NIGERIA: ‘WINDOW OF OPPORTuNITY’ FOR HIV DRUGS TREATMENT

A meeting of Nigerian delegates to the recently-concluded
XIV International AIDS Conference, held on Wednesday 10
July 2002, at the Fira Palace Hotel, Barcelona, Spain. Over
130 Nigerians attended the meeting, which has become
somewhat traditional at recent editions of the biennial
world AIDS conference. Similar meetings held at the 12th
AIDS conference in Geneva, Switzerland (1998) and also at
the 13th AIDS Conference Durban, South Africa in 2000.

We are grateful to Chikwe Ihekweazu, a Nigerian
epidemiologist with the Robert Koch Institute, Berlin,
Germany for taking painstaking and exhaustive minutes of
the meeting, which are reproduced below (with minor
editing). Two years ago in Durban, South Africa, Chikwe
also took the minutes of the meeting that held during the
conference then, and ensured that copies of those minutes
were available at the Barcelona meeting. Thank you Chikwe!
- eForum Moderator

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Summary of the meeting of Nigerian delegation to the 14th
International AIDS Conference, Barcelona, Spain, 10 July
2002

The meeting held at the Fira Palace Hotel, Barcelona and
was chaired by Professor Babatunde Osotimehin,
director-general of the newly-created National Agency for
Prevention and Care of HIV/AIDS (NAPCA), whose appointment
was still being rumoured as at the time of the meeting.
(The appointment was finally announced in Abuja a week
after, on 18 July).

The meeting held in two phases. The first phase was
actually a meeting between the Nigerian delegates and
foreign partners from the National Institutes of Health,
Fogarty International Center, the Institute of Human
Virology of University of Maryland, as well as the
Harvard School of Public Health.

Osotimehin opened the meeting by welcoming everybody and
subsequently asked for self-introduction by all present.
The exercise brought out the wide variety of background
from which participants at the meeting came from. Delegates
came from the donor agencies, the academia,
non-governmental organisations, associations of people
living with HIV/AIDS as well as multilateral organisations
such as Organisation for Petroleum Exporting Countries
(OPEC).

The foreign partners present were led by Nigeria-born Dr.
Samuel Adeniyi-Jones of the Division of AIDS, National
Institute of Allergy and Infectious Disease of the National
Institutes of Health (NIH). In his comments after the
introductions, Adeniji-Jones gave a synopsis of the NIH's
research interests into HIV/AIDS in Nigeria and activities
prior to this meeting. The initial contact between NIH and
the Nigerian government was made during the tenure of Dr.
Tim Menakaya as the Minister of Health.

Adeniyi-Jones noted that during an exploratory visit to
Nigeria afterwards, a team from the NIH found that health
care research infrastructure was "rudimentary" and very
little activity involving HIV/AIDS went on in the country.
However, after undertaking a tour of several parts of the
country, as well as discussions with various stakeholders
including Dr. Nasir Sani-Gwazo, then coordinator of the
National AIDS Control Programme of the Federal Ministry of
Health, the NIH were impressed by the relatively high level
of academic capacity
already existing in Nigeria. Also a window of opportunity
was identified with the anti-retroviral treatment programme
that was still at its planning stages at the time.

Participants at the meeting were also given an overview on
the experiences of the NIH in various other African
countries in training as well as capacity building. Kenneth
Bridbord of
the Fogarty Foundation, which is an independent
organisation that works in close alliance with the NIH
especially as regards capacity building, gave a breakdown
of the various opportunities for training as well as grants
that existed within the organisation. He also informed the
meeting that opportunities existed in open competition and
that all applications needed to be adequately researched
and presented in order to stand a chance of success.

The goals of NIH/Fogarty grant and training programmes are
aimed at developing collaborative research in the long run.
Innovative new programmes such as the Comprehensive
International Program of Research on AIDS (CIPRA), grants
are to be given in stages, with the first stage involving a
planning grant. This is to enable the research team develop
its capacity to make a successful grant application for
further stages. Nigerian professionals were encouraged to
seek information from other African countries that have
established long-term collaborations with NIH/Fogarty.

After the NIH/Fogarty presentation, Dr Phyllis Kankis of
the Harvard School of Public Health (HSPH) gave delegates
an insight into the activities of the AIDS Prevention
Initiative in Nigeria (APIN) supported by the HSPH and the
Bill and Melinda Gates Foundation. She said that an
extensive workshop programme had been carried out in
Nigeria to train professionals. So far 12 workshops had
been held in Nigeria and in neighbouring West African
countries. For more information, delegates were referred to
the APIN website:
http://www.apin.harvard.edu/

Osotimehin responded on behalf of Nigerian delegates. He
noted that there was
indeed a large deficit in research activity in Nigeria
despite the existing pool
of trained manpower. Dr. Joseph Nnorom of the Nigerian
office of the United States' Centres for Disease Control
(CDC) as well as Dr. Oni Idigbe of the Nigerian Institute
for Medical Research (NIMR) echoed his remarks. Prof John
Idoko of the Nigerian AIDS Research
Network noted that there was a need for strategic planning
for research and collaboration with the NIH.

