US embassy cable - 02ABUJA2651

UNCLAS SECTION 01 OF 04 ABUJA 002651 
 
SIPDIS 
 
 
DEPT FOR AF, AF/RA AND AF/W;  OES/EID FOR NANCY CARTER-FOSTER 
 
 
USAID/W FOR AFR/WA, MICHAEL KARBELING, GH/AA, ANN 
PETERSON, DUFF GILLESPIE AND FOR GH/HIV-AIDS, CONNIE 
CARINO 
 
 
E.O. 12958: N/A 
TAGS: PGOV, EAID, SOCI, NI 
SUBJECT: NIGERIA: HIV/AIDS 
 
REF: (A) LAGOS O1512, (B) LAGOS 01545, (C) LAGOS 
01583, (D) Lagos 1678 
 
 
1.  SUMMARY:  This cable summarizes the strategies 
and activities undertaken by USAID and CDC to build 
national and local capacities to alleviate the 
impact of HIV/AIDS and reduce the stigma and 
discrimination associated with the disease.  Key to 
USAID and CDC's efforts are technical assistance 
to the National Action Committee on AIDS (NACA) and 
its nascent state and local counterparts (i.e. SACAs 
and LACAs) as well as the Federal Ministry of Health 
(FMOH); capacity building for non-governmental 
organizations (NGOs); care and support of people 
living with AIDS (PLWA) and people affected by AIDS 
(PABA) and the central involvement of PLWAs in all 
activities; the training of voluntary counseling and 
testing (VCT) personnel and the development of VCT 
centers; the involvement of faith based 
organizations and religious leaders; and the use of 
mass media and advocacy.  With our increase in 
HIV/AIDS funding, USAID will become the largest 
financial donor in FY 03, followed by the World 
Bank.  CDC is the major source of technical 
assistance to the FMOH.  End Summary. 
 
 
2.  Overview: The first case of AIDS in Nigeria was 
reported in 1986, and the Government of the Federal 
Republic of Nigeria (GON) conducted the first HIV 
sentinel sero-prevalence survey in 1990.  In 
1990/91, the national prevalence rate was roughly 
1.8%.  Over the past twelve years this rate has 
steadily risen to 5.8% in 2001 - an increase of more 
300 percent.  Currently, there are roughly over 3.5 
million Nigerians living with HIV/AIDS.  Nigeria has 
the highest number of HIV/AIDS infected adults in 
West Africa and accounts for 11% of worldwide 
HIV/AIDS. 
 
 
3.  Working with the Government: Two years ago, 
President Olusegun Obasanjo established the National 
Action Committee on AIDS (NACA), a policy and 
coordination body that reports directly to him and 
pursues a multisectoral approach to HIV/AIDS.  USAID 
and CDC have supported NACA since its inception, 
supplying technical assistance to the organization 
on many occasions.  For example, the USAID-funded 
policy Project assisted NACA to develop the HIV/AIDS 
Emergency Action Plan (HEAP) that provides the 
framework for the national effort and helped NACA 
draft the National HIV/AIDS policy. 
 
 
4.  In July, seemingly out of frustration for NACA's 
inability to move as quickly as he had hoped, 
President Obasanjo disbanded NACA to create a new 
coordination and implementation structure under the 
Federal Ministry of Health (FMOH), the National AIDS 
Prevention and Control Agency (NAPCA). 
 
 
5.  USAID, the World Bank, and Britain's Department for 
International Development (DfiD), the three major 
HIV/AIDS donors in Nigeria, were concerned that creation 
of NAPCA under the FMOH might hamper the 
multisectoral national effort and that there was an 
inherent conflict of interest in a national 
structure that both coordinated and implemented 
programs.  The three donors endorsed an effort 
leading to the re-establishment of NACA under a more 
energetic leadership with greater direct access to 
the President through the reactivation of the 
Presidential Committee on AIDS (PCA).  USAID is 
attempting to help the new NACA leadership with 
provision of technical assistance to:  a) map donor 
supported HIV/AIDS activities nationwide;  b) develop 
an advocacy campaign in support of the bill to make 
NACA a legal entity;  and c) develop a national media 
campaign to combat stigma and discrimination. 
 
