This record is a partial extract of the original cable. The full text of the original cable is not available.

UNCLAS SECTION 01 OF 04 ABUJA 001347 
 
SIPDIS 
 
 
E.O. 12958: N/A 
TAGS: PREL PGOV TBIO SOCI KWMN NI HIV AIDS
SUBJECT: NIGERIA: FPOTUS CARTER AND BILL GATES, SR. VISIT 
ON HIV/AIDS 
 
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Summary: 
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¶1. FPOTUS Jimmy Carter and Bill Gates, Sr. and staff from The 
Carter Center and The Bill and Melinda Gates Foundation paid 
a very successful, well-publicized March 8-10 visit to 
Nigeria. The purpose of the visit was to galvanize greater 
domestic support for the fight against HIV/AIDS in Nigeria, 
increase the international spotlight on the HIV/AIDS crisis 
in Africa, and to help destigmatize HIV/AIDS and encourage 
leaders to interact with people living with HIV/AIDS (PLWHA). 
 Carter and Gates met with President Obasanjo, visited a 
Commercial Sex Worker (CSW) community, addressed Nigeria's 
first-ever National HIV/AIDS Summit, and met high-level 
officials in the Ministry of Health and the National Action 
Committee on Aids (NACA).  President Carter also gave an 
inspirational HIV/AIDS focused message at the Presidential 
Villa Chapel on Sunday, March 10. 
 
 
 
 
¶2.  Throughout the visit, the delegation specifically asked 
about local solutions and how to garner more support for 
combating the pandemic. They commended the positive programs 
instituted by the Nigerian government and encouraged it to 
recognize and use proven prevention methods. The delegation 
particularly emphasized Mother-to-Child transmission (MTCT) 
and prevention programs, which can dramatically halve the 
risk of HIV transmission to new-borns. They supported 
widespread implementation of HIV/AIDS prevention efforts, 
especially among groups at high-risk of contracting or 
spreading HIV, such as commercial sex workers, migrant 
workers, truckers, and intravenous drug-users.  The 
Carter/Gates team also encouraged all segments of society, 
including government, faith-based groups, businesses, and 
civil society organizations to engage in the fight against 
HIV/AIDS. The visit fulfilled the objectives of the 
delegation and more. End Summary. 
 
 
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Some Facts About HIV/AIDS In Nigeria 
------------------------------------ 
¶3. Officially, 5.8% of Nigeria's population between the ages 
of 15-49 is HIV positive, which equals an estimated 3.5 
million infected people.  Projections are that over four 
million Nigerians will be HIV positive by the year 2005. By 
the end of this year, 1.3 million Nigerians will have died of 
AIDS since the start of the epidemic. The toll has reached 
the point where it is estimated that one person dies of AIDS 
every 2 minutes (over 700 people a day). If nothing is done, 
it is estimated that a further one million will die by 2005. 
 
 
 
 
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Breakfast with the President 
---------------------------- 
 
 
¶4. The delegation met privately with President Obasanjo the 
morning of March 9.  Carter/Gates encouraged Obasanjo's 
continued leadership on HIV/AIDS and talked about increased 
funding and more effective policies, particularly focused on 
high-risk groups. (Comment: President Carter and President 
Obasanjo have been friends since Carter visited Nigeria in 
1978 when Obasanjo was then military Head of State.  This 
relationship was reportedly strained after Carter refused to 
certify the 1999 election as free and fair.  However, the 
long-standing relationship appeared to be intact during the 
visit.  End Comment.) 
 
 
¶5. The Carter/Gates team described the Obasanjo meeting as 
"successful".  They characterized President Obasanjo as 
personally engaged in the fight against HIV/AIDS and the 
Embassy concurs with that conclusion. Obasanjo told 
Carter/Gates that Nigeria's biggest need is funding and 
stressed that everyone in his government must be involved in 
the fight against HIV/AIDS.  Obasanjo's goal is to hold the 
infection rate at the official estimate of 5.8%, then push 
for an eventual reduction.  After seeing posters of President 
Obasanjo with PLWHAs, President Carter praised Obasanjo for 
his personal commitment, his public display of compassion, 
saying Obasanjo's efforts were an important part of reducing 
the social stigma associated with HIV/AIDS in Nigeria. 
 
