1 March 2016

Nigeria: U.S. HIV/Aids Partnership With Nigeria Remains on Track

opinion

There have been several inaccurate media reports lately concerning the U.S. government's support to persons living with HIV and AIDS (PLHIV) in Nigeria. In particular, claims made in some February 25, 2016 articles that the United States is reducing HIV/AIDS funding due to Nigeria's Same Sex Marriage Prohibition Act are flatly untrue.

This is what is true: U.S. funding decisions on international HIV/AIDS programs are not linked to other governments' views on same sex marriage or other LGBTI issues. Since 2004, the American people have provided $4.2 billion in HIV/AIDS prevention, treatment, and care for millions of Nigerians through the President's Emergency Plan for AIDS Relief (PEPFAR), clearly a massive U.S. commitment to the fight against HIV/AIDS in Nigeria.

Contrary to what is often reported, PEPFAR is committed to maintaining support for the more than 600,000 Nigerians it has placed on anti-retroviral therapy (ART). Last year alone, more than 8.5 million Nigerians were tested and counseled for HIV, and 55,000 women were provided drugs to prevent transmission of the virus to their unborn children with PEPFAR support. The patients on ART are receiving care in 490 local government areas (LGAs) located throughout Nigeria. Country-wide, approximately 750,000 Nigerians receive ART.

The burden of HIV is not spread evenly throughout the country. Surveillance data show that some parts of the country have higher rates of infection than others. Approximately 3.4 million Nigerians are infected with the virus. More than 1 million of those are located in seven states where PEPFAR, in consultation with the Nigerian government, has chosen to scale up services.

According to the latest National AIDS Spending Assessment, 75 percent of the national HIV response program is funded by donors, predominantly PEPFAR and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. As contributions from these sources are finite and have not increased in recent years, the only way HIV treatment has continued to be increased is by finding efficiencies and reducing costs. We are learning how to do more with the same amount of money or even less. In 2017, the PEPFAR budget will shrink, but the U.S. government is committed to maintaining all PLHIV placed on treatment and to scaling up services in the highest burden, highest HIV prevalent areas. We have selected those areas, 32 LGAs in seven states, because we can reach the greatest number of PLHIV in the areas of highest concentration with the fewest dollars. That means our limited budget can place more people on life-saving treatment by concentrating our efforts in a limited geographical area. By having the right mix of resources and services, we can gain control of the HIV epidemic and halt the transmission of the virus.

Decisions concerning the PEPFAR program are based on the latest science, international standards, and best practices. PEPFAR is increasing support for countries with the highest burden of disease and in which the host government is shouldering increased responsibility for responding to the epidemic. The United States seeks to engage and encourage the Nigerian government to mobilize greater resources for the HIV response in a new era of accountability, transparency, and impact. In no country, including Nigeria, are PEPFAR funding decisions related to a government's position on issues related to gay and lesbian populations, as recently (and erroneously) reported in the press here in Nigeria.

Epidemic control is defined as the point at which the number of new HIV infections has decreased and falls below the number of AIDS-related deaths. PEPFAR is committed to supporting the Joint United Nations Program on HIV/AIDS' (UNAIDS) "90-90-90" goal of having 90 percent of people living with HIV diagnosed, 90 percent of those diagnosed on ART, and 90 percent of those on ART virally suppressed. Doing so, in a small number of prioritized geographic areas, will provide proof of concept which we hope will encourage the Nigerian government to invest more significantly-and in a more focused manner-in the domestic HIV response.

The articles I cited above do make a request that the U.S. government fully supports-that the Nigerian government put more resources into the HIV response. But we also advocate that any new resources brought to the table be spent in the geographic areas of greatest need and where they can have the most impact-that is, where the HIV burden is greatest and HIV prevalence is highest. Continuing our historically strong bilateral partnership, we can look forward to reaching these goals together.

The author is the U.S. Ambassador to Nigeria.

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