Nigeria, Africa's most populous country, has created a body to coordinate the national response to HIV/Aids. Professor Babatunde Osotimehin, who serves as chairman of the National Action Committee on Aids, works with Nigeria's Ministry of Health, other government agencies, NGOs and international organizations to develop a comprehensive strategy. He spoke to AllAfrica's Tamela Hultman about the immense challenges facing Nigeria, as well as NACA's mission to overcome them.
What was NACA created to do?
The National Action Committee on Aids in Nigeria was established about four years ago to be the organization that would coordinate all the HIV activities in Nigeria. It was also meant to be a multi-sectoral instrument that ensures that all energies on the ground are captured to enable us to do this effectively. We have had the response to HIV/Aids from the health sector, which was the traditional sector that took responsibility when Aids broke across the world.
But we have realized now that HIV has ceased to be a health sector issue only. It is a security issue. It is an issue of agriculture, rural development, education and social safety. We need to bring everybody on board, both from public sector and civil society, and recognize those who are living with the virus, who are more important than anyone else because it's for them that we do all that we do.
What are the key challenges in your coordinating role?
Nigeria is a very diverse country. There are 36 states in this country. Each one of those states is a country by itself. We have to look at the uniqueness of each one of these states and acknowledge it, celebrate it and respect it for people to want to work with you. That's one challenge.
The other challenge is that over the course of the last four or five years, there have been many partners that have come from inside and outside of Nigeria who want to work on HIV/Aids. When we started, the number of civil society organizations that were registered to work with us for HIV/Aids was probably less than 50. Today, we have more than 700. We need someone to track all of these to see what they are doing and where they are doing it, and also to ensure quality across the board.
We also have a network of people living with HIV/Aids. Before we didn't have that. About five years ago, there was no Nigerian who came forward to acknowledge that he was living with the virus. Today, we have close to 80 so far. These need to be coordinationed.
Funding organizations and international organizations that are coming to Nigeria, not only because of HIV/Aids but because of democracy -- people now feel that Nigeria is a better place to work. Those who were here before have come back and have brought with them material resources and human resources. Not all of them are used to working in a coordinated fashion. You cannot control. Coordination should not be controlled. Coordination should be coordination.
You have to also think about capacity to deliver on everything that you do. A big challenge is capacity. Capacity, not only in terms of people understanding what you say, but the ability to address their minds to issues of HIV/Aids. Five years ago, we were in denial. Today, 90 percent of Nigerians are aware that there is HIV and Aids. Now, how many of them have the risk perception to change behavior? So we are working on that.
In many countries, there is tension between the national coordinating bodies for HIV/Aids and the Health ministries, because people expect the health-related organization to be under the Ministry of Health. Yet, in most places, HIV/Aids needs a multi-sectoral approach. So, even though there is not necessarily any ill will on either side, these relationships have to be negotiated. How do you deal with that sensitive issue?
There are two levels of looking at this. There is the institutional level of the Ministry of Health and the coordinating bodies, and there are the individuals. What I have found is that, in principle, the institutions agree that a multi-sectoral approach is better than the uni-sectoral approach. We are not in doubt on that, we all agree. But when it comes to negotiating space for individuals within these [institutions], then tensions arise.
What we have done in order to arrest this is to say, `Look, let us sit down and talk about this.' We had a couple of retreats where people have expressed their minds. We have emphasized now and again that we are not there to implement anything. We are there to coordinate. The Ministry of Health has a major implementing role, in fact, more than any other sector. What we should do is ensure that we facilitate the Ministry of Health to do that effectively, and we have noticed that in the last six months we had considerable synergy with the Ministry of Health, because I think we communicated better.
For everything that we do, the Ministry of Health is invited. We want to do what they are doing. We'd like to see them. We'd like to talk to them. We give the sense that we are together. And, indeed, we are together. When you get married, two people come together and it's give-or-take all the time for you to be able to accommodate each other.
How do you negotiate relationships with funding organizations, given that they often come in with ideas about what they want to do and resources to do them? How do you coordinate activities to make sure that gaps are filled and there aren't redundancies?
The most important [part] for us is to have a policy. Most of the time developing countries that have to handle these very delicate negotiations don't have an abiding policy. If they want to move the country ahead, it is usually easier to persuade funders to buy into the policy.
Second, you need diplomacy to negotiate space and ensure that people understand where you are coming from, because sometimes even when you have said something, they still have the tendency to go in the direction of space that you don't want them to go.
As access to treatment expands, what is the importance of maintaining a focus on prevention?
That has two sides to it because I look at intervention and treatment as a prevention strategy. But I would say that if you look at the population that we are dealing with, 5 percent of Nigerians are positive. 95 percent of them are not. They are negative. You must put in strategies that insure that the 95 percent who are negative, remain negative. So you have to still sustain their awareness and internalization of the messages that you give them to ensure that behavior change comes -- delayed sexual debut amongst young people, ensuring that the guy is faithful in his number of partners, reducing the number of sexual partners people have, and then the condom must be available wherever they want and whenever they want.
How big of a problem does Nigeria really have with HIV/Aids? Many observers outside say that, compared to southern Africa for example, where you are approaching 40 percent prevalence rates in some countries, five or six percent is not very much. How do you respond when you hear people say that Nigeria is not a priority because it doesn't have a big problem?
My response to that is that we must look at the population base. Even though we have a five percent [prevalence rate], you're looking at a population of about 130 million people so when you then look at actual numbers of the virus, you have a problem. It's larger than most countries.
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That's why it is a dynamic process. At a point in time, we said that five percent are still living out there. They're still related to other people and it is still a generalized epidemic, so they are still going to be interacting with other people. We are not on top of the issues of behavior changes, so the danger is is that it will go if we don't do something about it now. That is a major issue for us. We also recognize the demographic profile of Nigeria. It is a very young population, sexually active and very mobile. All of the ingredients of an increased epidemic are there, so we have to worry.
What is the threat? What happens to Nigeria if the epidemic spirals beyond control?
I don't want to think about that. Nigeria is a powerhouse of the west African sub-region. I like to think that it is the powerhouse of Africa. Human capital [will be] affected considerably and so businesses will be affected, education will be affected, food security will be affected, [and] security of life will be affected. I think that it will be a disaster if that happens. I hope it doesn't happen.
What would you like to say about your role at NACA that I haven't asked you?
I would like to say that it is the greatest challenge of my professional life. I was Provost of the college of medicine which is the largest in Nigeria. I looked after 6,000 students, but it was very structured. Here, we're a growing institution and we're confronting an epidemic at the same time. [It's] a great challenge, but we are doing better day by day.
When I started, I was alone in the technical part of NACA. Today, we have about 20 specialists on board. By the end of the year, we will have close to 40 specialists. We will be able to contend [with] this much better.
