Aids in Nigeria: the ticking time bomb
By Dr. Chinua Akukwe
Abuja, the capital of Nigeria is playing host to African leaders,
heads of United Nations agencies, leaders of bilateral organizations,
and heads of powerful advocacy, grassroots, philanthropic and academic
institutions attending the Organization of African Unity (OAU) summit on
AIDS. This special OAU summit is crucial as Africa attempts to craft a
continental response to the AIDS crisis that has claimed 17 million
lives and left more than 25 million people living under a death
However, as African leaders search for the magic wand to stop AIDS in
the continent, Nigeria is sitting on a ticking AIDS time bomb.
Officially, the rate of HIV infection in Nigeria is about 5.4 percent,
just slightly above the 5 percent trigger zone of AIDS Armageddon in any
country. In reality, the estimated 3 million Nigerians living with
HIV/AIDS are bigger than the population of many African nations. In
Nigeria's AIDS hot spots, mainly in the urban centers, the prevalence
rates range from 15 percent among the adult population to 20 percent in
pregnant women. Unfortunately, the epidemic is staking a claim to the
future of Nigeria going by the 70 percent infection rates among adults
ages 20 through 39.
With a population estimated between 110 and 120 million, Nigeria
presents a perfect comfort zone for AIDS. Nigeria, more than most
African countries, represents the ideal climate for an unchecked AIDS
rampage for multiple reasons.
Ten Reasons for the AIDS Time Bomb Situation in
- Nigeria has one of the highest rates of unsafe blood transfusions in
the world, at 14 percent. The HIV virus is easily transferred during
blood transfusions. In some hospitals in Nigeria, 60 percent of blood
transfusions may not undergo internationally acceptable screenings.
- The collective yawn about HIV/AIDS in Nigeria is tailor-made for a
cunning, silent, and efficient disease. Despite the occasional
statements by Obasanjo and few of his aides, the potential destructive
effect of AIDS is yet to permeate the consciousness of the average
Nigerian. Today, that distinction is reserved for high decibel clamors
for a sovereign conference, the legal fight for resource control, the
fight over Sharia, the high stakes political and economic struggles
over proposed deregulation of the petroleum sector, and the
subterranean quest for a second term of office by elected officials.
- The culture of silence and stigma about AIDS is widespread. Nigeria
was recently in the international spotlight because a high court judge
reportedly stopped an AIDS discrimination suit to ascertain if the
presence of the infected plaintiff put the entire courtroom in
jeopardy. Although the UN estimates that 1.7 million Nigerians have
died of AIDS, you will be hard pressed to identify the families of the
dead as the thick wall of silence extends from hospitals-that will not
identify AIDS-related illness as the cause of death in death
certificates- to the family members that will put out newspaper
announcements that their loved one died after a "brief
illness." This culture of silence extends even to the estimated
971,472 Nigerian AIDS orphans.
- Poverty is endemic in Nigeria. As noted recently in a lecture by the
former Secretary General of the Commonwealth, Emeka Anyaoku, Nigeria
had moved from being the 50th nation in the league of
well-off nations to the current ranking of 176 out of 206 nations.
Nigeria also labors under a controversial debt burden currently
"reconciled" at about $28.64 billion. Nigeria reportedly
spent $1.5 billion last year in debt repayments. Today, the giant of
Africa is officially classified as one of the 31 poorest nations on
earth, with nearly 70 percent of its citizens living in poverty.
Poverty in every country is the weakest spot in the war against AIDS:
AIDS thrives and wallows in poverty-ridden communities.
- Nigeria is a safe haven for gateway health conditions for HIV
infection. These conditions include Tuberculosis, sexually transmitted
diseases (STDs), and malnutrition. A person with HIV/AIDS is 30 times
more likely to contract TB. STDs facilitate the transmission of HIV,
and malnutrition weakens the immune system, giving the virus a
foothold in the body.
- Nigeria's ability to mount the necessary political battle against
AIDS is in doubt. Many Nigerian politicians are experts on AGIP
(Any-Government-in-Power). They also rarely reach consensus on
anything, and their modus operandi is winner-takes-all. Everything in
Nigeria must go through primordial ethnic hazing, and politicians have
learnt how to oil such distractions. The UN identifies lack of
political will as the death knell to the war against AIDS.
- The rate of infection in the powerful Military is reportedly on the
increase. The Economic Commission for Africa (ECA) estimate that 15-20
percent of Nigerian soldiers live with HIV/AIDS. The Military high
command in Nigeria may not tolerate high rates of untreated infections
and deaths of AIDS within its officers' corps and other ranks.
- The state of healthcare in Nigeria is to say the least, uninspiring.
From the avalanche of fake drugs to the moribund healthcare
infrastructure and the constant work stoppages by resident doctors,
the health care system is in tatters. It is even worse at the rural
areas where doctors and nurses are scarce. The UN and other
multilateral institutions identify poor healthcare infrastructure as a
major stumbling block to the various floating plans to supply AIDS
drugs and other essential medicines to African nations. Nigeria's
chronic struggles with other basic infrastructure such as road
networks, water supply, sewers, sanitation, electricity, telephones,
and functioning bureaucracy complicates any potential international
relief effort. The nation's much vaunted primary health care system
that could have served as the backbone of a national response to the
epidemic is now on life support following successive years of neglect.