Adeniyi-Jones emphasized the intention of the NIH to engage
in constructive dialogue to identify priorities for
research in Nigeria with Nigerian partners.

Osotimehin concluded the first phase of the meeting with
the announcement that a broad-based group with
representation from the Federal Ministry of Health, NIMR,
the Nigerian Institute of Pharmaceutical Research and
Development, non-governmental organisations, the Nigerian
AIDS Research Network, as well as representatives of people
living with HIV/AIDS would meet with the partners at a
later time to plan the way forward.

Many of the non-Nigerian participants left the meeting as
soon as this phase of the discussions was concluded.

The second phase of the meeting was opened by Osotimehin
welcoming participants a second time. He noted that the
meeting would be a follow-up to the one held in Durban,
South Africa at the 13th AIDS conference. He progressed by
reading out the key issues raised and resolutions reached
at the Durban meeting. He then called on the whole house to
review progress made since Durban and highlight gaps still
existent regarding the national response to HIV/AIDS in the
country.

A. Political will
It was noted that this had been shown at the highest level
in Nigeria since Durban and was manifest in the hosting of
the African Heads of States Summit in Abuja on HIV/AIDS,
Malaria and Tuberculosis. However the consensus was that
this had not trickled down to other levels of leadership in
Nigeria. Only a few State Governors have shown particular
interest. It was concluded that there was an urgent need to
mobilise all levels of leadership in the country both in
the public and private sectors in this regard.

B. Multisectoral approach
Although this was said to be in place, Prof. Osotimehin
reported that a lot of work still needs to be done in this
regard to get other sectors of the country involved.

C. Funding for HIV/AIDS programming
It was noted that this had increased significantly since
Durban both from within the country and from foreign
donors. However there remains a lot to be done. Various
sources of funds for programmes have not been fully
exploited by the country as demonstrated earlier at the
meeting with NIH. It was noted that other African countries
seem to have done a lot better in mobilising funds for
programmes in their countries.

D. Access to antiretroviral therapy
A pilot programme in this regard had successfully been
initiated by the Federal Government. However, significant
scaling-up was required if this was to have any significant
impact. It was also announced that arrangements had reached
advanced stages for the commencement of a Prevention of
Mother to Child Transmission (pMTCT) programme in Nigeria.
Deficits
identified included grossly insufficient voluntary testing
and counselling facilities available in the country.

The meeting was informed that funds promised by the United
States Government for preventing mother to child
transmission in Nigeria under a recent programme by the
Bush Administration would only be available from 2004.
High-level advocacy is needed to ensure that Nigerian is
able to tap into this facility as soon as possible, rather
than wait till 2004. Dr. Joseph Nnorom was mandated to
coordinate the next steps to be taken in this process.

E. HIV/AIDS cure claims
It was noted that although the intensity of such misleading
cure claims had reduced significantly over the past two
years, the claimants were still very much around.
Osotimehin remarked that he expected this trend to decline
as antiretroviral drugs become more accessible to people
living with HIV/AIDS.

F. PLWHA's involvement
The involvement of people living with HIV/AIDS (PLWHA) in
several levels of policy making and implementation was
noted to have improved significantly over the past two
years. This was evidenced by their significant
representation at the meeting.

G. Improved NGO networking
This was a hot topic at the Durban meeting where it was
noted that NGOs seemed
to be working at parallel purposes and without national
strategic vision. Since Durban, an umbrella body, the Civil
Society Consultative Group on HIVAIDS in Nigeria (CiSCGHAN)
has been formed. There was however no agreement on how
successfully the body has functioned since then.

H. Youth involvement
Osotomehin noted that this was one area where little had
been achieved in the past two years, and on which emphasis
will need to be placed in the future.

I. Research activities
This was another area which was extensively discussed at
the Durban meeting to which there had been little progress
to date. A Nigerian AIDS Research Network (co-ordinated by
Prof. Idoko) has been formed post- Durban; yet it was noted
that for various reasons, little co-ordinated activity had
been achieved since formation.