 
¶6. When asked about religious leadership, Obasanjo responded 
that some of the new generation churches and mosques are 
engaged, but in general faith-based institutions needed to be 
more active.  Commercial sex work is another area where more 
must be done.  In the area of public awareness, Obasanjo 
commented the GON has published pamphlets and booklets and 
erected billboards to reach the non-literate. The government 
provides condoms to all military barracks.  (This policy was 
established after it was learned that military peacekeepers 
returning from Sierra Leone had an estimated 11% HIV/AIDS 
infection rate.)  The GON has started the voluntary testing 
of pregnant women, but found it challenging because there are 
not enough counselors to reach all of those in need. 
Moreover, the utility of large-scale testing is of uncertain 
value at this point because there are few treatment options 
and the MTCT program is still in its infancy. The federal 
government is also giving money to each of the states to help 
establish HIV/AIDS prevention programs. (Comment: Only three 
of 36 governors have demonstrated a sustained personal 
involvement in the campaign against HIV/AIDS. End Comment.) 
 
 
------------------- 
You're Going Where? 
------------------- 
 
 
¶7.  Leaving the comfort of the President's Villa, the 
delegation next visited Mabushi village to meet with peer 
educators being trained by the NGO Women's Health Education 
and Development (WHED).  These peer educators are themselves 
CSWs, trained in HIV/AIDS awareness and prevention, now 
educating other CSWs.  President Carter and Mr. Gates met six 
women who explained how their involvement in commercial sex 
work began.  Carter and Gates asked specific questions and 
received some very frank answers during this discussion. This 
experience proved a valuable reference point to help the 
delegation speak credibly about the role commercial sex work 
plays in spreading HIV.  Carter/Gates mentioned Mabushi in 
every subsequent meeting, interview and speech, including 
Carter's interview with NBC and his speech at the HIV/AIDS 
Summit.  U.S. media personnel also asked questions of the sex 
workers during the session, and scheduled follow-up 
interviews in the afternoon. Both the NBC Nightly News and 
the Today Show aired significant footage of the Mabushi 
visit, and highlighted the nexus between commercial sex work 
and HIV/AIDS. 
 
 
¶8.  At the same time a larger group of CSWs and other members 
of the Carter/Gates delegation met with the Minister of 
Health and his Deputy who accompanied Carter/Gates to 
Mabushi. The Minister promised to provide WHED with over two 
million condoms free-of-charge by the end of the year, and 
also agreed to help with re-education and relocation of the 
women.  The Minister of Health confided that he was unaware 
of the depth of the CSW problem prior to his visit to 
Mabushi.  According to Sylvia Matthews of the Gates 
Foundation, these promises alone validated the entire Africa 
trip. WHED also received a $20,000 grant from the Aids 
Prevention Initiative in Nigeria (APIN) to expand the WHED 
program. Based on the results of WHED's initial efforts, 
future funding is possible. (Comment: Poloff met with the 
director of WHED two weeks after the visit.  She has been 
contacted by the Minister of Women's Affairs, and dialog on 
the re-education program has begun. End Comment.) 
 
 
----------------------------------- 
Nigerian National Forum on HIV/AIDS 
----------------------------------- 
 
