Ninety-five per cent of HIV/AIDS funding in Nigeria is presently provided by foreign donors. This is a silent time bomb for sustainability of HIV/AIDS treatment and prevention if government fails to take ownership soon. REGINA OTOKPA and CYNTHIA OKEKE x-ray calls from relevant stakeholders to state governments, to fulfill their promises towards investing in the fight against HIV/AIDS in Nigeria
Twenty years ago, the Federal Government took a bold step to embark on the treatment of HIV and AIDS, however, it slipped back to the background, as foreign donors stepped in to support its crusade of providing treatment for people living with the disease, with a view to stop its spread in order to gradually attain a possible elimination of the HIV/AIDS scourge in Nigeria.
Out of the 3.2 million people presently estimated to be living with the disease in Nigeria, about 1.1 million Nigerians are currently getting the life-saving treatment. This means that only about one in three persons who need treatment for HIV/AIDS in the country are getting it. Based on records from health officials, only nine states in the country have over half of the people living with the disease on treatment, leaving 27 states grappling with a high number of people without access to treatment.
According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), no fewer than 36 million people are currently living with AIDS globally, but experts predict that by 2030, the number of people infected with the virus is expected to shoot up to100 million. Despite this alarming figure, there is a threat of dwindling funds for AIDS research, treatment and prevention across the world.
For a country like Nigeria where about 95 per cent of the funds for the treatment of HIV patients in Nigeria is provided by foreign donors and the United States (US) Government, this spells doom if the government at all levels fail to take conscious measures to take ownership of the HIV/AIDS programmes targeted at treatment and prevention for its citizenry.
On this backdrop, the state governments early this year, made a pledge to devote one per cent of their monthly federal allocations towards complementing the federal government and donor agencies investment efforts in addressing the HIV scourge in their respective states, by helping people living with the virus access treatment.
In addition, President Muhammadu Buhari, authorised federal funds to pay for 60,000 new HIV-infected people to receive Antiretroviral (ARV) drugs, with a vow to add that same number to the treatment rolls each year. If successful, this programme is aimed at providing an exit gateway for the United States President’s Emergency Plan for AIDS Relief (PEPFAR), as future programmes acquire national ownership status.
Speaking recently at the Wole Soyinka’s “Keep the Promise” to AIDS Video campaign, organised by the AIDS Healthcare Foundation (AHF) in Abuja, the Director-General of the National Agency for the Control of AIDS (NACA), Sani Aliyu, expressed frustration over the poor funding of the health sector, and the failure of state governments to honor their promise to invest in fight against HIV/AIDS, as the federal health budget cannot devote 60 per cent of its budget towards a single disease condition.
Expressing the discomfort of the Nigerian Government over the funding gap responsible for its inability to uptake a higher percentage in the financing of HIV treatment, he maintained that the federal government was committed to changing the figures as soon as possible, by taking ownership and enhancing the sustainability of the HIV/AIDS response, which led to the conception and implementation of the ongoing Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS), with a sample size of about 170,000 people across the 774 local government areas of the country, to help arrive at a relatively accurate statistics on the burden of the disease.
“The government of Nigeria actually started putting people on treatment but not long after, partners, particularly the U.S. government, started supporting. We now have about 1.1 million Nigerians on treatment for HIV and most of them are doing well, all thanks to the availability of treatment. But the treatment is being funded predominantly by the U.S. government and the Global Fund.
“As far as government is concerned, access to HIV treatment is a right because that is what will enable those living with HIV to survive. Everybody has a right to life and right to life for people living with HIV includes access to medication,” he said.
He however expressed fears that the objective of the NAIIS and Federal Government’s drive to take ownership of the HIV/AIDS treatment and prevention response would not be achieved if state governments failed to fulfill their promise.
The NACA boss further explained that that part of government’s efforts to take ownership of HIV/AIDS programmes with a view to improving HIV treatment in the country at a lower cost, includes the ongoing moves to bring pharmaceutical companies to Nigeria to manufacture anti-retroviral drugs and HIV kits.
“As government, we are committed that those people who are placed on treatment to continue to be on treatment, and most importantly, identifying those that are not on treatment and ensuring that they have access to drugs.
“We owe it to the present generation and we also owe it to the future generation. Our partners have done a lot of job in the past few years, it is about time we step forward and take responsibility for our citizens.
“We have to invest in HIV treatment. Globally, the rest of the world is moving on and people are placed on treatment, so it should not be a problem for Nigeria. We want the state governments to implement the cost of HIV programmes in their budget. It was agreed that one per cent of their monthly federal allocation will go to HIV treatment. If this is done, the fight against the disease would improve tremendously,” he added.
Corroborating the position of NACA DG, Country Director, UNAIDS, Erasmus Morah, said it was saddening that 95 per cent of the fight against the disease was sponsored by foreigners and out-of-pocket spending.
Represented by the UNAIDS Strategic Intervention Advisor, Modupe Oduwole, he further lamented that the campaign against the disease by civil society organisations working on HIV/AIDS has dwindled in recent time.
Seeking a way forward for Nigeria, he advised government to own up to its responsibilities saying, “We are talking about how to make the money work and to make it go further, I submit that about four things that will be needed. One, as a body that ‘oversights’ HIV response in the country, you must ask yourself who is paying the bills, it is very important.
“If you want the money to go further, start by knowing who is paying the bills and how much they are actually paying. You will own the response the day you pay the bill. The figure we have out there will tell you that about 90 per cent of the commodity on HIV is secured with donor money, which is something that is to be addressed.
On the part of PEPFAR, the country Director Shirley Dady, maintained that the treatment of people living with the virus will be more cost effective when the government of Nigeria takes over the HIV programme at all levels.
According to her, this will enable PEPFAR attain its overreaching goal to locate and place 150,000 more people living with HIV on life-saving treatment in the coming year.
AIDS Healthcare Foundation Country Director, Echey Ijezie, who commended government and donors for the giant strides attained in the fight against HIV/AIDS over the years, however appealed to state governments and indeed the private sector, to step up its investments and most importantly, keep to all promises made on HIV/AIDS to ensure access to treatment and prevention services in Nigeria.
Calculating an annual unit cost of N47, 885 to put one person living with HIV on treatment for a year, he noted that funding AIDs locally in Nigeria was achievable, as “the annual cost of putting 50 per cent of the estimated people living with HIV on treatment is N20 billion.
“In Nigeria, we are happy about the impressive effort the government is making to bridge the gap, but importantly, government at the state level must join this effort and fund AIDS in their respective states. The same for the private sector,” he said.
However, the Executive Secretary, Association of Civil Society on HIV/AIDS in Nigeria (ACSAN), Nwakamma Ikenna, insisted that besides the role of civil society organisations and foreign donors, the media has a major role in holding government accountable on expenditure of funds in the fight against HIV in Nigeria.
Backing his call for the media to live up to their constitutional right of holding government accountable to citizen’s right to health especially those living with HIV/AIDS, the publisher of Premium Times, Dapo Olorunyomi, advised journalists to understand the connection between the HIV community care givers and those working in the front line of HIV/AIDS.
“We need to use that power to entrench the public health matter we have all been talking about. If it is true that the society deteriorates to the extent that journalism has deteriorated, I am proposing that health journalism should take the problem we are facing with HIV/AIDS funding as one of the most basic things to try to respond to,” he added.
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