United Press International - November 4, 2002
Roger Bate

With a population of over 120 million people, Nigeria provides the leadership in the north of Africa much like South Africa does in the south. And like its southern African neighbor, it is failing to address the AIDS pandemic.

U.N. estimates of AIDS rates in Nigeria have increased every year. Over 3.5 million Nigerians are HIV-positive -- about 6 percent of the population. That is up from 2.5 million last April. With so many AIDS patients, and probably many more undiagnosed, targeting 15,000 people was a small step, but definitely one in the right direction.

Stephen Lewis, special U.N. envoy on AIDS in Africa, even pointed out last year that the proposed Nigerian program would be "at least initially larger than anywhere else in the continent."

Obasanjo persuaded Cipla to reduce its AIDS drug cocktail from $600 per person to $350. Even though Cipla originally announced that Nigerian citizens would pay nothing, it turned out that they would have to pay 20 percent. Yet even $90 a year, far less than the $8,000 Europeans or Americans pay, still represented a substantial amount to the average Nigerian. Still, Daniel Berman, coordinator of the Doctors Without Borders' Access to Essential Medicines campaign, called Nigeria's agreement with Cipla "very significant," but presciently observed that Nigeria would have to gear up the public sector so it can effectively administer the drugs.

The research-based drug companies, which invented the drugs copied by Cipla, warned Nigeria that Cipla could not provide the pharmacological backup and advice that it was giving to the governments of Botswana and other countries in the south. They also echoed Berman's doubts about Nigeria's capacity to distribute the drugs. The media ignored these concerns and claimed that the drug companies were only worried about lost profit opportunities. British newspaper The Guardian praised Nigeria's plan because it would "infuriate" the companies, and showed that Nigeria had "defied" company pressure.

By the end of 2001, when 15,000 Nigerians should have been treated, only a handful had received anything. And by this summer only a few hundred patients had received any treatment. At that time the Nigerian government fired its National Action Committee Against AIDS, committee Chairman Ibironke Akinsete and 16 board members. It replaced the old committee with the National Agency for the Control and Prevention of HIV/AIDS. Even with these changes, less than 5 percent of the target had been achieved in the 18 months since the original announcement.

Despite the original committee's incompetence, Nigeria's woeful health infrastructure remains the real reason for the failure. There are few doctors and testing facilities to diagnose cases, there is rampant corruption where drugs and funding routinely goes missing, and the experts in conducting drug evaluation and efficacy trials for the drug companies are absent.

The treatment scheme also faced problems because it failed to recognize the severe social stigma attached to AIDS. Many patients were discouraged by requirements that patients go public about their HIV status and attend designated hospitals to register. Perhaps a confidential treatment program would have achieved better results.

Until this social stigma is reduced -- either long term through education or immediately through anonymity -- and health infrastructure is improved -- either by long-term development or by short-term aid -- drug delivery is unlikely to be improved. Within the next year, all the drugs supplied by Cipla will expire and should be destroyed.

This kind of massive failure will surely make the USAID, the World Bank and other donors think twice before expanding treatment in Africa, a terrifying prospect as the disease moves beyond a social tragedy to a truly destabilizing crisis. This is a tragedy that should have been avoided, but the preoccupation of pressure groups and governments with cheap drugs -- and with bashing the research pharmaceutical companies that originally created them -- provided by rip-off drug companies, has blinded policy-makers to the real causes of the AIDS pandemic, poverty and ignorance.

Dr. Roger Bate is a director of Africa Fighting Malaria, based in Johannesburg, South Africa.

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