HIV/AIDS Pandemic - We Need Strategic Approaches - ENCAP Chief. 5/12/10

What is the current state of statistics with respect to the prevalence of HIV/AIDS in Nigeria?

AllAfrica

On Wednesday the world celebrated World AIDS Day. With about five years to go on the MDG pledge end-date, all hands are on deck to support governments in meeting their commitment. Enhancing Nigerian Capacity for AIDS Prevention (ENCAP), is one of such efforts. EDEGBE ODEMWINGIE was there for LEADERSHIP SUNDAY as Victoria Agbara, Chief of Party, ENCAP Project, told a group of journalists in Abuja that there is need for a re-think on strategic approaches to HIV/AIDS programming. Excerpts:

It is the world AIDS Day. What is the current state of statistics with respect to the prevalence of HIV/AIDS Globally?

The recently released 2010 UNAIDS Global Report on the AIDS epidemic, indicates that after nearly 30 years of living with the epidemic, we are finally beginning to see a reversal in the spread. The report shows that an estimated 2.6 million people became newly infected with HIV, as opposed to 3.1 million in 1999. At the end of 2009, 33.3 million people were estimated to be living with HIV, up slightly from 32.8 million in 2008. This is largely due to more people living longer as a result of increased access to antiretroviral therapy. For instance in 2009, 1.8 million people died from AIDS-related illnesses, nearly one-fifth lower than the 2.1 million who died in 2004.

New data clearly indicate that HIV prevention and treatment efforts are working; the number of people newly infected with HIV is declining and AIDS-related deaths are decreasing. Globally, the number of new infections has fallen by 19%since the epidemic peaked in 1999. In 33 countries, HIV incidence has fallen by more than 25%. The biggest epidemics in sub-Saharan Africa (Ethiopia, Nigeria, South Africa, Zambia and Zimbabwe) have stabilized or are beginning to decline. Among young people in the most severely affected countries, HIV prevalence has fallen by more than 25% as a result of the adoption of safer sex practices. I must say however, that it is not all good news, a number of regions and countries do not fit the described trend.

What is the current state of statistics with respect to the prevalence of HIV/AIDS in Nigeria?

Median National HIV prevalence is at 4.6% based on the findings of the 2008, ANC survey which is normally used to monitor HIV prevalence trends in the country. However, the 2007 National AIDS and Reproductive Health Survey (NARHS) which is a population-based survey, estimates the National prevalence at 3.6%. Current estimates by the Federal Ministry of Health (FMOH), indicates that by 2009, 2.98 million people were living with HIV/AIDS in Nigeria. Despite the national prevalence of 4.6%, as many as 18 states actually have a prevalence rate that is higher than the national average. It is important to note that Nigeria, with about 2.98million people living with HIV, makes up about 9% of the global HIV burden.

If we look at prevalence by age groups, you'll find that the worst affected is the 25-29 years age group, prevalence for this group is 5.6%. The 2008 ANC survey reports over 300,000 new infections recorded and the results of a Modes of Transmission study conducted in 2008 indicate that over 40% of new HIV infections occur among couples, who at the time could be considered as engaging in 'low-risk' sex.

Although, Nigeria is one of the countries said to have a stabilized epidemic, the persistent high risk behaviour in spite of high level of awareness particularly among young people indicates that greater efforts are needed in order to reach the youth and young couples with effective prevention interventions to address their specific needs and stimulate the adoption of safer behaviours which would reduce the risk of HIV transmission. What is the current level of space funding for HIV/AIDS work in Nigeria? Would you say given the picture of the prevalence you have just painted this funding is sufficient to meet the challenge? If not how much more should we be asking for?

It is difficult to determine the exact amount of funds being spent to tackle the HIV/AIDS epidemics in Nigeria. This is in part due to the fact that there are various sources of finding, most of which are not coordinated through a central purse. In Nigeria, like most countries, the AIDS response is funded through multiple sources, these may include domestic public funding, international aid, private-sector, philanthropic and individual out-of-pocket funding. The most recent information available for Nigeria from the National AIDS Spending Assessment (NASA 2008), shows a total domestic and international expenditure of close to 400 million USD for the year, however, more than 90% of that amount came from international donors.

As regards your question on the sufficiency of available funding, I can tell you that even globally, resources available for the AIDS response have always fallen short of what is required. This makes it more important to ensure the use of more cost effective interventions which will achieve maximum impact for less.

You have said this project targets young adults and will involve very significantly capacity building. These are not new approaches to the best of our knowledge. So what is unique about the ENCAP project approach?

I agree, many other projects have and are targeting young adults and involve capacity building. However, ENCAP is unique in the sense that we focus on capacity building with great emphasis on quality and sustainability. We promote an internally driven process which allows the organization to take responsibility for their capacity building. We believe this approach will promote ownership and sustainability.

ENCAP's strategic approach is to build both organizational and technical capacity of our partners to achieve expected results in a way that is cost effective and sustainable. Joint capacity building activities will facilitate mentoring and networking between local organizations, while one-on-one, on-site coaching will deliver tailored support to each local partner. Capacity building events targeting organizational development will address a range of critical operational functions: management, leadership and governance, finance and accounting, grant management, human resources, strategic planning, and business development/resource mobilization. These activities will complement HIV technical assistance to help organizations implement HIV prevention programs that are proven effective and specifically tailored for target populations in each state. The ENCAP approach focuses less on formal training methodologies and more on practical, applied opportunities to translate new skills and information into new systems and processes that are actually institutionalized within organizations and communities, in addressing underserved populations, unmet needs and to ensure the sustainability of the intervention.

This resonates and aligns with national guidelines and strategy which encourages responsiveness and promotes decentralisation of interventions through the adoption of best practices and improvements in programme design. Furthermore, the organizations we work with are small community based organizations that operate in local communities and are best placed to understand the needs of the communities and have their trust to deliver on those needs.

How expansive is the project in terms of coverage; national or a part of the country, and duration?

The ENCAP project is funded by USAID and is implemented by Deloitte Consulting Overseas in collaboration with AED. The project will work intensively over a five (5) year period with 25 local partner organizations across five (5) states and the FCT; our target states include Bayelsa, Rivers, Benue, Taraba, and Ebonyi. The project is collaborating with NACA, SACAs, umbrella organizations and other partners working in target states to explore synergies and maximize the efficiency of interventions.

In Benue, Bayelsa and Rivers states for instance where we have had our formal launch, local project partners have been identified and have carried out a self-assessment to determine what their capacity building needs are. ENCAP will be working with them to address these needs. Most of the organizations we are working with would normally not have access to external funding but are doing great work in the communities they serve.

For us, it really isn't about the amount, it is more about the impact we hope to be able to make during the period and beyond the resources we have. However, to respond to your question, over a period of five years the project will receive close to $10million (N1.5 billion) to carry out both capacity building interventions and provide grants to partner organizations to implement prevention interventions. This is quite moderate considering the dual nature of the project; however we are confident we can achieve greater sustainability through this approach

What is the relationship of ENCAP with States National Action Committee on AIDS (SACAs) and the National Action Committee on AIDS (NACA) and other agencies?

This project recognizes NACA's mandate as the National Coordinating body and the SACAs at state level, as such we have made every effort to build a close working relationship with these agencies both at national and at state level, because we believe that these agencies constitute the backbone of a sustainable national response. We do not intend to reinvent the wheel here and so have intend to collaborate with other partners who have been working in our target states in order to complement their efforts and support the state response We believe that through a collaborative effort we can achieve maximum impact.