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In May 2006, when Global Fund cancelled an 81 million Dollars grant for Nigeria's HIV/AIDS programme, it was as if heaven had collapsed.....
In May 2006, when Global Fund cancelled an 81 million Dollars grant for Nigeria's HIV/AIDS programme, it was as if heaven had collapsed on Nigeria and that the HIV virus would destroy the country soonest.
As the news broke out, media houses, Faith-Based Organisations (FBOs), Support Groups and Civil Society Groups (CSGs) raised alarm over the development, creating an
impression that the action will jeopardise other donor-sponsored HIV programmes in the country.
Observers said that the facility was probably cancelled because the agency that implemented the Fund project on behalf of the government did not do a good job.
That government increased the number of people on its HIV treatment list from 40,000 in 2005 to 250,000 in 2006 and that treatment centres increased from 41 to 74 did not matter to them.
Similarly, the free treatment offered infected people by the federal government since January this year did not also mean much to those who saw Global Fund's decision as 'a total black out".
Even the support from other countries, UN agencies, international partners and the U.S. Presidential Emergency Plan for AIDS Relief (PEPFAR) and many others appeared not to exist anymore.
The cancellation led to enquiries about Nigeria's level of dependence on donors, especially as to whether it was making concerted efforts to fight HIV pandemic on its own and if such efforts were sustainable.
Going by the quality and variety of treatment, care support and prevention services available on HIV in hospitals, offices of FBOs, Civil Society Groups, Churches and Mosques in Kaduna, Plateau and Gombe States and FCT, a visitor gets the feeling that the impact of Global Fund's action is exaggerated.
In Kaduna, where the campaign against HIV started in 1989, three Antiretroviral (ARV) centres have been established, while over 1,000 persons living with the virus are being treated by the government. The only snag is that beneficiaries still pay N1,000 monthly, for their drugs, even when the federal government declared free treatment in January.
The Director of HIV/AIDS programmes in the state, Dr Usman Sarki, said there were plans to establish a fourth ARV centre in Saminaka, where the prevalence rate 'suddenly" increased to 10 per cent. He said that the centre would be established with the assistance of the Columbia University in the U.S.
He said that N200 million was appropriated for HIV projects this year, out of which N100 million is for procurement of ARV drugs and the remaining for logistics.
Kaduna State has several international partners, 20 NGOs, 16 line ministries, 17 sites for Prevention from Mother-to-Child Transmission (PMTCT), 31 Support Groups and many FBOs assisting it in fighting HIV. The 23 local governments are also involved.
In Plateau state, an AIDS Control Agency (PLACA) is in existence and N63 million has been set aside for its activities in 2006, even though only N10 million has so far been released.
A PLACA official, Mr Bala Rumtong, says Plateau has 59 NGOs, 16 line ministries, all 17 local governments, 53 Management Boards, 19 monitoring teams, 35 support groups and all federal government establishments in the state implementing one programme or the other.
Apart from a 3.5 million Dollars World Bank grant it received for the implementation of HIV programmes from 2002 to 2006, Rumtong says the state has three VCT centres while each local government in the state has been directed to establish at least one centre.
Information on the official number of people receiving treatment is not readily available, principally because the state government has fused its HIV programmes with those of other organisations. However, pieces of figures issued by various agencies indicate that over 3,000 people are receiving treatment.
Faith Alive Foundation, an American NGO, AIDS Prevention Initiative in Nigeria (APIN) and U.S. Presidential Emergency Plan for AIDS Relief(PEPFAR) have shown strong presence in the state.
Similarly, 10-year-old Gombe state has been getting the support of UNFPA, UNICEF and UNDP in fighting HIV, even though it is still setting up a formal structure for a campaign, courtesy of a 172 million dollars World Bank grant which matured for access two months ago.
Adamu Usman, Project Manager of Gombe State Action Committee on AIDS, says Free PMTCT services are available in eight secondary and nine primary health facilities owned by the state government. He also said that reagent for tests and ARV were provided free, just as treatment of opportunistic diseases were without cost.
In the FCT, the Project Manager of Action Committee on AIDS, Dr Isa Vatsa, says that there is tremendous political will to fight the HIV scourge and that N300 million has been appropriated for HIV programmes this year.
According to him, five ARV centres have been established, while there are enough drugs
to service 10,000 infected persons. 'Very soon condoms will be sent to hotels within the
FCT, so as to guard against unprotected sex," he said.
A strong immune booster called Immuners is being administered on some positive persons. Vatsa says the drug has reduced the mortality rate among users to 48 per ent.
About 74 NGOs are implementing HIV programmes with the support of the World Bank, while some Priests and Imams are currently undergoing training so that they acquire the right language and skill for handling issues concerning HIV .
