Coming to grips with the epidemic - World AIDS Day Special

Nigeria's HIV/AIDS prevalence rate of 5.8 percent may not sound especially high in a continent where double digit numbers are not unknown. But with a population of 120 million, it means that 3.47 million Nigerians are infected, representing more than 10 percent of all Africans, or over 8 percent of the global figure.

Yet Nigeria was one of the countries where the disease was slow in spreading and had presented a unique window of opportunity to halt its progress. By 1991 the country had a prevalence rate of 1.8 percent. This was to double in two years to 3.8 percent, rising to 4.5 percent in 1995 and reaching the exponential threshold of 5.4 percent by 1999.

"There were people who found it difficult to accept there was anything like AIDS," Dennis Agbolahor, a professor of biochemistry and member of the National HIV/AIDS Control Programme said this week on national television. And while doubts persisted, infections soared. The situation was not helped by successive military governments, prior to the election of President Olusegun Obasanjo in 1999, who did not consider combating the disease a priority.

"Delayed or uncoordinated response to the HIV/AIDS pandemic at the critical level of infection led to the snowballing of the situation," Cyrilla Bwakira, senior project officer in charge of HIV/AIDS for the UN Childrens Fund (UNICEF), told journalists during a briefing on Wednesday in the Nigerian capital, Abuja.

At last Nigeria appears to be coming to terms with the scope of the problem at hand. Presenting the results of the latest national prevalence survey in Abuja on Thursday, Minister of State for Health Amina Ndalolo noted the increase in rates of infection between the figures for 1999 and those for 2001 represented the lowest rise since HIV prevalence surveys started in Nigeria a decade ago.

"Although the figures showed an apparent reduction at the aggregate national level, it conceals a major problem at the local levels," Ndalolo said. Most of Nigeria's rural areas, she said, are now exhibiting high rates of infection comparable to the worst hit cosmopolitan areas.

Equally of concern is the fact that 30 of the 85 survey sites returned rates of infection above 10 percent. "The most alarming problem is the emergence of a fast-track epidemic in Abuja and environs," said the minister. She revealed that the country's capital, which had one of the lowest infection rates a few years ago, returned a prevalence rate of 10.2 percent.

On a positive note, the survey revealed the effectiveness of executing mass education and awareness campaigns with consistency. Two states, Kaduna in the north, and Benue in the central region - which yielded the highest prevalence levels in 1999 - showed remarkable drops in the latest survey following intensive education and awareness efforts.

A new initiative for the treatment of people living with the virus launched by Obasanjo's government have placed Nigeria in the fore of the anti-HIV/AIDS battle in Africa.

Under the programme, the first such in the continent, the government has imported generic antiretroviral drugs from India for distribution at less than 10 percent of the cost of brand names or less than one dollar per day. Initially scheduled to
start in September, the treatment programme was delayed because of the need to train health personnel involved on the intricacies of dispensing a cocktail of drugs that often have severe side-effects.

The scheme will now take off on 10 December in 18 centres across the country, enrolling a limited number of patients for the first three months. Afterwards, with the graduation of additional trainees to implement the scheme, it will be expanded to cover 100 centres to treat 10,000 people in the first year.

A major aspect of the treatment programme is the prevention of mother-to-child transmissions. International partners such as UNICEF and the World Health Organisation are also closely involved, providing expertise and experience required to make the effort effective.

The Nigerian Institute of Medical Research in Lagos and the Nigerian Institute of Pharmaceutical Research in Abuja have had their laboratories upgraded to international standards to provide the technical and research services that are indispensable to the campaign. The government has also given approval for the establishment of four new "state-of-the-art laboratories" in different parts of the country to complement these services and make them more widely available.

According to Dr Sani Gwarzo, coordinator of the National Sexually Transmitted Diseases Control, the government has also produced a manual for community-based care and is working with NGOs to push its acceptance. "The involvement of NGOs, particularly religious ones, has been a very useful strategy," he said.

Apart from providing care and treatment for those already afflicted by the virus, government officials and non-governmental partners as well said more effort will be devoted education and awareness campaigns. Not only will knowledge and awareness limit the spread of the virus, people will now gain the understanding to deal more compassionately with people living with the virus, thereby curbing stigmatisation.

Most analysts believe that with Obasanjo's demonstration of a political will to tackle the HIV/AIDS epidemic, the situation could begin to turn around in the next few years.

The very act of hosting an international HIV/AIDS summit in April, at which UN Secretary-General Kofi Annan presented his proposal for the establishment of a fund to combat the disease, has helped to attract assistance from international donors to
tackle the HIV menace.

In July a $90.3 million loan was approved by the World Bank in July to back the Nigeria's emergency action plan against
HIV/AIDS. Over the next three years, the fund will be spent on HIV prevention, treatment for the infected and care for the affected, particularly orphans.

"The role of leadership, as Nigeria's case has proved, is critical," HIV/AIDS activist, Wale Odunsi, told PlusNews. "Once the leadership assumes responsibility and consistently does what it is supposed to do, it is only a matter of time before positive behaviour follows in the rest of the population."