VZCZCXRO8537
PP RUEHMA RUEHPA
DE RUEHUJA #2504/01 2680726
ZNR UUUUU ZZH
P 250726Z SEP 06
FM AMEMBASSY ABUJA
TO RUEHC/SECSTATE WASHDC PRIORITY 7232
INFO RUEHOS/AMCONSUL LAGOS 5118
RUEHZK/ECOWAS COLLECTIVE

UNCLAS SECTION 01 OF 03 ABUJA 002504 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: KHIV SOCI TBIO ECON PREL PGOV NI
SUBJECT: THE STATE OF HIV/AIDS IN NIGERIA AS OF JULY 2006 
 
REF:  ABUJA 435 
 
¶1. (SBU) Summary:  This cable evaluates HIV/AIDS' impact on 
Nigerians and their institutions.  Roughly 4 million (UNAIDS, 2003) 
of the nation's 132 million people (PRB, 2005) are infected with 
HIV/AIDS, reflecting a national HIV/AIDS prevalence rate of 4.4%. 
(NPS, 2005)  Nigeria had at least 2.4 million HIV-positive workers 
in 2003. (ILO, 2004)  Though senior Nigerian officials are committed 
to combating HIV/AIDS, translating political commitment into program 
implementation on the ground often is unsuccessful.  HIV/AIDS could 
further destabilize Nigeria, where about 85 million Nigerians try to 
survive on less than $1 per day.  Most of Nigeria's economic 
activity occurs in the informal sector, which does not provide 
health and death benefits.  Despite some recent improvements, 
Nigeria's ineffectiveness in implementing its Round 1 Global Fund 
grant to fight HIV/AIDS causes considerable concern, and the Fund's 
Nigerian partners need deeper structural changes.  Because the GON 
recognizes the threat of HIV/AIDS and values its partnership with 
the U.S., our common effort to combat HIV/AIDS is strengthening our 
relationship.  End summary. 
 
¶2. (SBU) This is the second of Embassy Abuja's twice-yearly cables 
on the effects of HIV/AIDS on Nigeria.  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 2005 to be 4.4%. (NPS, 
2005)  This figure is lower than the rates of 5.8% in 2001 and 5.4% 
in 2003.  This, however, does not represent necessarily a downward 
trend in prevalence and for several reasons should be interpreted 
with a great deal of caution.  First, more rural sites were included 
in the 2005 survey than before (74 rural sites in 2005, 37 in 2003, 
and 0 in 2001), and the number of samples from each rural site 
increased from 50 in 2003 to 150 in 2005, making the sampling frame 
in 2005 different from previous surveys.  This survey also was a 
convenient sample of pregnant women attending antenatal clinics. 
Access to prevention-of-mother-to-child-transmission services has 
changed substantially since the last survey, and may result in a 
different HIV risk profile of the sampled women.  As such, 
complacency must not be permitted, and intervention efforts should 
be intensified.  Nigeria still has the world's third-highest number 
of HIV/AIDS cases, trailing only India and South Africa.  The 4.4% 
infection rate means roughly 4 million adults aged 15-49 (UNAIDS, 
2003) of Nigeria's approximately 132 million citizens and residents 
(Population Reference Bureau, 2005) 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 to 8.2 
million by 2010. (UNICEF, 2005) 
 
¶3. (U) 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 25 to 29 age group has the highest 
prevalence of HIV in Nigeria at 4.9%.  Youth 20 to 24 have the 
second-highest rate at 4.7%. (NPS, 2005)  Without sustained action 
to target and protect youth, a significantly larger wave of HIV/AIDS 
likely will result.  In May 2005, Nigeria launched a 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. 
organization 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. (U) 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 
would make up 17% of all deaths in Nigeria in 2005; the inclusion of 
Nigerian adults' deaths from AIDS would 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, fewer than 
4.1 million of these persons would live to at least 65. (ILO, 
"HIV/AIDS and Work," 2004) 
 
¶5. (U) 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 economically active persons, including those 
in paid employment, gainful self-employment, or unemployed but 
seeking work. (ILO, 2004)  The ILO estimated that Nigerians who will 
have died from AIDS during 1995 to 2005 would equal 3% of Nigeria's 
cumulative 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 places the 
severest economic impact on the poorest Nigerians. 
 
