan for AIDS Relief
(PEPFAR). Lambo then made nine major points with
respect to these principles.

Country ownership: It is being achieved in practical
terms through cooperation between the steering
committee and the USG.

Adherence to national policy plan guidelines: The GON
is realizing this by strengthening its existing work,
particularly in the 25 treatment sites established.

Coordination of efforts: To ensure that "Three by
Five", PEPFAR, the Global Fund, and GON initiatives do
not duplicate efforts, the implementing agencies' of
these programs should not concentrate their efforts in
one state (as is being done in Jos); instead they
should coordinate to ensure that treatment centers are
established in every state.

Strengthening systems: Success is possible only with
improvement of the overall health care system. Lambo
referred to a recent international survey ranking
Nigeria 187/191 and stated that only an efficient and
effective system can support the GON goal of having
350,000 on ARV treatment by 2006.

Focus on commodities: The GON wants to lower barriers
to ensure acceptance and use of generic drugs. The
National Agency for Food, Drug Administration and
Control (NAFDAC), Nigeria's regulatory body, is working
to certify ARV drugs for future use.

Support for basic research: It is necessary to ensure
that operational research is being conducted. Lambo
said this point is important to him because of his
background and the time he spent conducting post-
graduate research in Rochester, New York.

Capacity-building: It will be achieved when there are
adequate skills among the population and at the centers
to support often complicated treatment regimes.

Demonstrated commitment: Measurable success will be
achieved only when Nigeria can show quantifiable and
concrete results.

Sustainability: It will be achieved when the USG and
other donors make the commitment to continue investment
and collaboration. Lambo expressed concern that since
ARV treatment is often for a lifetime, beneficiaries
cannot be abandoned after five years; i.e., at the
conclusion of PEPFAR.

5. (SBU) Lambo emphasized Nigeria's commitment to
locally produced ARV drugs. He said three Nigerian
companies are prepared to begin production by November
2004. The GON is investigating the potential for
increasing production capacity through use of an
existing army drug manufacturing facility in Lagos.

6. (SBU) Ambassador Tobias applauded Nigeria's efforts
and the consistency of the GON message. He lauded
Lambo's demonstrated leadership and commitment, and
stated that Nigeria is a positive example for Africa
and the rest of the world. Ambassador Tobias expressed
the intent of the USG to provide assistance that would
be consistent with the intent of the Presidential
Emergency Plan, but only in ways that were also
consistent with the policies of the GON. Ambassador
Tobias closed the meeting by emphasizing that USG has
made a commitment to Nigeria and has the technology,
wherewithal, and obligation to assist; but the USG will
do so only within the coordinated framework of
Nigeria's HIV/AIDS policy.

7. (U) Ambassadors Tobias and Campbell have cleared
this message.


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