 
6.  Working to improve NACA is only part of USAID's 
efforts to build institutional capacity.  We realize 
the relationship and division of responsibilities 
between NACA and state and local government 
structures are still evolving and that tensions exist. 
To facilitate and expedite the development process, 
both USAID and the CDC have developed projects that 
provide technical assistance and support to the 
SACAs and LACAs in four USAID focus states (Lagos, 
Kano, Taraba and Anambra). 
 
 
7.  The CDC provides funding to the National 
Alliance of State and Territorial AIDS Directors 
(NASTAD) to work with NACA and SACA representatives 
to develop models of state level organizations 
appropriate to Nigeria.  In a complementary fashion, 
the USAID-funded IMPACT (Implementing AIDs 
Prevention and Control Activities) Project works to raise 
the level of political awareness and commitment of policy- 
makers in support of HIV/AIDS programs at the local 
level.  Technical assistance to the LACA includes 
training in management, advocacy and community 
mobilization, and monitoring and evaluation.  The 
success of this project will be measured by 
increased funding from the local governments to the 
LACA and by increased referrals and coordination 
among the groups working in HIV/AIDS.  Although 
neither the CDC nor IMPACT efforts are mature enough 
to be evaluated at this point, preliminary observations 
are encouraging.  Other donors are monitoring these 
projects with an eye to replication in other states 
and local government areas. 
 
 
8.  Cooperating with Civil Society:  Civil society 
organizations suffered enormously during military 
rule.  One of the greatest challenges facing the 
Mission is building the capacity of local non- 
governmental organizations (NGOs) and community- 
based organizations (CBOs).  In the HIV/AIDS arena, 
USAID supports over 60 local NGOs to build capacity. 
The 60-plus local NGOs receiving this intensive 
capacity building will increase access to better 
quality HIV/AIDS services in their areas.  Target 
populations include sex workers and their clients, 
transport workers, religious organizations, youth, 
trade unions and the uniformed services. 
 
 
9.  Raising Public Awareness - PLWA/PABA:   USAID is 
recognized as the major donor to projects for people 
living with AIDS (PLWA) and people affected by AIDS 
(PABA).  Some USAID-supported projects have a 
national reach while others are localized.  The 
focus of these projects includes documenting general 
human rights violations as well as the 
discrimination faced by PLWA at medical facilities. 
It also includes radio call-in shows run by PLWA 
to local support groups run by PLWA to community- 
based care and support projects for PLWA and PABA. 
USAID, for example, piloted the first two community- 
based projects for orphans and vulnerable children 
(OVC) in Nigeria.  These projects, located in areas 
with the highest HIV prevalence in the country, will 
not be formally evaluated until October.  However, it 
is obvious that these projects have galvanized 
support for PLWA and PABA and have lessened the AIDS 
stigma while energizing open discussion. 
 
 
10. Previous to project implementation, the stigma 
of HIV was so great in Benue State that there were 
instances of violent demonstrations against anyone 
who spoke publicly on the issue.  As a result of the 
OVC project, traditional and political leaders in 
Benue now hold meetings and openly discuss the 
gravity of the HIV/AIDS epidemic in public fora. 
USAID also funded Population Services 
Internationals' highly acclaimed televised anti- 
discrimination campaign during the World Cup and 
USAID will support NACA to develop a national media 
campaign to combat stigma.  In another project, 
USAID is supporting the production of videos 
containing testimonials of PLWA that will be used 
extensively to put a human face to the epidemic. 
 
 
11. The CDC is a major donor in terms of supplying 
technical assistance to the FMOH and NACA to improve 
prevention, care and treatment services to PLWA. 
For example, the CDC recently assisted the FMOH to 
complete site assessments of the three university 
teaching hospitals that that will serve as training 
centers for different cadres of health workers on 
comprehensive patient care including home-based 
care. 
 