 
ABUJA 00002504  002 OF 003 
 
 
¶6. (SBU) HIV/AIDS has the potential to further destabilize Nigeria, 
where the governance and infrastructure already have broken down and 
where about 85 million Nigerians try to survive on less than $1 per 
day.  In addition, HIV/AIDS poses a significant threat 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 production costs, and decreased household income and 
opportunities for education. (IMF, Nov. 2004)  It is difficult to 
quantify precisely HIV/AIDS' economic cost to Nigeria, but the 
disease reduces Nigeria's human and physical capital.  As spending 
shifts toward addressing HIV/AIDS, aggregate saving is likely to 
fall, leaving fewer resources for investment. (IMF, Nov. 2004) 
 
¶7. (U) 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, and close coordination between the GON Ministries of Health 
and Defense and the U.S. Mission, including USAID, the Department of 
Defense (DOD), the Centers for Disease Control and Prevention (CDC), 
and the National Institutes of Health (NIH).  U.S. Ambassador 
Campbell and Nigeria's Minister of Health co-chair a steering 
committee on 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 
activities with the Nigerian military. 
 
¶8. (U) The Nigerian military's HIV prevalence rate is unknown, 
according to a senior Nigerian military medical officer.  All 
potential recruits are supposed to be tested for HIV before being 
accepted for service, but the Nigerian military maintains little 
data and carries out no confirmatory testing.  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 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.  Nigeria's PEPFAR-funded military 
HIV program now is operating at five locations and has enrolled more 
than 1,000 persons for treatment.  The program is open to the 
civilian community near these hospitals, but this could place great 
strain on the system's staff, which is generally under strength. 
 
¶9. (SBU) Despite the commitment at the GON's senior level to 
combating HIV/AIDS in Nigeria, the ability to translate political 
commitment into program implementation on the ground often is 
limited.  Nigerian officials occasionally express complacency over 
Nigeria's success in capping the nation's infection rate at "only" 
about 5% - especially compared to other African countries' much 
higher rates.  AIDS' serious threat to Nigeria is relatively 
abstract to the typical Nigerian.  Many Nigerian institutions and a 
large percentage of Nigerians are in denial about the damage wreaked 
by the disease, in large part because of HIV/AIDS' stigma.  Unlike 
in Uganda, where AIDS has been widespread, only 21% of Nigerians 
report knowing someone who has AIDS or who died from it. (Nigeria 
National HIV/AIDS and Reproductive Health Survey, 2005)  Nigerians 
facing death from AIDS generally leave the city and return to their 
village.  The weakened AIDS sufferers usually die from malaria or 
tuberculosis, which is attributed as the cause of death rather than 
AIDS. 
 
¶10. (U) In fiscal year (FY) 2006, U.S. Government (USG) funding in 
Nigeria for PEPFAR is approximately $163 million.  Under the Office 
of the U.S. Global AIDS Coordinator and Ambassador Campbell, five 
USG agencies work together with Nigerian and international entities 
to implement sustainable prevention, care, and treatment programs. 
As of March 31, 2006, the USG was supporting 30,061 individuals on 
antiretroviral therapy (ART).  More than 106,000 individuals have 
received care and support services in USG-sponsored clinical- and 
community-based facilities.  Among the more than 44,400 pregnant 
women who received antenatal care at PEPFAR sites, 2,873 
HIV-positive women received ARV prophylaxis to reduce the risk of 
mother-to-child transmission.  Nearly 150,000 clients have received 
HIV test results at counseling and testing sites.  These prevention, 
care, and treatment services are provided in 15 Nigerian states: 
Anambra, Bauchi, Benue, Borno, Cross River, Edo, Enugu, Kaduna, 
Kano, Lagos, Nasarawa, Oyo, Plateau, Rivers, and the Federal Capital 
Territory. 
 
ABUJA 00002504  003 OF 003 
 
 
 
¶11. (SBU) Nigeria's ineffectiveness in using Global Fund money to 
fight HIV/AIDS causes the U.S. Mission Nigeria considerable concern. 
 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, 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.  Earlier this year, the Global Fund terminated two 
HIV grants to Nigeria totaling $81 million due to weak management 
and improper oversight of expenditures, failure to meet performance 
measures, and failure to implement promised CCM reforms.  Nigeria 
needs to demonstrate improved competency in managing its financial 
resources and in implementing programs - for the Global Fund's 
canceled grants demonstrate that Nigeria's challenge in its war 
against AIDS is not simply a lack of funding. 
 
¶12. (U) 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. (U) This cable was reviewed by Embassy Abuja's Economic Section, 
the HHS/CDC-Global AIDS Program Nigeria, the Centers for Disease 
Control and Prevention Abuja, and USAID Abuja.