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HIV/AIDS Emergency
Action Plan
A 3-Year Strategy to
3 Year
Deal with
Deal with
HIV / AIDS in Nigeria
HIV / AIDS in Nigeria
National Action Committee on
National Action Committee on
AIDS
AIDS
(NACA)
(NACA)
and its various partners
and its various partners
The HIV/AIDS threat is a
National Emergency
n It affects millions of people -
especially productive populations
in all sectors
n It will affect millions more
n It is affects all aspects of our
aspects
social and economic lives
economic lives
n It threatens our nation
n It is getting worse
This is a brief introduction to the “HIV/AIDS National Emergency Action Plan” (HEAP)
for HIV/AIDS in Nigeria. For an effective and coordinated response to the AIDS
epidemic there is a need for the development of an overall National Strategic Plan. The
process of doing this encompasses several elements of which the situation and response
analyses have already been completed. The HEAP is the next step.
The development and implementation of an HIV/AIDS National Emergency Action Plan
(HEAP) is critical to the control of the epidemic and to the mitigation of the impact of
HIV/AIDs on our society. With its acceptance, dissemination, and application, the HEAP
will allow the Government of Nigeria and its many partners to move ahead in supporting
those essential activities whose progress will serve as a bridge to the longer-term strategic
plan.
It is anticipated that, following the adoption of the HEAP, Nigeria’s national and
international professionals will join together in partnership toward the HEAP’s execution
thus ensuring that Nigeria will become one of the success stories from Africa in the fight
against this scourge that has so ravaged this continent.
This presentation briefly gives a background to the epidemic and outlines the main
elements of the HEAP.
Nigeria is not alone in Africa in terms of the AIDS epidemic. AIDS is a threat that is real
and is a national emergency.
HIV/AIDS in Nigeria :
Data sources
n Sero-
National Sero -prevalence Sentinel
Surveys
Surveys
n Projections based on sentinel
surveys and on current population
estimates using the AIDS Impact
Model (AIM)
Model (AIM)
The projections presented in the following slides are based on the National Sero-
prevalence Sentinel Surveys of 1991, 1994, 1996, 1999, and on current population
estimates from the National Population Commission. The projections were made by an
expert review committee coordinated by NASCOP, using the AIDS Impact Model
(AIM). Members of the review committee included representatives from Ministry of
Health, the University of Lagos and the donor community.
HIV Incubation Period
(Adults)
Not
Infected - Infected - - - - Infectious - - - - AIDS - - - Death
- - 3 - 10 years - - -1 yr-
A person does not develop AIDS as soon as he or she becomes infected with HIV. There
is a lengthy incubation period of about three to ten years. Some people may survive
longer than 10 years with an HIV infection while others may develop AIDS and die two
or three years after infection. The average time from infection with HIV to development
of the disease AIDS is about 7 to 8 years. That is, on average, a person does not develop
AIDS until 7 to 8 years after becoming infected. For most of this period the person may
not have any symptoms and, therefore, may not be aware that he or she is infected. This
contributes to the spread of HIV, since the person can transmit the infection to others
without realizing it.
The HIV/AIDS Pyramid
The HIV/AIDS Pyramid
(Nigerian Statistics)
26,276 Reported AIDS Cases (June 1998)
590,000 Estimated Actual AIDS Cases
(1999 Estimate)
2.6 million people with
HIV Infection
(1999 Estimate)
The lengthy incubation period is one reason that HIV/AIDS is often called a “hidden
epidemic.” The idea of a “hidden epidemic” can be seen in this graph which shows the
HIV/AIDS pyramid. The tip shows reported AIDS cases as of June 1998. Reported
AIDS cases represent only the visible part of the epidemic. This is what most people see.
However, there is much more to the epidemic than the number of reported cases.
The true number of AIDS cases in Nigeria is not known. However, as seen in the green
portion of the pyramid, it is estimated that almost 600,000 adults and children had
developed AIDS by the end of 1999.
The red portion of the pyramid indicates the much larger number of people who are
infected with HIV but have not yet developed AIDS. Many of these people show no
symptoms and do not even know they are infected. The worst of the epidemic is yet to
come as these HIV infected people develop AIDS. Most of them will die within the next
ten years or so. There is no cure for AIDS and no effective vaccine.