 
12. Faith-Based Approaches:  Other successful 
strategies that USAID has utilized to overcome 
stigma and discrimination is support to faith-based 
initiatives and the recruitment of religious leaders 
to advise  non-faith based projects.  Muslim and 
Christian clergy alike have considerable influence 
on the beliefs and attitudes of their followers. 
USAID funded projects recognize this influence and 
enlist these leaders in most undertakings.  For 
instance, a required component of all community- 
based projects supported through the USAID-funded 
IMPACT Project is a Project Advisory Committee 
(PAC).  A PAC is composed of local leaders who meet 
monthly.  They advise on project activities and how 
to present a project's objectives before the 
community.  Religious leaders are always included as 
PAC members.  Thus, the project with the Kano State 
branch of the National Transport Workers Union has 
several Muslim and traditional leaders whose counsel 
has allowed project staff to promote condom use in a 
socially acceptable manner. 
 
 
13. Other USAID-supported projects target the 
religious leaders themselves for interventions. 
The project with Church of Christ in Nigeria 
(COCIN), a major social and political force in the 
Middle Belt region, is an outstanding example of 
this approach. Due to USAID-sponsored interventions, 
COCIN's leadership has dramatically changed its 
original stance that equated HIV infection with 
punishment from God and forbade condom use.  The 
COCIN hierarchy now accepts that HIV/AIDS is a major 
danger to the church and its members; they actively 
support people living with HIV/AIDS (PLWHA); and 
promote condom use within the confines of marriage. 
 
 
14. Another critical component of USAID's effort to 
alleviate stigma and discrimination is the training 
of voluntary testing and counseling (VCT) personnel and 
the establishment of the first two dedicated 
voluntary counseling and testing (VCT) centers in 
Nigeria.  The USAID-funded IMPACT Project recently 
opened the country's first VCT center in a densely 
populated area of Lagos and will soon open the 
second center in the second largest city, Kano. 
These two urban VCT centers located in the country's 
two most populated states serve approximately 37% 
and 32% of their respective state populations. 
There are no other facilities in the country where a 
client can receive pre-test counseling, a rapid HIV 
test and post-test counseling, including referral to 
other services as necessary.  VCT is a critical element 
in prevention.  Those who test negative need to be 
counseled and motivated to maintain or adopt behaviors 
to keep them safe; those who are positive need to be 
counseled to adopt behaviors to protect others from 
infection and themselves from reinfection.  Positive persons 
also need to be referred to services such as support 
groups and treatment for opportunistic infections. 
Some experts believe that decrease in HIV prevalence 
in Uganda is attributable in part to the dramatic 
increase in people receiving VCT services. The 
IMPACT Project has also established 22 other 
Voluntary Counseling Centers (i.e., clients receive 
counseling but must go elsewhere for testing and 
referral to other services) and these represent a 
large proportion of the total counseling centers 
nationwide.  The CDC also supports the FMOH to 
develop models for VCT services in public 
facilities. 
 
 
15. CONCLUSION:  The national, state, and local 
structures created to lead the HIV/AIDS effort 
across the country and most local NGOs are still primarily 
in their developmental stages but USAID and the CDC are 
major actors in building their capacity.  Discrimination 
against PLWA remains high and is deep seated in Nigeria 
but here again USAID is at the forefront of efforts to 
reduce the stigma.  Another major contribution of the 
CDC has been technical assistance to the National 
Sero-prevalence survey, which provides critical information 
for program development. 
 
 
16.  Much remains to be done in Nigeria to combat 
the spread of HIV/AIDS and to halt the increase in 
Nigeria's HIV prevalence.  AIDS in Nigeria has had a 
terrible personal and familial impact on PLWA and 
PABA.  Increasingly, it is having social and 
economic and political impact that has made Nigerian 
policy-makers take notice.  Appropriate 
programming of  the $90 million World Bank loan, the 
$70 million from the Global Trust Fund and the $40 
million from the Government of Nigeria budget will 
help but more resources, planning, and personnel as 
well as the political will of all levels of government 
will be needed.  The USG, through USAID and CDC, is 
working with the Government of Nigeria and other 
donors to improve the response to HIV/AIDS and 
ensure services will be in place.  With half the 
population of Nigeria under the age of fifteen, 
another more damaging  wave of the epidemic is 
looming.  The need to mount sufficient remedial and 
prevention efforts in order to face this challenge 
cannot be overstated. Jeter