National HIV/AID Response Groans As Foreign Donors CShrink Due To Global Economic Recession

When the reality of economic recession dawned on major world economies in 2009, analysts were quick to point to doubting Thomases in Africa that the crisis was indeed real.

The analysts had explained that the crisis would affect all spheres of international endeavour but no one imagined a possible telltale signs on the Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome (HIV/AIDS) response and dream of an HIV-free generation. Now, the picture is clearer.

As 80 per cent of National HIV-AIDS Response (NHAR) in Nigeria comes from foreign donors, stakeholders are worried that withdrawal or capping in grants would pose a serious threat to the national response.

Indications have emerged that donor agencies and partners like Global Funds to AIDS in Nigeria and the United States government’s Presidential Emergency Plan for AIDS Relief (PEPFAR) would reduce their support due to reasons not unconnected with the global economic meltdown.

Global Fund (GF) is the biggest funding agency of HIV, tuberculosis (TB) and malaria in the world presently. It was set up with the backing of the G8 rich nations in 2001 and billed as a $10 billion a year war chest to fight major diseases. The advanced nations contribute into GF, which is in turn given as aids to poor nations.

Since the beginning of the economic meltdown however, contributions into the GF has reduced from $10 billion a year to about three billion; leading to a cut in allocation to recipient nations. A report, which looked in depth at the AIDS situations in India, Kenya, Latvia, Malawi, Swaziland and Venezuela, accused the United States President, Barrack Obama of using the global economic crisis to flat-line funds for PEPFAR rather than offer year-on-year increases as in previous years.

An estimated 33 million people around the world are infected with HIV that causes AIDS, and more than half of the 9.5 million people who need AIDS drugs cannot get them, according to the United Nations. Official statistics indicate that about 2.99 million people -about 1.23 million men and 1.72 million women – are affected by HIV/AIDS in Nigeria.

The Nigerian HIV/AIDS response, set up in 1999, has up to date enjoyed from donor agencies and partners like the GF funding and support of about 85 per cent. The Federal government’s counterpart contribution is about 15 per cent. About 80 per cent of this is used to execute projects in the state as the focus for the response shifts to the community. This has led to the success story of HIV/AIDS response in the country, but the present challenge is sustainability.

Former Director at the National Institute of Medical Research (NIMR), Dr. Oni Idigbe, reminisces that when the epidemic initially broke in Nigeria, it was thought to be a mere health sector issue and response. Today, the impact of HIV has extended beyond the health sector; to socio-economic sectors as young people with high productive life-style (on the economy) are getting infected and dying.

This informed the development in1999, when a national response that would be multi-sectoral, involving all other sectors and not just health was launched by the then President, Chief Olusegun Obasanjo. Between 2004 and now, a lot of initiatives have been introduced.

“We have started having the anti-retroviral treatment (ART) programme, Prevention of Mother To Child Transmission (PMTCT) programme, having programme for orphan and vulnerable children, community programme for home and community-based responses. We have started having expanded prevention, care, treatment and support; and most importantly from the angle of the finance, we have had some massive support from the United States government’s Presidential Emergency Plan for AIDS Relief (PEPFAR) and also from the Global Fund. These have greatly expanded the activities of our national response.”

Former Minister of Health, Prof. Babatunde Oshotimehin, also observed that PEPFAR has played an important role in the scale up of treatment, care and support of Nigerians not only in HIV and AIDS but in associated diseases such as Tuberculosis.

“This could not have been achieved without the commitment to working closely with our institutions and strengthening their systems, capacity and service delivery. Many of the PEPFAR implementing partners have provided tangible added value and are ensuring the platform is built for long-term sustainable action,” he added.

Launched in 2003, PEPFAR holds a place in history as the largest commitment by any nation to combat a single disease. Nigeria is one of the early 15 PEPFAR focus countries. The United States had committed nearly $1.5 billion US dollars since 2004 to address HIV/AIDS in Nigeria, including more than $442 million in fiscal year 2009.

Coordinating agency saddled with the responsibility of the Nigerian HIV/AIDS response and resource both at national and state level, National Agency for the Control of AIDS (NACA) in a bulletin said that there has been increased awareness as about 98 per cent of Nigerians are aware about the disease, though there is still existing gap between those with correct knowledge and behavioural change. It also reports a steady decline in the incidence rate from about six per cent in 2001 to about three per cent in 2008.

