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FM AMEMBASSY ABUJA
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RUEHZK/ECOWAS COLLECTIVE

UNCLAS SECTION 01 OF 03 ABUJA 000436 
 
SIPDIS 
 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: KHIV SOCI TBIO ECON PREL PGOV NI
SUBJECT: THE STATE OF HIV/AIDS IN NIGERIA AS OF DEC. 2005 
 
REF:  ABUJA 209 
 
¶1. Summary:  This cable evaluates broadly HIV/AIDS' impact 
on Nigerians and their institutions.  Roughly 4 million 
(UNAIDS, 2003) of the nation's 130 million people (PRB, 
2002) are infected with HIV/AIDS, reflecting a national 
HIV/AIDS infection rate of 5% (NPS, 2003).  Nigeria had at 
least 2.4 million HIV-positive workers in 2003. (ILO, 2004) 
Although senior Nigerian officials are committed to 
combating HIV/AIDS, the sense of urgency to do something 
about it diminishes increasingly down the Nigerian 
bureaucratic ladder.  HIV/AIDS has the potential to further 
destabilize Nigeria, where about 85 million Nigerians try to 
survive on less than USD 1 per day.  Most of Nigeria's 
economic activity occurs in the informal sector, which does 
not provide health and death benefits, so HIV/AIDS harms the 
poorest Nigerians disproportionately.  Despite some recent 
improvements in performance, Nigeria's ineffectiveness in 
using Global Fund money to fight HIV/AIDS causes the U.S. 
Mission Nigeria considerable concern, and deeper structural 
changes to the fund's Nigerian partners are needed.  Because 
the GON nonetheless recognizes the threat and values its 
partnership with the United States, our common effort to 
combat HIV/AIDS is strengthening our bilateral relationship. 
End summary. 
 
¶2. This is the second of Embassy Abuja's twice-yearly cables 
on the effects of HIV/AIDS on Nigerians and the Nigerian 
economy.  This cable seeks to evaluate broadly HIV/AIDS' 
impact on Nigeria's institutions and society.  Statistics on 
HIV and AIDS in Nigeria are fragmentary and not always up to 
date.  Nigeria's National HIV Sero-Prevalence Survey 
estimated the national rate of HIV/AIDS infection in 2003 to 
be 5%. (NPS, 2003)  This 5% infection rate means roughly 4 
million adults aged 15-49 (UNAIDS, 2003) of Nigeria's 
approximately 130 million citizens and residents (Population 
Reference Bureau, 2002) have HIV or AIDS.  In 2003, 310,000 
Nigerian adults and children died of AIDS. (IMF, "The 
Macroeconomics of HIV/AIDS," Nov. 2004)  Nigeria then had 7 
million orphans - who comprised 10.1% of its children - and 
that same year, it had 1.8 million AIDS orphans. (IMF, Nov. 
2004)  Because of HIV and AIDS, UNICEF predicts Nigeria's 
orphans will increase rapidly to 8.2 million by 2010. 
(UNICEF, 2005) 
 
¶3. Nigeria's youth bulge - 63% of its population is under 
age 25 (Nigeria Demographic and Health Survey, 2003) - makes 
the threat of HIV/AIDS very significant.  The country's 
highest prevalence of HIV, 5.6%, is found among its 20 to 24 
age group.  (NPS, 2003)  Unless there is sustained action to 
target and protect this age group, a significantly larger 
wave of HIV/AIDS likely will result.  In May 2005, Nigeria 
launched a new drive to improve its blood-bank system and 
stem the spread of HIV through contaminated blood.   At that 
time, the director of the U.S. charity Safe Blood for Africa 
said roughly 10% of 1 million samples of blood tested in 
Nigeria, taken largely from adults, were contaminated with 
HIV.  (UN Office for the Coordination of Humanitarian 
Affairs, 2005) 
 
¶4. A Nigerian child born today can expect to live 49 years, 
according to DHS, 2003 data.  Also using 2003 statistics, 
however, the UN Development Program calculates that a 
Nigerian's life expectancy at birth in 2003 was only 43.4 
years (UN Human Development Report, 2005) - and this figure 
likely is falling.  The IMF estimated that deaths of adults 
(ages 15 to 49) excluding AIDS will make up 17% of all 
deaths in Nigeria in 2005; the inclusion of Nigerian adults' 
deaths from AIDS will boost this figure to 27%. (IMF, Nov. 
2004)  In demonstrating how harsh daily life is in Nigeria, 
the International Labor Organization (ILO) estimated in 2004 
that of a projected 2005 population of 130 million, that 
fewer than 4.1 million of these persons would live to at 
least age 65. (ILO, "HIV/AIDS and Work," 2004)  (Note:  This 
ILO population projection is about 10 million shy of our 
current estimate, which is based on data compiled by the 
Population Reference Bureau.) 
 