1991-
Nigeria HIV Prevalence Increase: 1991- 1999
6
4.5 5.4
5
3.8
4
Percent
3 1.8
2
1
0
1991 1994 1996 1999
UNAIDS measures prevalence in a country by the percentage of 15 to 49 year olds who
are infected. In Nigeria, prevalence increased from 1.8 percent in 1991 to 4.5 percent in
1996. The Ministry of Health estimates that by 1999, 5.4% of persons 15 to 49 were
infected. Although the percentage levels may seem low when compared to Eastern and
Southern African countries, in fact, in actual numbers of persons infected, Nigeria has
one of the worst HIV/AIDS epidemics in the world - fourth only to India, Ethiopia, and
South Africa.
Nigeria: HIV Prevalence by Zone, 1999
Nigeria: HIV Prevalence by Zone, 1999
N.Central 8.0%
S.South 6.4%
S. East 5.9%
N.East 4.1%
S.West 3.5%
N.West 3.2%
0.0% 2.0% 4.0% 6.0% 8.0% 10.0%
Percent
Although the median prevalence rate at the national level is 5.4 percent there is
considerable variation across zones and states, ranging from 3.2% in the North West zone
to 8% in the North Central zone.
HIV Prevalence by State, 1999
HIV Prevalence by State, 1999
Under 2
2-4
4-6
6-10
10+
As this map shows, all states are affected. The most seriously affected states are Kaduna
(11.6 ), Benue (16.8), Nasarawa (10.8) and Akwa Ibom (12.5).
Nigeria: HIV Prevalence by Age Groups
(National Average,1999)
9 8.1
8 6.9
7
6 4.9
Percent
5
3.4
4
3
1.3
2
1 0.2
0
15-19 20-24 25-29 30-34 35-39 40+
Age
Infection rates vary with age, with the highest rate found amongst young adults (20-24).
However, there is also an alarming 4.9% prevalence among the adolescent population –
Nigeria’s future.
Projected HIV + Population
Aged 15 - 49 years (Nigeria)
6,000,000
5,000,000
4,000,000
Female
3,000,000
Male
2,000,000
1,000,000
0
1991 1993 1995 1997 1999 2001 2003 2005 2007 2009
The rapid growth in the 15 to 49 year population and an expected increase in HIV
prevalence will lead to an increase in the number of HIV infected people in the
population. Projections indicate that by the year 2005, the number of HIV infected adults
will be about 4 million, and by the year 2010, 5 million.
Projected Annual Number of
New AIDS Cases in Nigeria
400,000
350,000
300,000
250,000
Female
200,000 Male
150,000
100,000
50,000
0
92
96
02
06
0
4
8
0
4
8
0
199
199
199
200
200
200
201
19
19
20
20
The number of new AIDS cases will also increase rapidly. Current projections show the
number of adults developing AIDS each year will increase from more than 250,000 in
2000 to an estimated 360,000 in the year 2010.
Projected Cumulative Deaths
due to AIDS in Nigeria
4,500,000
4,000,000
3,500,000
3,000,000
2,500,000 Female
2,000,000 Male
1,500,000
1,000,000
500,000
0
90
92
94
96
00
02
04
06
08
10
98
19
19
19
19
20
20
20
20
20
20
19
By the year 1999, an estimated 850,000 Nigerians had probably died from AIDS, but the
full brunt of the epidemic is yet to come. Over the next ten years, perhaps another 3.3
million Nigerians will die from the disease.
NIGERIA: AIDS Deaths vs. All Deaths
Among the Population 15-49
600,000
500,000
400,000
300,000 All Deaths
AIDS Deaths
200,000
100,000
0
1990 1995 2000 2005 2010
Already, more than half of all deaths in the 15-49 age group can be directly attributed to
HIV/AIDS. If a high number of deaths occur to economically productive persons ages 15
to 49, the labour force will be disrupted. When deaths occur to trained and educated
persons, the overall economic development of the country can be disrupted.