 
¶9. After Mabushi, the delegation attended a special HIV/AIDS 
forum convened by President Obasanjo entitled "HIV/AIDS in 
Nigeria: the Road Ahead". The purpose of this first ever 
HIV/AIDS summit was to mobilize greater domestic political 
support, particularly at the state and local levels, for the 
national campaign against HIV/AIDS.  Along with the 
Carter/Gates delegation, Cabinet Ministers, governors, 
parliamentarians, religious and traditional leaders, PLWHAs, 
donors and leading HIV/AIDS experts were in attendance. Prior 
to the forum many National Assembly members, state governors, 
and other opinion leaders had shown little or no support for 
HIV/AIDS intervention.  The Saturday Forum was meant to 
convince these important players to join the fight. The Forum 
was well attended and well publicized by the domestic media, 
and was characterized by all as a  major success. Comment: 
The one disappointment was the relatively small number of 
governors who showed up, only about six of the total 36. 
This was surprising in view of the fact that the forum was a 
presidential initiative.  End Comment. USAID/Nigeria will 
capitalize on the momentum created by the Forum by 
implementing a new program that focuses on HIV/AIDS advocacy 
with National Assembly members. 
 
 
¶10. In his opening address, President Obasanjo stated the 
Saturday Forum was intended to bring national and 
international experts from various sectors together. One year 
after the Africa Summit on HIV/AIDS, the message was not 
getting down to "every nook and cranny" in the nation, he 
lamented.  The President referred to his inaugural address 
when he said that human resources were a nation's most 
valuable resource. However, the fact that 3.6 million 
Nigerians were already infected with the virus and that 
number was growing undermined the notion of economic 
development.   Due to denial and the inaction of the past, 
the HIV/AIDS epidemic now was felt at all levels of society. 
Denial and government inaction also meant that past HIV/AIDS 
programming was donor-driven and lacked adequate grass-roots 
participation.   Obasanjo thanked donors "( for keeping at 
it while the Federal Government of Nigeria was in denial." 
He ended his address by challenging the Forum's participants 
to "reexamine our commitment and target a zero increase in 
the prevalence rate and a decline in the rate from 2003 on." 
 
 
¶11.  Two of the most noteworthy Nigerian speakers were Dr. 
Pat Matemilola, Chairman of the Network of People Living with 
AIDS in Nigeria, and Dr. Peter Odili, Governor of Rivers 
State.    Governor Odili characterized the epidemic in his 
state, which has the third highest HIV prevalence rate 
nationally, as one fueled by the oil and gas industry. That 
industry has brought an influx of highly paid expatriate and 
Nigerian workers to the poverty-plagued state.  This influx 
of affluent oil industry personnel attracts a comparable 
influx of commercial sex workers.  As proof of the expansion 
of the problem, he said Rivers State HIV prevalence rate 
increased from 3.3% in 1999 to 7.7% in 2001. Unlike most 
states, however, Rivers has responded to the epidemic. The 
state has established a multi-sectoral State Action Committee 
on AIDS (SACA). The state government also provides a subsidy 
of 10,000 naira per month (approximately $85) towards 
anti-retroviral treatments and will soon provide free 
treatment for HIV/AIDS positive women. Finally, on World AIDS 
Day this year, Odili's government sponsored a social 
mobilization campaign called "the Million Man March". Dr. 
Matemilola's speech targeted "the waste (of funding) on 
research" in an environment where poor HIV- positive women 
cannot access Nevriapine in order to lessen mother-to-child 
transmission of the virus.  He also chided NACA and the 
Ministry of Health for their on-going bureaucratic struggle 
for control of the national HIV/AIDS effort.  Matemilola 
quoted the African proverb, "When two elephants fight, the 
grass suffers", indicating that the national HIV/AIDS program 
in general and people living with HIV/AIDS in particular have 
suffered the negative consequences of the bureaucratic 
tug-of-war. This statement drew a round of applause from the 
audience. 
 
 
¶12.  In his speech, President Carter challenged the forum 
participants to face their responsibility for combating 
HIV/AIDS.  He criticized African leaders who were in denial 
and ignore the epidemic, while praising President Obasanjo 
for leading the fight against HIV/AIDS in Nigeria and in 
Africa. He also stated that the battle against AIDS could not 
be won if every government official were not actively engaged 
in the fight.  Carter challenged the forum to overcome the 
social stigma of talking about HIV/AIDS and stressed the need 
for information and education.  The former President ended 
his speech by saying: "My prayer is that everyone assembled 
here, and everyone with whom you come in contact, will be 
inspired to be active and enthusiastic and dedicated to the 
control of this terrible disease." 
 