¶5. By the end of 2003, Nigeria had at least 2.4 million HIV- 
positive people aged 15 to 64 in its labor force - with 
"labor force" defined as all persons who are economically 
active, including all persons of working age who are in paid 
employment, gainful self-employment, or unemployed but 
available for and seeking work. (ILO, 2004)  The ILO 
estimated that Nigerians who will have died from AIDS during 
1995 to 2005 will equal 3% of Nigeria's cumulative total 
labor force during that decade. (ILO, 2004)  Because most of 
Nigeria's economic activity occurs in the informal sector, 
which does not provide health and death benefits, HIV/AIDS 
harms the poorest Nigerians disproportionately in economic 
terms. 
 
 
ABUJA 00000436  002 OF 003 
 
 
¶6. HIV/AIDS has the potential to further destabilize 
Nigeria, where government and services infrastructures 
already have broken down and where about 85 million 
Nigerians try to survive on less than USD 1 per day. 
HIV/AIDS poses a significant threat particularly to 
Nigeria's urban elite, who because of their mobility and 
behavior are more likely to be infected.  The urban elite 
are relatively young, in their economic prime, and better 
educated than the average Nigerian.  The consequences of 
these shortened lives and careers include fewer leaders in 
Nigeria's society and economy, declining productivity, 
greater costs of production, and decreased household income 
and opportunities for education. (IMF, Nov. 2004)  While it 
is difficult to quantify precisely HIV/AIDS' economic cost 
to Nigeria, the disease's effects reduce Nigeria's human and 
physical capital.  As spending shifts toward HIV/AIDS- 
related activities, aggregate saving is likely to fall, 
leaving fewer resources for investment. (IMF, Nov. 2004) 
 
¶7. Senior Government of Nigeria (GON) officials are 
realistic about the threat HIV/AIDS poses.  President 
Obasanjo personally lent his support by speaking on World 
AIDS Day at the December 2004 launch of the (U.S.) 
President's Emergency Plan for AIDS Relief (PEPFAR), and he 
launched on World AIDS Day in December 2005 the "Operation 
Heart to Heart" campaign for persons suffering from 
HIV/AIDS.  There is strong Nigerian public support for the 
Emergency Plan, as well as close coordination between the 
GON Ministries of Health and Defense and the U.S. Mission, 
including officials at USAID, the Department of Defense 
(DOD), and the Centers for Disease Control.  U.S. Ambassador 
Campbell and Nigeria's minister of health co-chair a 
biweekly steering committee on the issue of HIV/AIDS in 
Nigeria, while the Nigerian minister of state for defense 
has made HIV/AIDS prevention a priority.  PEPFAR has 
stimulated the Nigerian Ministry of Defense's (MOD) HIV 
program and the formation of the MOD-U.S. DOD HIV Program 
Steering Committee.  The committee is co-chaired by 
Ambassador Campbell and the Nigerian minister of state for 
defense, and oversees PEPFAR's policy and implementation in 
the Nigerian military.  Nigeria's military HIV program has 
begun operating at four locations and has enrolled more than 
300 persons for treatment.  This program is open to the 
civilian community surrounding these hospitals, but this 
could place great strain on the system's staffing, which is 
generally understrength. 
 
