Cheap AIDS treatment scheme still has big problems

A Nigerian government pilot programme to provide subsidised antiretroviral (ARV) treatment for people living with AIDS is inadequate and under threat from delayed funding and poor organisation, AIDS activists said on Wednesday.

The programme aims to provide cheap ARV treatment for 10,000 adults and 5,000 children living with AIDS throughout Nigeria. However, the activists, speaking on the sidelines of Nigeria's National AIDS conference in the capital Abuja, said few drugs were available outside Lagos and existing stocks might soon run out.

Women members of the Network of People living with AIDS (NEPWHAN) sang songs and waved coloured banners as they interrupted the four-day conference on Tuesday to highlight the suffering of people with AIDS in Nigeria.

"We're helpless, helpless, helpless," they cried. "We don't have drugs for HIV positive women, for our new-born babies, most of us have no job, no home," said the women’s wing of the They described their situation as "a scandal".

Nigeria has the third largest population of people living with HIV anywhere in the world. It is thought around 1 million people could benefit from ARV treatment which does not cure AIDS but can significantly prolong life expectancy and reduce suffering.

"There's an overwhelming demand for ARVs," said Lea Teclemariam, from the US-based agency Deliver, which is sponsored by USAID to provide logistic support to the AIDS programme in Nigeria.

In January 2002 the Nigerian government launched a programme to provide more affordable ARV treatment to 15,000 people at 25 designated centres across the country, with two more due to open by the end of the 2004.

The beneficiaries are charged just over US$7 per month for treatment compared to between $25 and $72 per month at commercial prices.

After a slow start, the full quota of 10,000 adults had been designated to receive the drugs by the end of 2003. However, there were no deliveries of pediatric medicines to Nigeria and plans to treat 5,000 children living with AIDS had to be shelved.

"Delivery of drugs is a big cause of concern for people living with AIDS because of the disruptions which occurred during the programme and the problems we face with distribution all over the country," Professor Pat Amilola of NEPWHAN, told IRIN.

The problem came to a head in January this year, when the government's initial one-year stock of ARV drugs ran out without being replenished.

Part of the problem was funding related. The Global Fund to fight AIDS, Malaria and Tuberculosis granted US $70 million to Nigeria to fight AIDS, but the money has been slow to come through.

"The President gave approval to purchase fresh drugs in September last year," Amilola explained. "But between the approval and the release of funds, it took at least three months."

Ranbaxy, an India-based pharmaceuticals manufacturer which is the main supplier of ARV drugs to the commercial market in Nigeria, stepped in to bridge the gap and even paid a 25% import tax on the stock provided.

But Amilola said the government has still not paid for the drugs delivered.

"We're very worried about the future," he said. "If they don't reduce the tax or if they don't pay the manufacturer properly, we'll run out of drugs again by the end of the year."

However, Ranbaxy assured IRIN it would not interrupt supply.

"Everything is in place: we're the partner company, we're doing our business and we'll continue to do so," said Rajesh Dhar, Ranbaxy managing director for Nigeria.

The government's management of the programme has also been criticised. Most of the ARV drugs are centralised in one medical store in the port city of Lagos and no well defined arrangements have been put in place to distribute them to the 25 designated clinics nationwide.

"For instance,” explained Amilola, “the centre of Makurdi, in the central Benue State, had only one month’s stock because it has neither the financial or technical means to get it there."

Professor Babatunde Osotimehin, chairman of the government’s National Action Committee on Aids (NACA), recognised there had been problems.

"We've started with a pilot phase, and there are still some stages to go through to the point of a full decentralisation," he said.

Osotimehin assured IRIN that the Nigerian government was committed to the programme and had enough “resources to back our treatment distribution."

The government had planned to double the number of beneficiaries of subsidised ARV drugs to 30,000 by the end of this year, but the problems encountered so far have forced it to shelve this expansion plan.

"We are doing all we can and we are learning as we go," said a Ministry of Health official. He passed the buck to donors, saying it was up to them to "enable Nigeria to provide cheap, reliable and effective drugs for all."

A government survey of women tested for HIV at ante-natal clinics released last weekend, estimated that 5.0 percent of Nigeria's population of more than 126 million was infected with the HIV virus last year. That represented a decrease from 5.8 percent in 2001, but the survey warned that infection rates were expected to rise again over the next five years.