Projected Number of AIDS
Orphans in Nigeria
3,000,000
2,500,000
2,000,000
1,500,000
1,000,000
500,000
0
96
06
0
2
4
8
0
2
4
8
0
199
199
199
199
200
200
200
200
201
19
20
One of the worst impacts of AIDS deaths to adults is an increase in the number of
orphans. We define an AIDS orphan as a child under the age of 15 who has lost the
mother to AIDS. With this definition, the number of AIDS orphans would increase to
more than 1.8 million by 2005 and to almost 2.4 million by 2010.
There will be a tremendous strain on social systems to cope with such a large number of
orphans.
Projected Annual Child Deaths
Deaths
due to AIDS in Nigeria
60,000
50,000
40,000
30,000
20,000
10,000
0
90
92
94
96
98
00
02
04
06
8
0
200
201
19
19
19
19
19
20
20
20
20
AIDS also affects child survival. About 30-40% of babies born to infected mothers will
also be infected with HIV. Most of these babies will develop AIDS and die within two
years. Few will survive past the age of five.
Current projections show that the number of children dying from AIDS each year is
estimated to increase from more than 37,000 in the year2000 to about 56,000 in 2010.
Multi-factorial causation of AIDS
Socio-economic
Behavioral Determinants
Determinants
HIV/AIDS
FACTORS
SYTEM FACTORS
Biological (Blood supply,
determinants contaminated instruments)
The magnitude and impact of determinants of the HIV/AIDS epidemic varies
considerably from state to state and from community to community in Nigeria. However,
as a summary statement, the HEAP partners will aggressively and proactively respond to
the following key determinants:
Social Determinants: The role and impact of commercial sex workers, of non-acceptance
by religious and conservative groups of all proven HIV preventive methods, of stigma
and discrimination against PLWAs (persons living with and affected by HIV/AIDS), of
low to irregular incomes, of peer pressure for high-risk behaviour, of culturally-dictated
subjugation and subordination of women, of weaknesses in the legal and political
framework and of lack of support for out-of school youths;
Behavioral Determinants: Unprotected sexual behaviour among mobile population
groups, unwillingness to acknowledge infection and seek assistance, and deterioration of
traditional social discipline and norms of behavior; and
Biological determinants: Uncontrolled proliferation of infection associated with sexually
transmitted diseases and both unsafe and unregulated blood transfusions.
AIDS affects all sectors.
Health Agriculture
Children
Labour Force
Economic AIDS Women
Development
Family
Education
Others Security
The HIV/AIDS epidemic is a development crisis in Nigeria and will be the most
significant problem facing the country over the next decade. AIDS is not just one more
problem among many in Nigeria. The epidemic is a development crisis that is ravaging
the country and undermining all social and economic development efforts. A radical
response that mobilizes all of Nigerian society is required. Government sectors, private
enterprise, NGOs, the churches, the schools, the traditional leadership and many other
groups and individuals need to be engaged in the effort to combat HIV/AIDS.
b For these reasons the HEAP uses a multi- sectoral approach.
Nigerian leaders have a critical role to play in stopping this epidemic. Leaders can help
make programs work by speaking out often and strongly about the devastating nature of
HIV/AIDS and the need for a broad and unequivocal response.
The HIV/AIDS Emergency
Action Plan
Strategy for
A Three Year Strategy for
Dealing with the Epidemic in
Nigeria
(Jointly conceived and developed by relevant
partners
partners under the leadership of NACA)
The National Emergency Action Plan (HEAP),developed as a response strategy to the
HIV/AIDS epidemic, identifies over two hundred activities which the Federal
Government intends to pursue over the period 2001 to 2004. Most activities under the
HEAP are conceived as short-term, high impact interventions whose implementation will
form the base for a medium term Strategic Plan for HIV/AIDS in Nigeria. The HEAP
will therefore serve as an important testing ground for deriving best practices,
coordinating strategies and high impact responses and as a bridge to the definition of a
longer-term vision for the future. The HEAP was designed to promote a multi-sectoral,
participatory response to HIV/AIDS prevention and impact mitigation. Moreover, as a
document for use in guiding the implementation of activities and the appropriate
assignment of available resources, the HEAP is intended to serve as an expression of the
Government of Nigeria’s interest in and commitment to a dynamic and proactive
response to the HIV/AIDS epidemic.
