In-depth: The Treatment Era: ART in Africa

NIGERIA: Restocked rollout expanded

ABUJA, 6 December 2004 (IRIN In-Depth) - As Nigeria, faced with one of the world's largest HIV-positive populations, expands its subsidised antiretroviral (ARV) programme, concern is mounting about how funds are being spent.

Two years ago Nigeria launched what, at the time, was a ground-breaking initiative to provide ARV drugs to 15,000 people living with HIV at less than 10 percent of the market price.

But a year later the project ran into difficulties when depleted drug stocks were not replenished and people receiving treatment were given either expired drugs or none at all.

While the 50 treatment centres across Nigeria have since been restocked and the scheme appears to be running smoothly again, fears of similar trip-ups remain strong among people on the treatment programme.

"It is commendable that the government is expanding the treatment programme," Sola Odumosu, an HIV/AIDS activist living with the virus, told PlusNews. "But I just hope they have it all figured out, so that we don't run into scarcities any more."

AIDS has spread steadily in Nigeria. Less than two percent of the population were infected with the HI virus in 1991, but that has risen to more than five percent of the country's 126 million people today.

Babatunde Oshotimehin, chairman of the National Action Committee on AIDS (NACA), said 100,000 people would be enrolled next year in a government scheme providing the ARV drugs that help to prolong life. That represents a six-fold increase on the present number of beneficiaries.

The number of government-run AIDS counselling, testing and treatment centres would double from 50 to 100 in 2005, while a NACA awareness campaign targets 20 to 29 year-olds, who have the country's highest HIV prevalence rate at 5.6 percent, Oshotimehin noted.

With more than six million people infected in Nigeria, health experts fear a three-fold increase in a few years that could cause severe harm to the country's economic and social development.

Some signs of hope have emerged from the last two national AIDS surveys, which showed a drop in the HIV prevalence rate from 5.8 percent in 2002 to 5.0 percent in 2002.

The government is hoping to build on that with a two-pronged approach of offering help to those infected with the virus, while curbing the rate at which the virus is spreading, Oshotimehim said.

The drive to expand AIDS control activities is being funded largely by a US $150 million grant from the United States and a $110 million soft loan from the World Bank.

A World Bank official in Washington told PlusNews that $16 million of the loan had been drawn down so far. The Bank's programme in Nigeria had recently been entirely restructured to allow the purchase of ARVs in all of Nigeria's 36 states, he added.

The official pointed out that the World Bank loan, denominated in Special Drawing Rights (SDRs) was originally worth just $90 million, but the dollar's sharp fall against the world's other main currencies had pushed up its value in dollar terms by $20 million.

The Nigerian government is also expecting $150 million from the US government's Emergency Plan for AIDS Relief.

"We hope to educate more people, treat more people and generally work to reduce the rate of infection," Oshotimehin told reporters.

More than 700 non-governmental organisations, including faith-based groups, professional associations and networks of people living with HIV, have been enlisted to work with the government to bring a message of care and prevention to the country.

UN agencies, such as the World Health Organisation and the UN Children's Fund, are also helping to influence positive behaviour changes among Nigerians regarding HIV/AIDS.

An HIV/AIDS curriculum for primary and junior secondary schools that is being taught in some schools will be implemented more widely.

NACA is counting on judicious use of the funds from the World Bank and the United States to sustain its campaign to roll back the AIDS pandemic.

But while Oshotimehin expects the foreign aid money to be used wisely, some AIDS activists are less hopeful.

Nsikak Ekpe, president of AIDS Alliance Nigeria, an activist group for people living with AIDS, has expressed fears that many of Nigeria's states were spending their own share of the funds on luxury items, such as flashy cars and big offices, rather than care, support and training aimed at developing a local capacity to deal with the disease.

"The antiretroviral programme in Nigeria is the most ambitious you can get anywhere," Ekpe told PlusNews. "The only problem is that we have found out that most state governments are playing with the funds and not using them well."

In several states, Ekpe said, the donor money had been used to procure expensive four-wheel drive cars and furnish offices. "This money is for the HIV/AIDS programme, and I don't think that simply means buying jeeps and other expensive goods."

But the World Bank again was reassuring. Nigerian states receiving loans first have to lay out plans, which are approved by the state and national AIDS committees as well as World Bank experts, the official in Washington said.

"Buying cars and furniture is what people always do first," he told PlusNews by telephone. "But we have seen several of the states start doing some very encouraging work after furnishing the office."

[Resource: "Scaling Up Antiretroviral Treatment in the Public Sector in Nigeria: A ComprehensiveAnalysis of Resource Requirements", 2004 - www.phrplus.org]

The Treatment Era ART in Africa December 2004 C O N T E N T S Lead Features The Treatment Era Overview - Focus on Mozambique PDF file  Download this in-depth report 2.3 MB Delivery AFRICA: Show us the money! AFRICA: Healthcare workers feel impact of HIV BOTSWANA: Model treatment programme has its problems DJIBOUTI: Grappling with the demand for ARVs LESOTHO: Not enough staff, poor infrastructure, but ART launched NIGERIA: Restocked rollout expanded SOUTH AFRICA: Lusikisiki - a new model for ARV delivery SOUTH AFRICA: Rollout bogs down UGANDA: PLWAs at the centre of AIDS response Access AFRICA: Treatment criteria - deciding who gets to live MOZAMBIQUE: People living with AIDS overlooked in response SENEGAL: Free ARVs not enough to ensure access SOUTH AFRICA: Poverty, stigma and ignorance blights ART SOUTH AFRICA: The two sides of workplace HIV/AIDS treatment programmes SOUTH AFRICA: Monitoring access to free ARVs ZAMBIA: Second-class women left behind in access queue Treatment AFRICA: A short history of antiretrovirals AFRICA: Local manufacture - competition key to cheaper ARVs AFRICA: "Positive living" eclipsed by ARV drive AFRICA: MSF calls for child-friendly ARVs SOUTH AFRICA: HIV-positive and pregnant - weighing the risk Interviews AFRICA: Interview with Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa AFRICA: Interview with Dr Jim Kim, director of WHO's HIV/AIDS department SOUTH AFRICA: Interview with treatment campaigner, Zackie Achmat ZAMBIA: Interview with Minister of Health Dr Brian Chituwo Links & References The WHO 3 by 5 Initiative www.who.int The Global Fund to Fight HIV/AIDS Tuberculosis and Malaria www.theglobalfund.org The President's Emergency Plan for AIDS Relief www.usaid.gov World Bank AIDS site www1.worldbank.org Pan-African Treatment Access Movement www.patam.org WHO Prequalification Project http://mednet3.who.int/ Eldis Resource on ARVs www.eldis.org In-Depth Feedback PlusNews welcomes feedback. Send your messages to feedback.

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