- Nigeria not yet out of the woods on HIV/AIDS
Nigeria still has a lot to worry about HIV/AIDS, despite the appreciable reduction in related deaths in the country in recent years. About 1.8 million people are living with HIV in the country, which is also home to around two-thirds of new infections in West and Central Africa. Last year, at least 45,000 people died from AIDS-related illnesses. This makes the attainment of the 90-90-90 goals a task that must be done, especially given the fact that Nigeria has one of the lowest levels of treatment coverage. Goal 90-90-90 is an ambitious treatment target to end the AIDS epidemic, making 2020 the year that 90% of people living with HIV will know their status; 90% of people with diagnosed HIV infection will receive sustained antiretroviral therapy and the same percentage of people will receive antiretroviral therapy for viral suppression.
It is against this background that we should worry that at a time when all stakeholders should be working towards meeting this ambitious target, we are still having all kinds of hindrances threatening its attainment. Particularly worrisome, according to the Civil Society Legislative Advocacy Centre (CISLAC) and Transparency International Nigeria (CISLAC/TI) are contractors acting as middlemen between manufacturers of antiretroviral drugs and the National Agency for the Control of AIDS (NACA). The contractors inflate the cost of the drugs, after frustrating efforts by NACA (in cahoots with some unscrupulous persons) to deal directly with the manufacturers. For instance, a drug which should normally cost about $7 (including landing cost) end up being bought for about $13 when bought through the middlemen. Indeed, the country is said to be losing about N8.5 billion whenever the drugs are imported. The wider implication of this is that it reduces the number of people with access to the antiretroviral drugs and in essence truncates government’s efforts at curtailing HIV/AIDS.
Auwal Musa Rafsanjani, executive director of CISLAC/TI, puts things in perspective: “As the Nigerian government struggles to sustain the provision of free antiretroviral drugs as part of HIV programmes at health facilities in the country for an estimated 3.1 million people living with HIV/AIDS, this effort is mostly sabotaged by inflated prices quoted by supplying contractors, whose activities render the supplies inadequate to eliminate the high and sometimes inequitable economic burden of HIV/AIDS on households.”
Even when some donor agencies like the United States and Global Fund have found a cost-efficient process by bypassing the middlemen to purchase the drugs directly from the manufacturers, some of the beneficiaries of the decadent system have resorted to petition writing to discourage NACA from doing same for sustainability and wider coverage. This has been the experience in the last five years.
We fully back NACA’s decision to launch a $150million HIV Trust Fund, to enable the country begin preparations for taking over ultimate ownership, management and funding of all HIV/AIDS issues. Donor funds may not be there forever, and understandably so, especially with the high level of corruption in the country generally, and in the efforts to curb the epidemic, in particular. Moreover, there comes a time that the donors want to divert attention to areas where HIV is yet to be controlled and would therefore want the beneficiary country they have been assisting to take full responsibility henceforth.
Attainment of the 90-90-90 goal is key, after which focus shifts to controlling the epidemic, and then sustaining the control level, meaning that there are few or no new cases of HIV and that very few people are dying of it because of access to better treatment facilities. We should not make attainment of the 90-90-90 goal go the way of other globally set targets like the millennium development goals (MDGs).
We therefore urge well-meaning Nigerians and corporate organisations to support the trust fund when it is launched. But then, NACA must remain focused. People who earned their money would not want to be party to a decadent system. HIV/AIDS may not be as prevalent as it was, that does not mean Nigeria is out of the woods yet. Therefore, stakeholders must play their parts conscientiously if we are to win the battle against it. These include governments that must check multiple taxations on pharmaceutical products as well as ensure that fraudulent practices in the chain are punished.
Ultimately, local production of antiretroviral drugs is important as the government cannot afford the N50 billion needed annually to treat the huge number of people living with HIV in the country.