- The local system of government in Nigeria is weak and incapable of
mounting effective community-based AIDS prevention and treatment
programs. After all the conferences and boardroom meetings, the
ultimate arbiter of AIDS relief would be the number of individuals
prevented from contracting HIV or dying of AIDS related illnesses.
Very little community mobilization against AIDS has taken place in
Nigeria. The traditional rulers, local teachers, village health
workers, sanitary workers, bus and motorcycle (Okada) drivers,
village/town development unions, local affiliates of political
parties, and grassroots non government organizations are yet to become
part of the national discussion on HIV/AIDS.
10. Nigeria's civil society organizations and the organized private
sector are yet to become fully engaged in the battle against AIDS. The
fight against AIDS requires strong public, civil society, and private
relationships at all levels of government. There are very few,
independent national organizations that can serve as bulwarks against
the policy prescriptions of the powerful Federal government. The
Nigeria Labor Congress (NLC), perhaps the natural leader of the civil
society entities, understandably is focusing on the welfare of the
dwindling public sector workforce. The NLC is currently engaged in a
battle with the Federal government over the proposed deregulation of
petroleum products. However, up to 20 percent of Nigerian civil
servants may be living with HIV/AIDS. The private sector has been at
the receiving end of the policy somersaults of successive Nigerian
governments. According to the Manufacturers Association of Nigeria
(MAN), 300 of the 600 members of the Ikeja branch had folded up as
at last year. In the ancient city of Kano, 140 of the 260 industries
went under in 2000 alone. It is difficult to predict the industrial,
banking, and regulation policies of Federal, state, and local
governments in Nigeria. Yet, it is no secret that the private sector
is the engine room of economic growth in the economically prosperous
Any Hope for Nigeria?
Nigeria is yet to hit the explosive rates of infection and deaths
seen in southern Africa. However, unless significant remedial steps are
taken, AIDS will truly take off in Nigeria. If the present trend of
infection is not reversed, by the year 2020, 75 million Nigerians will
likely be HIV positive or dying of AIDS. The epidemic potentially
represents the biggest threat to the corporate existence of Nigeria
since it can decimate the elite and trigger violent struggles for the
control of national resources as families and communities collapse from
the untimely deaths of its most promising citizens.
Nigerian leaders must take action in multiple ways to slow down the
spread of HIV.
First, Nigerian leaders at all levels of government must lead an
education campaign to end the silence, stigma, and indifference to AIDS.
Nigerians must be mobilized against AIDS. This campaign led by all
politicians should reach students, traditional rulers, professional
associations, traders, drivers and motor transport unions, the organized
private sector, itinerant workers, and the unemployed. The powerful
village/town development unions should be mobilized to fight AIDS. All
ethnic and regional organizations in Nigeria should join the battle. The
teaching hospitals, general hospitals, health centers and clinics should
become staging grounds for captive HIV/AIDS education. Every opportunity
should be used to inform Nigerians about AIDS and its risk factors. The
education campaign should be continuous, repetitive, and comprehensive.
Second, Nigeria should demonstrate its sincerity in the fight against
AIDS by matching its rhetoric with adequate funding. The Obasanjo
administration is moving in the right direction, especially with the N4
billion AIDS funding request in the 2001 appropriation sent to the
National Assembly. However, this princely sum pales in comparison to the
nearly $350 million that the Abuja stadium project will cost. Nigeria
should aim to provide AIDS drugs to individuals that need them. This can
be done through a combination of public sector funds, counterpart
funding from international agencies, grants from rich nations, and
private sector initiatives. The reported negotiations between the
Nigerian government and Indian generic manufacturers to provide AIDS
medicines to 10,000 Nigerians living with the disease is a step in the
Third, Nigeria should quickly move to revamp its primary health care
(PHC) program to serve as the backbone of a community-based public
health infrastructure to fight AIDS. The news that Nigerian government
will build 200 new PHCs is great. However, the priority should be on the
rehabilitation of existing centers. Under the wise leadership of
Chairman Olikoye Ransome-Kuti, the highly respected former Minister of
Health, the National Primary Health Care Agency should easily attract
international funding and support. The Federal government should speed
up its current efforts to revamp the secondary and tertiary systems of
care. This will provide the needed framework for the effective delivery,
distribution, and monitoring of AIDS drugs and other essential
commodities as soon as the international community develops a feasible
Fourth, Nigeria should convince the rich nations and their financial
institutions to allow a debt relief swap for verifiable expenditures on
AIDS and other health programs. As a resource rich nation, it is very
difficult to convince foreign creditors to repudiate the debt of a
nation that is yet to implement successful macroeconomic policies and
mount significant reforms against corruption.
Finally, the Obasanjo administration must deliver on the so-called
democracy dividends. After many years of military rule, Nigerians are
impatient regarding the gains of civil rule. The government must be seen
as moving in the right direction, implementing the right policies, and
involving all shades of political and economic opinions in the decision
making process. An effective government will not only engender goodwill
at home but also generate support from abroad. .
To the political elite of Nigeria, I hope that they remember the
immortal words of JF Kennedy, the former president of the United States
to wit: If a free society cannot help the many who are poor, it cannot
save the few who are rich. AIDS is an equal opportunity killer. With one
in five Africans a Nigerian, no stone should be left unturned in the
fight against HIV/AIDS.
Published: Wednesday, 09 May 2001
Dr. Chinua Akukwe is former Vice-Chairman of the National
Council for International Health (NCIH) Washington, DC, USA. Dr. Akukwe
currently serves on the Board of the Constituency for Africa (CFA),