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 sentence.

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.

1. 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.
2. 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.
3. 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.
4. 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 50^th 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.
5. 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.
6. 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.
7. 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.
8. 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.
9. 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 nations.

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 right direction.

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 plan.

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), Washington, DC.