US embassy cable - 04LAGOS1201

UNCLAS SECTION 01 OF 02 LAGOS 001201 
 
SIPDIS 
 
SENSITIVE BUT UNCLASSIFIED - HANDLE ACCORDINGLY 
 
E.O. 12958: N/A 
TAGS: TBIO, SOCI, ECON, ELAB, NI 
SUBJECT: MEASURABLE SUCCESS IN NIGERIAN HIV/AIDS 
INITIATIVES 
 
 
1. (SBU) SUMMARY: Ambassadors Tobias and Campbell and 
USAID Country Director Liberi met with Nigerian 
Minister of Health Lambo on June 4 to discuss 
coordination between the GON national HIV/AIDS strategy 
and USG objectives under the President's Emergency Plan 
for AIDS Relief (PEPFAR).  Reflecting GON efforts to 
meet increasing demand for treatment in existing 
centers, Lambo announced local production of 
antiretroviral (ARV) drugs to begin in November 2004. 
He also said that while there had been a registered 
decline in HIV/AIDS prevalence rates, there is no cause 
for complacency.  Tobias applauded the GON's efforts 
and said he hopes Nigeria will serve as an example for 
the region.  END SUMMARY. 
 
2. (SBU)  On Friday, June 4 in Lagos, Ambassador 
Randall Tobias, Ambassador John Campbell, and USAID 
Director Dawn Liberi met with the Nigerian Minister of 
Health, Professor Eyitayo Lambo.  Lambo said that, 
while Nigeria confronts public relations challenges 
pertaining to its polio vaccine program, HIV/AIDS 
initiatives are becoming more effective.  Lambo added 
that Nigeria's national prevalence rate of HIV/AIDS has 
declined from 5.8 percent to 5.0 percent, according to 
national sero-prevalence surveys conducted in 2001 and 
2003. He cautioned that Nigeria could only begin to 
claim success if the prevalence rate continues to 
decline in the next surveillance survey planned for 
2005.  Even with a lower prevalence rate, Lambo 
acknowledged that Nigeria's population of "140" million 
presents difficult challenges in reducing the number of 
people infected. 
 
3. (SBU) Lambo also said the GON has worked largely 
with the secondary and tertiary institutions in 
implementing HIV/AIDS education and prevention 
programs, adding that work in the primary institutions 
must be revitalized.  Lambo outlined achievements 
Nigeria has made since launching the 2002 pilot program 
to provide affordable antiretroviral (ARV) treatment. 
He said the GON has established 25 treatment centers, 
and over-enrollment in these centers indicates that the 
demand for ARV drugs and resources for treatment far 
exceeds the supply. (GON initiatives provide for an 
initial 10,000 adults and 5,000 children to benefit 
from a monthly administration of ARV drugs. 
Beneficiaries pay 1000N for this service, approximately 
$7 USD per month instead of the $25-$72 USD commercial 
cost for ARV treatment.  The GON is spending 1.5 
billion naira (approximately 11.5 million USD) on this 
subsidized service). 
 
4. (SBU) Lambo outlined five principles that guide all 
GON-supported HIV/AIDS initiatives: 1) country 
involvement, 2) accountability, 3) transparency, 4) 
value-for-money or showing results, and 5) 
sustainability. These reflect Nigeria's commitment to 
the President's Emergency Plan for AIDS Relief 
(PEPFAR). Lambo then made nine major points with 
respect to these principles. 
 
Country ownership: It is being achieved in practical 
terms through cooperation between the steering 
committee and the USG. 
 
Adherence to national policy plan guidelines: The GON 
is realizing this by strengthening its existing work, 
particularly in the 25 treatment sites established. 
 
Coordination of efforts: To ensure that "Three by 
Five", PEPFAR, the Global Fund, and GON initiatives do 
not duplicate efforts, the implementing agencies' of 
these programs should not concentrate their efforts in 
one state (as is being done in Jos); instead they 
should coordinate to ensure that treatment centers are 
established in every state. 
 
Strengthening systems: Success is possible only with 
improvement of the overall health care system.  Lambo 
referred to a recent international survey ranking 
Nigeria 187/191 and stated that only an efficient and 
effective system can support the GON goal of having 
350,000 on ARV treatment by 2006. 
 
Focus on commodities: The GON wants to lower barriers 
to ensure acceptance and use of generic drugs.  The 
National Agency for Food, Drug Administration and 
Control (NAFDAC), Nigeria's regulatory body, is working 
to certify ARV drugs for future use. 
 
Support for basic research: It is necessary to ensure 
that operational research is being conducted.  Lambo 
said this point is important to him because of his 
background and the time he spent conducting post- 
graduate research in Rochester, New York. 
 
Capacity-building: It will be achieved when there are 
adequate skills among the population and at the centers 
to support often complicated treatment regimes. 
 
Demonstrated commitment: Measurable success will be 
achieved only when Nigeria can show quantifiable and 
concrete results. 
 
Sustainability: It will be achieved when the USG and 
other donors make the commitment to continue investment 
and collaboration.  Lambo expressed concern that since 
ARV treatment is often for a lifetime, beneficiaries 
cannot be abandoned after five years; i.e., at the 
conclusion of PEPFAR. 
 
5. (SBU) Lambo emphasized Nigeria's commitment to 
locally produced ARV drugs.  He said three Nigerian 
companies are prepared to begin production by November 
2004. The GON is investigating the potential for 
increasing production capacity through use of an 
existing army drug manufacturing facility in Lagos. 
 
6. (SBU) Ambassador Tobias applauded Nigeria's efforts 
and the consistency of the GON message.  He lauded 
Lambo's demonstrated leadership and commitment, and 
stated that Nigeria is a positive example for Africa 
and the rest of the world.  Ambassador Tobias expressed 
the intent of the USG to provide assistance that would 
be consistent with the intent of the Presidential 
Emergency Plan, but only in ways that were also 
consistent with the policies of the GON.  Ambassador 
Tobias closed the meeting by emphasizing that USG has 
made a commitment to Nigeria and has the technology, 
wherewithal, and obligation to assist; but the USG will 
do so only within the coordinated framework of 
Nigeria's HIV/AIDS policy. 
 
7.  (U) Ambassadors Tobias and Campbell have cleared 
this message. 
 
HINSON-JONES