¶8. The Nigerian military's HIV prevalence rate is unknown 
but is estimated at between 5 and 10%, according to several 
small studies conducted in recent years.  All potential 
recruits are supposed to be tested for HIV before being 
accepted for service, but the Nigerian military maintains 
little data on this subject and carries out no confirmatory 
testing.  Unlike the U.S. armed forces, the Nigerian 
military does not continue mandatory in-service HIV testing 
for its personnel - though the advent of free testing and 
treatment has strengthened the concept of testing and 
tempered the Nigerian military's objections to instituting 
anonymous mass testing.  The Nigerian Air Force has 
mandatory HIV testing only for air crew members on flight 
status.  All military personnel seeking to serve outside 
Nigeria on peacekeeping operations are supposed to be tested 
for HIV, both before and after their deployment - but these 
test results generally are unavailable even to the Nigerian 
military's medical commands and to its Armed Forces Program 
on AIDS Control. 
 
¶9. Despite the commitment at the senior level of the GON to 
combating HIV/AIDS in Nigeria, government personnel's 
awareness of the extent of this disease diminishes 
increasingly down the Nigerian bureaucratic ladder. 
Nigerian officials occasionally express complacency over 
Nigeria's success in capping the nation's infection rate at 
"only" 5% - especially compared to other African countries' 
significantly higher rates.  Moreover, AIDS' serious threat 
to Nigeria is relatively abstract to the typical Nigerian. 
Many Nigerian institutions and a large percentage of 
Nigerian society still engage in denial of the damage 
wreaked by the disease, in large part because of HIV/AIDS' 
stigma in Nigerian society.  Unlike in Uganda, where AIDS 
has been widespread, only 25% of Nigerians report knowing 
someone who has AIDS or who died from it. (Nigeria National 
HIV/AIDS and Reproductive Health Survey, 2003)  Nigerians 
facing death from AIDS generally leave the city and return 
to their village.  The weakened AIDS sufferers usually die 
from malaria or tuberculosis (TB), which is attributed as 
the cause of death rather than AIDS. 
 
¶10. In fiscal year (FY) 2006, U.S. Government (USG) funding 
in Nigeria for PEPFAR is about USD 163 million.  Under the 
Office of the U.S. Global AIDS Coordinator and Ambassador 
Campbell, five USG agencies work collaboratively, including 
 
ABUJA 00000436  003 OF 003 
 
 
with Nigerian and international entities, to implement the 
Emergency Plan through sustainable prevention, care, and 
treatment programs.  As of the end of September 2005, the 
USG directly supported 18,885 individuals on antiretroviral 
therapy (ART) in the nine focus states of Anambra, Borno, 
Cross-River, Edo, Kano, Lagos, Oyo, Plateau, and the Federal 
Capital Territory.  Also as of September 2005, the USG was 
rapidly increasing the ART services its partners offer to 
meet its target of having 36,222 individuals on ART by March 
¶2006.  Currently, 447 USG-supported HIV-prevention programs 
target at-risk individuals.  In FY2005, about 67,925 
patients received basic health care and support at 128 USG- 
sponsored service outlets.  More than 98,000 clients have 
received counseling and testing in facilities supported by 
the Emergency Plan. 
 
¶11. Nigeria's ineffectiveness in using Global Fund money to 
fight HIV/AIDS has caused considerable concern in the U.S. 
Mission Nigeria.  The Global Fund for AIDS, Tuberculosis, 
and Malaria grant program in Nigeria is plagued by slow 
implementation and weak management by one of its principal 
recipients, Nigeria's National Action Committee on AIDS 
(NACA), as well as by the country coordination mechanism 
(CCM).  The Global Fund in Nigeria works through the CCM, 
which develops and submits grant proposals to the Global 
Fund, then oversees program implementation.  A lack of 
results, coupled with the lack of reform and proper 
oversight by the CCM, in December 2005 nearly cost Nigeria 
HIV/AIDS grants totaling almost USD 43 million.  While this 
funding ultimately was not canceled, the U.S. Mission 
Nigeria remains concerned that despite some progress made 
from July to December, NACA and the CCM need deeper 
structural changes to ensure that Global Fund money is well 
managed and that desired results are achieved in Nigeria. 
 
¶12. The GON fully recognizes the threat of HIV/AIDS.  It 
values its partnership with the United States and U.S. 
cooperation on the HIV/AIDS issue.  Our partnership in 
combating HIV/AIDS is strengthening our bilateral 
relationship. 
 
¶13. This cable was reviewed by Embassy Abuja's Economic 
Section, its Office of Defense Cooperation, and by USAID 
Abuja. 
 
CAMPBELL