The dual-track strategic approach
n Preparing the long-term National Strategic
Plan through a broad -based participatory
process
while
while
n Undertaking immediate action to build
capacity, remove barriers, empower
empower
communities and carry out preventive as
well as care & support activities
Guiding Principles of the HEAP
n
n A national framework with adaptation at
local levels
State and local levels
n A participatory process of partnership to
prepare, implement and monitor
multi-
n A multi-sectoral approach against a
development problem
n All communities and all persons are
involved in prevention and care and
support.
support.
n A proactive response to gender issues
The Government of Nigeria and its many partners in the implementation of the HEAP’s
response to the HIV/AIDS epidemic will be guided by an agenda of proactive principles.
Considered as a set of guidelines, the HEAP’s principles represent a multi-sectoral
consensus on priorities for action during the immediate future.
Objectives of HEAP
n and sensitization of general population
Increase awareness and sensitization of general population
key stakeholders
and key stakeholders
n Promote positive behavior change in both low risk and high
behavior change in both low risk and high
risk populations
risk populations
n Build partnerships and capacity for HIV/AIDS Control
n Ensure that communities and individuals are empowered to
community- action plans
design and initiate community-specific action plans
n Ensure laws and policies against discrimination and
stigmatization related to HIV/AIDS
n Provide care and support for PLWHA
n Mitigate the impact on PLWHA, AIDS orphans and other
affected groups
affected groups
n networks of PLWHA and others affected by AIDS
Create networks of PLWHA and others affected by AIDS
n Establish an effective HIV/AIDS surveillance system
n Stimulate research on HIV/AIDS
The HEAP has a number of overall objectives that deal with the following categories:
Awareness raising
Behavior change
Empowerment
Mitigation of the affects of AIDS
Care and support for PLWAs
Data and research
Strategic Components of HEAP
n Creation of an Enabling Environment
v Removal of Barriers
v Catalyzing Community Response
Catalyzing Community Response
n Specific Interventions against HIV/AIDS
Interventions against HIV/AIDS
v Preventive interventions
v Care and Support
The HEAP is built around two strategic components: CREATION OF AN ENABLING
ENVIRONMENT and SPECIFIC HIV/AIDS INTERVENTIONS TARGETED to
HIGH-RISK GROUPS. The wording and substance of these two components and of the
HEAP’s 15 strategies and of its over 200 activities was purposely chosen to reflect both
the HEAP’s currently limited timeframe as well as the urgency associated with the
establishment of the programme’s structure and of legislation and policies.
Creation of an Enabling Environment
1. Removal of Socio-Cultural Barriers
2. Removal of Information Barriers
3. Removal of Systemic Barriers
4. Catalyzing Community Responses
Strategy 1: Removal of Socio-Cultural Barriers
Under Strategy 1, NACA and its implementers will focus on largely advocacy initiatives. Under this
strategy, the need to sensitize the general public and to support advocacy and activities through the
development of legislation and policies centered on human rights of PLWAs and others affected by
HIV/AIDS. Due to the importance of this strategy, it is planned to complete the majority of the strategy’s
activities within the four quarters following the HEAP’s approval by the Government of Nigeria.
Strategy 2: Removal of Information Barriers
Strategy 2 will address the need to develop a reliable and timely flow of information to decisions makers
and program implementers. As part of this strategy, NACA will work with key ministries in establishing an
overall framework for HIV/AIDS research. Once developed, the framework will guide the public and
private sector in the definition of issues to be addressed, protocols to be followed, and dissemination
processes to follow.
Strategy 3: Removal of Systemic Barriers
Under Strategy 3, NACA will address its own need for organizational and capacity development as well as
that of SACAs and LACAs. However, as with any issue of such complexity, NACA will address its
organization development needs as well as the HEAP’s specificity over time and as conditions change and
call for modification. Similarly, NACA will identify SACA and LACA’s capacity development with an eye
towards implementing concrete activities only after the four quarters following the HEAP’s approval by the
Government of Nigeria.
Strategy 4: Catalyzing Community-Based Responses:
Under Strategy 4, the importance of including a separate strategy for catalyzing communities is recognized.
Accordingly, the strategy’s main thrust is the creation of a community-based fund to ensure unobstructed
flow of resources to local communities. The fund will support community mobilization, selection and
training of community volunteers, and the design and implementation of a Commu nity Action PLAN
(CAP). LACA will provide technical support to local communities in the development of their action plans
while funds will flow direct to communities whose plans are approved by SACA.