Matters arising
After the discussions on post-Durban progress, the floor
was then opened to delegates to air their views within the
little time left. A summary of these views are presented
below:

a. Information sharing:
The need for improved information sharing capacity among
all those involved in work relating to HIV/AIDS in Nigeria
was pointed out. One way this could be done is by
identifying and using information technology. Delegates
quickly noted that the Nigeria-AIDS eForum, an email
discussion forum, already exists with wide penetration
among HIV/AIDS related activists in Nigeria.

b. National ethical committee:
The absence of a functional ethical committee to guide
research as well as other HIV/AIDS related activity on the
national level was also highlighted. Osotimehin responded
that he should be held responsible for the correction of
this abnormally in the immediate future.

c. Role allocation:
It was noted that there was a need to involve more people
in decision-making and policy
formulation. Participation at key discussions and issues
around HIV/AIDS seemed to be revolved around few set of
people with little impact and involvement of those at the
grassroots. There was also the need to avoid a gender bias.
Osotimehin responded by promising an increased effort at
decentralisation of activities in the future.

d. Orphans and vulnerable children:
Attention was drawn to the non-existence of national
programmes targeting orphans in
Nigeria.

e. Policy:
The inadequacy of clear policy guidelines defining several
aspects of response to HIV/AIDS in Nigeria was noted.

f. Faith based organisations:
Faith based organisations were said not to be rising to
their responsibility in efforts to stem the tide of
HIV/AIDS in Nigeria, despite the fact that they are an
effective means of getting information across to people
since most Nigerians go to churches or mosques at least
once a week.

g. Involvement of the private sector in care delivery:
It was noted that private medical establishments were not
being adequately mobilised to scale up their response.
Physicians in private practice seem to be often at a loss
as regards what to do with patients diagnosed as HIV
positive. Dr. Salma Anas Kolo of the National AIDS Control
Programme of the Federal Ministry of Health responded that
the antiretroviral therapy programme was being implemented
in three phases and there were plans to involve the private
sector in the 3rd phase. She added that one of the
principles used in the planning of the programme was to use
existing capacity for the implementation of the programme
which included the private sector. She also defended the
choice of tertiary health care facilities as the initial
sites for the programme as a means of having a trickle down
effect.

h. Relating response to prevalence data:
A delegate complained that prevalence data from national
surveys do not seem to be the instrument for determining
responses in the country. Osotimehin however responded that
this was not the case. He noted that priority had been
given to the states identified as hot spots in the 1999
prevalence survey in planning of activities.

i. Laboratory facilities:
It was noted that there was an urgent need to scale up the
level of laboratory facilities in the country as well as to
implement quality control. Research into various aspects of
the epidemic as well as vaccine development would be
impossible at the present state of laboratory facilities in
place.

j. Peer rivalry:
The lack of co-operation among various actors was noted.
This lack of cooperation has been obvious at various levels
over the past two years at governmental, scientific, and
NGO levels and even among PLWHA. The need for greater
co-operation in the greater interest of the country was
stressed. Emphasis should be placed on effective
co-ordination as well as improving crisis management
capacity in the future.

k. Work place response:
It was noted that too little was being done by employers of
labour in promoting prevention among workers as well as
providing care. Government was also criticised for doing
too little in putting pressure on the organised private
sector in Nigeria to live up to their responsibility to
their employees.

l. Lack of visibility of Nigeria at international
HIV/AIDS-related activities:
It was noted that unlike several other "smaller" countries,
there was a very poor level of visibility at the conference
of Nigeria as a country. The country had no exhibition
booth or even called a press briefing on activities in
Nigeria. Osotimehin promised delegates that this would
improve considerably in the future. He noted that Nigeria
was at different levels of
collaboration with several partners and that commitment was
on the rise.

m. OPEC's involvement:
A participant noted the presence at the meeting of the
director-general of the OPEC Fund for International
Development, Nigerian-born Dr. Seyyid Abdullahi and asked
what contribution the Fund could make to the HIV/AIDS
programme. In response, Abdullahi informed that although
the OPEC Fund does have facilities to support in-country
HIV/AIDS programmes, such facilities are, by design,
available only to non-OPEC countries, a response that drew
chuckles from participants for its irony. (Nigerian is an
OPEC member-country). In response to another question,
Abdullahi noted that the Fund could support applications
for cross border activities along the West African coast.

n. Epilogue
The last contribution of the day was made by a person
living with HIV who called on all delegates to show
sincerity, honesty and commitment in the efforts to stem
the epidemic in
Nigeria. He stressed the need to match words with action in
line with the theme of the AIDS conference.

o. Closing
The meeting was closed by Osotimehin with the promise that
meeting participants would not wait for another two years
to see a significant improvement in the response to
HIV/AIDS in
Nigeria.

Minutes taken and submitted by
Chikwe Ihekweazu
Berlin, Germany
Email: [email protected]
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