US embassy cable - 04LAGOS2064

UNCLAS SECTION 01 OF 02 LAGOS 002064 
 
SIPDIS 
 
DEPT FOR S/GAC AND OES 
 
E.O. 12958: N/A 
TAGS: SOCI, KHIV, PGOV, NI 
SUBJECT: A LAGOS STATE PERSPECTIVE ON HIV/AIDS 
 
 
1. Summary. To gather input to develop the Five Year 
Strategy for Nigeria for the Emergency Plan for AIDS 
Relief, USG team members met officials of the Lagos 
State Ministry of Health and the Lagos State Action 
Committee on AIDS (LSACA) on September 20. The HIV/AIDS 
prevalence rate in the state (4.7 percent) is just 
below the national average (5.0 percent). Lagos State, 
however, has the highest prevalence rate of the 
Southwest states, and several "hotspots" within the 
state have rates well above the national average. Lagos 
has various prevention, care, and support programs in 
place, but state officials would like to expand and 
enhance them. Few people receive antiretroviral drugs, 
making treatment an area of significant need. The areas 
of need identified by the state officials align well 
with the goals of the Emergency Plan. End summary. 
 
2. USG team members met with the commissioner for 
health, Dr. Leke Pitan, and staff of the Lagos State 
Ministry of Health and (separately) the CEO of the 
Lagos State Action Committee on AIDS (LSACA), Dr. 
Aderemi Desalu, on September 20. 
 
Lagos Prevalence Rates: Just below national 
average but highest in the Southwest 
------------------------------------------- 
 
3. USG team members provided an overview of the country 
goals for the Emergency Plan for AIDS Relief. The 
presentation included prevalence rates drawn from the 
2003 National HIV Sero-prevalence Sentinel Survey from 
the Federal Ministry of Health. The state prevalence 
rate of 4.7 percent is slightly below the national 
prevalence of 5.0 percent, but Lagos has the highest 
prevalence of the Southwest states. Within the state, 
the prevalence rate varies by location, from 1.7 
percent on Lagos Island to 7.7 percent in Ikeja. 
(Comment: The reliability of the survey results has 
been difficult to gauge. The Lagos Island rate of 1.7 
percent seems much too low. End comment.) 
 
State Response: Solid programs 
underway, expansion needed 
------------------------------ 
 
4. Commissioner Pitan explained that LSACA, as part of 
the governor's office, is the lead agency for HIV/AIDS 
in the state. As the coordinating agency, LSACA works 
with eleven line ministries, including the Ministry of 
Health. (Comment: Effectiveness in some states has been 
hampered by confusion or wrangling over the scope of 
responsibilities of the SACA and other agencies. Lagos 
State is often cited by the World Bank as an example of 
how coordination can and should work. End comment.) 
 
5. The commissioner commented that most people in Lagos 
State know AIDS is real. He stressed the national 
importance of addressing HIV/AIDS in Lagos, given that 
the state's large population is drawn from all areas of 
Nigeria, with many Lagosians frequently traveling to 
their home villages and other parts of the country. He 
highlighted some of the programs in the state, 
including voluntary counseling and testing (VCT) 
centers, prevention of mother to child transmission 
(PMTCT) programs, and centralization of blood 
transfusion services. He added that the state plans to 
establish more VCT centers (with Family Health 
International) and to focus more on treatment. For 
instance, the state plans to embark on its own ARV 
program and is currently obtaining ARV bids from 
several leading pharmaceutical companies. 
 
Prevention: Blood supply system is clear area of need 
--------------------------------------------- -------- 
 
6. Prevention activities in Lagos State include PMTCT 
programs in twelve hospitals, peer educator and other 
programs in schools, and a safe injection program with 
John Snow, Inc. While noting that the bulk of Emergency 
Plan funding will go toward treatment, LSACA CEO Desalu 
also stressed the importance of prevention. 
 
7. A recent state law calls for screening and 
certification of the blood supply. Eighteen screening 
centers exist, but they are not all functional. The 
state remains far from full compliance with the new 
law. Ministry officials asked for USG assistance toward 
the goal of screening 100 percent of the blood supply 
and in increasing the number of volunteer donors. They 
explained that currently less than five percent of the 
blood supply comes from volunteer donors. Most of the 
supply comes from commercial donors (touts), and some 
comes from recipients' relatives. The officials implied 
that increasing the proportion of supply from volunteer 
donors would reduce the likelihood of HIV in the 
supply. 
 
Care and Support: VCT expansion and refinement needed 
--------------------------------------------- -------- 
 
8. Fourteen voluntary counseling and testing (VCT) 
centers operate in Lagos State, thirteen supported by 
Family Health International and USAID and one run by 
Medecins Sans Frontieres. Ministry officials said they 
plan to increase the number of VCT centers. One noted 
the importance of strengthening family planning 
programs and clinics that treat sexually transmitted 
infections (STI) and linking them to HIV programs. He 
suggested the low prevalence rate on Lagos Island is 
partially due to the fact that the island has had a 
clinic for STIs for over twenty years and an HIV/AIDS 
voluntary counseling and testing center for more than 
five years. 
 
9. Regarding barriers to people's using VCT centers, 
Pitan commented that without hope of antiretroviral 
treatment, many people see no reason to find out or 
make known their HIV status. Another official noted a 
need for youth-friendly services to encourage teenagers 
to be tested, while others commented that social stigma 
remains a significant barrier. 
 
10. A ministry official pleaded for an emphasis on 
children, as they are consistently on the periphery of 
HIV/AIDS strategies. She commented that supportive care 
would be valuable even if no drugs were available. 
Pitan said Lagos would be a good place to start 
pediatric AIDS activities, since Lagos has the largest 
pediatric center in Nigeria. 
 
Treatment: Few programs and significant need 
--------------------------------------------- 
 
11. The Ministry of Health officials requested that we 
allocate the majority of Emergency Plan funds to 
treatment and antiretroviral (ARV) drugs. In 
particular, they said they would like to add ARV 
treatment to the services provided by VCT centers and 
maternity centers.  Currently, only the Lagos 
University Teaching Hosipital is included in the 
National ARV Treatment Program. This site serves about 
500 clients. The Lagos Island General Hospital also 
provides ARV treatment for about seventy-five patients 
who self pay and ten patients for whom Medecins Sans 
Frontieres covers the costs. 
 
12. The ministry officials did not have definitive 
information on private hospitals, but they knew of none 
providing ARV treatment. They said that given the high 
cost, few patients would be likely to seek treatment 
through private hospitals. 
 
Health System: Capacity building 
needed to support programs 
-------------------------------- 
 
13. One of the ministry officials commented that none 
of these specific HIV/AIDS programs can function 
outside a functioning overall health caresystem. He 
requested some USG support for capacity building in the 
health system, especially at the primary care level. 
The USG team explained that the Emergency Plan places 
constraints on general system support, as all funding 
must be directly connected to HIV/AIDS prevention, care 
and support, and treatment. 
 
Comment 
------- 
 
14. HIV/AIDS issues receive relatively strong political 
support in Lagos State. LSACA is perhaps the most 
effective of Nigeria's SACAs, with several programs in 
place and a good working relationship with the Lagos 
State Ministry of Health. Clearly, however, much 
remains to be done to prevent and treat HIV/AIDS among 
the large population of Lagos State. The ministry and 
LSACA officials have a good understanding of what is 
needed, and the needs they identified align well with 
the goals of the Emergency Plan for AIDS Relief.