5. Preventive Interventions targeted
to special groups
1. The Youth
2. Empowerment of Women to Negotiate Safer
Sex
3. The Armed Forces and the Police
4. Prevention of Mother-to-Child Transmission
(MTCT)
5. Commercial Sex Workers
6. Prisons, Immigration & Border Control
7. Workplace policies and programs related to
HIV/AIDS
8. Transport Workers
5.1: Youth (High risk youth population and non-high risk youth population):
Strategy 5.1 deals with developing Nigerian youth’s capacity to define preventive strategies for responding
to the HIV/AIDS epidemic. Both in-school and out-of school youths will be incorporated in the program,.
5.2: Empowerment of Women to Negotiate Safer Sex:
As specified, the thrust of the Strategy 5.2 will be upon empowering women to determine their own
standards of sexual behavior.
5.3: HIV/AIDS Intervention with the Arme d Forces and the Police.
Substrategy 5.3, deals with efforts to ensure that the Armed Forces and POLICE can more effectively deal
with the epidemic. This will provide IEC and training materials as needs dictate. In reality, many of these
activities are already in progress, thus illustrating the importance of ensuring that all HIV/AIDS related
activities are coordinated in both the public and private sectors.
5.4: Prevention of Infection through MTCT
Under substrategy 5.4, NACA and its implementers will focus on developing a strategy to support efforts to
prevent HIV/AID transmission between mothers and their children. As such, this substrategy calls for the
development of IEC materials, the organization of rallies, the training of health workers.
5.5: Commercial Sex Workers
The objective of this is to undertake integrated participatory mapping, peer counseling and promotion of
condom use by CSWs.
5.6: Prisons, Immigration and Border Control
The objective of this is to reduce the rate of infection amongst the prison population and staff and
immigration personnel and at border control posts
5.7: Workplace policies and programs related to HIV/AIDS
Activities under sub strategy 57.7 will work towards preventing HIV infection and provide care and
support for workers infected and affected through the initiation of workplace policies & programs.
5.8: Transport Workers
Activities here will attempt to reduce the rate of infection amongst LDDS, touts, seafarers.
6. Preventive Interventions for the
General Population
n Health workers provided with materials
and training related to syndromic
management of STIs
n Policies and regulations with reference to
safe blood supply are developed and
implemented
n Structures and systems for providing
affordable VCCT services are developed
Under Strategy 6, the HEAP focuses on ensuring that:
• Health workers are provided with materials and training related to syndromic
management of STIs;
• Policies and regulations with reference to safe blood supply are developed and
implemented; and
• Structures and systems for providing affordable VCCT services are developed.
As this strategy is one of several of the HEAP’s strategies and substrategies which
require intensive development, actual implementation of statewide activities will most
probably not begin until at least the 5th quarter following the HEAP’s approval. However,
due to the importance of this strategy, NACA and its partners will need to address
logistics and procurement issues for drugs and medical supplies early on in the 1st four
quarters following the HEAP’s approval by the Government of Nigeria.
Care and Support
7. For Persons Infected with HIV/AIDS
8. For Persons Affected by HIV/AIDS
Strategy 7: Care & Support for Persons Infected by HIV/AIDS
Under Strategy 7, the numerous problematic issues associated with persons infected by
HIV/AIDS will be addressed. Accordingly, this strategy focuses on the development of
guidelines on such issues as appropriate and effective care for PLWAs infected with TB,
development of guidelines for training health workers and PLWAs themselves, and
establishing parameters on home-based care, this strategy is one of several of the HEAP’s
strategies and substrategies which require intensive development. Thus, actual
implementation of statewide activities will most probably not begin until at least the 5th
semester following the HEAP’s approval. However, due to the importance of this
strategy, NACA and its partners will need to address logistics and procurement issues for
drugs and medical supplies early on in the 1st four quarters following the HEAP’s
approval by the Government of Nigeria.
Strategy 8: Care & Support for Persons Affected by HIV/AIDS
Under Strategy 8, the numerous problematic issues associated with persons affected by
HIV/AIDS will be addressed. As the strategy focuses on the development of guidelines to
assist communities in developing a welfare scheme for orphans and family members
affected by HIV/AIDS, actual implementation of statewide activities will most probably
not begin until at least the 9th quarter following the HEAP’s approval.