Going back to Global Fund, President of Network of People Living with HIV in Nigeria, Dr Pat. Matemilola, says in spite of the cancellation of grant, people receiving treatment under the arrangement will continue to do so (or the next two years when the arrangement will expire.
On the other hand, Global Fund which has shown a lot of interest in the Prevention of Mother-to-Child Transmission (PMTCT) programme has not abandoned Nigeria, going by its approval of another 248 million Dollars grant few months ago. The facility will be dawn under the Fund's Round 5 programme which will commence soon.
Observers say that one of the reasons why Global Fund's action did not deal a serious blow on efforts to fight HIV pandemic in Nigeria, hinged on federal government decision to adopt a multi-sectoral approach to the campaign against the spread, prevention and treatment of the virus.
With a multi-sectoral approach, there is always a fall-back when a particular programme develops hiccup either in implementation or when an agreement fails.
Evidence from some states visited shows that multi-sectoral approach created opportunity for more infected persons to be treated, just as prevention, care, support and awareness creation on HIV have been boosted through the activities of NGOs, Support Group, FBOs, governments, partners and donors.
Laudable as it appears, multi-sectoral approach is fraught with challenges, commonest of which are denials, victimisation and stigmatisation. Voluntary Counselling and Testing (VCT) is still low because people are afraid of knowing their HIV status.
In some of the states, people are avoided or denied access to certain benefits or privileges because they are living with the virus.
Reaching the rural areas has not been easy, especially when treatment and VCT centres, as well as the activities of FBOs and NGOs take place in the urban areas.
The existence of homosexuals who refuse to volunteer themselves for testing and men who refuse to use condom, create obstacles and throw spanners in the wheel of progress.
Cure claimants, who say they have found solutions to HIV, poses a strong challenge to the multi-sectoral approach. There is neither proof that their activities is contributing to a reduction in the prevalence rate, nor that the herbs they administer on their clients is efficacious.
The need to address the problem of shortage of qualified medical personnel at treatment centres still exists. Workers at treatment centres complain of fatigue, pressure and long hours of work as few of them attend to the multitude who come for treatment, testing and counselling.
Some states complain that federal government's package on HIV, as delivered by NACA, is not enough, as it does not include the treatment of opportunistic diseases and testing for HIV.
Critics say that the delay in transforming AIDS committees into agencies by some state governments is making coordination of activities and programmes difficult. In Gombe state, this has resulted into a duplication and wastage' of funds.
Gombe Project Manager says some local governments received funds for activities already implemented and that NACA has a role to play in harmonising the activities of donor agencies, as well as avoiding a situation where it allows access to its funds without reference to state action committees.
Closely related is the observation that while there are multiplicity of donors in some states, others enjoy less of such privilege, even though over dependence on donors has the possibility of knocking some state governments out, if such support is withdrawn.
Observers say that Gombe state which appropriated Nl0 million for its 2006 HIV programme on the ground that it was rendering support through other means, may find it difficult to live up to expectation in fighting the scourge on its own if the World Bank and other UN agencies withdraw their support.
They say that there is need for more political will at the state level on the mobilisation and utilisation of funds.
Plateau state which is yet to take responsibility for the treatment of a certain number of patients as other states have done, may encounter problems if PEPFAR, APIN and Faith Alive Foundation decide to alter existing arrangements.
Similarly, lack of work place policies on HIV needs to be addressed. Other states need to imitate Gombe state which is making concerted efforts to have one off the ground. This is important for the protection of people living positive to avoid discrimination against them in their work place.
Matemilola says that a multi-sectoral approach should make room for a population-based study, so that a more reliable data on the number of infected persons in the country can be generated.
He says that using only pregnant women to estimate the number of people living positive is not good enough on grounds that the sample is not reflective of the entire society.
For Health Minister Eyitayo Lambo, there is need to rapidly scale up antiretroviral therapy programme since only 50,000, out of an estimated 2.9 million people living with HIV in the country, have access to treatment.
He wants a comprehensive package of services to be developed and delivered at all levels of government.
Numerous as the challenges are, NACA Chairman Babatunde Oshotimehin says that many of the challenges facing the multi-sectoral approach, including the harmonisation of programmes and activities of donor agencies, will be surmounted by the end of this year.
He noted that most of the problems arise from the fact that the nation's health systems were not optimal.
He advised younger states to study the HIV progress implemented by older states so as to tap from their experiences, while efforts are being made to transform all state action committees into agencies before the end of May 2007.
'This is for the sake of financing of HIV projects," Oshotinmehin says.
He stressed the need to maintain the tempo of activities or improve on them at the federal level, to ensure that HIV does not ravage the country in record time .
Ugoji is of the NAN.