 
¶13. The Aids Prevention Initiative in Nigeria (APIN), a $25 
million, three-year grantee of the Bill and Melinda Gates 
Foundation, which had previously been criticized by the GON, 
was showcased during the Forum.  Seven of the program's 
twenty speakers were associated with either the Gates 
Foundation or with APIN, including Bill Gates, Sr., Dr. 
Helene Gayle, Professor Jeffrey Sachs, and Phyllis Kanki. 
APIN was applauded by the Minister of Health for helping 
prepare Nigeria's proposals to the Global Fund.  Jeffrey 
Sachs received the greatest applause of the Forum following 
his suggestion to "write postcards" to the international 
lending institutions saying that Nigeria would no longer pay 
its debts.    According to Sachs, "The debt is unpayable and 
should no longer be paid".  Sachs estimated that Nigeria 
needs $1 billion annually to fight HIV/AIDS, contrary to the 
estimate of $226 million given by the NACA chairperson. He 
also suggested that most of the $1.5 billion Nigeria pays 
every year in debt servicing could be used to meet this gap 
once the "postcards were sent".   In addition, Sachs called 
for greater involvement by the oil industry saying "no world 
class business can be in this country without joining the 
fight as their own economic survival is at stake."   Dr. Pia 
Malaney, also from Harvard, posited that Nigeria's GNP is 
already 5% lower because of the HIV/AIDS epidemic and, if not 
contained, the toll will reach 25% by 2025. 
 
 
------------------- 
Goin' to the Chapel 
------------------- 
 
 
¶14.  The final event of the visit was the Sunday Church 
service at Aso Villa Chapel. Reverend Y.A. Obaje, the Villa 
Chaplain, said, "We consider President Carter to be a 
brother. He cares about the poor. He cares about the sick. He 
cares about the downtrodden. We consider him one of us." 
Accordingly, the congregation was pleased to have President 
Carter in their midst and to hear his sermon: "A Faith Based 
Approach to HIV/AIDS."  President Carter spoke directly to 
issues of stigma and prevention, and emphasized that it was 
imperative for religious leaders to discuss HIV/AIDS from the 
pulpit. Carter's inspirational sermon reached an audience 
beyond the immediate congregation. His message was broadcast 
live on Nigerian TV and radio, and was replayed several times 
during that day. Initial estimates indicate the radio 
broadcast reached approximately 26 million people and the TV 
broadcast reached an estimated 13 million.  The Gates 
Foundation is pursuing other avenues for wide dissemination 
of Carter's message within the Christian media.  (Note: After 
consultation with some Islamic leaders, the delegation 
decided that a different message was needed to reach the 
Muslim population. End Note.) 
 
 
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Comment 
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¶15.  There were numerous highlights of the Carter/Gates 
visit.  First, it helped educate the delegation on the 
HIV/AIDS situation in Nigeria, emphasising the areas of 
greatest needs.  Secondly, the delegation was able to 
generate unprecedented local attention while also focusing 
the international spotlight on the problem of HIV/AIDS in 
Nigeria. Accompanying the Carter/Gates team were Karen 
DeYoung of the Washington Post and Lynelle Gradwell, Robert 
Grant, Howard Smith and Keith Miller from NBC News.  HIV/AIDS 
received broad media coverage and attention from national, 
state and local officials and policy-makers that otherwise 
would have never occurred.  Finally the delegation was able 
to show the GON facets of the HIV/AIDS problem about which it 
had previously been unaware, particularly the enormity of the 
CSW issue. President Obasanjo has embraced the challenge that 
HIV/AIDS presents, and appears ready not only to continue, 
but to redouble his own efforts and efforts the of his 
government to confront seriously the growing menace of 
HIV/AIDS in Nigeria. From our perspective the Carter/Gates 
Visit was well worth the effort. End Comment. 
 
 
JETER