Adoption & Adaptation of
HEAP
n
n HEAP is a FRAMEWORK conceived of at
the national level by key partners
n To be translated into Action Plans by
implementing partners at:
u National level
u State level
u Local level
An objective of the HEAP is to foster the development of a dialogue with States and local
communities so that, within the HEAP’s first four quarters of approval by the
Government of Nigeria, 18 of Nigeria’s states – those which are currently assumed to be
facing the most dire impact of the epidemic – will develop a state-specific action plan for
implementation during the second year following the Government of Nigeria’s approval
of the HEAP. Current HEAP development strategy calls for state- level activities to be
developed, funded, and launched first within Nigeria’s six so-called hot spot states of
Benue, Plateau, Kaduna, Ebunyi, Lagos, and Akwa Ibom
The HEAP is implemented by a variety
of institutions and organizations.
NACA Federal Govt.
Federal Govt.
State Govt.
Govt.
Local Govt.
HEAP Local Govt.
SAC LACA
LACA
A
NGOs Private
Private Donors
Sector
Media Universities
Universities
International Agencies
Agencies
All segments of society and all organizations in Nigeria must be involved in the HEAP if
the fight against AIDS is to be successful. In addition to the national, state and local
governments, an equally important are Nigeria’s many potential private sector and
international partners. The HEAP provides for these institutions to identify specific
components, strategies, objectives and activities which best lend themselves to support
based on each of our partner’s comparative advantage.
HEAP: Implementation and Fund Flow
FEDERAL MIN. World OTHER INTERNATIONAL FINANCING AGENCIES
OF FINANCE Bank (IDA) (U.N. Agencies, AfDB, Bilateral donors, Foundations)
NACA/NPT HAF
NATIONAL NATIONAL
FEDERAL NATIONAL NGOs
LEVEL LINE CIVIL SOCIETY
LEVEL
MINISTRIES PRIVATE FIRMS
SACA/SPT HAF
STATE
STATE
LEVEL LEVEL
STATE NGOs
STATE LINE CIVIL SOCIETY
MINISTRIES PRIVATE FIRMS
LOCAL HAF LOCAL
LEVEL LEVEL
LACA
LOCAL COMMUNITIES
GOVERNMENT (Coordination and LOCAL NGOs
AUTHORITIES technical inputs) CIVIL SOCIETY
PRIVATE FIRMS
PUBLIC SECTOR COORDINATING & NON-PUBLIC SECTOR
IMPLEMENTING PARTNERS FACILITATING PARTNERS IMPLEMENTING PARTNERS
Each arrow represents flow of proposals, funds, & reports
The HEAP will be funded from a variety of national and international sources. The
Federal Government will provide support through line ministries at the federal level and
down through to the states. The World Bank will provide funds through a loan to Nigeria.
Other international donors such as the UN, USAID, DFID and others will continue to
provide support directly and through their local cooperating agencies. Additional
resources (not shown in the diagram here) can be expected to come from communities
themselves as they contribute to their support for civil society groups. Family level
resources will also be mobilized to assist with care and support for PLWAs and orphans
and other vulnerable children who are affected by the epidemic. Lastly, the private
commercial sector will play a vital role in the form of condoms and pharmaceutical
products used in treatment.
State-Level Next Steps
n Creation/Consolidation of Multi-sectoral State Action
Committee on AIDS in the Governor’s Office - with
stronger NGO representation
n Recruitment of State Program Teams
n Institutional Capacity Assessments
n NGO Assessments
n Baseline Studies
n Preparation of Annual Action Plans
n “Process Test” for HIV/AIDS Fund and its Operations
Manual
n Facilitate LACA creation in as many LGAs as possible
In order for the HEAP to be implemented at the state level, several steps are needed.
These steps have to do basically with establishing the necessary institutional base and
information base upon which the programs will be built. Primary among these are the
creation and consolidation of he SACAs and facilitation of the creation of the LACAs.
Developed in Cooperation with
Developed in Cooperation with
The POLICY Project
The POLICY Project
POLI CY
LI
