Cablegate: A Lagos State Perspective On Hiv/Aids

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

080546Z Oct 04




E.O. 12958: N/A

1. Summary. To gather input to develop the Five Year
Strategy for Nigeria for the Emergency Plan for AIDS
Relief, USG team members met officials of the Lagos
State Ministry of Health and the Lagos State Action
Committee on AIDS (LSACA) on September 20. The HIV/AIDS
prevalence rate in the state (4.7 percent) is just
below the national average (5.0 percent). Lagos State,
however, has the highest prevalence rate of the
Southwest states, and several "hotspots" within the
state have rates well above the national average. Lagos
has various prevention, care, and support programs in
place, but state officials would like to expand and
enhance them. Few people receive antiretroviral drugs,
making treatment an area of significant need. The areas
of need identified by the state officials align well
with the goals of the Emergency Plan. End summary.

2. USG team members met with the commissioner for
health, Dr. Leke Pitan, and staff of the Lagos State
Ministry of Health and (separately) the CEO of the
Lagos State Action Committee on AIDS (LSACA), Dr.
Aderemi Desalu, on September 20.

Lagos Prevalence Rates: Just below national
average but highest in the Southwest

3. USG team members provided an overview of the country
goals for the Emergency Plan for AIDS Relief. The
presentation included prevalence rates drawn from the
2003 National HIV Sero-prevalence Sentinel Survey from
the Federal Ministry of Health. The state prevalence
rate of 4.7 percent is slightly below the national
prevalence of 5.0 percent, but Lagos has the highest
prevalence of the Southwest states. Within the state,
the prevalence rate varies by location, from 1.7
percent on Lagos Island to 7.7 percent in Ikeja.
(Comment: The reliability of the survey results has
been difficult to gauge. The Lagos Island rate of 1.7
percent seems much too low. End comment.)

State Response: Solid programs
underway, expansion needed

4. Commissioner Pitan explained that LSACA, as part of
the governor's office, is the lead agency for HIV/AIDS
in the state. As the coordinating agency, LSACA works
with eleven line ministries, including the Ministry of
Health. (Comment: Effectiveness in some states has been
hampered by confusion or wrangling over the scope of
responsibilities of the SACA and other agencies. Lagos
State is often cited by the World Bank as an example of
how coordination can and should work. End comment.)

5. The commissioner commented that most people in Lagos
State know AIDS is real. He stressed the national
importance of addressing HIV/AIDS in Lagos, given that
the state's large population is drawn from all areas of
Nigeria, with many Lagosians frequently traveling to
their home villages and other parts of the country. He
highlighted some of the programs in the state,
including voluntary counseling and testing (VCT)
centers, prevention of mother to child transmission
(PMTCT) programs, and centralization of blood
transfusion services. He added that the state plans to
establish more VCT centers (with Family Health
International) and to focus more on treatment. For
instance, the state plans to embark on its own ARV
program and is currently obtaining ARV bids from
several leading pharmaceutical companies.

Prevention: Blood supply system is clear area of need
--------------------------------------------- --------

6. Prevention activities in Lagos State include PMTCT
programs in twelve hospitals, peer educator and other
programs in schools, and a safe injection program with
John Snow, Inc. While noting that the bulk of Emergency
Plan funding will go toward treatment, LSACA CEO Desalu
also stressed the importance of prevention.

7. A recent state law calls for screening and
certification of the blood supply. Eighteen screening
centers exist, but they are not all functional. The
state remains far from full compliance with the new
law. Ministry officials asked for USG assistance toward
the goal of screening 100 percent of the blood supply
and in increasing the number of volunteer donors. They
explained that currently less than five percent of the
blood supply comes from volunteer donors. Most of the
supply comes from commercial donors (touts), and some
comes from recipients' relatives. The officials implied
that increasing the proportion of supply from volunteer
donors would reduce the likelihood of HIV in the

Care and Support: VCT expansion and refinement needed
--------------------------------------------- --------

8. Fourteen voluntary counseling and testing (VCT)
centers operate in Lagos State, thirteen supported by
Family Health International and USAID and one run by
Medecins Sans Frontieres. Ministry officials said they
plan to increase the number of VCT centers. One noted
the importance of strengthening family planning
programs and clinics that treat sexually transmitted
infections (STI) and linking them to HIV programs. He
suggested the low prevalence rate on Lagos Island is
partially due to the fact that the island has had a
clinic for STIs for over twenty years and an HIV/AIDS
voluntary counseling and testing center for more than
five years.

9. Regarding barriers to people's using VCT centers,
Pitan commented that without hope of antiretroviral
treatment, many people see no reason to find out or
make known their HIV status. Another official noted a
need for youth-friendly services to encourage teenagers
to be tested, while others commented that social stigma
remains a significant barrier.

10. A ministry official pleaded for an emphasis on
children, as they are consistently on the periphery of
HIV/AIDS strategies. She commented that supportive care
would be valuable even if no drugs were available.
Pitan said Lagos would be a good place to start
pediatric AIDS activities, since Lagos has the largest
pediatric center in Nigeria.

Treatment: Few programs and significant need

11. The Ministry of Health officials requested that we
allocate the majority of Emergency Plan funds to
treatment and antiretroviral (ARV) drugs. In
particular, they said they would like to add ARV
treatment to the services provided by VCT centers and
maternity centers. Currently, only the Lagos
University Teaching Hosipital is included in the
National ARV Treatment Program. This site serves about
500 clients. The Lagos Island General Hospital also
provides ARV treatment for about seventy-five patients
who self pay and ten patients for whom Medecins Sans
Frontieres covers the costs.

12. The ministry officials did not have definitive
information on private hospitals, but they knew of none
providing ARV treatment. They said that given the high
cost, few patients would be likely to seek treatment
through private hospitals.

Health System: Capacity building
needed to support programs

13. One of the ministry officials commented that none
of these specific HIV/AIDS programs can function
outside a functioning overall health caresystem. He
requested some USG support for capacity building in the
health system, especially at the primary care level.
The USG team explained that the Emergency Plan places
constraints on general system support, as all funding
must be directly connected to HIV/AIDS prevention, care
and support, and treatment.


14. HIV/AIDS issues receive relatively strong political
support in Lagos State. LSACA is perhaps the most
effective of Nigeria's SACAs, with several programs in
place and a good working relationship with the Lagos
State Ministry of Health. Clearly, however, much
remains to be done to prevent and treat HIV/AIDS among
the large population of Lagos State. The ministry and
LSACA officials have a good understanding of what is
needed, and the needs they identified align well with
the goals of the Emergency Plan for AIDS Relief.

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