NACA stated that the people on Anti-Retroviral Therapy (ART) have increased from about 10,000 in 2004 to about 350,000 today as a result of the fact that the drugs are absolutely free. There are currently about 400 centres that supply drugs nationwide though there is a need to create more centres.

Idigbe, who is also Chairman, Local Organizing Committee, of the 5th National conference on HIV/AIDS, themed ‘Nigerian HIV response: Ownership and sustainability,’ holding from May 2 -5, 2010, has expressed worries that in the light of the current global economic recession, some donor/partners may either pack up their support; that is, they do not go beyond their present commitment or even reduce their support.

He observed that the alarming data in circulation portends the next phase of United Nations Joint Programme on HIV/AIDS (UNAIDS’) thrust as prevention and not solely treatment. ‘It looks like our prevention strategies started sliding,’ said he.

The thrust of UNAIDS’s programme is prevention for the next three to four years, because, for any two cases that you put on ARV, five new cases have emerged.

The concern therefore is that should the donor partners withdraw their support, those activities that they had all along been supporting would be in jeopardy.

There arises a need to begin to look inwards as to how to gradually take ownership of the national response.

“So that if these people go tomorrow those gaps that their possible exit would create, would be effectively closed up. The virus is always changing, so is the epidemic always changing, so we need to put in place structures to tackle the epidemic as it changes,” Idigbe said.

National Clinical Coordinator, Harvard School of Public Health, (HSPH) Dr. Ernest Ekong added that indications have emerged on transitioning of current programmes undertaken by most agencies. PEPFAR, for instance, being an American institution that is running these programmes in countries, including Nigeria has been mandated to hand over to indigenous non-liability corporations within the next few years.

While this may not be an abrupt withdrawal of support, PEPFAR has said that any agency that started a patient on treatment should not stop giving assistance to such patient.

“If the U.S. government has been able to start a number of patient on treatment, it is up to that body to make sure that at least those people on treatment are given drugs throughout their life time. So, we have been assured this in many meetings and not only in Nigeria,” he added.

“The whole idea is not to stop testing. The government is expected to take care of the other side. So, we are expecting that the government will be able to harness whatever is available through Global Fund, WHO, World Bank, even the U.K. group etc, and with this they should be able to support more testing.”

According to Country Director of Centre for Disease Control (CDC), Dr. Nancy Knight, as PEPFAR charts new horizon for the next five years (2009-2014), the US government’s cooperation will be guided by a Partnership Framework, which is being developed with the government of Nigeria. The PF will establish a five-year joint strategic agenda for cooperation between the government of Nigeria, the government of the United States, and other stakeholders to scale up the HIV/AIDS response in Nigeria. This is central to sustaining HIV/AIDS services currently being provided, she said.

NACA Director General, Prof. John Idoko said as these donors are capping or gradually stopping completely their funding support due to a number of reasons, including the global economic meltdown, Nigeria is faced with the need to critically and urgently revaluate her preparedness and ability to sustain the HIV/AIDS response and that NACA was mindful of this. This would include sustaining HIV/AIDS services currently being provided as well as encouraging the scale up of treatment, care and support of Nigerians with HIV/AIDS.

“In conjunction with the various states and stakeholders therefore, NACA intends to establish strong advocacy measures for a clear cut funding plan by the Nigerian government for HIV/AIDS and therefore take positive steps towards ownership and sustainability,” Idoko said.

Ekong, who is Vice Chairman, LOC, said that, as it is the case in other countries, well-to-do Nigerians both at the individual and corporate level ought to annually pledge certain amount to support HIV/AIDS course. He called for ” the “Bill Gates among Nigerians,” as well as private sectors like Chevron, Shell BP; and government at the state, local and Federal level to make provision for HIV/AIDS response in their budgets.

“For instance, government has said that one or two per cent of the corporate proceeds of any manufacturing company should go to the Raw Materials Research Council. Can we have similar legislation for HIV/AIDS? Can we say that all the medical equipments that come into the country, at least one per cent of it go into the HIV/AIDS response?”

Moreover, said Ekong, most donors come with their own agenda that may run contrary to national priority and such recipient country cannot have a firm control over programmes. “They can say that they have this X amount of money to channel in the area of orphanages, orphan and vulnerable children; but that might not be the priority of your national strategic plan. These are all reasons why we should get the control of our own programme in our national responses,” he observed. Right now, country ownership is the core area concern around the world of HIV/AIDS as a way of ensuring that funds that come from outside is well-managed; as well as sustainability of the structures that some of these international organisations have built.